In the efforts to educate parents about babies and safety, organizations and associations have tried to come up with catchy acronyms and short, memorable sayings to help highlight the main point of the recommendation being imparted while making it easy for parents to remember.
Among some of the catchy phrases and acronyms that you may be familiar with, such as "stop, drop, and roll" or TICKS (as it applies to babywearing), one that was developed for sleep is ABC - Alone on their Back in the Crib.
A = Alone
B = Back
C = Crib
Since this acronym has been developed and marketed in 1992 by the American Academy of Pediatrics (AAP), we have seen Sudden Infant Death Syndrome (SIDS) rates drop. In 2000, the rate had dropped 50 percent.
Breaking Down the ABCs
So what does each letter mean exactly?
A is for Alone. In this case, this would mean that your baby should sleep alone, in their own separate space for all sleep situations. This space should be in either their crib, a bassinet, or a Pack and Play. These spaces must meet FDA regulations and have passed safety testing for sleep surfaces for babies. (If you look up your crib, bassinet, or Pack and Play manuals, you will see what testing standards they passed. In the United States, it is not legal to market any sleep surface for a baby as a crib or bassinet unless they have passed the rigorous safety tests.) Bed-sharing, or co-sleeping in the same bed, with your baby is not a safe option. Bed-sharing is the single greatest risk factor for infant deaths that are sleep related. It has been found that nearly 70% of sleep-related deaths for infants were associated with bed-sharing. However, room sharing (sleeping in the same room as your baby, in their own respective sleep spaces) has been found to reduce the risk of SIDS by almost 50%, particularly in the first 6 months.
B is for Back. Since the AAP first recommended in 1992 that all babies be put to sleep flat on their backs, we have seen a significant decline of infant deaths in their beds. It is no longer recommended that babies be placed on their stomachs or their sides. When infants are placed on their backs, which is called the supine position, the chances of them suffocating on their own gases or on other objects are greatly reduced, versus if they were laid down in the prone position (on their stomachs). Despite this finding, there are still concerns of the baby choking or aspirating on their spit up, or if they vomit while sleeping. In actuality, it has been found that babies are safer to be in the supine position because of how their gag reflux works. Additionally, babies who are on their backs are more easily able to turn their heads and/or protect their airway if they were to spit up while sleeping, versus those who were laid down on their stomachs to sleep.
C is for Crib. The last part of the ABCs is the Crib. In this case, Crib can also mean a safety regulation-approved bassinet and pack and play/play yard. This DOES NOT include car seats, swings, co-sleepers that sit on parents' bed, Dock-A-Tots, and Rock and Plays that places your baby at an incline. The crib must meet FDA standards of being newer than 2011 and meet the new safety standards released by the CPSC (Consumer Product Safety Commission). To help prevent risks of suffocation and death, the mattress should be firm, covered with only a fitted sheet. The crib/bassinet/Pack and Play should be completely empty, with no blankets, stuffed animals. bumper pads, toys, or pillow. Having any of those items in the crib with your baby can increase their chances of suffocation. To add in another catchy saying: Bare is Best when it comes to your child's sleeping environment. Having your child sleep on any other mattress other than the one made for the crib/bassinet/pack and play also increases your child's chances of suffocation, due to the surface not being as firm as a crib mattress and can dull their arousal points which is what helps a baby wake up when things could be going wrong. Keeping your baby on a flat, firm surface will allow your baby's body to work in optimal fashion while in sleep mode.
Following the ABCs
When you follow the safe sleep guidelines of the ABCs, you have significantly decreased the risk of strangulation, asphyxiation, and SIDS happening to your child while they are sleeping.
While it may tempting to bring your child to your bed at night, or you may have a special stuffed animal that you want your child to sleep with, or you think that laying them on their stomach will help them sleep better, all of those actions carry a significant risk and will increase the risk of your child suffering from a sleep related death or injury. Stick with the ABCs, and rest easy knowing that you are doing what is right for your child in promoting a safe sleep environment.
If you need help creating a safe sleep environment for your baby, or you are unsure if you are using something that is not safe for your child to sleep in, don't hesitate to contact me and find out. After all, safe and independent sleep is our goal for your child!
I am a Pediatric Sleep Consultant who works with families to help them resolve their littles' sleep issues. As a mom of two littles herself, Katie has walked in the shoes of her clients and is passionate about helping them re-discover peaceful sleeps in their own homes.