Safe Sleep: A Guide For Parents And Caregivers
By Adam J. Langino, Esq.
Is my baby safe in his or her crib? All parents remember the stress of waking up and continually checking on the safety of their new child. As a trial lawyer who helps families whose children are injured by dangerous or defective products, I've investigated crib and infant sleep safety issues. Here's what I've learned:
Over 3,000 babies in the U.S. die suddenly and unexpectedly each year. Sudden unexpected infant death (also known as SIDS) is a medical term used to describe the sudden and unexpected death of a baby less than 1-year-old when the cause is not apparent. SIDS statistics include accidental suffocation in an unsafe sleeping environment and other deaths from unknown causes.i
U.S. National Institute of Health’s Recommendations
According to the U.S. National Institute of Health (NIH), “the best way to reduce the risk for sudden infant death syndrome (SIDS) is always to place the baby on his or her back for all sleep times in a separate sleep area, designed for a baby, with no soft objects, toys, or loose bedding.”ii “Research shows that the back sleep position carries the lowest risk of SIDS. Research also shows that babies who sleep on their backs are less likely to get fevers, stuffy noses, and ear infections. The back sleep position also makes it easier for babies to look around the room and move their arms and legs.”iii
U.S. Center for Disease Control’s Recommendations
The U.S. Center for Disease Control and Prevention (CDC) recommends similar safe sleep practices. The CDC suggests that parents can reduce the risk of SIDS by placing their baby on his or her back for all sleep times, including naps and at night.iv The CDC also recommends that parents keep their baby’s sleep area in the same room where they sleep until their baby is at least six months old.v The CDC says parents should keep soft bedding such as blankets, pillows, bumper pads, and soft toys out of their baby’s sleep area and that parents should not cover their baby’s head or allow their baby to get too hot.vi Finally, parents should use a firm, flat sleep surface in a safety-approved crib.vii
New Federal Safety Guidelines
What is a safety-approved crib? Beginning in mid-2022, manufacturers must meet a new federal safety rule for products intended for infant sleep.viii The new standard requires that an infant’s sleep surface angle be 10 degrees or lower.ix Why? After investigating infant deaths occurring between January 2019 and December 2020, the U.S. Consumer Product Safety Commission (“CPSC”) became aware of 254 incidents, including 21 fatalities, relating to infant sleep products (inclined and flat).x It found that infant inclined sleep products included design-related safety issues resulting in infants rolling over and asphyxiating, children developing respiratory problems, or developing physical deformations due to extended periods of use.xi The CPSC also found hazard patterns for flat infant sleep products, including infants falling out of the product or suffocating on soft structure sides.xii
U.S. Consumer Product Safety Commission Investigation
Recently, the U.S. Consumer Product Safety Commission ("CPSC") recalled inclined infant sleepers. Why? The “CPSC received reports of 1,108 incidents, including 73 infant deaths, related to infant incline sleep products from January 2005 through June 2019.”xiii The CPSC hired independent expert Erin Mannen, Ph.D., a mechanical engineer specializing in biomechanics at the University of Arkansas for Medical Sciences, to conduct infant testing to evaluate the design of inclined sleep products.xvi “Dr. Mannen found that none of the incline sleep products her team tested were safe for infant sleep.”xv “Dr. Mannen also found that soft and plush-like sleep.
In their "Safe to Sleep" public education campaign, the CPSC and the NIH put forward a few simple rules to keep babies sleeping safely in any crib, bassinet, or play yard.xvi
To prevent suffocation, never place pillows or thick quilts in a baby's sleep environment.
Make sure there are no gaps more significant than two fingers between the sides of the crib and the mattress.
Proper assembly of cribs is paramount - Follow the instructions provided and ensure that every part is installed correctly. If you are not sure, call the manufacturer for assistance.
Do not use cribs older than ten 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 correctly 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 lines.
From a lawyer's perspective, I wrote about the hidden dangers of inclined infant sleepers in 2019. In that article, I highlighted that the CPSC had received more than 700 reports since 2005 about injuries associated with infant incline sleepers. Before 2019, at least eight recalls have linked inclined sleep products to concerns about strangulation, suffocation, falls, and entrapment.
According to an April 9, 2019, American Academy of Pediatrics (AAP) position statement, the cause of death for some infants who died in inclined sleepers was listed as asphyxia, or the inability to breathe caused by the infant’s position. From a child safety product design perspective, some incline sleepers share at least two dangerous characteristics: 1) they place the infant at an incline, and 2) they recess the infant between the deep and soft fabric. The deep, soft fabric is dangerous for infants who lack neck control to keep their heads from falling into a compromised, suffocating position.
According to a study published in Pediatrics, which analyzed five years of infant death data, most infant suffocation deaths are attributed to soft bedding.xvii According to the AAP, infants should always sleep on their back, on a separate, flat, and firm sleep surface without any bumpers or bedding.xviii It advises parents against using inclined sleepers, such as those sold by Kids II and Fisher-Price, because of the risk that an infant can turn or roll into a dangerous position and suffocate. Since my 2019 article, many inclined infant sleepers have been recalled.xix
If parents are concerned about their incline sleeper, they can search the U.S. CPSC’s website at this link https://bit.ly/3wl5bkY.
Free Safe Sleep Resources
For parents, there are plenty of safe sleep resources. The U.S. CDC produced an easy-to-understand safe sleep video, which can be found here: https://bit.ly/3tlzcPL. In collaboration with the U.S. Department of Health and Human Services, the Eunice Kennedy Shriver National Institute of Child Health and Human Development created an interactive virtual room to help parents visualize a safe sleeping environment, which can be found here: https://bit.ly/3iiHTnB. Cribs for Kids® is a non-profit that works to prevent infant sleep-related deaths by educating parents and caregivers on the importance of practicing safe sleep for their babies through programs (such as the Safe Sleep Ambassador program) and by providing portable cribs to families who, otherwise, cannot afford a safe place for their babies to sleep. You may contact Cribs for Kids® here: https://bit.ly/36yZbdG. Finally, the American Academy of Pediatrics has a safe sleep site, too. Their site provides a “read aloud” option in English and Spanish so caregivers of any reading level can learn more, which can be found here: https://bit.ly/3L0TW5j.
I hope you find the above helpful in creating a safe sleeping environment for your child. If the unthinkable happens and your infant is injured in a dangerous sleeper, please feel free to reach out. I am licensed to practice law in Florida and North Carolina and co-counsel claims in other states. If you would like to learn more about me or my practice, click here. If you want to request a free consultation, click here. As always, stay safe and stay well.
i “About SIDS and SUID.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 15 June 2021, https://bit.ly/34ViWvq
ii “Frequently Asked Questions (FAQS) about SIDS and Safe Infant Sleep.” Eunice Kennedy Shriver National Institute of Child Health and Human Development, U.S. Department of Health and Human Services, https://safetosleep.nichd.nih.gov/safesleepbasics/faq?fbclid=IwAR3k07rL7l2u7JVtNDtEkEXcPGEPuTcSgSwj6Ivkgb1fqA8c-70sY-aO55g.
iv “About SIDS and SUID.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 15 June 2021, https://bit.ly/37weJPC https://bit.ly/3DXAN1V.
viii “CPSC Approves Major New Federal Safety Standard for Infant Sleep Products.” U.S. Consumer Product Safety Commission, https://www.cpsc.gov/Newsroom/News-Releases/2021/CPSC-Approves-Major-New-Federal-Safety-Standard-for-Infant-Sleep-Products.
xiii “Safe Sleep – Cribs and Infant Products.” U.S. Consumer Product Safety Commission, 2 June 2021, https://www.cpsc.gov/SafeSleep.
xvii Moon, Rachel Y., et al. “SIDS and Other Sleep-Related Infant Deaths: Evidence Base for 2016 Updated Recommendations for a Safe Infant Sleeping Environment.” Pediatrics, vol. 138, no. 5, 2016, https://doi.org/10.1542/peds.2016-2940.