Cozy Does Not Equal Safe

She thought she was doing the right thing.  She was leaving baby for two minutes to get her toddler dressed.  She put the 4 month-old in the middle of the bed and rolled up blankets around the edges in case baby scooted over, so baby wouldn't fall off. Minutes later she came back, finding baby against one of the blanket rolls face- in, pale and limp.  She screamed for her husband to call 911, snatched up baby, and began rescue breaths.  When the paramedics arrived, the infant was breathing. When they got to me in the Emergency Department, baby was still groggy but awake, and we all heaved a sigh of relief.  And shuttered to think, what if mom had been another few minutes..... October is SIDS Awareness Month.  SIDS is Sudden Infant Death Syndrome, sometimes called crib death, wherein babies are put down to sleep and found dead.  In the last 50 years it was surmised that many of these deaths were from smothering, babies often being found face down in thick bedclothes.  Two decades ago the American Academy of Pediatrics began it's Back-To-Sleep campaign, encouraging parents to put their babies to sleep on their backs.  The SIDS death rate plummeted. Since then we've found other factors in crib deaths.  When my kids were infants, my pediatric-nurse wife and I put them to bed on their backs, but on sheepskin, with bumper pads in their cribs.  We also placed stuffed animals with them.  My kids survived, but those things are now on the danger list too. Sheepskins, bumper pads, quilts, plush toys, and pillows are all smothering risks. One risk for SIDS that has been known for centuries is co-sleeping, or sleeping in the same bed or couch with baby.  Even medieval societies recognized this smothering risk. Germany had a law in the year 1291 forbidding women from taking children under 3 years-old into bed.  In 1862, the English Women's Journal warned, "Nor must we forget a frequent and lamentable cause of death that in which the infant is "overlaid" in its slumbers by a careless, perhaps drunken nurse or mother."  SIDS Awareness Month in October coincides with another fall tradition, Halloween.  In this spirit, doctors at Montreal Children's Hospital invented a training tool they called the Crib Of Horrors.  They placed a CPR baby mannequin in a crib with numerous safety hazards, and held a contest wherein staff from different units (Emergency Department, ICU, clinics, etc) would name as many violations as they could find.  The winner was the team that found the most hazards. They included several things we discussed above: piles of blankets near baby's head that he could smother in, loose pajamas that could cover baby's face, and other articles in the crib that could suffocate.  There were also more hospital-specific violations, like coils of oxygen tubing that could strangle a rolling baby. The Crib Of Horrors illustrates mistakes that parents often make when putting infants to bed.  Though it looks cozy, a crib with heavy blankets or quilts, stuffed animals, pillows, and bumper pads is unsafe.  And like the oxygen tubing, strings that hold pacifiers, or necklaces, are strangling risks. Babies should sleep in on their backs, face-up, in a thin, one-piece sleeper, on a thin mattress with a fitted sheet. Pacifiers have recently been shown to be protective against SIDS, so they're okay.  But no strings attached. When babies get colds, they become noisy breathers, rattling and snorting at night, occasionally gagging and vomiting mucus.  Parents become worried that baby may choke to death on secretions (which actually is NOT a SIDS risk).  To watch baby more closely, they violate the cardinal rule about not bringing baby into bed with them.  Unfortunately, "watching baby" often becomes "sleeping with baby." Like we mentioned above, the smothering hazards of "co-sleeping" with infants has been recognized for centuries.  We recommend "co-rooming", where baby sleeps in a crib next to parent's bed.  Thus baby is watched without being in the adult's bed where pillows, blankets, thick mattresses, and the adults themselves become smothering risks. Cozy does not equal safe when it comes to sleeping babies.  Keep infants on their backs, even if they have colds- babies are designed to handle congestion and reflexively keep their airways clear lying face-up.  Be sure your infant's bed doesn't become a Crib Of Horrors.