I just downloaded the entire American Academy of Pediatrics’ Technical Report-SIDS and Other Sleep-Related Infant Deaths: Expansion of Recommendations for a Safe Infant Sleeping Environment. It was a large file to read, but the bottom line for me was this: they must not have any sense what it is like to be a new parent, and maybe not what it is like for practicing pediatricians. In other words, they say what to do and what not to do to prevent SIDS, but don’t mention how to accomplish any of it in the world of actual babies and parents, where crying and sleeping is real, not theory. No wonder parents don’t follow the guidelines. Without useful strategies and simple explanations, most parents wouldn’t be willing to follow their recommendations for very long. In my opinion, the most difficult guidelines for parents are the instructions to only place newborns on their backs to sleep, and not to have a baby sleep in the bed on on the parent. Babies should be in the room, but not in the bed, with an adult. Simple, right? Not.
Sleep-deprived new parents are struggling to comprehend all the things they should and shouldn’t do. Defensive driver classes say that lack of sleep makes you drive like you are drunk. Why should we expect the parents of newborns who get 5 hours of sleep a day to think clearly? Because they aren’t behind the wheel? An exhausted parent isn’t just tired. They are less capable of judging what is safe and how to follow their pediatrician’s general recommendations. They are going to let a 4 week-old sleep in the car seat for over 30 minutes because he slept poorly last night, pick him up from his “tummy time” right away when he cries because they are so frazzled, and use a positioning wedge in the crib. They will be afraid to use a pacifier at 5 weeks, and will abandon swaddling when they can’t get it snug. I can’t blame them one bit. Babies aren’t simple. Their crying when they are put down rips a parent apart. No one knows how to deal with newborns without some help.
Not letting your baby sleep on you or next to you, and only placing a baby to sleep on his back means that a parent needs to be shown other good sleep strategies that leave both parties comforted and calm. Pediatricians know that back sleepers show initial delays in motor control that disappear by 18 months on average, but generally offer no other suggestions than to “do some tummy time.” There are some great methods to make Safe to Sleep successful, but the AAP doesn’t share any specific baby management secrets (if they have them.)
The New York Times ran a story in 2005 that made me stop in my tracks before I finished reading it. They reported on the increase in parents placing their babies on their backs to sleep after hearing about the Safe to Sleep protocol from professionals. Turns out, their newborns had a hard time sleeping in this position. It is well known that many babies don’t sleep as deeply or as long in this position, and for some simple reasons. Their random arm movements wake them, they turn their heads and motor reflexes wake them, and they traded the firm support of the womb for the feeling of floating in space on a bassinet mattress. Who could sleep well like that?
The NYT author quoted a parent that suggested that her NICU nurses encouraged stomach sleeping on discharge, even though they had to tell her officially not to do so. A Manhattan newborn care instructor was quoted saying that “the role of a professional is to say these are the recommendations and this is why. The role of the parent is to think critically and apply those recommendations in a way that makes their life manageable.”
I see things differently. Professionals should anticipate the need to provide practical strategies when they teach their lifesaving guidelines. Expecting exhausted parents to “think critically and apply these recommendations” is asking much too much from well-meaning but tired and vulnerable people. It just seems very unfair for pediatricians to know full well how hard those first few months are, and yet not be more practically helpful.
Then again, they may not have any direct experience or even know what to do with a baby after a checkup or a treatment. After all, they treat medical problems. SIDS is a medical problem. Sleeping, calming and caring for babies isn’t really a medical problem.
If doctors or other professionals are not able to provide real-life instruction in ways to make the Safe to Sleep program successful in the real world, they should have resources to offer to parents. As a Happiest Baby educator and a pediatric occupational therapist, I wish that every parent had the ability to learn how to use Dr. Karp’s amazing baby calming and sleep techniques from me, and how to carry and hold their babies to develop good head control. I wish I could show every parent how to make “tummy time” fun and easy. I write this blog in order to reach out to parents with love and support. They don’t have as many resources as they deserve.