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What You Need to Know About Infant Safe Sleeping and Co-Sleeping

Since the American Academy of Pediatrics (AAP) recommended all babies should be placed on their backs to sleep in 1992, deaths from Sudden Infant Death Syndrome have declined dramatically. But sleep-related deaths from other causes, including suffocation, entrapment and asphyxia, have increased.

Sleep needs for babies vary depending on their age. Even though you may think it will be easier for feedings or to get up in the middle of the night if your baby is co-sleeping with you, the AAP strongly believes in sharing your room and not your bed. Putting your baby in bed with you may raise the risk of strangulation, suffocation, entrapment, and SIDS.

Monica Kharbanda, MD, discusses the potential dangers of co-sleeping, why you should put your baby to sleep on their backs, and the latest recommendations from the American Academy of Pediatrics.

Learn more about BayCare’s children’s health services.

This podcast is for informational purposes only, and is not intended to be a substitute for professional medical advice, diagnosis, or treatment.  This podcast does not create a physician-patient relationship.  You should always consult your physician or other healthcare professional with any questions you may have regarding a medical condition.  If you think you may have a medical emergency, call your physician or 911 immediately.
What You Need to Know About Infant Safe Sleeping and Co-Sleeping
Featured Speaker:
Monica Kharbanda, MD
Dr. Monica Kharbanda has been a pediatrician for the past ten years. She completed her internship and residency in pediatrics at the prestigious LIJ-North shore Schneider Children’s Hospital, where she had the opportunity to train under some of the most well-known leaders in different pediatric specialties. In addition, she did extensive research at Feinstein Institute of Research at North Shore University Hospital -NYU school of Medicine in Pediatric AIDS. Her research led her to present at international AIDS conferences and publish in leading medical journals.

Learn more about Dr. Monica Kharbanda

Melanie Cole (Host): Since the American Academy of Pediatrics recommended in 1992 that all babies should be placed on their backs to sleep, deaths from Sudden Infant Death Syndrome have declined dramatically. My guest is Dr. Monica Kharbanda. She's a pediatrician and a member of the medical staff at Baycare Health System. Dr. Kharbanda, what is the best way to put a child to bed as recommended by the American Academy of Pediatrics?

Dr. Monica Kharbanda, MD (Guest): Back to sleep. That's the simplest way of telling a patient always, always put your baby back to sleep. There is no other safer way to have the baby sleep.

Melanie: So we're putting them to sleep on their backs. Are we swaddling them? What's the deal with clothes? Because parents worry with their new little newborns, "Oh but they're going to be cold." So there's a hat, and there's swaddles, and there's a little onesie. What should we be doing as far as clothes?

Dr. Kharbanda: It is fine to swaddle your baby, however make sure that baby is always on his or her back when swaddled. Swaddles should not be too tight or make it hard for the baby to breathe or move his or her head. When your baby looks like he or she is trying to roll over, you should stop swaddling. Make sure there is no loose soft objects in the crib either which could increase the risk of entrapment, suffocation, or tanglation in the baby's sleep area.

Melanie: So back to the rolling over for a minute, because babies do start to roll over, and you said that's when we should stop swaddling them. We put our babies to sleep on their backs. What if they roll over? Do you run in and roll them back over onto their backs? What do you do when they start rolling over?

Dr. Kharbanda: Well again, once they start rolling over, they would be strong enough to not choke and they'll roll themselves over if they're suffocating. But at the same time, you want to make sure that the crib does not have any loose bedding which includes pillows, quilts, comforters, blankets, toys, bumper pads, or any similar products that attach to the crib because you don't want the baby to be next to one of those and choke over. But usually once the baby starts rolling over, they'll be strong enough to roll themselves to a position that they can breathe.

Melanie: Parents don't always like the look of a crib that looks so empty like that. So what about wedges, positioners, or even stuffed animals? We don't want any of those things in the crib anymore, yes?

Dr. Kharbanda: Correct, nothing. Nothing in the crib except the baby.

Melanie: And what about pacifiers? Are those something that we can give baby to soothe before they go to bed?

Dr. Kharbanda: Yeah, sure. Actually it has been shown that pacifiers tend to reduce the incidents of deaths. If you're breastfeeding, I would wait until breastfeeding is going well before offering a pacifier. That would take at least three to four weeks. If you're not breastfeeding your baby, you can start the pacifier whenever you like it. It's okay if your baby does not want a pacifier. You can try offering it again later, but some babies just simply don't like it, and if the pacifier falls out after your baby falls asleep, don't panic, don't put it back in, it's okay.

Melanie: Well we all know how that feels, running back in and looking under the crib for the pacifier trying to calm your baby down in the middle of the night. Boy, I'm sure that's happened to so many parents. Now as far as co-sleeping, there are recommendations now, and the AAP has come out with policy about co-sleeping. Some parents, Dr. Kharbanda, think that it's safer and/or easier to breastfeed a newborn if they are in the same bed.

Dr. Kharbanda: No, absolutely, absolutely not. Co-sleeping is a big no-no. Even during feeding we say that you can feed the baby sitting on a sofa, or sitting on a rocking chair, but put the baby back to their crib. They have been recommending that- room sharing, so baby sleeps in the same room as you, but in a separate crib or a bassinet close to your bed. The AP recommends that room sharing, because it can decrease the risk of SIDS as much as 50% and it is much, much safer than bed sharing. So absolutely, absolutely no bed sharing.

Melanie: So what do you tell parents why? I mean because they say, "Well I'm right there, and I'm tired, my husband can bring me the baby and I can nurse and then we're right there all cuddled up." What do you tell parents? Really because there are some people that are very adamant about co-sleeping.

Dr. Kharbanda: Well I usually show the parents, "Look at the size of the baby, and look at the size of you. You're going to fall asleep, and you're going to roll over and choke your own baby. That's as simple as that."

Melanie: So what else should parents know about safe sleeping for their babies? We've talked about cribs, we've talked about swaddling and clothes, we've talked about co-sleeping, so what about drop side cribs and the safety of the cribs in general these days?

Dr. Kharbanda: Well I would use caution when buying the product. Make sure there is no recall on the product. I would not rely on any home breathing monitors that claim that they're going to reduce the risk of SIDS. There is not enough research on bedside or in-bed sleepers. Again, products that claim that they're going to reduce the risk of SIDS like wedges, positioners, mattresses, sleep surfaces, they have not been shown to reduce the risk of SIDS according to AAP.

Melanie: And what about things like tummy time? Because then people worry when they hear you can only put your child to bed on their back. Is tummy time still very important during the day?

Dr. Kharbanda: Definitely. So I always tell my parents, playtime should be tummy time. So whenever baby is awake in a happy mood, you can put the baby on your tummy, and that's the only rule you need to remember. Playtime is tummy time, and babies do- a lot of babies do develop flatness on the back of their head, and it gets better as they start getting stronger and you're doing more and more tummy time. You can slowly go up on it, do a couple of minutes a day twice a day, and you can never overdo tummy time, but the only rule that you need to follow is that it has to be playtime. It's not when the baby is asleep.

Melanie: And another important point that AAP likes to recommend is vaccinations because this is something that's so important for these little babies. So speak about what you tell parents when they ask you about vaccinations, the importance of following that schedule, and how vaccinations can help reduce the risk of SIDS.

Dr. Kharbanda: Oh definitely. You know, there's been so much research that has gone into the vaccines that are recommended by AAP, and we- all us pediatricians follows the CDC guidelines, that is why it is very, very important to schedule those well visits so that you can get all the vaccines that are recommended. These vaccines are life-saving, they protect you against life threatening diseases. Again, as simple as you can put it, your baby can die if they get one of these diseases which are preventable with vaccines. So yeah, I highly, highly, highly recommend my parents to get their kids immunized on time, follow the guidelines by AAP and CDC.

Melanie: Wrap it up for us, Dr. Kharbanda, with your best advice about safe sleeping for infants, the dangers of co-sleeping, and what you recommend as far as really taking the best care of our little ones.

Dr. Kharbanda: Go back to sleep. I cannot reiterate the importance of back to sleep. And the other thing I always tell my parents, "You need to rest too." Parents need their sleep too. You're never ever going to get your eight hours of sleep. You've got to do cat naps when your baby is sleeping. If you're rested, you're going to take care of your baby better. Back to sleep in a separate crib or a bassinet in your room, but separate from you so that you can attend to your baby when needed. And rest yourselves, everything else can wait. Your baby is very precious. You've waited nine months plus for this baby, you really, really want to enjoy the baby, but at the same time have a very safe environment for the baby.

Melanie: Thank you so much. It's really great information, and thank you for sharing your expertise with us today. You're listening to Baycare Health Chat. For more information, please visit That's This is Melanie Cole, thanks so much for listening.