How to Keep Your Sleeping Baby Safe: AAP

Policy Explained
Attention Parents
Recall Alert: Stop Using Fisher-Price Rock ‘n Play Sleeper Immediately

The U.S. Consumer Product Safety

Commission (CPSC) and Fisher-Price took
the advice of the American Academy of
Pediatrics and issued a recall of 4.7 million
Rock 'n Play infant sleepers following reports
of infant deaths. This product is dangerous
and parents and caregivers are urged to stop
using it right away.
An investigation by Consumer Reports that
found 32 infants had died while using the
sleeper since 2011. Some of the infants rolled
over while unrestrained and some were
unable to breathe due to their position.
To request a refund for the Rock 'n
Play, visit http://bit.ly/RockNPlayRecall or
call the company at 866-812-6518. Those who
have owned the Rock 'n Play for 6 months or
 less will receive a cash refund while those
who have owned them longer will receive a
voucher for a new Fisher-Price product.
The AAP does not recommend letting infants
sleep in inclined products like the Rock 'n
Play that require restraining a baby. AAP
policy calls for infants to sleep on their back,
on a separate, flat and firm sleep surface
without any bumpers, bedding or stuffed
toys.

By: Rachel Y. Moon, MD, FAAP

More than 3,500 babies in the U.S. die suddenly and unexpectedly every year while sleeping,
often due to sudden infant death syndrome (SIDS) or accidental deaths from suffocation or
strangulation.

In an effort to reduce the risk of all sleep-related infant deaths, the American Academy of
Pediatrics' (AAP) updated policy statement and technical report includes new evidence that
supports skin-to-skin care for newborn infants; addresses the use of bedside and in-bed sleepers;
and adds to recommendations on how to create a safe sleep environment.

Note: All of these recommendations, unless mentioned otherwise, are for babies up to 1 year of
age. Talk with your pediatrician if you have questions about any of the recommendations listed.
What You Can Do: Recommendations for Infant Sleep
Safety
 Until their first birthday, babies should sleep on their backs for all sleep times—for
naps and at night. We know babies who sleep on their backs are much less likely to die
of SIDS than babies who sleep on their stomachs or sides. The problem with the side
position is that the baby can roll more easily onto the stomach. Some parents worry that
babies will choke when on their backs, but the baby's airway anatomy and the gag reflex
will keep that from happening. Even babies with gastroesophageal reflux (GERD) should
sleep on their backs.
o Newborns should be placed skin-to-skin with their mother as soon after birth as
possible, at least for the first hour. After that, or when the mother needs to sleep
or cannot do skin-to-skin, babies should be placed on their backs in the
bassinet. While preemies may need to be on their stomachs temporarily while in
the NICU due to breathing problems, they should be placed on their backs after
the problems resolve, so that they can get used to being on their backs and before
going home.
o Some babies will roll onto their stomachs. You should always place your baby to
sleep on the back, but if your baby is comfortable rolling both ways (back to
tummy, tummy to back), then you do not have to return your baby to the back.
However, be sure that there are no blankets, pillows, stuffed toys, or bumper pads
around your baby, so that your baby does not roll into any of those items, which
could cause blockage of air flow.
o If your baby falls asleep in a car seat, stroller, swing, infant carrier, or sling, you
should move him or her to a firm sleep surface on his or her back as soon as
possible.
 Use a firm sleep surface. A crib, bassinet, portable crib, or play yard that meets the
safety standards of the Consumer Product Safety Commission (CPSC) is recommended
along with a tight-fitting, firm mattress and fitted sheet designed for that particular
product. Nothing else should be in the crib except for the baby. A firm surface is a hard
surface; it should not indent when the baby is lying on it. Bedside sleepers that meet
CPSC safety standards may be an option, but there are no published studies that have
examined the safety of these products. In addition, some crib mattresses and sleep
surfaces are advertised to reduce the risk of SIDS. There is no evidence that this is true,
but parents can use these products if they meet CPSC safety standards.
 Room share—keep baby's sleep area in the same room where you sleep for the first
6 months or, ideally, for the first year. Place your baby's crib, bassinet, portable crib, or
play yard in your bedroom, close to your bed. The AAP recommends room sharing
because it can decrease the risk of SIDS by as much as 50% and is much safer than bed
sharing. In addition, room sharing will make it easier for you to feed, comfort, and watch
your baby.
 Only bring your baby into your bed to feed or comfort. Place your baby back in his or
her own sleep space when you are ready to go to sleep. If there is any possibility that you
might fall asleep, make sure there are no pillows, sheets, blankets, or any other items that
 could cover your baby's face, head, and neck, or overheat your baby. As soon as you
wake up, be sure to move the baby to his or her own bed.
 Never place your baby to sleep on a couch, sofa, or armchair. This is an extremely
dangerous place for your baby to sleep.
 Bed-sharing is not recommended for any babies. However, certain situations make
bed-sharing even more dangerous. Therefore, you should not bed share with your baby if:
o Your baby is younger than 4 months old.
o Your baby was born prematurely or with low birth weight.
o You or any other person in the bed is a smoker (even if you do not smoke in bed).
o The mother of the baby smoked during pregnancy.
o You have taken any medicines or drugs that might make it harder for you to wake
up.
o You drank any alcohol.
o You are not the baby's parent.
o The surface is soft, such as a waterbed, old mattress, sofa, couch, or armchair.
o There is soft bedding like pillows or blankets on the bed.
 Keep soft objects, loose bedding, or any objects that could increase the risk of
entrapment, suffocation, or strangulation out of the baby's sleep area. These include
pillows, quilts, comforters, sheepskins, blankets, toys, bumper pads or similar products
that attach to crib slats or sides. If you are worried about your baby getting cold, you can
use infant sleep clothing, such as a wearable blanket. In general, your baby should be
dressed with only one layer more than you are wearing.
 It is fine to swaddle your baby. However, make sure that the baby is always on his or
her back when swaddled. The swaddle should not be too tight or make it hard for the
baby to breathe or move his or her hips. When your baby looks like he or she is trying to
roll over, you should stop swaddling.
 Try giving a pacifier at nap time and bedtime. This helps reduce the risk of SIDS,
even if it falls out after the baby is asleep. If you are breastfeeding, wait until
breastfeeding is going well before offering a pacifier. This usually takes 2-3 weeks. If
you are not breastfeeding your baby, you can start the pacifier whenever you like. It's OK
if your baby doesn't want a pacifier. You can try offering again later, but some babies
simply don't like them. If the pacifier falls out after your baby falls asleep, you don't have
to put it back in.

What Moms Can Do: Recommendations for Prenatal &

Postnatal
 Do not smoke during pregnancy or after your baby is born. Keep your baby away
from smokers and places where people smoke. If you are a smoker or you smoked during
pregnancy, it is very important that you do not bed share with your baby. Also, keep your
car and home smoke-free. Don't smoke anywhere near your baby, even if you are outside.
 Do not use alcohol or illicit drugs during pregnancy or after the baby is born. It is
very important not to bed share with your baby if you have been drinking alcohol or
taken any medicines or illicit drugs that can make it harder for you to wake up.
  Breastfed babies have a lower risk of SIDS. Breastfeed or feed your baby expressed
breast milk. The AAP recommends breastfeeding as the sole source of nutrition for your
baby for about 6 months. Even after you add solid foods to your baby's diet, continue
breastfeeding for at least 12 months, or longer if you and your baby desire.
 Schedule and go to all well-child visits. Your baby will receive important
immunizations at these doctor visits. Recent evidence suggests that immunizations may
have a protective effect against SIDS.
 Make sure your baby has tummy time every day. Awake tummy time should be
supervised by an awake adult. This helps with baby's motor development and prevents
flat head syndrome. See Back to Sleep, Tummy to Play for more information and ways to
play with the baby during tummy time.

Use Caution When Buying Products

 Use caution when a product claims to reduce the risk of SIDS. Wedges, positioners,
special mattresses and specialized sleep surfaces have not been shown to reduce the risk
of SIDS, according to the AAP.
 Do not rely on home heart or breathing monitors to reduce the risk of SIDS. If you
have questions about using these monitors for other health conditions, talk with your
pediatrician.
 There isn't enough research on bedside or in-bed sleepers. The AAP can't recommend
for or against these products because there have been no studies that have looked at their
effect on SIDS or if they increase the risk of injury and death from suffocation.

Additional Information & Resources:

 Sleep Position: Why Back is Best
 New Crib Standards: What Parents Need to Know
 Safe Sleep for Babies (Video)
 The Healthy Children Show: Sleep (Video)

About Dr. Moon:

Rachel Y. Moon, MD, FAAP is a pediatrician and SIDS researcher at the

University of Virginia. She is also the Division Head of General Pediatrics and Professor of
Pediatrics at the University of Virginia School of Medicine. Her research centers on SIDS and
SIDS risk factors, particularly in high risk populations, such as African-Americans and infants
attending child care. Within the American Academy of Pediatrics (AAP), she is chair of the Task
Force on SIDS and Associate Editor for the journal Pediatrics. Dr. Moon is also the editor of
Sleep: What Every Parent Needs to Know.

Stages of Newborn Sleep

Sleep patterns in newborns are different from those in older children and adults.

For newborns, sleep is about equally divided between rapid

eye movement (REM) and non-REM sleep and follows these
stages:

Stage 1: Drowsiness, in which the baby starts to fall asleep.

Stage 2: REM sleep (also referred to as active sleep), in which the baby may twitch or jerk her arms or
legs, and her eyes move under her closed eyelids. Breathing is often irregular and may stop for 5 to 10
seconds—a condition called normal periodic breathing of infancy—then start again with a burst of rapid
breathing at the rate of 50 to 60 breaths a minute for 10 to 15 seconds, followed by regular
breathing until the cycle repeats itself. The baby’s skin color does not change with the pauses in
breathing and there is no cause for concern (in contrast with apnea). Babies generally outgrow periodic
breathing by about the middle of the first year.

Stage 3: Light sleep, in which breathing becomes more regular and sleep becomes less active.

Stages 4 and 5: Deep non-REM sleep (also referred to as quiet sleep). Twitching and other movements
cease, and the baby falls into sleep that becomes progressively deeper. During these stages, the baby
may be more difficult to awake.
Snoring
Reviewed by: Steven Dowshen, MD


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 Print

UUGHGHGHHHSSHHH!! UUGHGHGHHHSSHHH!!

There's nothing worse than the sound of someone snoring if you're trying to fall asleep. Or
maybe it's you who snores, and people tease you about the noise you make in your sleep.

Snoring isn't just noisy. Sometimes it's a sign of a serious medical problem that should be treated
by a doctor. Read on to find out more about the snore!

Snoozing or Snoring?

Snoring is a fairly common problem that can happen to anyone — young or old. Snoring
happens when a person can't move air freely through his or her nose and mouth during sleep.
That annoying sound is caused by certain structures in the mouth and throat — the tongue, upper
throat, soft palate (say: PAL-et), uvula (say: YOO-vyuh-luh), as well as big tonsils and adenoids
— vibrating against each other.

People usually find out they snore from the people who live with them. Kids may find out they
snore from a brother or sister or from a friend who sleeps over. Snoring keeps other people
awake and probably doesn't let the snoring person get top quality rest, either.

What Makes You Snore?

People snore for many reasons. Here are some of the most common:

 Seasonal allergies can make some people's noses stuffy and cause them to snore.
 Blocked nasal passages or airways (due to a cold or sinus infection) can cause a rattling
snore.
 A deviated septum (say: DEE-vee-ate-ed SEP-tum) is when the septum (the tissue and
cartilage separating the two nostrils in your nose) is crooked. Some people with a very
deviated septum have surgery to straighten it out. This also helps them breathe better —
not just stop snoring.
 Enlarged or swollen tonsils or adenoids may cause a person to snore. Tonsils and
adenoids (adenoids are glands located inside of your head, near the inner parts of your
nasal passages) help trap harmful bacteria, but they can become very big and swollen all
of the time. Many kids who snore have this problem.
  Drinking alcohol can relax the tongue and throat muscles too much, which partially
blocks air movement as someone is breathing and can contribute to snoring noises.
 Being overweight can cause narrowing of the air passages. Many people who are very
overweight snore.

Snoring is also one symptom of a serious sleep disorder known as sleep apnea. When a person
has sleep apnea, his or her breathing is irregular during sleep. Typically, someone with sleep
apnea will actually stop breathing for short amounts of time 30 to 300 times a night! It can be a
big problem if the person doesn't get enough oxygen.

People with this disorder often wake up with bad headaches and feel exhausted all day long.
They may be very drowsy and have difficulty staying awake while having a conversation or even
while driving. Kids affected by sleep apnea may be irritable and have difficulty concentrating,
particularly in school and with homework.

Snoring Solutions

According to the U.S. government's patent office (this is where you go to register an idea or
invention), hundreds of anti-snoring devices are on the market. Some of them startle you awake
when they sense you are snoring. Unfortunately, they may only work because they keep you
awake!

Those small white strips some football players wear across their noses that kind of look like
a bandage are another anti-snoring device. Football players wear them during the game to
breathe easier while running a play or making a tackle. Some people wear these breathing strips
to try to stop snoring.

Other snoring solutions include tilting the top of a bed upward a few inches, changing sleeping
positions (from the back to a side), and not eating a heavy meal (or for an adult, not drinking
alcohol) before bedtime. These kinds of "cures" may work only for someone who snores
occasionally and lightly — or they may not work at all.

If you can't stop snoring or the snoring becomes heavy, it's a good idea to see a doctor. He or she
might tell you how to keep your nasal passages clear and will check your tonsils and adenoids to
be sure they aren't enlarged and don't have to be removed.

Some people need to lose weight, change their diets, or develop regular sleeping patterns to stop
snoring. It may be helpful to remove allergy triggers (stuffed animals, pets, and feather/down
pillows and comforters) from the person's bedroom. The doctor might also suggest medications
for allergies or congestion due to a cold.

If someone might have sleep apnea, the doctor will order a test to monitor the person during
sleep. This is usually done in a sleep center (a medical building that has equipment to monitor
breathing during sleep). The person is attached to machines that check heart rate, oxygen and
carbon dioxide levels, eye movement, chest wall movement, and the flow of air through the nose.
The doctor can then tell if the person has a disorder like sleep apnea. The best thing about the test
is that it doesn't hurt at all. After all, you sleep right through it!

Once doctors know what's wrong, a person can be treated for it, usually with lifestyle changes,
sometimes medicines, or even surgery, if necessary.

Solving a snoring problem lets everyone breathe and sleep a little easier!