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Safe Sleep for Babies

Katharina Graw-Panzer, M.D. discusses how to keep babies safe while sleeping. She shares the latest infant sleep safety recommendations, guidance for forming healthy sleep habits with newborns, and what parents should know about preventing sudden infant death syndrome (SIDS).

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Safe Sleep for Babies
Featured Speaker:
Katharina Graw-Panzer, M.D.
Dr. Katharina Graw-Panzer is an assistant professor of pediatrics at Weill Cornell Medicine and the Pulmonary Director of the Pediatric Aerodigestive Program and the Pediatric Technology Dependence/Home Ventilation Program. 

Learn more about Katharina Graw-Panzer, M.D.

Melanie Cole (Host): There's no handbook for your child's health, but we do have a podcast featuring world-class clinical and research physicians covering everything from your child's allergies to zinc levels.

Welcome to Kids Health Cast by Weill Cornell Medicine. I'm Melanie Cole. And our topic today is safe sleep and SIDS. Joining me is Dr. Katharina Graw-Panzer. She's an assistant professor of Clinical Pediatrics at Weill Cornell Medicine, a pediatric pulmonologist and sleep physician, and the Director of the Pediatric Aerodigestive Program at Weill Cornell Medicine.

Dr. Graw-Panzer, thank you so much for joining us today. Always a good topic because it's never too often for parents to hear about back to sleep, what progress we've made on SIDS over the last bunch of decades. So can you tell us the latest information regarding safe sleeping for baby? We know it's safer to sleep on their back, but why? Can you tell us about the AAP recommendations on safe sleep?

Dr Katharina Graw-Panzer: Thank you, Melanie, for inviting me to talk about infant sleep. That's a topic very important and dear to my heart. So, the AAP addresses not just SIDS but also all sleep-related infant deaths in their recommendations on how to place your child to sleep, how to have the sleep environment and how to stay healthy during pregnancy and afterwards to make sure your child is safe.

So the idea behind sleeping on the back stems back from the nineties when the recommendations were made, and there was a tremendous decrease in the SIDS rate by more than 50%, which is incredible. So different factors which can increase an infant death or SIDS when the child sleeps on the belly, which I would like to address. So one is that child breathes out the air and would rebreathe the CO2, that leads to low oxygen levels in the blood. Also, babies sleep much deeper when they're on the tummy, which on one hand parents like. They like if their baby sleeps tight and well. On the other hand, we do like if babies are a little bit more arousable and wake up, that means that they are able to protect their airways.

Melanie Cole (Host): So as we're talking to parents, Dr. Graw-Panzer, tell us a little bit about some of the things that you've seen the parents do, like co-sleeping. Some parents I knew when my kids were little did that. What do they say about that?

Dr Katharina Graw-Panzer: Okay. Yeah. So co-sleeping is not recommended because it places the baby on the same surface, like the adult would sleep on and as well as their bedding. So, what we recommend instead now is that the baby sleeps in the same room as a parent. So they are supervised in a sense, but they don't share the same sleep surface. So that anything like a crib or bassinet next to a parent bed would be perfect.

Melanie Cole (Host): This is not always an easy discussion to have with parents, is it? Especially when it comes to things like co-sleeping, what do you want to tell parents right now about that if you were talking to them in your office? You just told us why it's not a great idea, but is this a difficult conversation with parents?

Dr Katharina Graw-Panzer: Yes. Because parents like to have their babies close to them, and it also is encouraged for breastfeeding. That was a recommendation in the past, that we knew that breastfeeding easier if you have your baby in the bed with you. However, I think parent always wants the best for their child. So what I try to tell my parents is that they can have the baby in the bed to nurse them. But as soon as the child sleeps, they can place them back in their own bed. I think even though it is maybe a difficult conversation, parents need to know and, like I said, they really don't want any harm to their child and that's one of the things I like to address.

Melanie Cole (Host): Yeah, no. It's an important point that you made. And now on to swaddling, Dr. Graw-Panzer. Swaddling, I don't know how long that really has been around, but I liked doing it with my kids when they were little. Now, there's swaddle sacks, and there's these little zip things and little snappy things. So tell us a little bit about the importance of swaddling, whether it is important. What does that do for baby? And what if they get to the point where they're pulling off the swaddle?

Dr Katharina Graw-Panzer: Okay, good. Yeah. So swaddle is done in the US quite frequently, especially we see it in the nurseries. So what happens when the baby is swaddled, their arms are basically wrapped tightly around the body. And usually, babies have nice strong startle reflex. You might have seen that whenever they hear a little noise, their arms open up, that's called the moro reflex. But when that happens during sleep, they might wake up with this startled response. So by swaddling them, you kind of reduce that. However, the risk with the swaddling, A, is it could be too tight or the bedding comes loose, the swaddle could become loose and then be in the way close to the airway, or it could be a risk for suffocation.

So the idea is one can swaddle their baby when they're little, but once they are older and the swaddle blanket becomes loose, you should stop doing that. Also when the baby is swaddled, they always have to be supine. When a baby is swaddled and sleeps on the tummy, they have a higher risk of SIDS, so that's one important consideration.

Melanie Cole (Host): It is. And when you're wrap them up like a little tiny burrito, they look so cute. Now, we know we're supposed to put them to sleep on their back, what about when they start to roll over? When can we leave babies on their stomach if they roll over? I remember, doctor, running in there, rolling the baby back onto their back until it was like, you know, five times a night or something. So what are we supposed to do when they do that?

Dr Katharina Graw-Panzer: So the good thing is once the baby knows how to roll over by themselves, they can be left in that position. Usually around four to six months, the baby learns to roll over. And once they're able to roll from the back to the tummy, they can be left in that position. I still recommend to place the baby to supine when you place them to sleep at night, but then they can be left as they are able to turn around.

Melanie Cole (Host): And tummy time is an important thing for little babies, right? To give them some supervised tummy time, maybe just for a few minutes at a time, but once they can hold their little heads up, right?

Dr Katharina Graw-Panzer: Correct? Yeah, that's correct what you're saying. So tummy time is always a time when the child is awake. So you basically place them on the tummy and they are trying to lift the head and get exercise for their necks. And this might reduce the risk for the flat head. But this is just while they're awake and while the parents are supervising them, that they don't fall asleep.

Melanie Cole (Host): Yeah, no kidding. So now onto the cribs, I remember when we were little kids, I'm probably much older than you are, but I mean, we had our little cribs all stuffed up with lots of stuff. But now, they tell us we shouldn't be doing that. So what should we or are we allowed to put in baby's crib? Blankets, stuffed animals, bumpers, any of those things or really none of those things?

Dr Katharina Graw-Panzer: Yeah. Yeah, that's a good question. I think the picture of how will we the crib has changed a lot. So what the baby needs is really just their sleep surface. They don't need any of the things we feel might make it cozy for them. So basically, they should sleep on their firm little mattress, which has a fitted sheet, and nothing else should be in the bed. So meaning no blankets, no stuffed animals, no bumpers, nothing of that sort, because this all could lead to accidental suffocation and that's not what we want. So even wedges are not recommended anymore or bumpers for the sides, because all of the cribs which are produced, they are safe. So there is no bumpers required either.

Melanie Cole (Host): Well, I think as long as we put them in cute little pajamas, they don't really need any of those other things, right? And they're going to be warm enough anyway. Now, there's always been this discussion about whether or not to put a pacifier in. And I remember crawling around in the middle of the night, trying to get that thing from under the bed until I would throw a couple of them in there so that if one dropped out... because it does help them to sleep. But is there any studies or things that say we shouldn't be putting pacifiers in or we should be? Tell us about that?

Dr Katharina Graw-Panzer: So for pacifiers, interestingly they have shown that pacifiers are protective for SIDS. But It depends if the child takes pacifier. So as long as they like it and use it, they can be used for the baby to fall asleep. But it doesn't mean you have to put it back once the child falls asleep and it falls out. So the protective effects still holds throughout the night even if it falls out, So good idea is for a parent to try it out once they're able to nurse nicely. And if they're not interested, that's fine. You don't have to worry about that either. It can be tried a few weeks later again, but then, if the child doesn't like pacifiers, you don't have to be worried that, you know, your child is an increased risk for SIDS. It's just something which can be tried out.

Melanie Cole (Host): Well, it's a good thing to try out if you're a parent who feels that this is something that comforts your child because if they find their little pacifier in the middle of the night and they can get it back into their little mouths, it can help them to self-sooth. And I'm glad that you say these are not dangerous. That's very reassuring for so many parents.

Now, for other parents, it's hard to get those kids to sleep. Doctor, many parents wonder if we can let baby nap in their car seat? Can we do that? Why or why not? Is that recommended?

Dr Katharina Graw-Panzer: Yeah. So any sleep surface other than the crib or bassinet is really not recommended, any upright position, meaning any car seat or rocking chair or baby carrier. So even though the baby might fall asleep in there, the child should be placed in their crib as soon as you're home so they sleep safely. There are different risks associated with these car seats. One is the child may slide into position, the head may change, so they touch some soft sides and may suffocate or the head may have been down and the airway could obstruct through that. So, yes, neither of these other sleep places are really recommended and should be avoided.

I think it's important, like you mentioned, to address good sleep habits and sleep routines and to start them early on, so the habits will form. We like to start with sleep training as soon as the baby starts to asleep longer periods at a time when they're a few months old and you can start with these habits early on, like creating a bedtime routine, like feeding the baby, having a nice bath and reading a little story and putting the baby in their bed, so they learn how to fall asleep by themselves in a safe manner.

Melanie Cole (Host): Such important information. Thank you so much. As we wrap up, we'd love your best advice for parents as they are new parents and babies are safer on their backs, what would you like them to know about prevention of SIDS and getting a good quality night's sleep for baby?

Dr Katharina Graw-Panzer: I think one is that the parent they should feel empowered to use all the skills they learn when they're discharged from the hospital, like how to put their baby to bed, how to create a safe sleep environment. And I think we have a lot of help now when the baby is discharged from the nursery. There are many influencers, many other people who tell the parent what they should do and shouldn't do and how the environment should look like, but I'm very happy to see that everybody's pulling on the same strings to tell the parents how they can keep their baby safe, meaning like a sleep environment with just a crib and nothing else and to put the baby on the back to sleep for every sleep.

Then the other thing is also, I always like to talk about the importance of forming healthy sleep habits, because learning to sleep is such an important skill. It's like learning to walk, learning to feed. And I think learning to sleep is one of them as well. And it should be always a nice time in the evening the family can cherish with the baby. And the sleep time and the bedtime routine are very nice moments for the parent to be with the child and also for the baby to learn how to sleep by themselves.

Melanie Cole (Host): Great information, doctor. Thank you so much for joining us today and really sharing your incredible expertise for parents today.

And Weill Cornell Medicine continues to see our patients in person as well as through video visits and you can be confident of the safety of your appointments at Weill Cornell Medicine.

That concludes today's episode of Kids Health Cast. We'd like to invite our audience to download, subscribe, rate, and review Kids' Health Cast on Apple Podcast, Spotify and Google Podcast. For more health tips, please visit and search podcasts. And don't forget to check out Back To Health. I'm Melanie Cole.

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