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Bryanne Colvin, MD (Guest): Hi, this is Dr. Bryanne Colvin a Washington University Neonatologist and a MomDoc at St. Louis Children’s Hospital.

Melanie Cole (Host): This is MomDocs, podcast from St. Louis Children’s Hospital. I’m Melanie Cole. Today, we’re talking about getting our little kiddos to sleep safely. Dr. Colvin, I’m so glad to have you with us. What are some key things to remember about safe sleep? I hear it’s safer to put babies to sleep on their back. Is that true?

Dr. Colvin: Yes ma’am and actually it is as simple as ABC. So, babies, when you put them to sleep for every sleep, should always be put in their crib alone, on their back and in their crib.

Host: And why is that?

Dr. Colvin: What we’re trying to do with safe sleep, is prevent something called SIDS or sudden infant death syndrome, which has now been renamed to sudden unexplained infant death or SUID and research has shown that for babies to be safest and to prevent SIDS or SUID; there are several things that we need to remember. So, we found that placing babies on their backs to sleep is best. We always use a firm sleep surface so, not a lot of blankets or sleep positioners. And we place babies by themselves in their cribs. And that means nothing else is around them in the crib. So, no fluffy blankets, stuffed animals, crib bumpers or anything else in the crib with them.

And all of these things together, help prevent the baby from dying in their sleep.

Host: So, what about swaddling? Because that’s something I think every new parent has to learn and that’s a blanket and some babies don’t stay that well in their swaddles.

Dr. Colvin: Right. So, swaddling is for infant comfort. Obviously, babies spend nine months inside their mom’s womb and they like being cuddled up close and contained in that space. So, we – while swaddling in and of itself doesn’t necessarily reduce the risk of SIDS, what it does do is provide infant comfort while they are on their back in their crib. So, swaddling is great. We like swaddling. What we want to do is prevent overheating, so we don’t want the baby to be over-swaddled or swaddled in something that’s too warm.

But swaddling is certainly a great option for your baby’s comfort to help them sleep.

Host: What about things like pacifiers? Are we allowed to give them one of those, a little binky as they fall asleep?

Dr. Colvin: Absolutely. So, pacifiers are actually recommended by the AAP in order to prevent sleep-related deaths. For whatever reason, they help the baby remember to breath. The caveat with that is that we want breastfeeding to be established prior to introducing a pacifier.

Host: Oh, that’s so interesting. And I remember with my daughter, geez at three years old it was tough to get the binky away from her. But they fall out and parents keep running back in pushing them back in their mouth. Is that okay?

Dr. Colvin: Absolutely. I have done that many a time myself. So, I think you need to be guided by your baby’s behavior. If the pacifier falls out and the baby is asleep; that’s totally fine. It’s not that the pacifier has to stay in the baby’s mouth to prevent the sleep-related deaths, but that they go to sleep with a pacifier.

Host: When can we stop swaddling?

Dr. Colvin: So, you want to ensure that you are no longer swaddling with the arms in once the baby starts to try to roll. So, once the baby is starting to roll over independently; you want to make sure the baby’s arms are out. And then you would switch to something like a wearable blanket to make sure that the baby stays sufficiently warm or no longer swaddled at all.

Host: Well, I’m glad you brought up the fact of starting to roll. As we know we are supposed to put babies to sleep on their back; then comes the point where some of them flip on over to their stomach because that’s where they are more comfortable. How many times are we supposed to go back in and flip them back to their back before we let them stay on their stomach?

Dr. Colvin: So, once they can roll independently or by themselves; you no longer have to roll them over. So, as long as you are putting them to bed on their back; that’s fine. You don’t need to go over and flip them over. At that point, we assume that the baby is strong enough to flip one way or the other and maintain their ability to lift their head up off of the bed at that point. If they are strong enough to roll over; they are certainly strong enough to move their head around.

Host: And that’s one of the advantages of tummy time, right? To help them build that stronger neck.

Dr. Colvin: Absolutely. Tummy time. So awake, observed tummy time is very important for babies and a vital part of safe sleep. So, you want to do that at least every day. The way I remembered doing tummy time with my kids was that every time we did a diaper change, we flipped them onto their tummy and did tummy time until they were angry with us. And that was a great way for us in our lives to remember to do it.

Host: Until they were angry. I know that. I know that sound as well. So, now on to naps. Car seats – sometimes babies are pretty comfortable in there. Can we let them nap in their car seat or rock-n-plays? What about those kinds of things?

Dr. Colvin: So, the recommendation for safe sleep is for the babies to always be on a firm flat sleep surface. When the baby is in a car, obviously the baby needs to be in a car seat. But once you’re home or at the place where you are going; the baby if they are asleep, really should be taken out of the car seat for safety. Because of the way the baby is positioned, we worry about compressing or closing the airway because the baby’s neck is not strong, especially early on in life. Rock-n-plays as many of you may know have just recently been recalled based on several deaths that were reported related to being in the rock-n-play. Initially, they were mostly concerned about deaths related to the rock-n-plays flipping over.

But we were also finding that there were several babies less than three months of age who have died in the rock-n-play more likely related to the incline position of the baby. And that position would be true for any sort of device or product where the baby is inclined, like a car seat or a bouncer or something like that. So, if the baby is asleep, especially if you are not watching the baby; that baby should always be flat on their back in a crib by themselves. And that is the safest place for that baby to be.

Host: That’s really important information for new parents to hear. Dr. Colvin, so now we’ve done all of those things and we’re exhausted. When can we start sleep training. I know there are so many methods out there. The Cry it Out, the Crawl out of Room, the Sit Next to Their Bed. There are so many methods but when can we start trying some of these to get them on that schedule at night?

Dr. Colvin: Right, so this is something that I think we all struggle with as parents with new babies. I think the most important things to remember are that the baby has to be healthy for you to try to start sleep training. The baby must be healthy, they must be growing appropriately with no other concerns for their growth and development. And then I think especially with guidance of your pediatrician; is an ideal time to start talking about sleep training, likely, at your four or six month check up with your pediatrician. And it should be that conversation at that visit that is the starting point for when you should start trying to do or you can consider trying to do sleep training.

Sleep training is still fairly controversial about Cry it Out and that sort of thing. But that should be a discussion with them for every individual case because every baby is different. For my kids, around four to six months of life, when they were gaining really good weight and they were old enough to sleep through the night, they are rolling on their own, developmentally appropriate; was a good time for my babies.

Host: Well I’ll tell you, that’s when I did it too and it’s not easy for a parent. You got to stick your finger in your ears and la, la, la, la and hope that you don’t run in every ten seconds. It’s pretty hard to do. What about parents that are co-sleeping and feel that that’s the way that babies will sleep the best?

Dr. Colvin: So, I’m going to try and be clear about co-sleeping. So, in the most recent AAP recommendations, they got rid of the term co-sleeping because it was confusing. We now talk about room sharing and bed sharing. The AAP recommends room sharing with the baby on a separate sleep surface, so in their own crib or bassinet or whatever that you have until at least the first six months of life, but they recommend the first twelve months of life. And they found that having the baby in the room with you, so room sharing, does help prevent SIDS in that first twelve months of life.

Bed sharing is not recommended by the American Academy of Pediatrics. No matter how you position yourself, no matter what you have; you are at risk for accidentally suffocating your baby based on rolling or other things. So, it is never safe to bed share, but it is safe to room share.

Host: Thank you for clarifying that. So, Dr. Colvin, wrap it up for us. Give us your best advice and sleep tips as children start maturing and what you want us to know about the importance of safe sleep for our babies.

Dr. Colvin: So, sleep is important. Sleep is important for babies and moms and dads. It’s tough to have a newborn who wakes up all the time especially those with colic. So, just hang in there, it’ll get better. The most important things with safe sleep again to remember your ABCs. You are always putting the baby down alone, on their back and in a crib. A couple of extra tips remembering room sharing without bed sharing, making sure their sleep space is empty with no extra blankets, stuffed animals, crib bumpers, sleep positioners or anything like that. And really, just hang in there, enjoy your time with your baby and make sure that don’t be tempted to do something unsafe just to get a little bit of sleep. It’s more important to have a lifetime of memories with your baby.

Host: Beautifully put. It’s such great information Doctor, thank you so much for joining us for all those tired parents out there. If you found this podcast enlightening, please share on your social media and be sure to check out all the other helpful podcasts in our library. Head on over to the website at www.stlouischildrens.org to get connected with one of our providers. This is Melanie Cole. Thanks for tuning in.