Sleep Safety Checklist

By Patricia Donohue-Carey
Issue 114 September/October 2002

mother and baby in bed

The following list was compiled from various sources, including the AAP policy statement on SIDS risk and the AAP book Caring for Your Baby and Young Child, Birth to Age 5.1,2 While not officially endorsed by any one group, it represents a thorough range of currently recognized precautions aimed at maximizing infant safety in cribs and, for those parents who choose to bedshare, adult beds.

Recommendations That Apply to Infant Sleep in Both Cribs and Adult Beds

  • Use a firm mattress. A soft mattress can result in infant suffocation.
  • There should be no gaps between the mattress and the frame of the crib or bed. Infants and small children can become wedged in gaps and asphyxiate.
  • Bedding should fit tightly around the mattress. Fitted sheets that become loose from a corner can cover and smother a baby.
  • Avoid strings or ties on all nightclothes (both baby’s and parents’). These pose a strangulation risk.
  • Avoid soft bedding and other items, including comforters, pillows, featherbeds, stuffed animals, etc. Each of these poses a risk of suffocation.
  • Keep baby’s face uncovered to allow ventilation.
  • Put baby on his or her back to sleep. Babies sleeping on their backs are less likely to become victims of SIDS.
  • Adults should avoid smoking. Exposure to tobacco, both pre- and post-delivery, is associated with a higher risk of SIDS.
  • Avoid overheating the room in which the baby sleeps and avoid overdressing the baby. Overheating is associated with an increased risk of SIDS.
  • Avoid placing a crib near window treatment cords or sashes. These pose a strangulation risk.

Advice Specific to Cribs

  • When baby learns to sit, lower the mattress level so that he or she cannot fall out or climb over the side rail.
  • When baby learns to stand, set the mattress level at its lowest point and remove crib bumpers.
  • When baby reaches a height of 35 inches or the side rail is less than three-quarters of his or her height, move the baby to another bed. Babies can fall from their cribs if the side rails are not at the right level in relationship to the mattress surface.
  • Crib bumpers should have at least six ties, and these should be no longer than 6 inches in length. Bumper ties that are too long can pose a strangulation risk.
    Hang crib mobiles well out of reach and remove them when baby starts to sit or reaches five months of age, whichever comes first. Mobiles become strangulation or choking hazards if baby can reach them.
  • Remove crib gyms when baby can get up on all fours. Babies can become entangled in these and risk strangulation.
  • Keep baby warm by dressing him or her in a blanket sleeper. If you use a blanket, make sure your baby’s head remains uncovered during sleep.3

Additional Recommendations for Bedsharing

  • A parent’s very long hair (at or approaching waist-length) should be pulled back and fastened. The hair can become wound about the baby’s neck, posing a strangulation risk.
  • Adults using alcohol or other drugs, those taking over-the-counter or prescription medications that may cause them to sleep too soundly,and those suffering from extreme exhaustion should not bedshare. Such adults may not be aware of the baby in the bed, creating a risk of overlying and suffocation.
  • Head/foot board railings should have spaces no wider than those allowed in safety-approved cribs. As with cribs, these spaces can become places for baby to become entrapped and suffocate.
  • Refrain from using bed rails with infants under one year. Babies can become wedged between the mattress and the side rail, resulting in suffocation.
  • Refrain from allowing siblings in bed with an infant less than one year old. Very young babies are at a greater risk of overlying and suffocation by older siblings.
    Do not bedshare in a waterbed. The surface of a waterbed can prevent ventilation if a baby moves to a facedown position.
  • Avoid placing an adult bed directly alongside furniture or a wall. Babies and young children can become trapped between the bed and other furniture or a wall and suffocate.

General Advice Regarding Infant Sleep

  • Do not sleep with baby on sofas or overstuffed chairs.
  • Do not put baby to sleep alone in an adult bed. (Both of these practices put baby at risk for wedging, entrapment, and suffocation.)

Parents who choose to bedshare with their infants must be proactive. They must evaluate their sleep environment and make it as safe as possible for their baby. Both parents should feel comfortable with the decision to place baby in the environment that is chosen, whether crib or adult bed, and should be committed to following that environment’s safety precautions, as noted above. No one sleep environment can guarantee that a baby will be risk free, but there are ways of reducing risk in both cribs and adult beds.

NOTES
1. American Academy of Pediatrics policy statement, “Changing Concepts of Sudden Infant Death Syndrome: Implications for Infant Sleeping Environments and Sleep Position (RE9946),” www.aap.org/policyrRe9946.html, March 2000.
2. American Academy of Pediatrics, Caring for Your Baby and Young Child, Birth to Age 5 (New York: Bantam Books, 1998), 16-17.
3. SIDS Alliance, “Safe Infant Bedding Practices,” www.sidsalliance.org/Healthcare/ default.asp

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