A New Focus for Baby Sleep Safety

Mar 27

I have a baby, which means I spent much of the past few months in a sleep-deprived daze trying to get him to fall asleep—and stay asleep.  I’ve realized through the semi-obsessive talk with my “mommy friends” about how many hours and how many naps, as well as much internet research into what’s “normal,” that the question of how and where a baby sleeps remains controversial.  To prevent SIDS (sudden infant death syndrome), the focus of public health messaging for the past two decades has been on putting babies on their backs to sleep.  Thanks in part to the Back to Sleep campaign (created by NICHD in the early 90s and supported by Ogilvy in the early 2000s), this recommendation is well known and SIDS deaths have declined dramatically.  Yet the number of babies sleeping on their backs has plateaued and SIDS continues to be the leading cause of death among infants aged one month to 12 months.  At the same time, rates are on the rise of other sleep-related causes of infant death, such as entrapment or suffocation from accidents like babies getting caught between sofa cushions or adults rolling over babies in bed.

What’s happening here?  Have parents gotten complacent?  The rates of SIDS have decreased so dramatically over the years that perhaps new parents today don’t know anyone who has been impacted by SIDS and may not feel the urgency associated with back sleeping. Could the increase in co-sleeping be an unintended consequence of the success of Back to Sleep messaging?  As any parent knows, babies don’t sleep as well on their backs as on their tummies, but they sure do sleep well snuggled next to mom and dad.

In response to the increase in sleep-related deaths, the American Academy of Pediatrics expanded its sleep recommendations in 2011 to outline a comprehensive safe sleep environment, adding recommendations like breastfeeding, immunizations, and avoiding crib bumpers.  The recommendations also weigh in against bed-sharing, opting for room-sharing instead. This shouldn’t be surprising, given the data that clearly shows the dangers. Yet the recommendations also acknowledge that there isn’t evidence yet showing it can be done safely, not necessarily that it can’t be done safely.

Ad showing a baby sleeping on a bed next to a large knifeWith dangerous sleep practices on the rise, it makes sense there would be a renewed focus on public education.  The Back to Sleep campaign renamed itself Safe to Sleep. And you see campaigns like this one from the Milwaukee Health Department that aim to get the message out about the dangers of bringing baby to bed with you.  Knife-wielding babies?  Yep, that certainly gets my attention.  But did I learn enough from it?  The parent in me has a hard time reconciling this directive with my personal experiences of having my baby sleep longer next to me in those early months.  And the public health educator in me is wondering if we are missing a huge teachable moment here by telling parents not to practice this behavior instead of sharing information on how to do it safely. (By the way, the Milwaukee Health Department released new ads less than a year later with babies in cribs on their backs.)

Will the guilt and blame associated with bed-sharing lead parents to hide this behavior from their pediatricians or support networks?  Are we missing an opportunity here to educate parents about how to bed-share more safely, such as by removing fluffy blankets and tying back long hair?  Perhaps similar to the argument for sex education for teens…if people are going to do it anyway, isn’t it our responsibility to teach them how to do it safely?

What is the right balance between condoning a behavior and teaching safety? Are there messages about other behaviors with this type of dilemma that have it figured out?

This entry was posted on Wednesday, March 27th, 2013 at 3:30 pm and is filed under Behavior Change, Public Health, Social Marketing. You can follow any responses to this entry through the RSS 2.0. Both comments and pings are currently closed.

Comments are closed.