Introduction
Sudden infant death syndrome (SIDS) is considered responsible for causing deaths in infants and is regarded as the fourth most common cause of infant deaths. Sudden infant syndrome (SIDS) is the unexplained death that occurs during sleep in healthy infants less than one year of age. Though the cause is unknown, it is considered that brain defects, low birth weight, respiratory infections, infants sleeping on the stomach or one side, and sleeping face down on a soft surface can lead to sudden infant death syndrome (SIDS).
What Is the Sleep Pattern of Infants?
Newborn babies sleep for almost nine to 12 hours at night and around two to five hours in the morning. The sleeping time reduces to around two to four naps around two months of age and around one to two naps at one year of age. By six months of age, babies sleep in the night and do not wake up for nighttime feedings but, 25 to 50 % of babies may wake up for night feeds. The sleeping routines can be interrupted in case of illness, developmental milestones like crawling, pulling to a stand, and so on.
Though some babies awaken at night, they can get back to sleep (self-soothers) but, few babies might have accustomed to sleeping only when their parents hold them or rock them. These babies who are dependent on their parents to sleep are called ‘signalers’. This might pose a difficulty for the baby to sleep on their own later.
Which Sleeping Position Is Considered Safe for Babies?
The ideal and the best position to put the babies is to make them lie on their backs. The American Academy of Pediatrics (AAP) states that making babies sleep on their side can pose a threat besides offering no benefits. The American Academy of Pediatrics (AAP) further states that it is recommended to make the babies lie on their backs till one year of age.
What Is the Risk Involved in Placing the Babies on Their Side?
Newborn infants have poor head and neck control and if they roll to their side, there are chances that they can fall onto the stomach. This can cause the head to be pressed against the pillow causing difficulty in breathing. Babies develop head and neck support by four months of age.
How to Change the Sleeping Positions of Babies?
Babies must initially be made to lie on their backs and must be adapted to this position by feeding them before sleeping, rubbing their bellies gently, and singing or rocking them as they fall asleep. Infant sleep positioners that hold the babies in position and prevent them from rolling should not be used as they can cause troubled breathing and pose a risk for sudden infant death syndrome (SIDS).
How to Ensure a Safe Sleeping Position?
By adopting a few safety measures as mentioned below, babies can be kept safe even if they roll to their side or on their tummies.
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Sleep In The Same Room: Putting the baby in a cradle or a crib and sleeping nearby the baby can allow the parents or the caretakers to check on the baby often.
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Do Not Smoke: The baby’s environment should be free from people who smoke. Those who smoke should be asked to smoke outside, clean their hands, change their dress, and then be allowed to touch the baby.
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Do Not Use Heavy Blankets: Heavy blankets should not be used to keep the babies warm.
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No Overheating: The use of room heaters or wrapping the baby in too many layers of clothing should be avoided as it can overheat the baby.
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Swaddling The Baby: Babies must be swaddled only before they learn to roll to their side. They should be swaddled tight only near the chest and not near the knees or hips. Swaddling should be stopped once the baby begins to roll to the side.
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Keep The Cradle Or The Crib Empty: The cradle or the crib should not be loaded with toys, blankets, or other objects as it can cause suffocation.
Can Infants Be Placed on Their Sides During Short Naps?
The parents or caretakers must be well aware that it is always best to position the babies on their backs irrespective of the duration of sleep. After four months, babies learn to roll over. In such cases, the babies can be allowed to have tummy time or lie on their sides when awake but must be monitored regularly.
Will Babies Choke or Throw up When Allowed to Sleep on Their Backs?
Babies will eventually learn to either throw up or cough when they are made to lie on their backs. This reflex ensures that the airway is open. When the babies lie in a supine (head upward) position, the trachea (windpipe) lies above the esophagus (food pipe). Anything that is reflexed upwards moves against gravity and therefore does not get aspirated into the trachea.
In contrast, when anything is reflexed upwards when the baby lies on their stomach or towards one side, the contents get accumulated near the opening of the trachea, increasing the chances of aspiration.
Moreover, the sensitive tissues that trigger the reflex are more common on the posterior pharyngeal wall (back wall of the swallowing passage) than the anterior wall and offer increased protection when the baby lies in face upward (supine) position.
How Should Preterm Babies Be Positioned to Sleep?
Premature babies are at a higher risk of developing Sudden Infant Death Syndrome (SIDS) than full-term babies so, it is extremely important to position these babies on their backs. Premature babies with acute respiratory disease may require positioning on their stomachs. This should be done in a hospital setting under strict supervision by healthcare professionals. Since these babies may spend a few days to months at the hospital before discharge, they must be made to lie on their backs once the respiratory condition is stabilized.
Will Babies Have Difficulty Sleeping in the Back Position?
Babies lying on their backs can be cranky, fussy, and cry often. They will not have a deep sleep when compared to those lying on their stomachs. The absence of deep sleep can protect babies from sudden infant death syndrome (SIDS). In contrast, infants sleeping on their stomachs may move to deep sleep, will be less responsive, difficult to be awakened, and show less movement but all these can be risk factors for sudden infant death syndrome (SIDS). Pacifiers can be used to calm the baby before sleeping and have been found to reduce the risk of sudden infant death syndrome (SIDS) to a certain extent. Swaddling, rocking, and swinging too can help calm the babies.
Which Is the Crucial Time for Babies to Sleep in the Back Position?
The first six months after the baby’s birth is the time when the baby learns to develop sleeping habits. It is at this time that they must be familiarized to sleep on their backs and this should be continued till one year of age since sudden infant death syndrome (SIDS) is common in infants less than one year of age.
What Is the Best Sleeping Surface for Babies?
Quality and a safety-approved crib or a cradle with a minimum covering such as a rubber pad or a thin sheet between the infant and the underlying mattress are recommended. The surface should be firm and they must not be allowed to sleep on sofas, adult beds, or water beds. Any soft or bulky toys, blankets, or other objects should not be placed in the crib as it can cause overheating or the baby can struggle to breathe if they press their face against such items.
When Is Tummy Time for Babies Advised?
Tummy time or allowing the babies to lie on their stomachs is ideal because it strengthens the muscles in the neck and shoulders and aids the babies to achieve developmental milestones. It enhances motor development (functions that involve specific movements of the body’s muscles to carry out a particular task). There is no specific duration for tummy time but increased tummy time promotes good motor development and also prevents flat spots on the head.
Is Bed Sharing With Babies Advisable?
Bed sharing is followed by many mothers as they find it easy to breastfeed, monitor their babies, and feel that it enhances bonding. Studies show that bed sharing poses a great risk for sudden infant death syndrome (SIDS) and must not be followed. Parents or caretakers can sleep in the same room where the babies sleep but not share the bed with infants. Bedsharing increases the risk of sudden infant death syndrome (SIDS) when:
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The mother is a smoker or an alcohol consumer or is tired.
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More than one-bed sharer.
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The baby is covered by a heavy blanket or a comforter.
Bedsharing can be risky even if the mother is a non-smoker or a non-alcoholic. The mother can breastfeed the baby and then put them back in the crib or cradle and position them on their backs.
Conclusion
The ABC of safe sleeping practice is that babies should be allowed to sleep ‘Alone’ on their ‘Backs’ and in a ‘Crib’. The National Institutes of Health (NIH) considers newborn babies sleeping on their backs as the safest sleeping position. Simple changes in the sleeping position of babies can be life-saving. Research also shows that babies who lie on their backs are less susceptible to ear infections, nasal congestion, and fevers. In conclusion, the gold standard and the widely accepted sleeping position of babies is to make them lie on their backs.
