Perchance To Dream—A Baby Bedding Primer

by Melissa Clark Vickers
April 26, 2011

For many parents, the confirmation of a pregnancy marks the beginning of a redecorating scheme to prepare the nursery for the upcoming birth. Until recently, this often meant purchasing an entire ensemble—crib, changing table, rocking chair—and deciding the all-important theme. Duckies or lammies? Pink or blue? Stripes, boats, butterflies, or airplanes? Once that decision is made, the room can be completed with bumper pads, quilts, and an array of stuffed animals, all to make the baby safe and sound.

Parents still fret about design and color schemes, but being a safety-conscious parent today means some things had to change. Those fluffy items, for instance; they’re gone from the crib for fear of suffocating the baby. Parents who opted for an even more traditional sleeping arrangement for their babies—placing an infant in the parents’ bed (a practice known as bedsharing—were admonished to never put the baby in bed with them.

Parents trying to decide how and where their baby will sleep encounter mixed messages. Sleep options vary, and not all experts agree. Ultimately, the decision is a personal one. But it should also be an informed one. What’s safe? What’s not? Read on to learn more.

Where to sleep
The American Academy of Pediatrics (AAP) recognizes the importance of infants sleeping in close proximity to their parents, making middle-of-the-night care and feeding easy. Their 2005 policy statement calls for “the infant’s crib or bassinet [to] be placed in the parents’ bedroom,” stating that “when placed close to their bed, [this allows] for more convenient breastfeeding and contact.” It is an important distinction—co-sleeping (in which the infant sleeps within close proximity to the parents) is highly recommended; bedsharing (infants and parents sharing the same surface) can pose some serious safety risks if not practiced correctly, including a higher risk of sudden infant death syndrome (SIDS). The AAP recommends against bringing the baby into the parents’ bed, citing concerns for possible suffocation dangers. These dangers are hotly disputed by some researchers, saying that under certain circumstances bedsharing is safe, even safer than having a baby sleep separately from his mother. Click here to learn more on co-sleeping versus bedsharing.

Sleep surfaces
Sleep surfaces vary and each has a unique set of pros and cons:

The traditional crib. Cribs come in a variety of designs and styles. Some are designed to convert to toddler beds. Most cribs are suitable for a newborn and can handle the weight and size of a baby through the toddler years. Structural safety of cribs is important. Because of this, the AAP recommends that parents:

1. Check for the Juvenile Products Manufacturers Association (JPMA) certification.
2. Ensure that slats in the crib frame are no more than 2 3/8 inches apart to prevent the baby’s head from getting stuck in between.
3. Find a mattress that fits tightly in the crib.
4. Purchase a crib with solid end panels and no cutouts and with corner posts that are flush with the end panels so clothing can’t get caught.
5. Check packaging to ensure all hardware is original and unbroken.

In December of last year, the U.S. Consumer Products Safety Commission (CPSC) created new standards for cribs to go into effect in June 2011, including:

• No more manufacture and sale of “drop-side” cribs. These cribs allowed one side of the crib to be lowered for easier access to the baby, but have been responsible for at least 30 deaths in the last 10 years due to hardware failures creating dangerous gaps between the frame and the mattress.
• Stronger mattress supports
• More durable crib hardware
• More rigorous safety testing

Cradles, bassinets, and Moses baskets. These are much smaller baby beds designed for newborns and young infants. They are cozier and easier to keep draft-free than the larger cribs, and can fit in a parents’ bedroom more easily. However, they are quickly outgrown.

Co-sleeper. A cross between a crib and bedsharing—a co-sleeper is a bed designed to attach to the side of the parents’ bed. It resembles a crib but with only three sides (the fourth side is open and attaches to the parents’ bed). Co-sleepers allow for quick access and many of the benefits of bedsharing, without the dangers of sharing an adult bed.

Some locations are never safe for babies—waterbeds, sofas, or recliners are not appropriate places for babies to nap or sleep. Babies may fall into cracks or may turn on the soft surfaces and be unable to lift their heads to breathe properly.

Outfitting the bed
Part of the fun of decorating the nursery includes picking out quilts and blankets for the crib. But suffocation concerns have caused major shifts in product recommendations. The CPSC suggests that as many as 900 baby deaths a year attributed to SIDS are actually the result of suffocation from soft bedding, including quilts, comforters, pillows, and sheepskins that cause babies to re-breathe air with dangerous levels of carbon dioxide.

Babies who are unable to roll over on their own can become entangled in cushy or padded fabrics that can interfere with their ability to breathe. Also, babies who manage to pull a blanket over their face or bury their face in a stuffed animal may not be able to turn away, making it difficult to breathe. For similar reasons, crib bumpers are generally not recommended. Just because a crib bumper attaches to the side of a crib doesn’t mean that it is safe. Most crib bumpers, like crib bedding, are padded and can increase a baby’s risk of entrapment and suffocation. In addition, many crib bumpers are sold with strings longer than six inches (the maximum length recommended), which can cause strangulation.

Recently, the city of Chicago and state of Maryland outlawed the sale of crib bumper pads, prompting the AAP to revisit their position on the use of crib bumpers. The AAP has issued a new statement in which it takes a strong stance against crib bumpers, changing it’s recommendation to remove crib bumper pads as soon as your baby is able to move around in the crib to warning parents against any use of crib bumper pads. The revised recommendation is part of updated and expanded guidelines on safe sleep and SIDS prevention. The guidelines cite the potential risk for suffocation from soft pillow-like bumpers, strangulation from the ties used to attach them to the sides of the crib, and entrapment beneath or against the bumpers. The guidelines cite studies in which crib bumpers resulted in infant deaths. The use of crib bumpers for decorative purposes does not justify the potential risk.

Also, avoid infant sleep positioners altogether. Designed to help ensure that your baby stays on his back or his side while sleeping, sleep positioners don’t work and pose serious dangers to a sleeping baby. In September 2010, the CPSC and the U.S. Food and Drug Administration (FDA) issued a statement warning parents and caregivers to stop using infant sleep positioners after receiving 12 reports in the last 13 years of infant deaths from suffocation when trapped between a sleep positioner and the side of a crib or bassinet. Most of the infants suffocated after rolling from their sides to their stomachs.

When outfitting your baby’s crib, keep it simple:

• firm and safety-approved crib mattress
• fitted sheet
• fitted mattress protector (optional)