The American Academy of Pediatrics has just come out with expanded guidelines for infant sleep safety and SIDS reduction, so I thought it would be a perfect time to talk about sleep.
I have to admit that prior to my son’s birth I had very little appreciation for how important sleep is to new parents. . . or all parents for that matter. In residency we had maybe one or two sleep lectures that mainly focused on the Ferber method, and I read a number of parenting books prior to starting practice, but let me tell you I had NO IDEA. Sleep is the holy grail of parenting. Since our son’s birth I have, at various points, been pretty obsessed with sleep- his, ours- and for various reasons. Given my newfound interest in this topic, I’ve been spending a lot more time talking with families about it and have learned a lot. What I’ve learned will probably fill a number of posts, but today I’ll focus on the newborn period.
Parents of newborns are really, really tired. During the first 7-8 weeks of our son’s life I was more tired than during residency. When I teach residents now I tell them to think of it as being on call “q1”, or every night. So, when I talk to parents of newborns at that first visit, I try to keep it relatively simple and focus on safe sleeping. Here are a few thoughts.
-Babies should sleep on their backs. The Back to Sleep campaign has done amazing things for decreasing risk of SIDS- rates are down greater than 50% since the campaign began in the early 1990’s.
-One of the only other proven risks for SIDS is environmental tobacco exposure. Knowing that you are keeping your baby safe might be the motivation for family members to finally be able to quit.
-Overheating is also a risk factor for SIDS. Babies should not be over-bundled.
-If you can, breastfeed! Breastfeeding babies who sleep in the vicinity of their mom actually have lower risk of SIDS because their breathing and arousal patterns are in sync.
-Immunize your child. We know that at least some cases of SIDS are associated with preceding infection.
-In addition to SIDS, overlying and suffocation deaths are also of great concern. The AAP recommends sleeping in the same room with your baby, but not the same bed. This is especially important if either parent smokes, or has consumed drugs or alcohol, all of which increase risk greatly.
-The baby’s bed should be “bare”. That means no pillows, bumper pads, blankets, or stuffed toys.
-Finally, studies show that about 50% of families admit to co-sleeping at least some of the time. There are many cultures around the world in which this is the norm. And, their are many families for whom there is either not enough space or money for a crib. The goal is to make the safest sleeping environment possible for the baby. A breastfed baby sleeping next to their mother, without any surrounding blankets or pillows, is probably a great deal safer than sleeping on a futon or bean bag chair.
For more information on newborn sleep and the new AAP Guidelines, check out the Healthy Children website summary.
Thoughts? Did you follow the AAP sleep guidelines with your newborn? Did you find practical challenges?
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My Two Hats 
Great post! As a bit of a paranoid mom, I tried to follow the recommendations pretty closely, even though my daughter much preferred to sleep on her stomach. I actually found it the hardest to sleep in the same room with my babies, as weird as it sounds. I wake up every time my baby makes a peep, even if it is just a grunt in his sleep, which can add to the sleeplessness when you don’t actually have to get up with the baby! I’d be curious about when most parents make the transition from the parents’ room to having their baby sleep in their own room…
We had our little guy in our room (in a mini-crib/co-sleeper) until about 5 months, but I know a lot of moms who feel the same way about all of the grunts and snorts. Sleep is so hard to come by as the parent of a young infant, that I’d say whenever feels right and leads to the most sleep for everyone is probably best.
I never thought I would sleep with my kids past the first few weeks (when they slept in a hard/hardsided cosleeper in our bed for easy of feeding), and with my first I never did because he didn’t sleep well with us around and he was SO VERY DIFFICULT during the daytime that I couldn’t bear the idea of being around him all night.
But with my second, he’d start in his crib which was basically in our room, but I finally figured out how to sleep and nurse and quite honestly, I never turned back. I know all of the guidelines, but sometimes as a parent, you throw those out the door for parental survival. We don’t smoke, and while he frequently awoke me with his smurfling and snarfling, it was better than being fully awoken several times, all night.
Your comments illustrate perfectly the trouble with “guidelines”. They are simply that, guidelines, and offer a one size fits all approach. You show that even within the same family, children are all very individual, and I think often need individual approaches. Besides, “parental survival” is essential. 🙂
Great post! Sleeping is the holy grail indeed. My son slept on his belly, on a bare crib on a firm mattress. That was the only way he was able to sleep longer hours. Letting our newborn sleep on his stomach was a huge decision, we discussed it for several days. The guidelines here in the US are against it now, although it was the norm some years ago and it’s still okay in other countries. So after talking to my family in Peru and doing some research, we let our baby sleep on his tummy when he was 8 or 9 weeks. We were constantly up the first weeks to make sure that he was breathing, but after sawing him sleeping so peacefully, we finally calmed down. Now he has his own bed -he’s been off the crib since month 8!
Just discovered your blog my dear – thanks to Ellen!
In my experience, if I hadn’t practiced co-sleeping with my daughter, I never would have gotten any sleep at all! My daughter nursed constantly – day and night (which now I believe was due to a low milk supply caused by hypothyroidism which I didn’t know I had at the time – if I only I had known then!). And, because I’m such a light sleeper, I never worried about some of the common concerns people have about co-sleeping.
This brings me back to to that time when my daughter was a newborn and everyone has advice for you and thinks they know best. I firmly believe that we need to have a paradigm shift when it comes to how we talk to new mothers (and fathers). Of course new mothers should be armed with plenty of good information and the support they need to keep their babies safe. But, I also think there is something missing from the whole process of pregnancy, birth and baby-raising – empowerment. Mothers need to be reminded that they are strong and that their bodies are made for this and that instinct should not be cast aside in favor of guidelines, but rather be held in high esteem parallel to guidelines. After all, a mother knows her baby best.
Hi my friend! Your comment is stated so beautifully. It gets at a major reason I wanted to start writing- having my son made me realize all of the things you stated so eloquently- I could have all of the textbook knowledge in the world and still feel somewhat helpless or alone at times with a newborn. I think it is so important that we in the medical field try to support and help optimize what works best for the parents and family- to empower them. Guidelines are a place to start, but only that. Mothers do know themselves and their child best. Co-sleeping is a good example of this. Many families in the US and even more in other cultures co-sleep. I talk about SIDS and overlying risks with families, but I have also started talking with the family about the safest ways to co-sleep if it seems like that is their preference. And, I love the data coming out about breastfed infants who sleep in the vicinity of their mom having lower risk of SIDS. Our bodies are amazing, and the connection between mom and baby is amazing, and we need to respect that.
H, I’m so glad that you are doing this blog (sharing these thoughts & your experience). Right now, Chris is upstairs with a frantic baby K and I am getting a “break”. We have tried all manner of sleeping arrangements since bringing her home. First, the co-sleeper attached to the bed; next, pack n play downstairs & me in adjoining room; then, crib; now, she starts in the crib and usually ends up sleeping in a bed with me (around 2 am) because she nurses so frequently. I have so much guilt and fear about co-sleeping, even while it’s working! It is somewhat calming to read Ms Weber’s comments (and your reply). Thank you.
Oh, I’m so glad. Knowing that you find some comfort through the blog via other parents and shared experiences makes me so happy. Thanks for spending your “break” reading. Those are precious minutes.
Sleep is SUCH a fraught topic! I think, like feeding and discipline (and media, as in your later posts) this is another topic where before the actual little person arrives, you may have all the plans in the world, armed with all the guidelines and data, and after the person is here, none of that matters. As interesting to me as the guidelines are the proliferation of sleep BOOKS out there, and how each one motivates their publication with a mixture of fear mongering (“if your child doesn’t sleep well, as defined by MY BOOK, he will have learning problems, behavior problems, and probably cancer” Weissbluth, I’m talking about YOU) and unrealistic expectations (“12 hours by 12 weeks” – seriously?). Anyways, love your posts, very informative yet down to earth!
Oh my gosh, I could not agree more about all of the books. I read a number of them for a talk I was giving to the residents on sleep (our little A was about 12 weeks at the time), and came away feeling confused and overwhelmed. They all seemed to contradict each other in various ways. And, yes, the fear mongering. At one point I was adding up the number of hours he slept in each 24 hours and felt somehow I had “failed” if it wasn’t enough. Then I just had to let go. Thanks so much for reading!
Ditto on the Weissbluth reaction! Thanks for the laugh. 🙂
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