Ask Us Anything About… Safe Infant Sleep

Description – The video begins inside the Injury Prevention Program office at Penn State Health Children’s Hospital. Two individuals are standing together looking at the camera. From left to right is, Scott Gilbert and Amy Bollinger of the pediatric trauma and injury prevention program at Penn State Health Children’s Hospital.

Scott Gilbert – From Penn State Health and Penn State Health Children’s Hospital, welcome to Ask Us Anything About Safe Infant Sleep. I’m Scott Gilbert. Each year in the United States, there are 3500 infant deaths due to sleep-related injuries and we’re here to talk with Amy Bollinger of the pediatric trauma and injury prevention program here at Penn State Health Children’s Hospital about how you can keep your infant safe while sleeping. Amy, thanks so much for being here today. Let’s start with the ABC’s of safe sleeping. There’s an acronym that’s very simple, very important. Tell us what A, B, and C stand for.

Amy Bollinger – Sure, so ABC stands for alone, back, and crib. Alone meaning that your infant should be alone in his or her own sleep space. Back means that you place your baby on his or her back to go to sleep, and crib meaning that your baby should sleep in a crib with nothing else in that crib but your baby.

Scott Gilbert – So, let’s go through each of those very briefly. The first one is alone and that means they are sleeping alone in their crib and not in mom and dad’s bed.

Amy Bollinger  – Correct. We know that over half of all sudden unexpected deaths due to suffocation involve co-sleeping with a parent.

Scott Gilbert – So, co-sleeping under any circumstance is acceptable or not?

Amy Bollinger  – The American Academy of Pediatrics does not recommend bed sharing for the risk of suffocation.

Scott Gilbert – Now, we did have a comment on our Facebook page from someone who said that they are very scared of having their child in their bed for that very reason, you know, but she mentioned the only time my son is in my bed is in the morning when we’re both awake. That’s probably OK.

Amy Bollinger  – That’s OK. If the parent or caregiver is awake and able to watch the baby, that’s fine. That’s safe.

Scott Gilbert – But also leaving a child on the bed is– even if the child is awake– a bad idea. They could roll off.

Amy Bollinger  – They absolutely can and they do. We see that very often in our pediatric trauma program. Parents, well-meaning, lay their baby on the bed in the middle of the bed, step out of the room and come back to find their baby on the floor.

Scott Gilbert – You’re watching Ask Us Anything About Safe Infant Sleep from Penn State Health. I’m Scott Gilbert along with Amy Bollinger. We welcome your questions. Just had a comment here to this Facebook post and whether you’re watching this video live or on playback, we’ll make sure we get some answers for you. We’re talking about the ABC’s of safe sleep, putting your child down alone is the A, B is on their back in the crib. So, why is that so important because– I’ve got to be honest– I think way back when I was in a crib, I slept on my stomach. Not that I remember.

Amy Bollinger  – So did I. In fact, when I had my own children, my mom reminded me of that every time she babysat.

Scott Gilbert – We all survived it, so what’s the big deal?

Amy Bollinger  – We did survive it, but as time has evolved, so have studies and we know differently now. Babies– all of us have two tubes in the backs of our throats. One’s a breathing tube and one is a tube for food and drink. When a baby lies down on his or her back, he– the food and drink tube is on the back and the breathing tube is up. So, if a baby spits up, that spit up is going to come up and go back and wash right down into the food and drink tube, not the breathing tube.

Scott Gilbert – Whereas if they’re on their stomach, something different.

Amy Bollinger  – It’s reversed. So, the breathing tube is now at the lowest point on the crib and the food and drink tube is on the upper portion. So, when they spit up, anything that backwashes is going right into that breathing tube.

Scott Gilbert – And we have a diagram. In fact, I’m going to hold this up so Mike can get a shot of it. We will also put a copy of this diagram on the Facebook post for this particular video so you can kind of get a diagram, because it does sound unusual. Everyone’s afraid that their baby is going to choke on their own– their own vomit, when in fact that’s not really a risk if they’re on their back. It is if they’re on their stomach. So, that runs kind of counter intuitive to what a lot of people think.

Amy Bollinger  – It really is.

Scott Gilbert – So, we talk about alone on their back and then the third one, of course, is in a crib. Tell me about what that crib should be like and look like.

Amy Bollinger  – Right. So, we talk about a sleep space in injury prevention because a crib could mean a few different things. Many families cannot afford a three- and four-hundred-dollar crib, so a portable crib such as a pack and play is perfectly safe for your baby to sleep in as long as you are using a fitted sheet designed for that portable crib. In the crib, there should be nothing. No bumper pads, no loose fluffy blankets, no stuffed animals, nothing. They are all very high risk for suffocation and what we call entrapment.

Scott Gilbert – Sometimes what we hear is when It comes to the crib bumper– so, it goes along the outer edge there– because you see these slats in a crib, someone may say, well, what if my child’s arm could easily slip through or a leg could slip through and get stuck. They’re young, they might not be able to get it out. That crib bumper could prevent that.

Amy Bollinger  – Well, that’s not necessarily true. Bumper pads were first designed when slats of cribs were much wider and they were designed 20, 30, 40 years ago so that baby’s heads would not get stuck between the slats. Now that the slats are closer together, the risk of having head and strangulation is mitigated. We don’t see that any more. It is not likely that a baby will get his or her arm or leg stuck in-between those slats and not be able to move them out himself or herself.

Scott Gilbert – Sure. Well, we welcome your questions for Amy Bollinger of the pediatric trauma and injury prevention program here at Penn State Health Children’s Hospital. We’re in the safety center of the children’s hospital, it may look familiar to some patients and families here and we do welcome your questions on safe infant sleep. Just add them to the comment field below this post. We’re talking about putting baby to sleep in a nice, safe crib and, as you mentioned, that means free of a lot of items, but there are a lot of things you can buy, a lot of accessories you can buy for a crib that would seem to enhance the safety. One of them might be a wedge-shaped device that you can put the baby up next to to keep them from rolling over onto their stomach.

Amy Bollinger  – Sure. And, again, you know, the American Academy of Pediatrics says they are absolutely not safe. They are– they put your baby at an increased risk of suffocation.

Scott Gilbert – And that’s really what we’re talking about. I mean all of these risks seem to back to that one individual factor, suffocation.

Amy Bollinger  – They do. Sudden unexpected infant death is not completely preventable. There are, unfortunately, babies and families who have to go through a devastating loss such as an infant death, but there are factors and things that we can do to prevent the suffocation and strangulation piece of the umbrella term of sudden unexpected infant death.

Scott Gilbert – To prevent at least some of them.

Amy Bollinger  – To prevent at least some of them, right. No parents put something in his or her baby’s crib with the intent of doing harm. So, we want to be sure that we’re educating moms and dads and grandparents and aunts and uncles about what the right thing is to do, the safest thing is to do for your baby.

Scott Gilbert – And there are some factors that go beyond the crib. One of those is smoking in the household. That’s been shown to increase the risk of sudden infant death, correct?

Amy Bollinger  – It really has. Pregnant women who smoke during their pregnancy have a three– their babies have a three times higher incidence of sudden unexpected infant death as compared to moms who don’t smoke during pregnancy.

Scott Gilbert – This is very information– very important information here on Ask Us Anything About Safe Infant Sleep and for that reason we ask you to share this Facebook post on your feed so we can help to get the word out and, of course, we do welcome your questions as well here for Amy Bollinger. We’re talking about some of the myths. Any other myths or anything we didn’t touch on there that sometimes come up when, you know– kind of anything we want to set the record straight on to make sure people have, like you said, the most current information, which admittedly is evolving.

Amy Bollinger  – Sure. One of the things that we recommend also is that infants not sleep unsupervised in any kind of sitting devices. A car seat, a high chair, anything that puts the baby in a sitting or reclining position because babies move around and they can get themselves stuck in a position where they cannot protect their airway.

Scott Gilbert – And, you know, that’s an interesting factor because we had a colicky baby in our house and the only way she’d fall asleep in the middle of the night was if we drive her around. And, you know, what happens if you take her out of the car seat after that drive. She’s going to wake up.

Amy Bollinger  – That’s right.

Scott Gilbert – But, bottom line, that’s not safe. Now, specifically when we talk about the car seat, why is that not safe?

Amy Bollinger  – Because babies can scooch down and actually get their necks hung up on the straps themselves and if that happens and the caregivers are asleep, they have no way of saving or protecting their infant.

Scott Gilbert – Suddenly fell guilty, but we lucked out, but there are a lot of these things that– it’s true, like you say, these factors may not be a problem, you might get away with them, the problem is you might not and that’s why it’s important to keep the ABC’s in mind.

Amy Bollinger  – Absolutely. Absolutely.

Scott Gilbert – And you told me about something else, interestingly, before the interview about some binkies that have– is it binkies that have stuffed animals on them? Pacifiers.

Amy Bollinger  – We call them pacifiers.

Scott Gilbert – OK. All right. Yeah.

Amy Bollinger  – In hospitals, you know.

Scott Gilbert – That’s right. Well– and this one doesn’t have a stuffed animal on it, but they actually make those now where they have stuffed animals on the other end?

Amy Bollinger  – So, I don’t know what the official term is for the pacifiers that have the stuffed animals. I’m a little old, at this point, but there are apparently stuffed animals that attach to a pacifier. Those stuffed animals can actually– are actually large enough that they can completely cover an infant’s nose and mouth, which can lead to airway compromise and eventually suffocation. So, we don’t recommend those in the crib.

Scott Gilbert – And so, you– we think about these things as something that would comfort the child, when in fact they could actually put them at harm. So, how old should a child be then before you can introduce things such as maybe an extra blanket or stuffed animals? At what age or size is it OK to do that?

Amy Bollinger  – We say not under one year. A minimum of one year and even longer in the sleep space. There are very rare instances where infants are suffocated or strangled by blankets that get wrapped around the rails of the crib and then around their heads and necks. Very, very rare, but we see it. And– so we recommend absolutely nothing in that crib under the age of one year.

Scott Gilbert – No need to take chances, right?

Amy Bollinger  – Right.

Scott Gilbert – Well, we thank you for watching and we do welcome your questions. Again, even if you’re watching this video on playback, if there’s something we didn’t touch on, feel free to add it to the question and comment field there and we’ll make sure we get that question to Amy Bollinger. She’s manager of the pediatric trauma and injury prevention program here at Penn State Health Children’s Hospital. Amy, thank you for your time, and thank you for watching Ask Us Anything About Safe Infant Sleep from Penn State Health.