Dr. Sears' Safe Co-sleeping checklist

Here are some ways to educate parents on how to sleep safely with their baby:

• Use an Arm's Reach® Co-Sleeper® Bassinet. An alternative to sleeping with baby in your bed is the Arm's Reach® Co-Sleeper®. This crib-like bed fits safely and snuggly adjacent to parent's bed. The co-sleeper® arrangement gives parents and baby their own separate sleeping spaces yet, keeps baby within arm's reach for easy nighttime care. To learn more about the Arm's Reach® Co-Sleeper® Bassinet visit www.armsreach.com.

• Take precautions to prevent baby from rolling out of bed, even though it is unlikely when baby is sleeping next to mother. Like heat-seeking missiles, babies automatically gravitate toward a warm body. Yet, to be safe, place baby between mother and a guardrail or push the mattress flush against the wall and position baby between mother and the wall. Guardrails enclosed with plastic mesh are safer than those with slats, which can entrap baby's limbs or head. Be sure the guardrail is flush against the mattress so there is no crevice that baby could sink into.

• Place baby adjacent to mother, rather than between mother and father. Mothers we have interviewed on the subject of sharing sleep feel they are so physically and mentally aware of their baby's presence even while sleeping, that it's extremely unlikely they would roll over onto their baby. Some fathers, on the other hand, may not enjoy the same sensitivity of baby's presence while asleep; so it is possible they might roll over on or throw out an arm onto baby. After a few months of sleep-sharing, most dads seem to develop a keen awareness of their baby's presence.

• Place baby to sleep on his back.

• Use a large bed, preferably a queen-size or king-size. A king-size bed may wind up being your most useful piece of "baby furniture." If you only have a cozy double bed, use the money that you would ordinarily spend on a fancy crib and other less necessary baby furniture and treat yourselves to a safe and comfortable king-size bed.

• Some parents and babies sleep better if baby is still in touching and hearing distance, but not in the same bed. For them, a bedside co-sleeper is a safe option.

Here are some things to avoid:

• Do not sleep with your baby if:
  1. You are under the influence of any drug (such as alcohol or tranquilizing medications) that diminishes your sensitivity to your baby's presence. If you are drunk or drugged, these chemicals lessen your arousability from sleep.

  2. You are extremely obese. Obesity itself may cause sleep apnea in the mother, in addition to the smothering danger of pendulous breasts and large fat rolls.

  3. You are exhausted from sleep deprivation. This lessens your awareness of your baby and your arousability from sleep.

  4. You are breastfeeding a baby on a cushiony surface, such as a waterbed or couch. An exhausted mother could fall asleep breastfeeding and roll over on the baby.

  5. You are the child's baby-sitter. A baby-sitter's awareness and arousability is unlikely to be as acute as a mother's.

• Don't allow older siblings to sleep with a baby under nine months. Sleeping children do not have the same awareness of tiny babies as do parents, and too small or too crowded a bed space is an unsafe sleeping arrangement for a tiny baby.

• Don't fall asleep with baby on a couch. Baby may get wedged between the back of the couch and the larger person's body, or baby's head may become buried in cushion crevices or soft cushions.

• Do not sleep with baby on a free-floating, wavy waterbed or similar "sinky" surface in which baby could suffocate.

• Don't overheat or overbundle baby. Be particularly aware of overbundling if baby is sleeping with a parent. Other warm bodies are an added heat source.

• Don't wear lingerie with string ties longer than eight inches. Ditto for dangling jewelry. Baby may get caught in these entrapments.

• Avoid pungent hair sprays, deodorants, and perfumes. Not only will these camouflage the natural maternal smells that baby is used to and attracted to, but foreign odors may irritate and clog baby's tiny nasal passages. Reserve these enticements for sleeping alone with your spouse.

Parents should use common sense when sharing sleep. Anything that could cause you to sleep more soundly than usual or that alters your sleep patterns can affect your baby's safety. Nearly all the highly suspected (but seldom proven) cases of fatal "overlying" I could find in the literature could have been avoided if parents had observed common sense sleeping practices.

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