October is Safe Sleep Awareness Month. So, it’s the appropriate time to ask, “How we are doing with helping our babies sleep safely?” Unfortunately, the answer is “not so great.”
Every year, over 3,500 infants die in their sleep. These tragedies, called sudden unexplained infant death, or SUID, hit every U.S. community — rich and poor. The death rate rivals the number of Americans who died in 9/11. But, unlike a one-time terrorist attack, this tragedy unfolds daily across America.
SUID has various causes, including suffocation, strangulation and a mysterious condition called sudden infant death syndrome (SIDS), where healthy babies simply stop breathing during their sleep.
The question worried parents want answered is, “What can I do to protect my baby?”
Back to Sleep: an Important First Step
In 1994, doctors launched a massive educational campaign called “Back to Sleep.”
For generations, doctors warned against letting babies sleep on their backs. We thought that in that position infants might choke on their own spit-up. Then, in the early 1990s a startling discovery was made. Research showed that back-sleeping babies did not choke and were, in fact, three to four times less likely to die from SIDS or suffocation than babies who slept on their stomachs.
Within a few years of starting Back to Sleep, SUID deaths plummeted by almost 40 percent, according to data from the Centers for Disease Control and Prevention, from a terrifying 6,000 SUID deaths in 1994 to around 3,800 deaths in 1998.
To build on that success, doctors next launched a “Safe to Sleep” initiative that cautioned parents to avoid other risk factors, such as smoking, bulky bedding, bed-sharing and formula feeding. A new slogan, “The ABC’s of Safe Sleep for Baby,” was introduced to help parents remember the key message that babies should sleep alone (A) on their back (B) and in a crib (C).
We hoped to remand SUID to the history books. However, despite enormous efforts, the rate of SUID stubbornly refused to drop. In fact, it has barely budged over the past 20 years.
[See: How to Promote Safe Sleep for Your Infant.]
Reducing Infant Sleep Death: Where Did We Go Wrong?
Why did our success stall? It turns out, Back to Sleep had a fatal flaw: Babies don’t sleep well on their backs! Although back-sleeping is safer, in that position babies startle more and accidentally whack themselves in the face, causing more waking and crying.
This increased waking and crying led to more parental exhaustion and tempted millions of bone-weary parents to do something that significantly raised their babies’ risk of sleep death: bed-sharing.
Within 10 years, Back to Sleep led to a tragic consequence: The number of parents bringing their babies into bed rose two- to 10-fold. By 2009, as many as 60 percent of nursing moms acknowledged bringing the baby into bed during the predawn hours. As a result, a modest drop in SIDS since 1998 has been completely offset by a 400 percent increase in suffocation deaths.
The problem with bed-sharing is that it can’t be done safely. Exhaustion makes us forgetful and careless. Research shows even moderate sleep deprivation can impair the brain as severely as being drunk. (It’s no wonder exhaustion, like intoxication, is a major cause of car crashes.)
Ask any mom if she would bring her baby into her bed if she’s drunk, and she will give you a cold stare and a sharp, “Are you crazy!” But, ask if she bed-shares when she’s exhausted, and many may laughingly declare, “Of course! I’m exhausted all the time!” Most mothers are shocked to learn that bed-sharing — when deeply tired — is essentially the same as drunk parenting. Research finds almost 70 percent of SUID deaths now occur in a parent’s bed.
Recently, a few states have tried to reverse this dangerous trend with a new approach: cardboard boxes. Acting on the belief that bed-sharing occurs because parents lack a safe crib or bassinet in the home, health departments have spent millions of dollars passing these boxes out to new parents.
Unfortunately, cardboard boxes are unlikely to reduce the death rate. The Wisconsin Department of Health reported that 72 percent of parents whose baby died while bed-sharing owned a safe crib or bassinet, but chose not to use it.
Despite decades of urging mothers to follow the “ABC’s,” a 2017 report found that only about 44 percent actually do so every night. Why would loving parents put their babies in harm’s way? Because they are painfully exhausted. New moms rank lack of sleep as their greatest struggle, well above the stresses associated with a lack of time or money.
The bottom line is that millions of parents ignore their doctor’s safe sleep advice, and bed-share, because their doctors are ignoring their desperate plea for help improving their babies’ sleep.
[Read: Sleep Training Your Baby: Options Beyond Crying It Out.]
Better Sleep: the Key to Preventing Sleep Death
To reduce SUID, we must persuade tired parents not to bed-share. And, to do that, we must improve their babies’ sleep.
Fortunately, as most grandmothers know, there are three tried and true ways to increase babies’ sleep:
1. Swaddling. This imitates the snug holding babies experience in utero and reduces their ability to startle themselves awake.
2. White noise. This recreates the constant loud whoosh babies hear in the womb, from the blood flowing through their mother’s arteries. (No wonder babies snooze so well at noisy parties.)
3. Rhythmic motion. Adults fall asleep on bouncy buses and trains; and, babies are lulled by motion, too. Before birth, babies are continuously rocked by the gentle undulation of their mom’s diaphragm as she breaths.
Of course, no mother can rock, snuggle and shush her baby 24/7. So, modern parents use swaddling, sound machines and swings to deliver these soothing sensations. But, we are now learning that those common calming approaches can sometimes be unsafe.
Sleeping in a swing or rocker, for example, can be risky. In 2016, the American Academy of Pediatrics warned parents not to let babies snooze in a seated device because their baby’s heavy head might roll forward, closing off the windpipe and causing suffocation. Recently, the AAP also advised parents that swaddling babies over 2 months old could be unsafe. They cited studies showing that wrapped babies who roll to the stomach have a higher risk of SUID.
To find a better, safer way to boost sleep, I assembled a team of MIT-trained engineers and one of America’s leading designers to create a totally new type of baby bed. The goal was to safely rock, shush and swaddle babies all night long. To further enhance safety, the bed was designed to automatically respond to fussing with an increased jiggly motion and stronger sound to lull the baby and remove the parents’ temptation to bring the baby into their bed. Finally, the sleeper also comes with a special swaddle that secures the wrapped baby to the bed to prevent accidental rolling, a key contributor to SUID. (In recognition of its contribution to sleep and safety, this bed, called SNOO, received the National Sleep Foundation’s 2017 Innovation of the Year award.)
Safer Babies: the Obvious Path Forward
It’s now clear that to prevent these tragic deaths we must add more zzz’s to our safe sleep ABCs.
Back to Sleep and Safe to Sleep awareness campaigns had great early success. But, over the past 20 years they have not reduced SUID any further. Most frighteningly of all, they may, inadvertently, be causing sleep deaths.
[See: The 11 Most Dangerous Places in Your Home for Babies and Small Kids.]
Currently our most promising tools to boost sleep to protect babies are swaddling, white noise and SNOO. The medical community urgently needs to conduct further studies to evaluate the ability of these readily available tools to improve sleep and save babies’ lives.
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Is Standard Safe Sleep Advice Inadvertently Causing Infant Deaths? originally appeared on usnews.com
