Safe Sleep for Newborns

Ask any new mom or dad what they find most difficult in a child’s first year, and they will probably mention sleep deprivation. By a baby’s first birthday, most parents have tried some sort of intervention – something to help their child learn to fall asleep and stay asleep on her own so that everyone can get a good night’s rest.

Now there is a new factor that has to be taken into consideration when developing a sleep plan for your baby. The American Academy of Pediatrics (AAP) has just released new guidelines for safe sleeping practices. These guidelines include the recommendation that babies under 6 months, and preferably up to one year of age, should sleep in the same room as their parents. This represents a new effort to reduce Sudden Infant Death Syndrome (SIDS), as research shows that sharing a room with parents can reduce SIDS by up to 50 percent.

Other AAP recommendations for reducing the risk of SIDS include:

• Avoiding cigarette, alcohol, and drug use during pregnancy (and after birth)
• Putting babies to sleep on their backs
• Breastfeeding
• Using a pacifier
• Following the immunization schedule

The AAP statement recommends babies sleep in a crib, bassinet, or co-sleeper near – not in – the parents’ bed. However, the academy acknowledges that mothers often nurse their babies while in their beds and fall asleep unintentionally. With that in mind, here are some suggestions for safe bed-sharing:
• Ensure the mattress is firm and flat
• Place the baby so he cannot fall out of the bed, or slip between a mattress and wall or headboard
• Keep the sheets and blankets very light
• Keep the room cool
• Babies should never be in bed with adults who have consumed any alcohol or altering medications or substances

Since many parents occasionally co-sleep (planned or unplanned!) at some point, it’s best to follow these guidelines even if they don’t plan to bed-share 100 percent of the time.

How to Prevent SIDS and Encourage Safe Sleep
One of the biggest threats to an infant’s sleep safety is SIDS (Sudden Infant Death Syndrome), also known as “crib death“ or “cot death”.

SIDS is the sudden and unexplained death of an infant who is younger than 1 year old. Research has not yet determined what causes SIDS. However, infants who sleep on their backs are less likely to experience SIDS. As a preventative measure, the American Academy of Pediatrics recommends that babies be put to sleep on their backs.

What You Can Do

Put your baby to sleep on their back. Once babies can roll over on their own—usually around 4 to 7 months—they are able to choose their own sleep position.
Use a firm mattress. Never put your baby to sleep on a pillow, sheepskin, waterbed or other soft surfaces.
Avoid warm rooms Keep your baby’s bedroom at a temperature that is comfortable for an adult in a short-sleeved shirt.
Keep a nonsmoking environment. Research finds that exposure to secondhand smoke doubles a baby’s risk of SIDS.
Clear the crib Toys and loose bedding may inhibit the baby’s sleeping
Use a pacifier This is a very individual decision and parents have widely different beliefs about pacifier use, however, pacifiers have been linked with a lower risk of SIDS.

Even though you are putting your baby to sleep on his or her back, it is still very important to give babies “tummy time” each day. This is time spent on their stomachs playing and exploring during the day. Tummy time helps babies develop the neck and shoulder muscle strength they will need to roll over, sit up, and crawl. Tummy time can also reduce the risk of positional plagiocephaly, an increasingly common condition in which babies develop a flat spot on the back of their heads from spending too much time lying on their backs.
Once babies can roll over on their own—usually around 4 to 7 months—they are able to choose their own sleep position, and often do not stay on their backs all night long. At that point, it is safe to let babies pick a sleep position on their own.
Deciding where a young baby should sleep depends on several factors, the most important being your own beliefs and values. Some families have children sleeping in their room for years; others want them in their own room from the start, and then there’s everything in between.
If you want to move her to her own room, rest assured, two months is not too young to sleep on her own in the crib. However, it is too young to expect that she will sleep through the night. If getting up and walking to her room for feedings is going to make you more tired than you are already, you may want to wait a bit for the big move.
When you do decide to transition your little one to her own room, help her prepare for the change by making her room a safe, familiar place. During her alert periods, make sure she spends some time in her room with you playing and reading. And use her bedroom for diapering and for bedtime and naptime routines. You might also want to gradually get her used to the crib by starting with naps and then to bedtime which is often the harder transition. With these warm and nurturing experiences, your daughter will learn to connect her room with cozy, safe feelings.
While most babies are not able to sleep through the night without feedings until they are between 4 and 6 months old (ask your pediatrician to be sure), you can help your little one begin learning how to put herself to sleep now. Because babies are so incredibly adorable and cuddly we hold them, rock them, feed them, or sing them to sleep. This is great for both parents and babies, since it makes the two of you feel close and bonded. (It also makes it easier for them to fall asleep!) The problem is that when babies connect these actions with the process of falling asleep when they wake up during the night (as we all do), they need that rocking, singing or feeding to fall back asleep. So, the secret is to create a loving and nurturing bedtime routine with lots of cuddling, talking, and singing together but when you put your baby to sleep, you put her down awake. She will soon learn how to soothe herself to sleep—a skill she’ll use all the rest of her life. And in the short-term, you might even get a little more sleep, too!

Helping Babies Learn to Fall Asleep On Their Own: What Research Says By Rebecca Parlakian, MA, Ed.
Parents get advice (and judgment!) from all sides, especially when the topic of sleep comes up. Everyone has something to say. But what do we actually know, based on the research? Let’s start at the beginning.

Baby Sleep Patterns: Just the Facts
Babies don’t begin showing a regular “day-waking, night-sleeping” pattern until about 4 months of age.[1] This is why we recommend that you wait until your baby is at least 4 months old before you begin sleep training of any kind.
Talk to your child’s health care provider before starting sleep training. Always check with your health care provider before sleep training if your child has special health care needs.
Grown-Ups Need Sleep Too
Most new parents are tired. Parents who lack good sleep for weeks and months are more likely to report feeling stressed, anxious, or depressed.[2] A lack of sleep can also make it harder to cope with everyday feelings and challenges,[3] like soothing babies when they fuss.
To Cry, or Not To Cry (That Is the Question)
For babies, crying is a normal response to settling down at bedtime. There are many ways to help babies learn how to self-soothe and fall asleep. It’s up to parents to choose what sleep method works best for their babies and their families. Because babies learn through routines, it’s important that parents pick a method that they can use consistently, one that won’t wear them out.

What is “Crying It Out”?

There are different ways to think about helping babies learn to fall asleep on their own.
• Graduated crying-it-out (often called the “Ferber method”) is when parents put their baby down after a bedtime routine and let the baby cry until they fall asleep. Parents check on the baby, waiting longer and longer periods of time before going in the room, starting at 2 minutes and gradually moving up to 30 minutes. (Experts recommend parents not pick up or talk to the baby when they go in the baby’s room.) This routine is repeated until the baby falls asleep independently.
• Bedtime fading: Parents shift a baby’s bedtime later by 10—15 minutes each night so the baby is tired at bedtime. When the baby reaches a point where he falls asleep soon after being put down, that becomes “bedtime.”
What does the research say?
• Both graduated crying-it-out and bedtime fading helped babies fall asleep faster, compared to babies whose parents who received information about infant sleep (but not specific strategies).[4]
• Mothers who used graduated crying-it-out or bedtime fading showed less stress than moms who just received sleep information, but not strategies.[5]
• Families using graduated crying-it-out also found that their babies were less likely to wake during the night.[6]
• The choice of a bedtime strategy does not impact a baby’s relationship with parents.[7] Parents don’t “damage” their relationship with their babies by using graduated crying-it-out.
What’s the takeaway?
Learning to fall asleep is a new skill for babies. They often fuss and cry as a normal part of this early learning. Short periods of crying help babies learn to settle down, fall asleep, and master the skill of falling asleep.
Some babies have a harder time than others learning to fall asleep on their own. Sleep challenges are probably one of the hardest parts of early parenting.
When babies regularly receive loving, responsive care throughout the day, sleep training is not harmful to their brain development or to their relationship with parents. Some parents say their children “just slept well from the start.” Or that they learned to fall asleep fairly easily with parent support. And then there’s the rest of us.

Sleep is one of the first and most challenging issues that many parents face. A blog post can’t possibly address or solve all the complex challenges parents encounter around sleep. Instead, here we focus on ways to establish healthy sleep habits from the start—to hopefully prevent situations like a baby who won’t fall asleep unless fed, held, or rocked; a toddler who comes into your room for a visit at 3:00 a.m.; or a 2-year-old whose bedtime routine is now 75 minutes long and getting longer every night.

Ways to Nurture Healthy Sleep Habits from the Start

1. Put yourself in your child’s shoes.
For babies and young children, bedtime can be a stressful experience, especially if it means separating from the people they love, and ending other fun activities (Baths! Stories! Songs!). It also means going to sleep, perhaps alone, in a darkened room, which can be scary. When you’re exhausted and frustrated, it can be hard to look at things from your child’s perspective. But learning to fall back to sleep in the middle of the night is a hard skill for many children to master. Despite all evidence to the contrary, your children are not trying to drive you crazy or manipulate you. Most of all, they need your patience and support to learn this new skill.

2. Take good care of yourself.
Don’t skimp on self-care—keep your well-being at the top of your to-do list. This doesn’t mean weekend getaways and trips to the spa. It means making sleep a priority when you can, such as going to bed earlier and letting go of tasks that can wait. Your need for sleep is as important as your baby’s. You matter! You’ll have more patience if you take care of yourself too.
3. Tune in to your unique child’s needs.
Every child is wired differently and has a different capacity for self-soothing, which means that there is a wide range of behavior in the sleep department. So avoid comparing what your child is doing to others. Don’t fall prey to the “shoulds.” Tune in to what your child is telling you through his behavior, and let that be your guide. For example, you might find that your baby needs more time to transition from playtime to sleep, to help his body get into a more relaxed state, so the bedtime routine may need to be longer and more gradual.
Questions to Ask When Helping Children Learn to Sleep

• Does the environment say “Sleep”?
Pay attention to your child’s sleep environment and bedtime routines. Is it adequately dark? Are toys covered or put away to reduce distractions? Is it fairly quiet? Is the TV off? If there is a nightlight, is it very dim? (Some recommend red as the best color. It also helps to have a predictable sleep routine your child can count on each night—such as bath, tooth-brushing, story, and special goodnight kiss—to cue your child that it’s time for sleep.

• How do you help your child prepare for bedtime?
Let your child know when bedtime is approaching. Put on a timer to help your child prepare for the transition 5 minutes before it’s time to go to bed. It can also be helpful to create a ritual that signals a change, such as having your child “help” you switch off the light when it’s time get into bed. Creating a visual reminder of the bedtime routine can also work. Take photos of each step of your routine (bath, tooth-brushing, story, etc.) and put them up on the wall in your child’s room in order. Then point out the steps each night as you do them. Each of these strategies helps children begin to understand what will happen next, which can make bedtime easier.

• What helps a child who has trouble separating at night-time?
Experiment with routines that help to ease separations: Try a stuffed toy or blanket as a transition object (for children 1-year-old and above); promise to come back and check-in after 3 minutes for a last good-night kiss; or record yourself singing lullabies…switch them on as you leave the room. As a final send-off for older children, decide where the two of you might go during dreamtime that night, “Should we meet at the beach in our dreams? I will see you there.”
• How do you set clear but gentle limits?
Be clear about the rules and expectations around sleep. Children whose parents establish and follow through on clear bedtime routines tend to learn to be good sleepers. Parents set the stage by making the expectations clear, “After the bath, we will read three books, I will sing you a lullaby, give you our special kiss, and will say goodnight. Then I will see you in the morning.” Many young children use stalling tactics to delay bedtime—asking for snacks, water, and “just one more book.” When that happens, parents can matter-of-factly remind children of the routine (“We read our books and we sang our song. Now it’s time for bed. Do you want 1 kiss or 2 kisses?”) and stick to it.
Tweetable Takeway
Bedtime is the biggest transition and separation of the day—that’s why it can be hard for parents and their little ones. #ParentForward
About Baby Steps
This article was featured in Baby Steps, a ZERO TO THREE newsletter for parents and caregivers. Each issue offers science-based information on a topic of interest to parents and caregivers of young children—from sleep to challenging behaviors, and everything in between.

Here’s the latest news on sleep safety for young children.
It’s recommended that babies up to 6 months old sleep in the same room with their parents in a crib, bassinet, or co-sleeper—a three-sided crib that attaches to the parents’ bed—and always on a flat and firm surface. Experts say car seats and swings should not be used for regular sleep. It’s also not advisable to hold the baby while they sleep if there is any possibility you may fall asleep too.

From: website Zero to Three. The author is Sarah S. MacLaughlin