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Introduction: With a relentless focus on excellence in healthcare, Pullman Regional Hospital presents The Health Podcast.

Evo Terra: 28 years ago I became a parent and like any first time parent, I obsessively checked them breathing of my sleeping baby boy. Oh, it seemed like several times a minute. But two years ago I became a grandparent. Now I happily leave the obsessive breathing checks to her parents, but even though she's now a happy and healthy toddler, I still wonder if we're doing the right thing today. My guest will be Liz Montgomery, the Executive Director of Safe Start. She'll help us understand the guidelines to safe infant sleep, per the American Academy of Pediatrics. So let's get right into it, Liz. What does safe sleep mean?

Liz Montgomery: Safe sleep is how your infant, so one month to 12 months of age should sleep for every sleep, including nap times and at nighttime, babies need to sleep, they sleep safest alone, which means in their crib or bassinet or pack and play. No pillows, no toys, no blankets. The American Academy of Pediatric wants you to room share, but not bed share. So that is safe sleep on their backs in a crib, in a safe sleep environment.

Host: Great. Well let's talk more about that safe sleep environment for a minute. One of the questions that I know I struggle with is where do we put the baby? They go on the back, on the stomach, on the side. What's the best way for us caregivers to help the baby sleep?

Liz Montgomery: For sure. So babies need to be placed on their backs for every sleep on a flat firm surface. So a crib and they need to, the reason for back to sleep is because babies who sleep on their tummies tend to overheat more easily. They have their face right up in the mattress. And so when we have our babies sleeping on their backs, it prevents from some overheating and suffocation hazards for that baby. So, but there is a time when they can sleep on their stomach. So, when the baby can roll front to back and back to front consistently, they can choose their sleep position, assuming that you have nothing in that crib and that you start them on their back.

Host: Start the baby on the back. I think that's an important lesson. I seem to recall, and I can't recall if it was for him, I had my kid or when my mom was talking about this, a generation before, but isn't there a greater risk of choking when babies are on their backs?

Liz Montgomery: Actually it's the other way around. So we used to believe that we used to put babies on their tummies like in the eighties, seventies eighties even the early nineties, because we were afraid that when they slept on their backs and they spit up, that they would choke. But now we know after research and more data, but even just looking at the anatomy of your baby, the food pipe actually sits below the windpipe. So if a baby's on its back and it spits up, it would literally have to go up against gravity into the airways or the ones that your baby. So when your baby's sleeping on its tummy and it spits up, it can, if it spits up, it can breathe it right back into their lungs and aspirate, which has definitely been some major issues and causes of death of some of our babies. So always on their back.

Host: Okay, good. Good to know. And what types of things? You mentioned that the sleep area be free of anything, but I got to tell you, I have some really cute stuffed bears and my son likes to put his daughter in with a big pillow and a blanket and all that. You're saying none of that?

Liz Montgomery: Right. The American Academy of Pediatrics is very clear looking at the sleep environment. So pillows can be a strangulation or suffocation hazard. Blankets can be an overheating hazard. A strangulation hazard of course suffocation hazard, anything like that. The toys, they can be suffocation hazards. And so really your baby when they're sleeping, they're not really looking at all of that cute fun stuff. We can play with that stuff when they're awake, but when they're sleeping, those are more of a hazard than anything. So we need to keep everything out of that crib. And that by the way, includes crib bumpers. Remember those?

Host: Yeah.

Liz Montgomery: Yeah. So no more curb bumpers. Those are can be a suffocation hazard. Even the mesh bumpers can be a strangulation hazard. So crib bumpers were invented back in the day in the fifties and sixties because the flats on the cribs were really far apart and babies would get stuck and severely injured, even death. So instead of adding more slats on the crib, which is what we have now, they invented the crib bumper, but then we ended up with suffocation and strangulation deaths from them. So crib bumpers are no-go. We'll take a bump on a head versus a suffocation. We can fix a bump on the head.

Host: Yeah, that's true. Yeah.

Liz Montgomery: So no more.

Host: Yeah. So are these the things we should be thinking about when we put the baby down? Even for short sleep times? Like just a nap?

Liz Montgomery: Yeah. Even for nap time. I mean, it takes, you know, think about how long it would take for a baby to die without oxygen. They need oxygen. So even if you look away for five minutes and you know, a blanket could have gotten over your baby's face or even tummy sleeping, you know, we already talked about the dangers of that. But yeah, for every sleep, even nap time, they need to be on a flat firm surface.

Host: They seem like very common sense things that if you just think about it for a moment, it should work, right. Ignore all the things you might've heard and stick with the fact that you know, baby's fine sleeping on his or her own. Is there any other information about safe sleep that people should be aware of?

Liz Montgomery: You know, we get a lot of questions about bed sharing, so that's when baby sleeps in bed with the adults. In fact, over half of our deaths every year in the United States happen when an infant is sharing a sleep surface with an adult.

Host: Oh my goodness.

Liz Montgomery: Yeah. It's, it's a big risk for our families. So, you know, from smothering, rolling onto your baby, the adult that is much too soft of a surface, they can roll into the, think about our mattresses. They're super soft, right? Well, we have an issue with a soft surface is, you know when you sleep on a soft surface, you kind of cushion down into it and baby's chin can go to their chest and pinch off their little airways and we can get pillows on our babies, blankets on our babies. It takes five pounds of pressure for five minutes for a baby to suffocate. So we want babies out of adult beds and into their pack and play or a bassinet or crib in your room. Actually for the first year is what the recommendation is, is sleeping in your room, not in your bed. That's a really big, a really big issue that we talk a lot about because it's really easy to fall asleep in the middle of the night with your baby. And so it's keeping them right there near your bed is our best option. So, yeah. Another thing in inclined sleep, we also talk a lot about inclined sleep and the dangers of inclined sleep for best when baby's head is above their feet. And that causes, so like sleeping in swings or bouncy seats, even their car seats. Of course we want baby strapped in car seats, but when you get to where you're going, take them out so that inclined sleep their tiny little heads are giant, right? And they're heavy and they don't have a lot of neck muscles. So what happens with inclined sleep is their chin, their heads fall forward, chin goes to their chest and can pinch off their airways, so a flat firm surface. So their airway stay nice and open, but never ever at an incline, even for reflux. So we hear that a lot. Well, should I incline my baby's beds for sleep for their reflux, meaning they spit up a lot. And the answer is no, there's a study, a concluding study that came out in 2009 saying the inclined sleep does not help with reflux. It puts them at a danger of an unsafe sleep accident. So, and by the way are unsafe sleep accidents and our SIDS deaths are the number one cause of death of our babies age one month to 12 months of age, the number one cause. So this is really, really important information. And a lot of families we find, or even caregivers, they just don't know. They're just not up to date or they've read something incorrect on the internet or Facebook or, so that's some really important stuff. So yeah.

Host: There are a lot of sources of really bad information out there. So Liz, where can people find good information about safe sleep?

Liz Montgomery: For sure. So the American Academy of Pediatrics, number one. Also number one is the Center for Disease Control and also the National Institute of Health safe to sleep campaign. Very, they're top notch sources. They're the best of the best. They are research-based, the best medically evidence-based information that we have here in the United States. And they all three agree by the way, on the safe sleep recommendations.

Host: Well, that sounds like those are the people that we should be listening to and hopefully everybody will and we can make sure that our babies sleep safely throughout the day and the night, as well. So. All right, Liz, thank you very much for all the information. That's Liz Montgomery, a safe sleep educator and the Executive Director of Safe Start. Liz travels the Northwest training parents, caregivers, first responders, doctors and nurses on the guidelines of safe infant sleep per the American Academy of Pediatrics. If you visit Liz's website safestartinw.org you can register for some Safe Sleep 101 one classes. These are live classes you can take from the comfort of your own home. For more pregnancy and new parent education and resources or to subscribe to the monthly pregnancy e-newsletter, please visit PullmanRegional.org/birthplace. If you found this episode helpful, please share it on your social channels and be sure to check our entire library of past episodes, which you can find at PullmanRegional.org. Thank you for listening to this episode of The Health Podcast, the show by Pullman Regional Hospital. I am Evo Terra.