At first glance, sleep safety for your infant seems like it should be straightforward. The American Academy of Pediatrics issues safe sleep recommendations, and most of us understand that “back is best” and that the adorable blanket your best friend knitted for your little one should really not go anywhere near his crib.
But walk into a big box baby store, and sleep safety suddenly gets a lot more confusing. There are a million sleep-related products out there — from monitors to crib bumpers to sleep wedges – and it can be easy to assume that a product is safe when it’s actually untested, unregulated and even hazardous.
The reality is that many of the items you see on store shelves don’t line up well with the safety measures recommended by health officials. And while some baby items — such as cribs — have to meet government standards, others are only restricted once babies have used them and gotten hurt.
So how can you help your little one (and you!) get a decent night’s sleep while following the safety recommendations established by the experts? There are a few things you should keep in mind:
Doctor Knows Best
The most authoritative recommendations on sleep safety come from the American Academy of Pediatrics (AAP). The organization’s Safe Sleep Guidelines are updated every five years — most recently in 2016. Since 1992, when the group began recommending that babies be put to sleep on their backs, SIDS rates in the United States have dropped by about two-thirds.
While the recommendations from the AAP’s Task Force on Sudden Infant Death Syndrome are considered the gold standard for sleep safety, the group has no jurisdiction over consumer products. So it’s up to parents to make sure that the environment they’re creating for their child meets the recommendations. The advocacy group Kids In Danger (KID) has a safe sleep checklist parents can use if they’re not sure about a product.
- Be put to sleep on their backs at least until they turn 1. (Once children can roll front-to-back and back-to-front on their own, there’s no need to intervene if they turn themselves over.)
- Sleep on a firm sleep surface. (If they fall asleep in a car seat, swing, carrier or other device, they should be moved to a firm surface as soon as possible.)
- Sleep in the same room as a parent for at least the first six months and ideally at least the first year.
- Sleep in a setting without soft objects, loose bedding, or anything that could entrap, suffocate or strangle them.
- Never sleep on a couch, sofa or armchair.
- Not be swaddled or be swaddled only until they begin to try to roll over, with swaddles that are not too tight and don’t restrict breathing or hip movement.
- Be offered a pacifier before sleep once breastfeeding is established. (It’s OK if it falls out after your baby is asleep or if your baby turns it down.)
- Be brought into a parent’s bed only for feeding or comforting. (If there’s any chance you might fall asleep, make sure to remove sheets, pillows and other items that could suffocate or overheat your baby.)
- Not bed share with parents, especially in circumstances that make the baby more vulnerable.
It’s worth noting that the group’s recommendations on bed sharing, in particular, have sparked some debate among parents. The guidelines are revised every five years, and the AAP recently adjusted its recommendations in an attempt to acknowledge the reality that many parents do bring their children into bed, especially for nursing.
It May Be on the Shelf — But That Doesn’t Mean It’s Safe
Of all the types of durable infant and toddler products, only 17 categories are currently subject to detailed regulation from the U.S. Consumer Product Safety Commission (CPSC). Plenty of infant products fall outside this realm — in a gray area of gadgets and accessories that undergo practically no review by doctors or regulators before landing on store shelves.
“Periodically I’ll walk through baby stores…and I’m just amazed and appalled at what’s being sold,” says Dr. Fern Hauck, a coauthor of the AAP’s Safe Sleep Guidelines since 2005 and a professor at the University of Virginia School of Medicine’s department of Family Medicine. “A lot of sleep items and products that are sold in stores, a parent cannot assume that they’re safe.”
If you’re considering buying a crib, a play yard or a bedside sleeper, rest assured that every product on sale in the U.S. — from the cheapest to the fanciest — has met a vigorous set of requirements established by the CPSC.
But when it comes to bumpers, blankets, bed nests or loungers, monitors, sleep wedges, baby boxes and a number of other products, there is little oversight beyond some basic requirements minimizing lead and phthalate levels.
It’s a situation that concerns Nancy Cowles, the executive director of KID. “If you have safety standards for some products, parents are going to assume that all products have them,” she says.
How can you tell how well a product has been vetted and whether it’s safe?
- First, check whether the product falls under one of the 17 categories regulated more vigorously by the CPSC. These items have met category-specific mandatory standards before hitting store shelves: full-size cribs, non-full-size cribs, bassinets, bedside sleepers, toddler beds, play yards, bed rails, swings, handheld carriers, soft infant and toddler carriers, sling carriers, frame child carriers, strollers, walkers, bath seats, hook-on chairs and infant bath tubs.
- Next, you can check what claims the manufacturer of a product is making. The organization ASTM International, which represents manufacturers and other players, establishes some standards that companies may opt to meet. Be aware that companies are allowed to self-certify that they meet an ASTM standard, so there may not be an independent analysis involved.
- Search for parent reports of issues on SaferProducts.gov. The road to a recall can be a lengthy one, and this can allow you to find out about potential issues reported by other consumers.
- Ask yourself whether you’ll use the product safely. Some products, like swings, meet strict standards but aren’t intended to be used as sleepers. If you think you may fall asleep while your baby is in a swing or other product, you may decide not to purchase it to begin with.
- Check if the item meets the AAP’s recommendations. KID’s safe sleep checklist can also be a handy aid.
What About Crib Bumpers?
Crib bumpers are probably the most obvious example of a product that stays on store shelves despite warnings from the experts. Some local governments have banned them and the federal government says they’re dangerous, but the CPSC is still leaving it to individual families to make their own decisions.
“Bumpers are not necessary for infant safety or well-being, and they can contribute to unsafe situations,” says Hauck, a member of the AAP Task Force on SIDS. “There have been reports of infants who have been strangulated or suffocated or injured by bumpers.”
There may be more regulations for bumpers in the future. The CPSC is scheduled to release a proposed rule and invite public comment in the coming months. The agency’s staff is also working with an ASTM subcommittee on the issue, said Nychelle Fleming, a CPSC spokeswoman.
Other regulations are being considered as well. In June, the CPSC ended its public comment period for standards for inclined infant sleep products.
Start Out with a Plan
The U.S. approach to regulation leaves a fair amount of responsibility in the hands of parents. It’s ultimately up to you to create a safe sleeping space for your child, and it can be hard to consider the finer points of official recommendations when you’re grappling with sleep deprivation in the months after your little one arrives.
That’s why the experts recommend that you plan ahead. “Parents are exhausted…especially in the early weeks,” says Hauck. “They need to start parenthood with clear ideas of what they plan to do, and to try to stick to that as best they can.”