Parents Often Ignore Back-to-Sleep Recommendations After Baby Wakes

Most parents know that placing newborns on their backs to sleep can slash the risk of sudden infant death syndrome (SIDS), but a new study suggests that many may forget that rule when baby wakes up wailing in the middle of the night.

It’s very common for babies to wake up in the wee hours, and parents of newborns are often sleep-deprived, the researchers explained.

“Our findings reflect that caregivers may be making different decisions in the middle of the night when they are exhausted than they do when they are first putting their baby to sleep,” said study author Dr. Mersine Bryan. She is a pediatrician at the University of Washington and Seattle Children’s Hospital.

“When you as the caregiver are going to go to sleep or fall asleep, it is important to put the baby in their safe place like a crib or bassinet, and always on their back every time to keep them safe,” Bryan said.

The American Academy of Pediatrics recommends that all healthy infants younger than 1 year of age be placed on their backs to sleep, in addition to other safe sleeping measures including using a separate space and location. If a newborn can’t breathe while sleeping on their stomach, they can’t do anything to fix it and may suffocate. This is why placing infants on their backs is considered safer.

The online survey of 1,500 parents of U.S. infants found that 39% of parents said they changed their baby’s sleep practice after nighttime waking, with fewer than half those parents adhering to these safe sleep practices after middle-of-the-night awakenings.

For the study, the researchers compared sleep practices for infants aged 1 or younger when they first go to sleep and after nighttime waking. Specifically, 42% of parents placed their infants on their backs at both time points, while 13% who initially placed their infants on their backs didn’t do the same during middle-of-the-night awakenings, the study found.

The report was published online May 30 in the journal Pediatrics.

Three top SIDS experts agreed that the findings call attention to an important gap between knowledge and action.

“After an awakening overnight, babies are frequently put back to sleep in a less safe sleep situation,” said Dr. Kyran Quinlan, director of the division of general pediatrics at Rush University Medical Center in Chicago.

This is important information that could help guide new education campaigns, he noted.

“We need all the insights we can get to help parents protect their infants, since this is the leading cause of death between 1 month and 1 year of age,” Quinlan said.

Dr. Thomas Hegyi, medical director of the SIDS Center of New Jersey Rutgers Robert Wood Johnson Medical School in New Brunswick, N.J., agreed. “One of the 10 most important discoveries in pediatrics has been the Safe-to-Sleep campaign, which reduced the risk of SIDS by more than 50%, but we still have further to go to get our message out there,” he said.

There appears to be a disconnect when it comes to middle-of-the-night awakenings. “We need to continue to educate parents about safe sleep and reducing risk for SIDS before delivery, in the hospital after delivery, and again at every pediatrician visit,” Hegyi said.

Dr. Fern Hauck is a professor of family medicine at the University of Virginia’s School of Medicine, in Charlottesville. “Nighttime awakenings are normal and frequent among newborns, where frequent feedings are essential to infant growth,” she said. “The infant may wake up several times a night in the first few months of life when parents are most tired and SIDS risk is also highest, and vigilance is even more important during this time.”

Some caregivers feel that the baby is more comfortable or sleeps better on their stomach or that sleeping in the adult bed with them makes it easier to feed and/or keep a closer watch, but these are dangerous practices, Hauck said.

Safe sleep practices should be followed for every sleep, whether while napping or during the night. “This should be conveyed to all caregivers who are taking care of the infant including babysitters, grandparents, and daycare staff,” she stressed.

More information

The American Academy of Pediatrics has more on infant sleep safety for caregivers.

SOURCES: Mersine Bryan MD, pediatrician, University of Washington and Seattle Children’s Hospital; Kyran Quinlan, MD, professor, director, division of general pediatrics, Rush University Medical Center, Chicago; Thomas Hegyi, MD, medical director, SIDS Center of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, N.J.; Fern Hauck, MD, Spencer P. Bass, MD Twenty-First Century Professor of Family Medicine, University of Virginia School of Medicine, Charlottesville, Va.; Pediatrics, June 2022

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