As Kim and I are now blessed to have recently become grandparents, the forever pediatric issue of safe infant sleep now has renewed personal urgency for me. In a 2012 policy statement the American Academy of Pediatrics urged parents to avoid soft bedding objects like pillows or bumpers in the crib with young infants. In a study examining 1985-2012 researchers reported that infant suffocation in cribs, while rare(about 77 cases in that period), were almost always associated with bumpers: 2/3 caused by the bumpers themselves and the rest when the infant became tangled between the bumper and another object like a pillow or toy. There were an additional 146 nonlethal choking and near suffocations also all associated with bumpers in that time period.
Parents who use bumpers usually express concerns about avoiding head injury or limb entrapment. However, young infants lack both the strength and the coordination to slam their heads against the crib with enough force to cause any significant injury. And while it is rarely possible for a limb to get stuck between the slats, it is virtually impossible for this to result in a fracture or any other serious arm or leg injury–so the worst that could likely occur is an uncomfortable and upsetting, but ultimately essentially harmless, experience.
So the basic recommendations are:
• To prevent suffocation, never place pillows or thick quilts in a baby’s sleep environment.
• Make sure there are no gaps larger than two fingers between the sides of the crib and the mattress.
• Proper assembly of cribs is paramount – Follow the instructions provided and make sure that every part is installed correctly. If you are not sure, call the manufacturer for assistance.
• Do not use cribs older than 10 years or broken or modified cribs. Infants can strangle to death if their bodies pass through gaps between loose components or broken slats while their heads remain entrapped.
• Set up play yards properly according to manufacturers’ directions. Only use the mattress pad provided with the play yard; do not add extra padding.
• Never place a crib near a window with blind, curtain cords or baby monitor cords; babies can strangle on cords.
The consumer Product Safety Commission recently reviewed the data and added these additional concerns regarding the use of crib bumpers:
- They limit mattress space
- Cover key failure points in the crib
- are difficult to install
- frequently used in older infants beyond even the manufacturer’s recommended age
- used outside cribs
- sends mixed signals about padded objects in crib
So we pediatricians usually advise that “bare is best:” a flat, firm mattress without pillows or toys, no crib bumpers or thick quilts or blankets. Young infants can wear a head cap and be swaddled in a receiving blanket and older infants can just use warm pajamas for comfort.
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