Sudden Infant Death Syndrome, commonly referred to as SIDS, is the “sudden” and unexplained death of a baby. When a baby dies from SIDS, the cause is unclear and therefore hard to prevent. New advances in technology, such as the Owlet baby monitor, are designed to help alert parents if their baby stops breathing. However, the medical community is still stumped as to why this occurs. Enter the Safe to Sleep (also known as “back to sleep”) campaign. This campaign aims at reducing the occurrence of SIDS and other sleep related deaths through parent education.
Back in the day, babies were placed to sleep in plush bassinettes full of blankets, pillows, and stuffed animals. They were often placed on their stomachs to sleep and rarely used swaddles. As cute as those frilly cribs looked, they were also deadly for many infants. This led to the charge to remove the “plush” from cribs. In the early 1990s, the recommendation to remove all soft objects from the crib and to use firm mattresses greatly decreased the rates of infant death. However, it was also during this time that the idea that accidental suffocation and SIDS were the same thing. They’re not! A baby who stops breathing because he rolls face down into a pillow is not the victim of SIDS. The difficulty with combining these ideas together is that the list to “prevent SIDS” continues to grow to a point where it’s difficult to manage.
Currently, it is recommended to do the following to prevent the risk of SIDS and other sleep related deaths: back to sleep, firm crib mattress, avoid blankets/pillows/plush toys, breastfeed, offer pacifier, avoid smoking/drinking, avoid co-sleeping, vaccinate, swaddle (not too tight), and keep baby in your room for 6 months to one year of age. Phew! That’s a lot to remember.
These recommendations have been proven to reduce the rate of sleep-related deaths in infants; however, they have also contributed to significantly worse sleep in infants and subsequent exhaustion in parents. The main sleep offender is the directive to place your baby to sleep on his back on a hard, flat surface. While this is absolutely safer and will prevent accidental suffocation it also greatly increases reflux and GI pain in babies. This is just one example of how these recommendations make it much harder for infants, and their parents, to get good rest…and much more likely to engage in unsafe sleep practices just to get a minute of sleep.
Most new parents expect to feel some level of exhaustion in the first few months of their baby’s life. Adults who had previously enjoyed 8-9 hours of uninterrupted sleep are now having it chopped up into 2-3 hour intervals to support feeding schedules. A predictable, interrupted sleep schedule is hard enough to deal with but what about the parents whose babies are only sleeping every 20-30 minutes then waking again? And keep in mind that this type of choppy, sporadically interrupted sleep pattern is still an effective torture strategy used by the military to extract information. I’m sure it works very well. This is because human beings cannot function without deep, consistent, REM sleep and unfortunately when you’re woken often your brain doesn’t get the chance to enter a REM cycle as often as it needs.
I recently attended a training entitled, “The 4th Trimester: A critical transition” presented by Dr. Alison Stuebe. During this lecture she discussed this “epidemic” of exhausted parents and referenced a study on exhaustion in parents during the first 12 weeks postpartum. This study found that most of these parents were operating at the same level as a highly intoxicated person. The scariest information highlighted by this study was that during the first 12 weeks most parents are not only caring for their children, they’re also driving cars, and completing other daily tasks that aren’t safe to do when you’re functioning at such an impaired level. Dr. Stuebe made a comment that I think perfectly illustrates this current situation: “Is a baby’s safety worth more than the parents?”
I want to be clear, this blog post is not to discourage parents from following the Safe to Sleep guidelines. Instead this post is meant to empower parents to ask their pediatricians for ideas and suggestions on how to achieve better sleep for their babies while maintaining these safety standards. If your doctor is not listening to you or doesn’t take your level of exhaustion seriously then it’s time to find a new doctor. Pediatricians are specialists in this field and most often parents themselves; they are the best possible people to give suggestions, ideas, and support during this time.
Based on my experience and the current list of recommendations this is what I often suggest to parents: (always ask your pediatrician before trying a sleep strategy)
Back to Sleep
Having your baby sleep on her back is safer and proven to prevent accidental suffocation. However, it also worsens the symptoms of reflux so for the first few months use an elevated bassinette or “rock’n’play” that keeps your baby at a 30 degree angle to assist in digestion and limit reflux. It’s also important to hold your baby upright for 20-30 minutes after feeding (this is why you need to trade-off with your partner, even if you’re nursing). Also talk with your doctor about anti-reflux medication, elimination diets (for nursing moms), and alternative formulas (easier to digest).
Every now and then there will be a scary, heart-stopping moment when it’s not recommended for babies to use swaddles (which makes it almost impossible for them to sleep) but fortunately for now they’re still okay to use. The main concern with swaddles comes from parents doing them too tightly (this isn’t an issue if you just get the Velcro ones and stop trying to use a blanket) or from babies rolling over while swaddled. I personally like swaddles made with material that provides some stretch so that your baby can have a little movement without full range of motion. Additionally, if you’re worried about your baby rolling try the Zipadee-Zip brand which allows for half-range of arm motion so if your baby rolls he can prop himself up.
I absolutely agree that “breast is best” and babies benefit greatly from the antibodies, immunities, and nutrition provided through the mother’s milk. The issue becomes that only one parent can assist with feeding so this is when you need to also prioritize your own health. If you’re able to breastfeed throughout the day, set aside at least one bottle/night where your partner can feed either pumped breastmilk or formula to give you a break. Your partner can assist with the 20-30 minutes of holding post-feed while you rest, if you feel strongly about being “bottle free”. If you’re unable to breastfeed and your baby is experiencing reflux ask your pediatrician about milk-protein allergies and alternative formulas.
Relax the Nap
Schedules are awesome for sleep and we hope that feeding schedules align with sleep schedules so that the day falls into a rhythm. However, having the idea that your baby will be napping in her crib for 4-5 naps/day is not realistic. What’s best for your baby during the day is to sleep…anyway you can get her to sleep. This might mean napping in a swing, while you’re wearing her in a carrier, or while walking with the stroller. The infant sleep period is brief and any associations learned early on can be unlearned when he/she is old enough for sleep training. Focus right now on increasing the cumulative sleep so that your baby is more likely to rest at night; an over-tired baby will wake more often so don’t try to keep him up.
If you imagined having complete loss of control over your muscles and then pictured being placed tummy down on the floor- how happy would you be? Not. Very. Happy. Babies don’t love tummy time because it’s uncomfortable and works muscles that are very weak. That being said it is vital for developing motor skills and helps promote safety at night in the event that your baby were to roll over. Here’s what’s important to remember with tummy time: keep it short, try using your chest as the “floor” to give skin-to-skin time, place toys at eye level, and always supervise your baby. Babies with reflux particularly don’t like tummy time so use a flat pillow or boppy pillow under the chest to take some pressure off the stomach (ask your pediatrician about how to safely use this during tummy time).
My main plea is to pediatricians, SIDS experts, and sleep supporters everywhere…remember that when we give these recommendations they MUST come with a reasonable way to accomplish them for these families. We cannot discount that while safety is the most important infants also desperately need a lot of sleep and so do their parents. Work with the families, offer strategies and advice, and don’t leave them hanging out there exhausted and scared. There is a way to safely help your baby sleep more, even in the early days, and we (parents and sleep experts) need to speak up about what we’ve tried that works. Because sleep is everything.
About the Author
Courtney Palm is a licensed therapist who specializes in child development and pediatric sleep. She has worked for California and Colorado’s state agencies providing clinical evaluations to children receiving early intervention services for developmental delays. She also works for Children’s Hospital Colorado in the postpartum depression clinic supporting the mom/baby dynamic through a variety of intervention including assessment and sleep support. During her time of graduate study at Pepperdine University and the Child Development Institute she began specializing in evaluation and treatment of sleep issues/disorders. Over the past ten years Courtney has provided sleep therapy across a variety of clinical settings: early intervention services, private practice, hospital-based psychiatry programs, and trauma centers. As part of her private practice Courtney completes annual continuing education in this field while also offering training to therapists and educators looking to learn more about pediatric sleep intervention.
This past year, she developed a mobile app for iOS called Cradle Baby Sleep Trainer. This app is designed to put parents in the driver’s seat by guiding them through building a personalized sleep plan. Most parents read dozens of sleep books, listen to a variety of contradictory sleep advice, and start/stop sleep plans before they ever achieve success. The Cradle app removes the “analysis paralysis” associated with sleep training by enabling parents to build a personalized sleep plan, receive step-by-step directions, and track sleep progress based on a matrix that Courtney developed from sleep training more than 2,500 babies. To learn more about the Cradle app visit www.cradleapp.com or email email@example.com