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JAMA Pediatrics Patient Page
October 31, 2022

What Parents Should Know About Safe Sleep for Infants

Author Affiliations
  • 1Department of Pediatrics, University of Florida, Gainesville
  • 2Department of Pediatrics, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina
JAMA Pediatr. 2022;176(12):1276. doi:10.1001/jamapediatrics.2022.4303

On average, newborns sleep for 16 to 17 hours daily, or approximately 70% of the day.

The length of time an infant sleeps decreases with age but remains high, with 6-month-old infants resting for 13 to 14 hours daily. While needed for normal growth and development, it can also be dangerous. Approximately 3500 infants die each year from sleep-related deaths in the US, and many are preventable. Parents have so many responsibilities that begin the day they take their newborn home from the hospital. An important task is creating a safe sleep environment.

Phrases such as 鈥渂ack to sleep鈥 and 鈥渂ack is best鈥 emphasize that the safest sleeping position for infants is on their backs on a firm, flat surface. Examples of safe sleep spaces include cribs, bassinets, and play yards without any pillows, blankets, loose sheets, crib bumpers, or toys. Baby swings, in-bed sleepers, and car seats can be used when infants are awake but are not safe for sleeping. Swaddling, the wrapping and tucking of an infant in a blanket to soothe them, is safe until about 3 to 4 months of age, or until the infant begins to show signs of wanting to roll over. At that point, swaddling during sleep should be stopped to decrease the risk of suffocation in a loosened swaddle blanket.

Surface sharing or co-sleeping is a dangerous practice with severe consequences. When a parent, sibling, or other individual sleeps on the same surface as the infant in a bed, chair, or on the couch, this increases the risk of suffocation more than 60 times. An infant who is suffocated can have permanent brain damage or die. When a caregiver begins to feel drowsy, the infant should be placed in a separate safe sleep space as described above. Some infants have trouble falling asleep without being held, and this can lead to co-sleeping. Tips that may help the infant fall asleep in the crib, bassinet, or play yard include wearing a warm snug outfit or listening to white noise on a sound machine. For close monitoring and bonding, the crib, bassinet, or play yard should remain in the parent鈥檚 room for at least the first 6 months of life. Infants who stay in the parent鈥檚 room during sleep have a lower risk of sudden infant death syndrome (SIDS).

There are other practices parents can do to reduce the risk of sleep-related infant deaths, such as breastfeeding (especially in the first months of life), offering a pacifier, and ensuring a nonsmoking and drug-free environment. Parents can play an active role in helping their infant thrive.

Infants spend more time asleep than awake, and sleep is crucial for an infant鈥檚 growth and brain development. Even as infants grow, toddlers, children, and adolescents need safe and consistent sleep practices. For infants, sleep is one of the most important activities they do but can also be one of the most dangerous. Sleep is just as important as feeding or play time, and a parent is the most important person in ensuring safe sleep for infants.

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  • Centers for Disease Control and Prevention:

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Article Information

Published Online: October 31, 2022. doi:10.1001/jamapediatrics.2022.4303

Conflict of Interest Disclosures: None reported.

1 Comment for this article
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Risk and danger of using child safety seats- other than its intended purposes
Ediriweera Desapriya, PhD | Department of Pediatrics, faculty of Medicine, University of British Columbia
The majority of infants injuries and deaths in sitting devices were in child safety seats. Child safety seats including infant seats were designed primarily for transporting infants and young children. Despite the intended purpose of these devices (safe transportation in motor vehicles), infants and young children spend a significant amount of time in child safety seats (1). Available research shows that mean time an infant spent in a sitting device including child safety seat was 5.7 hours (range 0鈥16 hours) per day (1).

The American Academy of Pediatrics (AAP) has released recommendations for a safe infant sleep
environment and strongly advises parents and caregivers to refrain from using car safety seats for routine sleep (2).
Despite American Academy of Pediatrics guidelines and clinical guideline recommendations, infants often spend prolonged periods of time in child safety seats when not traveling. Our studies based on Canadian children's hospitals' surveillance data child safety seats are frequently used as an alternative to a crib or bassinet (3, 4). Interestingly, our studies also show that most car safety seats-related infant injuries and deaths occur in non-traveling situations (3, 4). It is important that we educate parents and caregivers about the importance of using car safety seats only for their intended purpose, such as only for transportation. Furthermore, we need to emphasize that, car safety seats are not an acceptable substitute for a crib or bassinet.
References:
(1). Liaw P, Moon RY, Han A, Colvin JD. Infant Deaths in Sitting Devices. Pediatrics. 2019 Jul;144(1):e20182576. doi: 10.1542/peds.2018-2576. Epub 2019 May 20. PMID: 31110162.
(2). Moon RY; TASK FORCE ON SUDDEN INFANT DEATH SYNDROME. SIDS and Other Sleep-Related Infant Deaths: Evidence Base for 2016 Updated Recommendations for a Safe Infant Sleeping Environment. Pediatrics. 2016 Nov;138(5):e20162940. doi: 10.1542/peds.2016-2940. PMID: 27940805.
(3). Desapriya EB, Joshi P, Subzwari S, Nolan M. Infant injuries from child restraint safety seat misuse at British Columbia Children's Hospital. Pediatr Int. 2008 Oct;50(5):674-8. doi: 10.1111/j.1442-200X.2008.02635.x. PMID: 19261118.
(4). Singhal A, Adams E, Desapriya E. Improper use of child restraint seats as a sleeping environment: Two cases of childhood death. Paediatr Child Health. 2012 Nov;17(9):498-500. doi: 10.1093/pch/17.9.498. PMID: 24179419; PMCID: PMC3496352.
CONFLICT OF INTEREST: None Reported
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