Denise Geleitsmann demonstrates how to put a baby to bed in one of the portable cribs that Austin Public Health hands out to families who need a safe space for their baby to sleep. This baby is wearing a sleep sack and there are no blankets or pillows or toys in the crib with the baby.
Nicole Villalpando/American-Statesman
Babies should be put to bed in a crib or bassinet on their backs with no blankets, no pillows, no toys. That message has been shared nationally through a massive Back to Sleep campaign starting in 1992. Initially the number of babies who died from sleep-related deaths dropped in the U.S. because of that messaging through ads, hospitals and pediatricians.
Those gains have stalled, though, said Denise Geleitsmann, the author of a new Austin Public Health report on infant deaths during sleep in Travis County from 2018 to 2023. The risk factors continue to be the same as the previous report that studied numbers from 2013 to 2018.
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The current report looked at medical examiner records of the 51 babies who died in Austin from accidental suffocation or strangulation in bed. That cause of death remains the No. 1 cause of accidental death in infants in Travis County.
“The data we found shows that many of these deaths are avoidable,” said Austin-Travis County Health Authority Dr. Desmar Walkes.
Here’s what the report found about the babies who died:
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Only 16% of those deaths were in babies who were sleeping in a safe environment: crib or bassinet with nothing in that space.
84% had blankets present
71% had pillows present
68% were in an adult bed
61% were sharing a bed with another person
39% were not placed on their back
63% were found in a position that was not on their back
86% were with their primary caregiver/parent
68% died in the evening or at night
Why does where a baby sleeps matter?
Geleitsmann explains: Babies, especially young babies, cannot move something out of their way to be able to breathe. They cannot roll over to get out of the way of a blanket, pillow or toy.
Rather than using a blanket, if it is cold, dress the baby in two layers: a onesie and a sleep sack or a onesie and pajamas.
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Putting babies in a non-approved crib or bassinet also can cause suffocation. Adult beds are too soft and can be suffocating, plus an asleep adult can accidently roll over the baby.
Couches are some of the worse places to put a baby, Geleitsmann said, because there are crevices between the cushions and the back or sides of the couch where a baby can get stuck. Car seats are fine in the car, but once you take them out of the car, the angle of the carrier changes and pushes the baby’s neck forward instead of backward, which can collapse the airway. Swings and other infant seats also shouldn’t be used for sleeping for that reason.
None of this means you can’t hold a baby while sitting in a rocker or a couch or even bring the baby into bed with you for a feeding, but as soon as you are done, you need to put the baby in their own bed, she said.
What other factors did the report find?
47% of the babies who died were younger than 3 months
74% were not breast-fed
69% were boys
27% were born prematurely
25% were known to have an illness or medical condition at the time of death
31% of the babies were exposed to tobacco smoke
The deaths happened in 23 ZIP codes, but almost one-third were in 78723, 78724 or 78744
The deaths were disproportionately African American: 39% (versus the 9% of the live births in Travis County who are African American)
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The researchers aren’t sure why those ZIP codes and why African American babies have higher rates, Geleitsmann said, but some of the theories include less access to available health care, less prenatal care and less touch points to educate caregivers about putting baby back to sleep.
How should you put a baby to bed?
A 2022 American Academy of Pediatrics made these recommendations after it didn’t see improvements in infant deaths:
Put babies on their backs for every sleep.
Use a firm, flat, non-inclined sleep surface to reduce the risk of suffocation or becoming wedged in the surface.
Use breast milk instead of formula because breast-fed babies wake up more frequently and have less incidents of sleep deaths.
Infants should sleep in the caregiver’s room, close to the caregiver’s bed, but on a separate surface designed for infants, ideally for at least the first 6 months. This allows you to be close by for feedings and then easily return the baby to their bed.
Do not use soft objects such as pillows, toys, quilts, mattress toppers, blankets, comforters, non-fitted sheets in the bed.
Use a pacifier during naps and bedtime, which also reduces the risk of sleep deaths.
Avoid smoking or other nicotine use. Even third-hand smoke of holding a baby to your smokey clothing can affect their airways.
Avoid alcohol, marijuana, opioids and illicit drug use during pregnancy and after birth.
Avoid dressing infants too warmly or with head coverings.
Seek prenatal and post-natal care as well as pediatric care and immunizations for the baby.
During the day, place awake babies on their tummies, increasing to 15 to 30 minutes daily by age 7 weeks. This encourages development, including the ability to lift their head off the ground and the ability to roll over.
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What will be done after the report?
“It’s crucial that we continue to educate families about safe sleep environments to protect our most vulnerable residents,” Walkes said.
Austin Public Health has a safe sleep coalition with local hospitals, government entities and community groups. That coalition started after the last report but then COVID-19 happened. Austin Public Health has re-deployed the group. The coalition is already talking about focusing on education in the hospitals right after birth, in clinics before and after birth, spreading education information around targeted ZIP codes and communities that showed a high level of risk.
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Austin Public Health’s injury prevention program does provide portable cribs to families who need them. Those are usually referred to the program through hospitals or community partners.