Caitlin Whyte (Host): This is the Your Best Life Podcast. I'm your host, Caitlin Whyte, bringing you insights from the dedicated team at Holy Cross Health. Holy Cross Silver Spring and Holy Cross Germantown have achieved gold certification from the Cribs for Kids National Safe Sleep Hospital certification program.

This certification recognizes healthcare team members' commitment to best practices in infant safe sleep, ensuring the highest standards of care for their youngest patients.

 With me today is Tamara Sidorov, a Registered Nurse talking about safe sleep methods for infants.

Well, Tamara, getting sleep with a newborn can be really, really challenging. Why is it so hard for new parents to get rest during this stage? And what should they know about newborn sleep patterns?

Tamara Sidorov, RN: Having a new baby is exhausting. Even though babies sleep a lot, like over 15 hours a day. And while that sounds like a great night's rest for you or for me; for a newborn baby, their total sleeping time is divided into naps every one to three hours. Sometimes the naps are just 30 minutes and sometimes three hours, and to make matters more challenging, newborn babies are just famously inconsistent sleepers.

So as a caregiver to a newborn baby, your sleep is often inconsistent as well. The early days of newborn life are challenging, but eventually babies sleep through the night and parents, you will too.

Host: Now, what is Safe Sleep and why is it so important?

Tamara Sidorov, RN: The American Academy of Pediatrics recommends that babies under one year of age be placed on their back for every sleep, nap time and nighttime to reduce the risk of a sleep related incident or SUID. Many families are familiar with the term SIDS, that was first introduced in the 1990s with the Back to Sleep campaign.

Today we use the term SUID, which stands for Sudden Unexplained Infant Death. It's an umbrella term, which includes SIDS and incidents that occur in the newborn sleeping environment. Safe sleep can be a tough topic to talk about. Birthing parents are still healing from delivery, totally exhausted, often operating at a sleep deficit, and the newborn is totally dependent on us as parents. It can feel overwhelming and it can feel scary.

But practicing Safe Sleep, it's an evidence-based approach to reduce the risk of a sleep-related incident or death.

Host: So what does a Safe Sleep environment look like?

Tamara Sidorov, RN: Well. It's as simple as A, B, C. Babies less than one year of age should always sleep A, alone in a crib with no pillows, no bumpers, no stuffed animals, no nothing, B, on their back for every sleep, nap time and nighttime. Not on their side, not on their tummy. In fact, putting a baby to sleep on their tummy doubles the risk of a sleep related death.

Babies should always sleep B on their back, and C, babies should always sleep in a crib or bassinet, any flat firm surface with a tightly fitted sheet. Not on an adult mattress, not on a couch, not on a Boppy or a Dock A TOT, not in a car seat, and not in a swing. A Safe Sleep environment should follow the A, B, C's of Safe Sleep until the baby's first birthday; alone, on their back, in a crib.

Host: Well, let's talk about some situations we may see our babies in as they sleep. What if a baby is sleeping on their back and spits up?

Tamara Sidorov, RN: Ooh. Good question. There are many myths and misconceptions about baby sleep and spit up. Babies spit up, sometimes it's a lot. This is related to their short esophagus. That's the food pipe and their loose, lower esophageal sphincter. That's the muscle that connects the esophagus to the stomach, both of which mature over time.

So remember that spit up and reflux are temporary, but for the early newborn days, some parents do worry that babies could choke when they're sleeping on their backs. The good news is that a baby's anatomy is designed to handle this spit up. So their airway, which is the windpipe and their gag reflex, will help to prevent a spitting up baby from choking when they're on their back.

In fact, research shows that babies are more likely to choke or aspirate when they're sleeping on their stomach. The American Academy of Pediatrics recommends that the safest approach for babies with reflux, or for babies who spit up a lot, is to always sleep flat on their backs according to the ABC's of Safe Sleep.

Host: Great. And what if a baby falls asleep in the car seat or a swing? What should we do then?

Tamara Sidorov, RN: Ooh, another good question. Well, remember your ABC's of Safe Sleep, alone, on their back, in a crib. So if your baby falls asleep in a swing or a bouncer, or the car ride is over and the baby is asleep in the car seat, pick them up and put them in their Safe Sleep environment where baby is alone, on their back, in a crib.

As of 2022, under the Safe Sleep for Babies Act, inclined infant sleepers are now banned in the United States, so any sleep space that inclines more than 10 degrees is unsafe and therefore not recommended for baby sleep. Just remember that swings and bouncers are for soothing, not for sleeping.

Host: And what if a baby rolls over from their back to their tummy while they're sleeping?

Tamara Sidorov, RN: Hmm. Yeah. As babies get older and stronger, they may start rolling from their back to their tummy, and once babies begin to demonstrate signs of attempting to roll, which usually occurs around three months, caregivers should stop swaddling when the baby reaches this developmental milestone, whether it's at three months or for some babies earlier.

According to the American Academy of Pediatrics, caregivers should still place baby on their back for naptime and nighttime sleep. And in this case, if baby rolls onto their tummy, you don't need to turn them to their back again. But it's still really important to keep the crib empty, because baby could roll into loose bedding or pillows, which could interfere with breathing.

Host: And of course, what if our baby wakes up fussy during the night?

Tamara Sidorov, RN: Yeah, that's a great question and a common challenge when caring for a newborn. As sleep deprived parents, you may find yourself trying to crack the code of maximizing newborn sleep. Unfortunately, in the first few months of life, babies are notoriously unpredictable sleepers, and maybe you finally shut your eyes to rest and baby's making these noises, because babies can be pretty noisy sleepers, and sometimes it's hard to tease out if they're just making squeaks and grunts or if they're awake and ready to feed.

But there are tools that we can use to help settle a fussy baby. First, let's remember that crying is your baby's way to communicate a need, like they're hungry, have a dirty diaper, they're hot, they're cold, they're tired, or even overstimulated. So the first step to settle a fussy baby is to meet their expressed need.

Then, consider swaddling. Swaddling can be a great tool to help baby feel safe and comfortable. Check out SafeSleepacademy.org for tips on safe swaddling. In the first few months of life, babies wake up multiple times in the middle of the night for feedings. Knowing this ahead of time might help parents assemble a support team to work through night feedings.

When possible take turns with a support person for night feedings and other care opportunities like diapering, bottle washing, or being the swaddle maste. Having a plan and a routine can really benefit your mental health.

Host: Well, is there anything else parents can do to reduce the risk of a sleep related incident?

Tamara Sidorov, RN: Room sharing, not bed sharing.

What this means is having the baby's crib or bassinet in the caregiver's room, and this has shown to decrease the risk of a SUID by more than 50%. When possible, breastfeed or feed the baby breast milk. Also, caregivers can offer a pacifier to baby, but if it falls out during sleep, there's no need to put it back in.

Also avoid overheating the baby. The most recent American Academy of Pediatrics recommendation states that babies should not wear hats or use soft, fluffy blankets while in their Safe Sleep environment. Babies' caregivers should remain drug and alcohol-free during pregnancy and during the baby's early years.

Keeping baby's surroundings free of cigarette smoke, vape, drugs, alcohol. And tummy time because babies need exercise too. When baby is awake and supervised, place baby on a firm surface on their tummy with their arms at their side so baby can begin to lift up their head and exercise all those little muscles in their neck.

If baby falls asleep during tummy time, or you get called away, return the baby to their back and place them in their Safe Sleep environment. There are so many products on the market, it can feel overwhelming, and some products even promise to improve baby's sleep. Wouldn't that be a literal dream? Be wary of anything that doesn't follow the ABC's of Safe Sleep. If you're not sure, check the Consumer Product Safety commission@cpsc.gov/safesleep, when registering for a baby shower or before using an infant care product. There's a lot of advice on the internet and people might offer you advice whether you asked for it or not. But feel empowered to share that Safe Sleep guidelines have evolved with time and research, and it can be literally life saving when all caregivers follow the current ABC's of Safe Sleep to reduce the risk of a sleep related accident.

Host: Well wrap it all up for us today. Where can parents turn for support?

Tamara Sidorov, RN: Caring for a new baby, it's challenging and exhausting. It's easy to forget about you, the parent or newborn caregiver. Self-care is always so important, but especially in the early newborn days. Consider doing a daily self-care activity. It can be as simple as going for a walk. Fresh air can be a great reboot or eating a favorite food.

If you're feeling overwhelmed, maybe baby is crying and having a hard time settling; it's okay to take a break, phone a friend to watch the baby, or put the baby in their Safe Sleep space and take a moment to reboot. Babies are emotional sponges and often will have a hard time settling if their caregiver is feeling stressed and overwhelmed.

And if you can't shake the baby blues or need to connect with a supportive human who gets it, head to postpartumsupportinternational@postpartum.net to learn about resources to help support you and your family. Eventually your baby will sleep through the night and you will too. In the meantime, talk to your pediatrician or visit SafeSleepacademy.org for evidence-based information about Safe Sleep and general newborn care.

Host: Some wonderful tips today. Thank you for joining us. That was Tamara Sidorov from Holy Cross Health. For more information, go to holycrosshealth.org. And if you enjoyed this podcast, please share it on your social channels and check out the entire podcast library. For topics of interest to you, I'm Caitlin Whyte.

And this is the Your Best Life Podcast. Thank you for listening.