Infant Sleep Suggestions to Use In a Pinch
I have (at least) eight new gray hairs. I like to think I’ve “earned” one for each week my family has been practicing social distancing. And these hairs not only serve as a reminder that I really miss my stylist, but they also highlight just one of the many ways this situation is popping up as a physical manifestation of stress.
As a child injury prevention expert (and as such an essential, frontline worker), I often see frazzled parents making understandable, but less safe sleep choices—even in the absence of a global pandemic. But in the past few weeks as COVID-19 has created more stress and an unprecedented new way of life, I’ve seen an uptick in accidents like skull fractures for older babies (8-12 months) because they are rolling out of unsafe sleep areas.
So—what’s a stressed parent to do?
Below, we have detailed a few “in a pinch”, “better”, and “best” suggestions in response to some common situations families are finding themselves in nowadays where parents/caregivers have to make safety trade-offs (please keep in mind these are recommendations for babies a year or younger).
We should also note that these suggestions are based on a harm-reduction model. Translation? We know (and research tells us) that despite comprehensive and widespread safe sleep campaigns like Back to Sleep and the ABC’s of Safe Sleep, parents and caregivers regularly admit that they are not practicing safe sleep consistently—with or without Stay at Home orders.
So, instead of berating parents for making an exhausted choice or ignoring that these choices and behaviors even exist, we want to take another tack. We want to acknowledge that yes, sometimes less-than-ideal sleep situations happen. It’s real life. We’re human—and imperfect. And we’d rather have open and honest conversations about how to make safer choices, via baby steps if necessary, than force families to feel embarrassed and shamed and thus keep quiet what is *actually* happening in their homes.
Some quick real talk: most babies in most situations can wake themselves up and move a bit if they have trouble breathing. But not all babies can do this. And we don’t yet know how to tell the difference between babies that can and babies that can’t. All of these techniques for best safe sleep are actually meant to keep your baby from sleeping so deeply that they can’t wake and rescue themselves. Yeah. You read that right. Safe sleep = crappier sleep. I wish I had better news.
Situation #1: You’re a typical, exhausted parent
This applies to pretty much every parent. Having a baby is hard. Simply existing during a pandemic is hard. Combine the two and, well, it’s just really hard. Babies need you all.the.time. Then you read some well-meaning blog post about self-care that tells you it’s important for you to get sleep, take a shower, or have “me time,” too. So, how can your sweet pea sleep safely while you also, you know, get some peace as well?
Best: Use a portable sleep space such as a bassinet or baby box. This does not mean one of those devices that takes three hands to break down and move(i.e, it doesn’t fit through a doorway when assembled)—nor does it mean a big soft sleep pillow/lounger. No, get something that is light enough that you can carry it with one hand and that allows you to leave baby safely unattended for a spell (think needing to make a snack or take a shower). This will give you the ABCs of safe sleep within arms reach, no matter where you are or what you’re doing.
Better: Keep a safe sleep space set up where you spend the most time. Where are you spending most of your time these days? Living room? Kitchen? Your bedroom? Wherever that is, set up a safe sleep station where you can put baby down nearby. A safe sleep station might be a pack ‘n’ play or mini crib. This is less ideal because you can’t easily move your safe sleep station around the house, but at least you’ll have a place for baby in the room where you spend the most time so you can keep an eye on them while doing what you need to do.
In a Pinch: Put baby down wherever you are. You could put her to sleep in a bouncer or swing, but that increases the risk of suffocation. Instead, put your baby flat on her back on the floor. You can even put a thin blanket underneath her or use one of those activity mats. Resist the urge to put pillows around her. I promise your baby is perfectly comfortable without pillows. If you have pets, put them outside or shut them in another room. And make sure other adults and children in your home are aware of where baby is sleeping.
Situation #2: Bed-sharing
Yeah, we went there. Most providers discourage bringing baby into bed, and with good reason. There’s no “better, best” for this one—there’s no way to make bed-sharing perfectly safe. So instead, here’s a checklist to make sure your bed is as safe as possible for you and baby, if you should find yourself in that situation.
- Plan ahead. Look at your sleeping situation in the (harsh) light of day and figure out what will make it safest for baby. Try to avoid deciding to bed-share for the first time in the middle of the night when none of us have our wits about us.
- Keep your bedding to the bare minimum. Ideally, it would just be you and the baby in bed, nothing else. But you can consider the use of a pillow for yourself and a blanket you will wrap around your body (keeping it away from baby). That’s it. Nothing else.
- Only bed-share with one parent at a time. If baby’s in bed, send one parent to another room or couch for the night. (Think of it as a vacation?)
- Sleep on a firm mattress. Nothing squishy like a couch, armchair, or waterbed (do people even have those anymore?). No soft pillow-top mattresses or squishy mattress covers.
- Choose bed over a couch or chair. Studies show bed-sharing is riskiest if you sleep on the sofa or in a recliner. If you think you might fall asleep while feeding your baby – feed baby in bed.
- Make bed-sharing for parents only. Bed-sharing with adults other than a parent has a higher risk of suffocation. (Why? Parents tend to be more aware of baby and sleep less deeply when baby is nearby vs other caregivers.)
- Quit smoking if you do smoke. Being exposed to smoke raises baby’s risk of SIDS.
- Don’t take medicines or drugs that make you sleepy before you bed share.
- Avoid alcohol before bed-sharing.
- Avoid in-bed sleepers that look cozy/nest-like or promise longer sleep. Cozy almost always equals unsafe. Longer sleep is a myth. Babies need to wake often(sorry) when little. The goal of safer bedsharing is to keep your baby’s space open and protected. Away from anything that might cover her face.
Keep in mind, bed-sharing is most risky if:
- Your baby is less than 4 months old
- Your baby was born premature or low birth weight
- You smoked during pregnancy
- You are excessively tired (Well who isn’t? You have a baby.)
Situation #3: Baby loves sleeping in a less-than-safe space
The truth is that most products that help babies sleep more deeply aren’t safe. It’s a sad reality of parenting. Places like bouncy seats, baby pillows/loungers, car seats, recalled Rock ‘n’ Plays, soft-sided in-bed sleepers, and a parent’s chest are ok for awake and play time, but not-so-safe for sleep time.
Why? These items can increase the risk of suffocation by putting baby’s face too close to a soft, suffocate-able surface. Also, products like loungers, car seats, bouncy seats and the like all put babies in that “chin-to-chest” position.
Do me a favor – tuck your chin to your chest and take a breath. Great. Now raise your head to normal walking-about level. Take another breath. Notice the difference? Any kind of incline (yes, even a car seat or bouncy seat) will tuck baby’s chin towards her chest. That’s no good for the airway. Their tiny airways can get closed off when in this position and they may not wake up in time to adjust.
Best: Suck it up and make the switch. SIDS and suffocation are scary. No one here wants to scare parents, however the best thing you can do is get your kiddo into a safe sleep space as soon as possible. Will they immediately love it? Probably not. Frankly, they’d really like to be back in utero, so anything short of that is likely to piss them off for a little while. But, happily, babies are incredibly adaptable. Before long your little one will be sleeping just as well in the new, safer bed. Caveat: If your kid was a crappy sleeper in the less-than-safe space, they probably aren’t going to suddenly start sleeping magnificently in their new safe sleep spot.
Better: Delay, but don’t give up on a safe sleep space. Super fresh infants may love a snuggly bed, but as they get a little older, they’ll become more amenable to a flatter, firmer bed. Consider making the switch to a bassinet or baby box when your little one is 2-3 weeks old. Most babies will adapt without much fuss.
In a Pinch: Wear your baby for nap time. Littles love sleeping right next to your heart. Wearing your baby during their nap time will help keep them out of chin-to-chest position and still probably results in them sleeping well. Be sure to carefully follow the instructions that come with your wrap or carrier to make sure baby is in a safe position. If you’re unsure, ask a member of your local babywearing group for feedback. Bonus: You’ll have two hands free and can do stuff around the house/actually eat a meal.
Situation #4: My little one has acid-reflux
Nearly all babies have acid reflux to some degree because the sphincters (insert Wayne’s World joke) at the ends of their esophagi aren’t very strong yet. And some babies have acid reflux bad enough to require medicine.
Often, well-meaning parents and pediatricians recommend elevating baby’s head. We think, “Hey, it works for adults, it should work for babies, right?” Not in this case. Surprisingly, the research shows that lifting baby’s head may actually *increase* symptoms of reflux. Not to mention that raising baby’s head for sleep is a pretty risky maneuver on the safety front. A raised head can shift baby’s chin onto his chest and make it hard for him to breathe. So, when your kiddo has reflux, what can you do to help them sleep?
Happily, this is an easy one. No need for a “in a pinch, better, best.” Just keep following the ABCs of safe sleep—Alone in their safe sleep space (no blankets or stuffies), on their Back, and in a Crib (or bassinet or baby box). Their sphincters (heh.) will get stronger over time and the reflux will ease.
These are just a few examples of how to get through this marathon called parenthood. It’s not always perfect and it’s time we stopped shaming parents and gave them the damn tools they need to make more informed decisions. Real life doesn’t come with an instruction manual. So, do the best you can when it comes to safe sleep and if nothing else remember—face up, face clear, baby near.