VO: This is weekly Dose of Wellness, brought to you by Memorial Care Health System. Here's Deborah Howell.

Deborah Howell (Host): And welcome to our show. I am Deborah Howell and today we'll be talking about safe sleep habits for your baby. Our guest today is Terri Nikoletich. Terri is a Registered Nurse and the Program Director for Perinatal Health Education and Lactation Support Services at Miller Children's and Women's Hospital, Long Beach.

She also oversees the Welcome Baby Program, which is a home visitation program supporting women prenatally and after they have their baby, and the Baby Friendly Hospital Initiative. Welcome, Terri!

Terri Nikoletech, RN, MSN, MPH, CSN: Thank you.

Host: Practicing safe sleep habits with your newborn can protect them from sudden infant death syndrome or SIDS and other dangers. So Terri, what are normal newborn sleep patterns like?

Terri Nikoletech, RN, MSN, MPH, CSN: First I'd like to help make sure everyone understands that, um, there's still a lot of research going on to identify the actual cause of Sudden Infant Death Syndrome or SIDS. We don't really know what the cause of it is yet, but we do know how to reduce the risk of it happening. And one of those, and those are some of the things that we'll be talking about this morning. Normal newborn sleep patterns vary greatly baby to baby, but in the first few days, the average newborn sleeps between 16 and 18 hours a day. By four weeks, they may be sleeping an average of about 14 hours, but the range is considerable, and most babies don't stay asleep for longer than two to four hours, day or night, for the first few weeks. So, while the baby gets lots of sleep, the mother and or the partner may not get quite as much.

Host: Okay, that sounds reasonable. So where is the safest place when those babies are sleeping for their two or four hours to put them?

Terri Nikoletech, RN, MSN, MPH, CSN: The recommendation is that babies sleep in the same room as the mother and partner, but in their own sleep base. It's important that the environment that they're in is also free of smoke. The baby should never be exposed directly to smoking or indirectly by secondhand smoke. It's also important that parents not leave their infant asleep in their car seat. Um, if the inclination is, you know, if the baby falls asleep, um, and they're removing the car seat from the car, they may just want to set the car seat down when they get inside and allow the baby to keep sleeping.

But we know that that's not the safest position for a new baby, especially who doesn't have great head control. Um, they should always be removed from that car seat and laid in their bed as soon as they get home. And again, um, during night, the baby needs to remain close to, um, their, their mom or, or caregiver.

So ideally in the same room that they are also sleeping, but not in bed necessarily with them.

Host: Okay, Terri, back to the car seat. What are the dangers of leaving the baby in the car seat?

Terri Nikoletech, RN, MSN, MPH, CSN: A small baby, um, for a number of months doesn't have very good head control. So, it's always possible for that head to slump forward slightly and not necessarily be noticed and potentially, um, causing them to not get a good amount of a good air exchange.

So, short trips around usually fine, um, I think the concern is when the baby remains in the car seat for a long period of time, such as if you were taking a really long trip, ideally, um, one, uh, somebody would be sitting in the back seat with the baby so that you could keep an eye on the baby. Regardless of what's happening, the baby should always be removed from the car seat at whatever point the trip is over so that they can be placed in a, in a position that's much safer for them.

Host: Okay, that's very important information. Thank you. Now, what type of mattress should your baby use?

Terri Nikoletech, RN, MSN, MPH, CSN: A baby doesn't need any special type of a mattress, they just need a firm mattress that fits tightly against the sides of the crib. Um, you want a mattress that maintains its shape. I believe there are some mattresses out there that are, you know, almost like your TempurPedic where they kind of mold. That's actually not a safe mattress for a baby. They want to be on a firm mattress that maintains its shape, will not indent or conform to the shape of the baby's head when the infant is placed on the surface.

Host: That's really interesting. What could happen with the TempurPedic style?

Terri Nikoletech, RN, MSN, MPH, CSN: Well, it's just that the baby, it's that inclination the baby could sink lower. We know that the firm surface is what's ideally important for a new baby.

Host: Okay, and what kind of items should be kept out of the crib?

Terri Nikoletech, RN, MSN, MPH, CSN: Actually, all items should be kept out of the crib. There should not be any extra loose blankets or bumper pads, no stuffed animals. Um, all of those could potentially pose a risk of suffocation. So a newborn should always be in its own safe sleep space with no extraneous items in the space.

Host: And at what age is it safe to have a stuffed animal in the crib?

Terri Nikoletech, RN, MSN, MPH, CSN: You know, I can't really think of an age that it would be all right. I would imagine, you know, as they get to be a toddler and they're very mobile and can move around. And, you know, a lot of babies, um, as they get older, develop lovies that they like to cuddle with. But that's a child that is able to self position and move its head away and sit up. And it's a, it's a whole different ballgame at that point in time.

Host: Okay. And how should you lay your baby in their crib?

Terri Nikoletech, RN, MSN, MPH, CSN: Babies should always be placed on their backs to sleep. Once they begin rolling, which is usually around four to six months, they should still continue to be put down on their back for sleep time. But if they roll over during the night, it's not necessary to put them, place them back onto their back. A mom would never get enough sleep if she was constantly getting up to check that. And so, and once a baby is able to self position, um, they're, they're usually pretty good.

Host: Okay. That sounds good. And a lot of people might not really think about this, but how should you dress your baby for bedtime?

Terri Nikoletech, RN, MSN, MPH, CSN: Well, your baby feels like you do. So, if it's a hot day and you're wearing shorts and a tank top, you should not be putting your baby to bed in a blanket sleeper with extra covers. You dress, you would instead dress your baby in a light sleeper, um, possibly a onesie, um, lightly swaddled or possibly using a lightweight sleep sack of some sort.

It's just important that there always be room for the baby to move. Um, it's important for their development that they can move their legs and move their hips and move their arms and so they don't want to be restrained in anything, um, but you just gauge it by how you're feeling. Um, a baby overheating, um, being too warm is actually one of the risk for SIDS to occur. So it's important to keep them in pretty much how you feel.

Host: Okay, how you dress is how you dress your baby. Yeah. And are they very, very mobile when they're that young at night?

Terri Nikoletech, RN, MSN, MPH, CSN: When they're newborns, no, they're not. And they do like to be swaddled, but you would do it in a way where it still allowed them to shift themselves a little bit. Um, and you wouldn't use any extra blankets. But once they hit to be four to six months, they're starting to roll one way and then the other way and they're spinning a little bit and they're turning. So, you don't want loose items in their crib that they could possibly place over their face.

Host: And let's define swaddling for those who may have not, may have never swaddled a child.

Terri Nikoletech, RN, MSN, MPH, CSN: Well, swaddling, um, there's definitely a way to do it. I think a lot of people have kind of gotten away from swaddling and instead maybe use a sleep sack. Um, either is fine. But the swaddling needs to be away from. It's just a way to, um, wrap a baby a little snugger. Um, they like that feeling of being secure, especially a newborn. Um, because they've been, um, pretty in a pretty tight environment. And they like that, um, that comfort of being wrapped, um, fairly snugly. But once they're shifting around after the first few weeks or so, you don't necessarily need to swaddle as often.

Host: Okay.

Terri Nikoletech, RN, MSN, MPH, CSN: When they're in the hospital, we always... Um, you know, we always assist mom in showing her how to wrap a baby in a safe way.

Host: Very good. Let's talk a little bit about co-sleeping. Are there any dangers?

Terri Nikoletech, RN, MSN, MPH, CSN: Well, the American Academy recommends that, Academy of Pediatrics recommends that babies sleep in the same room as their mom, but not necessarily co-sleep. And when they talk about co-sleeping, they're talking about a mom actually, you know, tucking a baby in close to her and having the baby sleep there during the night. It's very helpful when you're a breastfeeding mom to have your baby very close to you because babies latch on and latch off throughout the night, but they do worry about the oversleeping that could occur that could potentially lead to suffocation. So, it's alright to bring an infant into bed necessarily to feed the baby, but once the baby has nursed and you are starting to get sleepy and the baby is now asleep, it's important to return that baby, um, to its own crib for, for sleep, so that the baby's in, again, in a safe, um, independent sleep environment. Some families find that using a co-sleeper, which is a small bed that kind of attaches to the side of their bed, and they can easily shift the baby over into its own space, works really well because mom is very close by, um, to the baby and it's easy for back and forth.

Um, and again, it keeps the baby in its own space. But you can do the same thing with other by keeping a bassinet or a cradle or some smaller type of bedding close by so that the baby can be moved away from you and less likely to be caught in an oversleeping type of a situation.

Host: Absolutely. And that way mom, mom gets as much sleep as she possibly can cause she's going to need it.

Terri Nikoletech, RN, MSN, MPH, CSN: Yes, she does. And yet, and they're, yes. And it's. And it's safer for the baby, and we of course would never want a mom to sleep with a baby in a recliner or in a couch, on a couch, where a baby potentially could get wedged on the side, and unfortunately those things have happened. So, um, when we talk about not co-sleeping in a bed, sometimes we have parents that choose other places to sleep then, and that in itself is not safe. So, always best to have the baby in its own safe sleep space.

Deborah Howell (Host): Very good. We hear that loud and clear. Now where can listeners go to get more information about the maternity services available at Miller Children's?

Terri Nikoletech, RN, MSN, MPH, CSN: They just need to go to MillerChildrens.org/maternity. And I would also encourage them to look up other safe sleep recommendations that reduce their risk of SIDS. There's actually quite a long list, um, and it includes things like exclusive breastfeeding, keeping your immunizations up to date. Um, once breastfeeding is established, consider using a pacifier at nap times and at bedtimes. Um, those few, um, safe sleep strategies along with many others can lessen the chance of a baby, um, succumbing to SIDS.

Host: Very good. Thank you so, so much. That's all the time we have for today. I want to appreciate once again, Terry Nicoletech for being with us. I'm Deborah Howell. Thanks for listening and have yourself a great day.