Patient Presentation
A 4-month-old female came to clinic for well child care. The mother reported using a bedside sleeper next to her bed for the infant to sleep in. She liked this because she could roll over at night and take the infant into her bed to breastfeed and return the infant to the bedside sleeper easily. The mother was a non-smoker and non-drinker. The past medical history showed a full-term infant without prenatal or natal problems. The pertinent physical exam showed a smiling infant with growth parameters between 75-90%. The physical examination was unremarkable.
The diagnosis of a healthy infant was made. The resident physician was not sure how she should counsel the mother about the bedside sleeping arrangement. The attending physician tried to quickly look up the American Academy of Pediatrics (AAP) recommendations but could not find the relevant information during clinic. The attending did say that he himself did not recommend bedside sleepers because he was afraid of entrapment in the area between the bassinet and the adult bed, in addition to having loose adult bedding around the infant. He did note that there were some in-bed sleeper products that wall off an area of the adult bed to make a separate sleeping area for the infant in the adult bed. This he did not recommend and knew that the AAP also did not recommend it. The following day, the attending had more time to review the AAP guidelines.
Discussion
Infant sleeping practices are different around the world, but need to provide a warm, safe sleeping environment with as little inconvenience and cost for the family.
Learning Point
Bedside or in-bed sleepers are neither recommended for or against by the AAP on the basis that there is no data to make a recommendation. The AAP’s guidelines from 2011 were updated in 2016 and recommend that infants room-share with their parents until 1 year of age. Infants are recommended to sleep on a separate surface from their parents designed for infants. “A crib, bassinet, portable crib or play yard that conforms to the safety standards of the Consumer Product Safety Commission…with a snugly fitting and firm mattresses and no drop sides, is recommended.” No soft materials or additional objects should be in the sleep area and the area should also be free of hazards such as window-covering cords, wires etc. to prevent strangulation. The AAP also does not recommend bed rails for infants. Bedrails are placed along the side of the bed and are intended to prevent a larger child such as an older toddler, preschooler or school age child from falling off the side of the bed. Car seats and other sitting devices are also not recommended as places for infants to sleep.
The ASTM International has standards for bedside sleepers that were published in 2014.
Consumer Reports, an independent, non-profit consumer advocacy organization, stopped reviewing this product category in 2016.
Questions for Further Discussion
1. What are some common sleeping arrangements in your practice location?
2. What parent recommendations do you offer for different sleeping arrangements?
3. How common is sudden infant death syndrome (SIDS) and/or deaths from sleeping environment in your practice location?
Related Cases
- Symptom/Presentation: Health Maintenance and Disease Prevention
- Specialty: General Pediatrics
- Age:
Infant
To Learn More
To view pediatric review articles on this topic from the past year check PubMed.
Evidence-based medicine information on this topic can be found at SearchingPediatrics.com, the National Guideline Clearinghouse and the Cochrane Database of Systematic Reviews.
Information prescriptions for patients can be found at MedlinePlus for these topics: SIDS and Infant and Newborn Care..
To view current news articles on this topic check Google News.
To view images related to this topic check Google Images.
Arm’s Reach Concepts Recalls Infant Bed-Side Sleepers Due to Entrapment, Suffocation and Fall Hazards. Consumer Product Safety Commission. Available from the Internet at http://www.cpsc.gov/cpscpub/prerel/prhtml11/11187.html (rev. 4/5/2011, cited 3/2/2012).
American Academy of Pediatrics Technical Report. SIDS and Other Sleep-Related Infant Deaths: Expansion of Recommendations for a Safe Infant Sleeping Environment. Pediatrics. 2011:128;e1341-e1367.
Bassinet Buying Guide. Consumer Reports. Available from the Internet at http://www.consumerreports.org/cro/babies-kids/baby-toddler/bassinets/bassinet-buying-advice/index.htm (rev. 1/2012, cited 3/2/12).
ASTM. ASTM Bedside Sleeper Standard Incorporated into Federal Rule | http://www.astm.org. https://www.astm.org/cms/drupal-7.51/newsroom/astm-bedside-sleeper-standard-incorporated-federal-rule. Accessed July 25, 2019.
American Academy of Pediatrics. SIDS and Other Sleep-Related Infant Deaths: Updated 2016 Recommendations for a Safe Infant Sleeping Environment. Pediatrics. 138(5):e20162938.
Bedside Sleepers Business Guidance & Small Entity Compliance Guide. CPSC.gov. https://www.cpsc.gov/Business–Manufacturing/Business-Education/Business-Guidance/Bedside-Sleepers. Published July 16, 2016. Accessed July 25, 2019.
ACGME Competencies Highlighted by Case
1. When interacting with patients and their families, the health care professional communicates effectively and demonstrates caring and respectful behaviors.
2. Essential and accurate information about the patients’ is gathered.
3. Informed decisions about diagnostic and therapeutic interventions based on patient information and preferences, up-to-date scientific evidence, and clinical judgment is made.
4. Patient management plans are developed and carried out.
5. Patients and their families are counseled and educated.
6. Information technology to support patient care decisions and patient education is used.
8. Health care services aimed at preventing health problems or maintaining health are provided.
10. An investigatory and analytic thinking approach to the clinical situation is demonstrated.
11. Basic and clinically supportive sciences appropriate to their discipline are known and applied.
12. Evidence from scientific studies related to the patients’ health problems is located, appraised and assimilated.
13. Information about other populations of patients, especially the larger population from which this patient is drawn, is obtained and used.
14. Knowledge of study designs and statistical methods to appraisal clinical studies and other information on diagnostic and therapeutic effectiveness is applied.
15. Information technology to manage information, access on-line medical information and support the healthcare professional’s own education is used.
16. Learning of students and other health care professionals is facilitated.
19. The health professional works effectively with others as a member or leader of a health care team or other professional group.
23. Differing types of medical practice and delivery systems including methods of controlling health care costs and allocating resources are known.
24. Cost-effective health care and resource allocation that does not compromise quality of care is practiced.
Author
Donna M. D’Alessandro, MD
Professor of Pediatrics, University of Iowa Children’s Hospital
(Note: This case was updated on 7/25/19 to reflect terminology that was changed and at the same time the AAP 2016 Guidelines, the ASTM and the Consumer Product Safety Commission references were were added.)
Pediatric Education 