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Frequently Asked Questions


Every year, some infants die while sleeping. Parents can reduce the risks of this tragedy by knowing and following some simple guidelines. These guidelines will help you meet the goal of making sure the sleeping baby’s breathing remains clear and unobstructed and you will be assured that the baby does not get into a position that could cause injury or even death.  Here are some general questions asked by parents and caregivers:

What is the safest way for a baby to sleep?
The safest way for your baby to sleep is alone, on the back, in a crib. Babies have died because they were smothered by an adult, another child, a pet, or objects in the adult bed such as pillows, comforters, soft bedding, bumper pads or stuffed animals. Babies can get trapped between the bed and the wall or bed frame, or between the cushions on a sofa.  Sometimes a baby is injured by rolling off an adult bed.

What if my babysitter wants to let my baby nap on a sofa or a cushioned chair?
Even away from home, a baby should always sleep in a safety-approved crib. Some parents use a portable crib or Pack ‘n Play for trips away from home.

I like the closeness of sleeping with my baby, how can I do this safely?
Cuddling with the baby during feeding time and waking hours best develops that closeness. At bedtime, room-sharing is safest. With a baby-safe crib placed next to yours, the baby will still sense your nearness, but will have a safe place to sleep.

Guidelines for Parents and Caregivers…

  • The safest way for your baby to sleep is alone, on the back, in a crib.
  • The baby’s crib should have a firm mattress, closely fitted to the sides of the crib, and a tight-fitting sheet.
  • Don’t over-dress or over-bundle the baby. One light cover, tucked at the bottom and sides of the crib should be enough. Allow no covers near the baby’s head. Use no pillows, bumpers, or toys.
  • Never let a baby fall asleep ANYWHERE with someone who is smoking, is tired or ill, has taken medications that cause drowsiness, has been drinking alcohol, or is extremely overweight.
  • A baby should sleep in a smoke-free home.
  • Breastfeeding has important health benefits for babies, but do it safely. When breastfeeding, make sure you are sitting up and are in a position that will allow you to stay awake. Consider using a timer or alarm that you set to go off 10-15 minutes after you begin breastfeeding.  When finished, return the baby to the crib.

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BELOW ARE QUESTIONS AND ANSWERS FROM “Ask the Pediatrician”:

 

April 07, 2015 9:49 PM
Subject:  Mesh Bumper

QUESTION: 

I noticed this product that is a mesh crib bumper. I know that bumpers are dangerous but I am still worried about limb entrapment. Do you have any recommendation to this bumper?

http://breathablebaby.com/

thanks

ANSWER:  Thank you for your question. Crib bumpers have been traditionally used because of the impression that they will protect an infant from injury i.e.(limp entrapment between crib slats or head injury from hitting the railing).  There have been reports, however, of infant deaths from suffocation, entrapment, and strangulation associated with bumper pads as well. Although it is true that bumper pads can prevent  minor injuries, the risk of strangulation or suffocation far out weighs the potential benefits of preventing minor injury with bumper pads. With that in mind, I cannot recommend the use of any type of bumper pad, “breathable” or not! Your baby will be fine without one.

Sincerely,

Eileen Tyrala, MD FAAP
Medical Director, Cribs for Kids®
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April 07, 2015 10:31 PM
Subject: Safety within a hospital setting

QUESTION 1: Hello Dr. Tyrala- My name is xxxxxxxxxx  and I am a pediatric occupational therapist in a fairly new inpatient pediatric rehab setting. Yesterday I attended a sleep safe symposium and I am very interested in sharing all of this wonderful information to the staff on our unit. We tend to have acutely ill patients who are NG or G tube fed (bolus or continuous), ventilated infants, and infants with significant high/low tone. Given we are a rehab, we are struggling with positioning for these kiddos. Do you have any recommendations for these children or should we be placing them flat on their backs as well? I appreciate any suggestions. Thank you.

ANSWER 1:  Thank you for your question. I don’t think that one size will fit all here with regards to recommendations for sleep position for this diverse population.

Before I attempt to answer, however,  I would like to get a little more information about the types of patients you are seeking advice about.  Are  most of your patients former premature infants who  require long term hospitalization to recover from chronic lung disease or who have feeding difficulties? Do  the ventilated infants have tracheostomies or are they still intubated? Are some (most) of these babies neurologically compromised? Are they all under one year of age? What other types of medical conditions do they have?

All of these factors will come into play when it comes to determining the best sleep position for infants in these categories.  I will look forward to your response.

Sincerely,
Eileen Tyrala, MD FAAP
Medical Director, Cribs for Kids®

QUESTION 1A:  Thank you for your response Dr. Tyrala. For our infants under the age of one, we typically have NICU graduates admitted with CLD, FTT, feeding difficulties (NG or G tube), etc. We also accept infants from acute care who are trached with or without ventilation who are admitted for either vent weaning or  trach/vent care education prior to going home. We also have infants with a variety of developmental disabilities such as Trisomy 21,CP, etc. and TBI from abuse. We are the “stepping stone” from acute care to home. I am aware that some of these infants are going to qualify for home care nursing and I am not as concerned about these positions we recommend but I would like to model for the parents the least restrictive and safe positioning for their transition home. We currently make a horseshoe shaped “nest” with bendy bumpers to position them in supine. I think as therapists we try to provide them with the best positioning but not always think about the safe transition home as far as crib setups. Thank you for your suggestions…

ANSWER 1A:  Thank you for clarifying your question. I should start out by saying that full consideration of a babies’ medical needs should always be first and foremost when it comes to deciding what the safest sleep position for a particular baby should be. If a non-ventilated baby with a tracheostomy, is stable in a supine sleeping position, then I would encourage that full consideration be given to placing that infant supine for sleep. This is the type of baby who most likely will  be cared for in the home environment before the trach is removed  and safe sleep modeling should begin as soon as it is feasible and safe!

As for infants with tracheostomies who are ventilated , the best sleep position for them will  be dependent to a large extent on  their pulmonary needs. Are there issues with pulmonary toilet that would make the  use of a flat, supine position unsafe.? Sleep position for this type of infant should be determined after full discussion with and  consultation with the nursing staff as they will be the best judge of whether an infant with this type of medical problem can safely tolerate this position.  As type of baby would almost assuredly be going home with 24 hours nursing support, I would not worry as much about babies in this category.

I would say that under  circumstances where an infant is receiving NG or G-tube feedings, as soon as thermal stability can be maintained outside of the isolette, then consideration for a supine sleep position should occur. Once again, it should only occur  in consultation with the nursing staff.

Neurologically compromised infants with  either low or increased tone  may also require special consideration. If these children are ultimately to go home, however, particularly without nursing support, then I would encourage a transition to a safe sleep environment as early as possible. Hopefully none of your babys’ cribs have stuffed animals, pillows or excess blankets in them to give parents the idea that these are good things to have in their babies cribs at home.

I am  concerned about the horse shoe nest that you are describing. I would ask yourself if it is really needed for positioning. As soon as the baby starts to move around at all, it will become a hazard. Parents will also see you using it and duplicate it in the home environment. Believe me, they are watching everything you say and do!

Ultimately the best decisions re sleep environment will be made when there is joint communication between your group and  the nursing staff.  Does your unit have an infant safe sleep policy? If it doesn’t this would be a good place to start and would start the dialogue between OT and nursing that is so very necessary for success. in this area.Sample NICU safe sleep policies can be found on the Cribs for Kids web site.

I hope my comments have been helpful.

Sincerely,

Eileen Tyrala, MD FAAP
Medical Director, Cribs for Kids®

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March 01, 2015 7:16 PM
Subject: SIDS and unknown cause

QUESTION: Would you explain the difference between death caused by SIDS versus death unknown?

ANSWER: Thank you for your question. SIDS stands for Sudden Infant Death Syndrome. A death that is declared to be caused by SIDS is an infant death  for which there can be found no cause  after an autopsy, a review of the medical history and a complete death scene investigation have occurred.

If by “unknown” you mean a death such as the type I have described, then SIDS and “unknown” would be one and the same. If you are referring to deaths that are classified as “undetermined”, however, they fall into a different category. These are infants for whom there is no explanation for their death despite all of the above, but the infant was found in an unsafe sleep environment. This could mean that the baby was placed on its’ stomach to sleep, was sleeping on an adult mattress, was sleeping with someone else at the time of death but there was no absolute proof of a death by suffocation.  Currently, the majority of sleep related infant deaths are classified as undetermined, followed by suffocation and then SIDS.

I hope this information has been helpful.

Sincerely,

Eileen Tyrala, MD FAAP
Medical Director, Cribs for Kids®

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February 27, 2015 9:48 AM
Subject: Cosleepers, bassinet on pnp, mesh bumpers

QUESTION: I am desperately trying to find a sleep solution for my 7 month, 17lbs son. He can sit on his own, roll over, and not quite pull himself up yet. We used a rock n play until a couple weeks ago, which I now see isn’t recommended. We switched him to a pack n play, but he screams every single time we lay him down. I think because it’s so far down and he’s not used to a flat surface. I’m assuming we can’t use the bassinet that comes with it for him at this age? He’s been sleeping with me off and on, since that’s the only way he’ll sleep, but I know that’s not a good idea, and I don’t want to.

I borrowed a cosleeper (http://www.amazon.com/First-Years-Secure-Sleeper-Colors/dp/B00012CHFI/ref=sr_1_1?s=baby-products&ie=UTF8&qid=1424982588&sr=1-1&keywords=cosleeper) last night, and he seemed to like that better. But, it’s too short for him and I also wonder if it’s safe when he’s able to roll over now? He didn’t seem like he would, since he takes up the entire thing, but I can’t be sure.

Third question, we also tried to put him in a crib, but within minutes he gets his feet stuck and screams. I bought a high mesh crib liner (the higher one since he can already sit up), but now I see that isn’t recommended either.

I’m at a loss of what I can use that is safe for him, and what he will actually sleep in! Please help!

ANSWER:  Thank you for your question. You are correct that the bassinet feature of the Pack ‘n Play® is not suitable for him at his current weight. It is only recommended for use up to 15 pounds.  Similarly, (although I do not recommend co-sleepers), he is way too big for that device and that small of a sleeping area. Babies at 7 months and 17 pounds need  room to move around in to promote normal motor development. Developmentally he should be  ready for a larger open area to sleep in, but behaviorally, it sounds as if he is not. I will tell you straight out that it is not going to be easy to break his current sleep habits but you can do it! I would  refer you to Dr Harvey Karp’s book, “The Happiest Baby Guide to Great Sleep” He has many helpful suggestions to offer. He emphasizes  having the baby develop healthy but independent sleep associations such as singing a lullaby that he associates with bedtime, placing him in his crib while he is still drowsy, not when he is already asleep, keeping the lighting and sound down in the room, avoidance of stimulating activities pre bed, a gentle (non-stimulating massage), use of white noise. The use of a “lovey” as he calls it to help him focus on himself for sleep. He has to learn that he must put himself to sleep and that he cannot depend on anyone else to do that for him. That is the key!

Good luck!

Eileen Tyrala, MD FAAP
Medical Director, Cribs for Kids®

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February 23, 2015 7:09 PM
Subject:  Napper attachment on Pack ‘n Play®

QUESTION: I am eight months pregnant and I recently bought a Graco Pack ‘n Play® with a reversible napper/changing station attachment. I was planning to keep the pack and play next to my bed for the first few months, and have him sleep in that, to make nighttime feedings easier. I thought the “newborn napper” attachment would be perfect for sleep because it seemed to be marketed for that. But now that I have read the manual, it says the baby must be supervised while in the napper at all times. Even for daytime naps that is not necessarily realistic! (Dont they say to sleep when your baby sleeps?) I also noticed when it arrived that the fabric on the napper is very soft and the surface is not firm at all. This does not seem safe, from what I know of SIDs prevention. Now I am afraid I chose an unsafe sleeping surface for my baby. My question is, are napper attachments on pack and plays safe for overnight sleep in newborns?

ANSWER: Thank you for your question and your very astute observations!  Softness and not being firm are not features we want to see in a sleeping area for infants! I don’t know what Graco was thinking when they first designed  and marketed the Newborn Napper feature on it’s Pack ‘n Play® unit, but it became very obvious, very quickly, that this product did not meet safe sleep standards, hence the statement in the manual that babies should be observed at all times in the napper.

I would remove the napper piece and just use the bassinette feature exclusively for napping and sleeping.

I hope this has been helpful.

Sincerely,

Eileen Tyrala, MD FAAP
Medical Director, Cribs for Kids®

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May 1, 2014
Subject: My Newborn Might Turn Over in the Pack ‘n Play®

QUESTION: My newborn is only 7 days old and is turning over on his side while sleeping at night. He started doing this at the hospital on day two while in his swaddle. At our 4 day checkup I asked the pediatrician if I should use the sleep positioned to prevent him from turning but he said no, just swaddle him. However, he can flip to his side while swaddled. In addition to flipping in his side he will kick his legs up in the air and pump them back and fourth, resulting in him moving in a clockwise/counter clockwise direction until he hits the side of the pack and play. I am terrified he is soon going to turn just a little more and land on his stomach and face. And by terrified I mean to the point where I try and stay up for as long as possible until I accidentally fall asleep and I only am getting about 2 hours of sleep a night. I know this is not sustainable so I am trying to find a better solution. Just to give you a little more info, I had a previous son die from SIDS about a year ago, which is also why I am overly concerned about this. I really would be ok with my little one sleeping in the pack and play, except I know he can easily flip over to his stomach since he already flips to his side. Although I don’t want to do anything to increase my babies risk of SIDS, I also don’t want him flipping over and suffocating. I just don’t know what to do. Based on what I researched, I have heard that sleep positioners pose a suffocation risk. The rock and play because he is too young and muscles are fully developed. So what exactly do I do????? Please help.

ANSWER:  Thank you for your question. It sounds as if the swaddling is giving your son extra leverage to maneuver his body to the side position.  If this is the case, I would definitely not swaddle him! Swaddling  an infant who is on his side  may allow him to flip onto his stomach which, if still swaddled, would limit his ability to use his shoulders or arms to help him lift his head.

If he can  truly  get onto his side if he is not swaddled,  I would place him in  a sleep sack that would allow him maximum freedom in the crib. If he is as mobile as you say, side positioners or any other items in the crib would pose an even greater risk than usual to him as he might maneuver himself  into them.

Unfortunately, if he is truly getting himself up onto his side when not swaddled at 7 days of age, I think your only option is to re-position him onto his back as best you can.  It will not be necessary to do this for ever, but I think you have no choice at least for the first month of life. The Rock ‘n Play or any other type of non-crib sleeping environment is definitely not the solution!

I am sorry that I could not be more helpful. Let us hope that he loses these powers fairly quickly and returns to a less advance state fairly quickly.

Eileen Tyrala, MD FAAP
Medical Director, Cribs for Kids®

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February 08, 2014
Subject: 5-Month-Old Not Sleeping in Crib

QUESTION:  I’m struggling with encouraging my son to sleep in his crib. He is our 2nd and our oldest son was sleeping through the night in his crib at 8 weeks.

He is most happy being held and snuggling with mommy. I don’t co-sleep because it scares me, but he falls asleep at night nursing in bed with me. He can be DEEP in sleep and the moment he realizes he is laying flat in his bed, he screams and screams.

At 5 months old, we are exhausted with this process. A few things . . . he gets lots of play time on tummy and flat on back. He naps for 1+ hours a few times a day in the Rock N Play sleeper.

I’ve tried sleep training this week, going in to comfort him every 10 mins. But he cried for a total of 70 mins. That amount of distress for him really bothered me and I want to be sensitive to what his personality needs. Last night I put him in the Rock N Play and he slept for 10 hours, not a peep.

I’ve also heard of the Baby Merlin’s Magic Sleepsuit but it kind of scares me too.  So as you can tell I’m going in a million directions here. I would like to have him in an empty crib, in a sleeper and sleep sack if needed. But I am not having any success.

The Rock N Play and Magic Sleepsuit concern me.  Any guidance you can offer would be greatly appreciated.

ANSWER:  Let me start by commenting about the two products you mentioned in your letter.

I think  your son is way too old for the Rock N,Play! Although I am not a fan of this product for babies of any size, at his age his increased motor skills make it more likely that  he will get himself too close to the cushiony sides presenting a suffocation risk. The inclined position of the device can also cause babies to get into a slumped down position, making it harder for them to breathe.

Although I have never seen the Magic Sleepsuit, it looks interesting but not for a five month old. The developer describes it as a transitional device for babies from swaddling who still need to have some dampening of their arm movements to decrease their arousal. She specifically states, however, that it is not for babies who are rolling over.

It sounds as if you have tried all of the obvious techniques to promote sleep: no loud noises, no bright lights, soothing environment before sleep time, so what to do? Perhaps he would respond to some type of vibrating device  that would give the illusion of motion which seems to calm many babies. I would only use devices that could be placed under the mattress, so as not to interfere with the firmness of his sleep surface.

If he needs slight elevation, you could try putting  a towel under the mattress, positioned so that it elevates his chest slightly, but where there would be no danger of him getting into a slumped down position.

Have you tried using white noise? Perhaps that could add a calming touch as well.

If none of these suggestions work, there are two books that might be helpful. One is by Dr. Harvey Karp’s book, “The Happiest Baby Guide to Great Sleep” on techniques for putting everyone from a newborn to a 5 year old to sleep. The other is Dr. Rachel Moon’s book from the American Academy of Pediatrics, “Sleep, What Every Parent Needs to Know”.

Hope this has been helpful!

Eileen Tyrala, MD FAAP
Medical Director, Cribs for Kids®

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February 2, 2014 
Subject: Summer Infant by your Side Sleeper

QUESTION:  I am wondering what your thoughts are on the following mesh sided sleeper?  http://www.summerinfant.com/byyoursidesleeper

Would you consider it safe to use in the bed between parents (each with separate blanket so as not to touch sides of bassinet)?

Alternatively, could it be used outside of the bed (elevated on flat stable surface) similar to the way you use a pack n play in your room? I have been using it this way and occasionally find baby half rolled on his side with face up against mesh siding.

We have a Pack ‘n Play® which we could transition him too as well but with this bassinet outside the bed I wondered if having the smaller sleep environment (with completely mesh walls) might be actually safer than a Pack ‘n Play® since he does not have the room to fully roll on to stomach and potentially get stuck face down? He is 8 weeks old and can not roll completely on to tummy yet but will be able to soon I imagine.

Thank you!

ANSWER:  A family in my practice told me about this product, but I have never seen it in person. I have no idea how sturdy it is, or whether it might collapse if an adult rolled into it. Also, the fabric strip in the middle of the side portion looks like a bumper, although it is probably there for support. Until this product, and others like it, can be tested for safety, I cannot recommend it.

I would never put it on another surface! This would be inviting disaster if it were to slip off and fall to the floor.  The Pack ‘n Play® has a great safety record and is officially approved by the Consumer Product Safety Commission as a safe place for an infant to sleep. If you are worried about your baby turning over earlier than most, I recommend lots of tummy time! With lots of neck and upper body strength, when he does flip over onto this stomach, he will just pick his head up, turn it to the side, and not end up stuck in the face down position.

I hope this has been helpful!
Eileen Tyrala, MD FAAP
Medical Director, Cribs for Kids®

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‎January‎ ‎30, ‎2014
Subject
: Sleeping with Blankets

QUESTION: My son is 10 months old and has been sleeping with a knitted blanket since day 1 ( he hated being swaddled). He is now really moving around in his sleep and while trying to fall asleep and ends up in weird sleeping positions. I am worried that he is going to put his face into the blankets ( he has during nap time and I have had to move him) and suffocate. I have been thinking about using a sleep sack, but we are worried that his hands and arms will get cold. His hands are like ice most of the time already. I am not sleeping well during the night because I worry about him putting himself in a position that is very uncomfortable or could stop him from breathing. I just don’t know what to do. Please help! Thank-you.

ANSWER:  It sounds as if your son probably needs that blanket to help him fall asleep! Would you consider removing it from the crib after he was asleep?  That might solve the problem and your worries about him as well!

I think a sleep sack is a great idea as an all purpose sleeper! They are really cute and come in all delightful designs. I think that should keep him warm and you less worried!

Hope this has been helpful!

Eileen Tyrala, MD FAAP
Medical Director, Cribs for Kids®

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‎January‎ ‎29‎, ‎2014 ‎
Subject: Pack ‘n Play® with Bassinet Safety

QUESTION:  I am a first time mother, due at the end of March. I would really like to put my baby right in his own room and in his crib right away. However, I know myself and I will worry about whether he is breathing and is okay, since the room is just on the other side of the house. It is not a very big house and there is no carpet so it is loud. I’m considering having him sleep for the first couple of weeks in a Pack ‘n Play® with bassinet next to me until I am able to learn about his sleeping. Would you suggest I just put him right away in his own room and in his crib? I’m just very concerned about his safety. Thank you so much for your time.

ANSWER:  We are not sure why it is so, but all the research studies have shown that a baby is safest, and at least risk from a sleep-related death, if they sleep in their parents’ room for the first six months of life. All the baby monitors in the world don’t seem to do as good a job of  monitoring baby as Mom and Dad sleeping in the same room with them! My thought is that it has to do with a heightened state of parental awareness that  provokes a response at the first sign of any type of distress by the baby.

My strong recommendation is that you have your new baby sleep in your room (room share) for the first 6 months of life and then consider putting him into his own room. The Pack ‘n Play® is a fine place for him to sleep for the first six months, early on in the bassinet part and later on in the bottom portion.

I hope this has been helpful,
Eileen Tyrala, MD FAAP
Medical Director, Cribs for Kids®

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January 21, 2014 
Subject:  Pack ‘n Play®

QUESTION:  I currently have a crib set up for our daughter due in Feb, but we have a pack and play set up in our bedroom for when she is really young and still breast feeding. I have heard some concerns that babies cannot sleep full time in a Pack ‘n Play® because the mattress is not firm as a regular crib mattress, which can cause an issue with SIDS. Is this true? Also, we got our crib as a gift from our neighbors who also gave us the mattress as it fits special in this crib (that their daughter barely used). I have also heard that re-using a crib mattress is strong discouraged as another cause of SIDS. Thank you.

ANSWER: There is no problem with an infant using the Pack ‘n Play® as her everyday sleeping area. The firmness of that mattress is just fine.

Generally we do not recommend the use of second hand cribs, however, because of the risk of loose or lost screws, lost instruction manuals, re-calls that you are unaware of, etc, etc. Re-using the mattress is an issue if it is overly worn, soiled, moldy or otherwise unacceptable for use by an infant. I would recommend using some careful judgment before using this well meaning but potentially unsafe gift!

Eileen Tyrala, MD FAAP
Medical Director, Cribs for Kids®

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January 20, 2014 
Subject: Crib and or Pack ‘n Play®?

QUESTION:  I have a Pack ‘n Play® and the bassinet on it is good till she’s 15 lb. I keep thinking I need a crib with it when she comes in April or will I not need a crib till she reaches the weight limit?

ANSWER: You do not need a crib as long as you have the Pack ‘n Play®. Even when the baby is too big for the bassinet feature, the bottom part of the Pack ‘n Play® is good up until 30 pounds. If you wanted to, you could bypass the crib altogether! Many people do!

Eileen Tyrala, MD FAAP
Medical Director, Cribs for Kids®

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January 20, 2014
Subject: Mini-crib vs. Pack ‘n Play®

QUESTION: We live in a very small apartment and I’m trying to save some space. I was thinking of purchasing a mini crib but have read mixed things about it and am now nervous. I read other posts from you that a Pack ‘n Play® is a safe place for a newborn to toddler to sleep in. My cousin gave me three of them! She does not have any of the attachments the PNP, they are just bare bones and the newest one is at least three years old. Will this be ok to use? What should I buy for it? I know you said that the mattress that comes with is save but, being that it is a few yrs old, should I buy a new one? And clearly new sheets and nothing else, so that we prevent from SIDS.

Thank you for any advice!

ANSWER:  Although the older versions of the Pack N Play do not have the bassinet attachment, it is still a fine sleeping area for your baby. As there is nothing to put together with this unit and no screws that can come loose, I think it is fine to use this older unit. I would use your judgment about replacing the mattress. If it seems musty or not as fresh and clean as you would like, then I would replace it.

Hope this has been helpful!

Eileen Tyrala, MD FAAP
Medical Director, Cribs for Kids®

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January‎ ‎28‎, ‎2014
Subject: Too Large for Pack ‘n Play®

QUESTION: I am extremely concerned my grandson NOT in proper crib.  My understanding & EXPERIENCE shows Pack ‘n Play® flimsy & the”mattress” is cardboard & has only netting of 8” attached to a metal piece.  He could pull himself up & he doesn’t like sensation of flimsy crib & likes a mattress on bed where I change his diapers.

I do not like how Pack ‘n Play® slides on floor & is crushable if someone fell into it, which a person can slip at night an adult or another person can collapse Pack ‘n Play®.
mine is the least expensive graco model given by hospital as temp place for newborn.  What can you tell me so my daughter LISTENS & buys a crib?

ANSWER:  The Pack ‘n Play® is made to hold babies up to 30 pounds so I don’t think you have to worry that he is too big or too strong for the unit just yet! It is a really sturdy piece of equipment with a locking system for the rails that has never failed! I guess it is possible that an adult who was not aware of the PAck N’Play being there, could fall into it in the dark, but I have never heard of that happening!

The mattress in the bottom of the unit is thin, but remember it is supposed to be so that the baby has a firm sleeping surface.  Soft, cushiony mattresses have been shown to be a risk factor for sleep related infant deaths.

There is nothing wrong with getting a full size crib for your grandson but if your daughter finds it more convenient for the baby to sleep in a Pack ‘n Play®,  I would not worry  about his safety. He is just fine in there!

I hope this has eased your mind  a bit.

Sincerely,
Eileen Tyrala, MD FAAP
Medical Director, Cribs for Kids®

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‎January‎ ‎28‎, ‎2014 ‎
Subject: Safe Crib Materials

QUESTION:
 My question is concerning the materials used in safe cribs, particularly the wood used. I am a RN in a labor and delivery unit but have little contact with pediatricians. My husband and I are going to adopt a newborn since we are infertile. In preparing for the coming home study, we were researching safest cribs available and found many varying opinions. If the crib is certified and properly meets required regulations, is there a considerable difference in the wood material used? Pine is a popular material, however I have read reviews fearing the pine is too soft and breakable, easy for a child to for instance pull a bar off of the side while attempting to pull himself up. Hardwoods are recommended, but almost impossible to find. Do you suggest any specific crib for safety? Does the material matter?

ANSWER: Thank you for your question. As long as a crib is certified by the Juvenile Products Manufacturer’s Association (which adheres to the standards that have been set by the Consumer Product Safety Commission and should be so stated on the informational brochure that comes with the crib) , there  should not be a problem. The wood that cribs are made of is part of that evaluation process and rest assured it has  been subjected to rigorous testing by the CPSC. If there had been any problem with pine as a wood for cribs, it would not be used.

I do not have any specific recommendations about brands of cribs or specific models. Remember, many babies spend all of their sleeping days (and nights) in Pack N’Plays and do just fine! It does not have to be fancy to be safe and appropriate for your new baby.

On a personal note, I too, am an adoptive parent, having received my baby girl as a newborn. I know how much you want to make everything right for this newcomer in your life.
Just relax for the home study and be yourself. It is a little intimidating but you will get through it!

Best of luck,
Eileen Tyrala, MD FAAP
Medical Director, Cribs for Kids®

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‎January‎ ‎19‎, ‎2014 ‎
Subject: Vibration from Crib Mattress

QUESTION: We were given a mattress with a vibration setting in it for our newborn. She is 6 weeks and we just started using the vibration setting is it ok to have her sleep with the vibration on all night or could that be harmful in anyway. She sleeps better with the vibration but it doesn’t have a timer and I just don’t know if it be on all night is good.

ANSWER:  I don’t see any  physical problems  for your daughter with extended use of the vibration setting on the mattress. The issue down the road, however, is that she will not sleep in any setting that does not have a vibration effect.  Babies are creatures of habit! You might want to use it intermittently so that she does not get overly accustomed to it.

Eileen Tyrala, MD FAAP
Medical Director, Cribs for Kids®

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January‎ ‎19‎, ‎2014
Subject: PNP Supplemental Mattress

QUESTION: Is the Dream on Me 3″ Foam Mattress manufactured by Graco specifically for the Pack ‘n Play® safe? My 15 month old daughter has adamantly refused to sleep in her PNP for approximately the past three months whenver we travel. I’m not sure if it’s the uncomfortable thin mattress that came with her PNP or the unfamiliar rooms or a combination of both factors causing her discontent, but sleep is not an option anymore when she’s not in her own crib.
Thanks in advance for your input!

ANSWER:  Your daughter’s reluctance to sleep in the Pack ‘n Play® probably reflects all of the factors that you mentioned in your email.  We don’t hold sleep surfaces for 15 month old children to the same standards that we do for infants. This sleep surface would not be recommended for the traditional Pack ‘n Play® that you would use for an infant. If you did want to hold the Dream on Me foam mattress to the same standard, however, you could try the following:  This link  is to a You Tube video that has tried to put some science into determining whether any particular sleep surface is firm enough for an infant:  http://youtu.be/OjtGfddsAmE

I hope this has been helpful,
Eileen Tyrala, MD FAAP
Medical Director, Cribs for Kids®

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January 15, 2014
Subject: Bassinet Feature of Pack ‘n Play®

QUESTION: As I’m preparing for the arrival of my first child I’m researching the many sleeping options for newborns.  The Pack ‘n Play® option seems to be very popular.  Are there any concerns with the elevated bassinet feature of the pack n play or should babies be placed in the bottom of the play yard for sleeping?  It seems the bassinet clips onto the rails of the Pack ‘n Play® and I didn’t know if there are any reported incidents of this not being safe.
Thank you!

ANSWER:  To date, and to my knowledge, no  safety issues with the bassinet feature of the Pack ‘n Play® have been reported. In addition, Cribs for Kids has distributed many thousands of these units  and we have never had a report of a problem.

I think it is a very safe product and a good choice of a sleeping area for your new baby!
Best of luck to you!

Eileen Tyrala, MD FAAP
Medical Director, Cribs for Kids®

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November 16, 2014
Subject:
Crib safety

QUESTION: Would this crib compromise my baby’s breathing? http://storkcraftdirect.com/products/convertible-cribs/verona-4-in-1-stages-crib/

I’m concerned because of its design. Please advise. Thank you for a great site!

ANSWER:  In looking at the pictures of this product on line, I was  concerned about the side of the crib that was made out of a solid material,  which I assume is a wood product. This is obviously not a breathable surface which theoretically could create a problem if the baby were to get his face or nose  “smooshed”  against the side.  On the other hand it is a firm surface that would not be able to layer itself around the baby’s nose and/or face. Although I am not aware of any problems that have been reported with this product, I would probably stay away from it  and stick with a design that does not have a solid panel for one of the sides.

I hope this has been helpful.

Eileen Tyrala, MD FAAP
Medical Director, Cribs for Kids®

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November 6, 2014
Subject: Pack ‘n Play®

QUESTION: I bought a Pack ‘n Play® that has a raised bassinet which isn’t firm.  I’m worried it wont be safe for her to sleep in every night until I can get an actual crib. The material is thin and without some kind of blanket I’m worried she will get cold. Will it be safe for her to sleep in? This is above the play area and the bassinet is mesh sided.

ANSWER:  Thank you for your question. The bassinet feature of the  Pack ‘n Play® has an excellent safety record. The sleep surface is firm enough and meets all of the requirements of a safe sleep surface for an  infant.  The mesh feature is actually a very postive thing as it is completely breathable and makes for easy visibility of the baby when placed next to your bed. If you are worried about the baby getting cold, I would recommend that you place her in a sleeper sack.

Many use the Pack ‘n Play® as the only sleep environment for their baby until they reach the upper weight limit which is 30 pounds so you may not even have to purchase another crib!

I think that you will find  the Pack ‘n Play® to be a very safe and good sleep environment for your baby.

I hope this has been helpful.

Eileen Tyrala, MD FAAP
Medical Director, Cribs for Kids®

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November 7, 2014
Subject: Pack ‘n Play® Sheet Question

ANSWER: We are transitioning our two month old baby from the pack n play newborn napper to the pack n play bassinet. The first night did not go well as our baby could not get comfortable. I went out and bought two quilted pack n play sheets – one by graco amd one by carters. The next night, she went right to sleep on the quilted sheet. Since these sheets are made specifically for the pack n play, are they safe?

QUESTION:  The key issue with any crib sheet is that it must be  tightly fitting and that there be no nooks and crannies on the surface where an infant could get their nose or face wedged. In looking at this product on-line, it appears to meet that criteria. If you get it and don’t think it meets that criteria, then I would not use it.

Eileen Tyrala, MD FAAP
Medical Director, Cribs for Kids®

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November 6, 2014
Subject
: 
 Cold Body

QUESTION:  Hi! I have a 7-month-old baby its summer and my child’s body is cold at night even if he is covered. Or he perspires a lot even if his not under the blanket is this something I should be worried about?

ANSWER:  Let me start by asking what  is the temperature of your baby’s room? It is important to avoid extremes of temperature so that the room is neither too hot or too cold. The ideal room temperature for an infant to sleep in is between 68 and 72 degrees so first check that out. Generally in the colder months, a one piece sleep sacks (with a onesie underneath)  is all that is needed to keep a baby warm as long as the room is not too cold. In the warmer months, I would  use a one piece sleep outfit that is made from a lighter weight cotton fabric. If the baby seems cold with that then you can use a regular sleep sack but that does tend to be a bit heavier. Remember, the baby should never be too hot, so if he or she is sweating alot, then some of his clothing needs to be removed or lightened up.

I hope this has been helpful.

Eileen Tyrala, MD FAAP
Medical Director, Cribs for Kids®

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November 6, 2014
Subject
: Pack n’ Play with Bumpers

QUESTION: My parents are looking to get a Pack ‘n Play® so my baby has a place to sleep when we visit, they found a decent one online but I noticed it has bumpers. I know you aren’t suppose to use them in cribs but are the ones built into these Pack ‘n Plays okay?

ANSWER:  I am not familiar with a Pack ‘n Play® that has built in bumpers. Could you send me a link to a picture of the unit in question? The bottom line though is that no sleeping area for a baby should have bumpers! If there is any question about this at all, I would stick to the old original that has no bumpers and only mesh where the sleep pad meets the sides of the play yard.

Sincerely,
Eileen Tyrala, MD FAAP
Medical Director, Cribs for Kids®

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October 21, 2013
Subject: Pack ‘n Play®

QUESTION: So my husband and I are looking to buy in the safest and cheapest way possible due to the fact we do not have any family within a thousand miles radius. We were wondering about buying  a Pack ‘n Play® to use as a bassinet and a crib permanently. Also any other safe, cheap tips as far as buying for our baby.

ANSWER: Thank you for your question.  My advice is to purchase the Pack ‘n Play® model that has the bassinet feature but nothing else. That is really all that you need. Forget the other bells and whistles that they want to sell you for hundreds of dollars more! Most of those extras are not safe for infant sleeping anyway! The Pack ‘n Play® is safe for children up to 30 pounds and it is perfectly fine to use it from birth well into the second year of life. Many do not need to have another sleep area for their child until he or she is ready to go into a toddler bed.

My advice is to stick to basic items for your baby.  You (or the baby) do not need all the latest devices and gizmos to raise a  baby who will fulfill his or her full developmental potential ! Remember, there is no substitute for human interaction when it comes to infant development and that is free! Start out by breast feeding your infant. Nothing is better than breast feeding to promote both bonding and infant development. Talk to you baby all the time. Show your baby colorful things to look at. Show your baby your love by placing him or her in a safe sleep environment. Make your baby feel loved and everything will work out just fine!

Eileen Tyrala, MD FAAP
Medical Director, Cribs for Kids®

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October 21, 2013
Subject: Baby Crib Storage

QUESTION:  Our baby crib, along with other infant items, has been stored in our large outside storage shed for about three years.  In the shed is not only storage but law equipment, such as blowers, weed eater, gas cans, etc.  My question is this….is the baby crib and other baby items okay to use with upcoming baby even if they have been stored where gas and other chemicals have also been stored?  When you walk into the storage shed there is a smell of gas.  Thank you for your input.

ANSWER:  From the way you phrased this, it sounds as if  you would prefer not to use anything for your new baby that has been stored in this outdoor storage area. I would agree  as  I don’t think I would feel comfortable using anything for a new baby that had been stored with the lawn mower and had been outside for that long.

The other thing about using an old crib is that you have to be very sure that all of the original hardware (and the instructions) are there and that everything is still in good condition. Also, some times there have been re-calls of cribs that you may not be aware of. (If it is a drop side crib, it was re-called!)

I hope this has been helpful.

Eileen Tyrala, MD FAAP
Medical Director, Cribs for Kids®

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October 17, 2013
Subject: Crib vs. Pack ‘n Play

QUESTION:  My wife and I are having a son in January of 2014.  We are trying to decide between a crib and a Pack ‘n Play®.  We have read reports that are both for and again substituting a pack n’ play for a crib.  Our relatives said that pack n’ plays are fine to use instead of cribs, but I’m still a little skeptical.  Also, are there any medical sites that I could read articles on this topic (e.g. Medscape, Up-to-date).  Both my wife and I are physicians, but not in pediatrics, thus we weren’t sure and would like to do more reading on this topic.

ANSWER:  Thank you for your question. I would agree with your relatives that the Pack ‘n Play® is just as good as a full size crib for an infant. One aspect that makes it particularly attractive to me are the mesh sides that allow you to see the infant at all times and protect against the risk of a stray arm or foot getting caught between the crib rails. In addition it is compact  and portable which allows it to be used in what ever room you need, particularly your bedroom, where we recommend the baby sleep for the first 6 months of life. The Consumer Product Safety Commission has specifically identified the Graco Pack n’ Play® as a safe sleep environment for infants as it meets all of the requirements for a safe sleep environment for infants ( firm sleep surface, no bumpers) and it  has a patented safety lock for the rails that is virtually fail proof.

I would refer you to the 2011 AAP SIDS Task Force Recommendations on a Safe Infant Sleep Environment and the accompanying technical report (Pediatrics, Volume 128, Number 5, November 2011). Indeed there is an Up To Date article on both SIDS and SUID which both look good, but I think you will find the AAP technical report more specific for your purposes.

I hope this has been helpful.

Eileen Tyrala, MD FAAP
Medical Director, Cribs for Kids®

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October 17, 2013
Subject: Safe Sleep Studies

QUESTION:  Are there published studies and results regarding the safety of infants napping for short periods of time, completely supervised available?  Articles authored by experts in this field, and key opinion leaders, on this topic,  would also be helpful.

Do publications exist on the subject of differentiating between night sleep and daytime napping, and how guidelines differ for these separate sleep environments and patterns?

ANSWER:  When it comes to infant sleep, there is no distinction between “napping” and “sleeping”. They are one and the same.   Indeed, the 2011 SIDS Task Force Recommendations on reducing the risk of SIDS and sleep related infant deaths stress that all infant safe sleep recommendations apply to all sleep times, both napping and sleeping. It is critical that a baby become accustomed to sleeping alone, on the back, and in a sleep environment that avoids soft bedding, sleeping on adult mattresses or sofas, overheating, and exposure to tobacco smoke at all times.  Therefore, regardless of observation and “supervision” there is only one recommendation for an infant sleep environment, even if it is for only short periods of time.

I hope this information has been helpful.

Eileen Tyrala, MD FAAP
Medical Director, Cribs for Kids®

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October 4, 2013
Subject: Hitting His Head on Crib Rails & Corners / Brain Damage

QUESTION:  My 9 month old, since he started crawling at 6 months and started standing up at 8 months, hits his head constantly on crib rails (feel like it’s worse with standing). I always hear a whack- it makes me so upset.  I have spoken to pediatrician who stated not to worry and can’t really protect with bumpers and are unsafe. One time he hit his head while standing up and had bruise on front portion of his head but no bump. Another time he hit his head on the corner of the wooden crib. In one month he had hit his head so many times, only one time he had a bruise and I am sick with worry that all those repetitive head hits on the forehead can cause brain damage.  I want to put bumpers on the crib, but the doctors says no and hasn’t given me any solutions. At this point, I just bring him into bed with me because I don’t want him to hit his head anymore. Should I place him in a Pack ‘n Play®? I don’t want him to have learning difficulties & concentrating etc when he gets older. Can repetitive hits to the forehead without bumps, or swelling and immediate crying and resolution cause brain damage even subtle? I know babies are resilient but really it can’t be good to have such hits on crib rails no matter how little they weigh or short height. Do you think he has any damage from the hits thus far? He meets all his developmental milestones? How many times do most babies at this age hit their heads in crib?

ANSWER:
  Thank you for your question. First of all, I would agree with your pediatrician that your son has not suffered any brain damage from these events! Generally we only worry about possible brain injury when a baby falls from a height of three feet or more. Rest assured that these are truly minor events. They are obviously very distressing when they occur, however. The best solution would be to put him in a Pack ‘n Play®? that has all mesh sides and no wooden parts or hard rails to worry about. Very soon, he will not be falling at all and be cruising around the crib (or Pack ‘n Play®?) and these worries will be over!

Eileen Tyrala, MD FAAP
Medical Director, Cribs for Kids®

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October 4, 2013
Subject: Graco Day2Night Seep System

QUESTION:  Hello! We are expecting our first baby in December and are still trying to figure out what will be best for those first few months when we’ll want him sleeping in our room.

I really love the new Graco Day2Night Sleep System. Basically it’s a pack n play with a bassinet and stand. The main reason I like it is that we could keep the pack n play on our main level for during the day naps and have the bassinet upstairs in our bedroom. The bassinet can also be removed from the stand and carried to another room and even placed in the pack n play.

I have some concerns with the bassinet however. The sides are fabric not mesh and it seems fairly deep (I would guess 6-8″ deep). I’m a pediatric nurse and am very aware of SIDS prevention. I have very mixed feelings about if this bassinet is safe for our newborn. I realize the time that we’ll be using it he will not be rolling over, but it still concerns me since the sides are not breathable. We are planning on having an Angel Care monitor underneath whatever the baby is sleeping on.

I would greatly appreciate your advice on this product! If you don’t recommend this, is there another bassinet that you would recommend? I’ve looked at the Dream on Me Karley bassinets that do have mesh sides but have seen mixed reviews on the mattress that’s included.

I hope to hear from you soon. Thank you very much!!

ANSWER:  Thank you for your question. I wish I could share your enthusiasm for the Day2Night Sleep System! The bassinet feature of this product is much less safe than the built in bassinet that comes with most Pack ‘n Plays.
As you point out, the sides are not breathable and, in addition, since it is opaque, you would not be able to see the baby when he or she is in there, 2 of the major selling points for the regular bassinet. The sides also come very close to the baby which means that a minimally active infant would be able to get their face very close to that non-breathable surface. I would also question that stability of the stand that the bassinet sits on when it is not in the Pack ‘n Play.

My recommendation is to stick with the regular Pack ‘n Play.

Eileen Tyrala, MD FAAP
Medical Director, Cribs for Kids®

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October 4, 2013
Subject: Transitioning to Crib

QUESTION:  I am a speech-language pathologist and mother of a 19 month old with milk soy protein allergies and reflux. We are followed closely by a pediatric GI and her pediatrician. My daughter’s reflux is currently managed with prevacid 2x a day. However, early on she did have a Standifer’s syndrome episode and a few scary choking episodes. That being said the rock-n-play was suggested by her pediatrician and used by us as parents. Clinically as a speech pathologist my fear was of her aspirating refluxed material and developing pneumonia or having an apnea like episode. All that being said, I have read on here that babies under the age of 12 months are too young to associate items such as small blankets with comfort. However, we are transitioning from the rock-n-play (she is now too long and is able to roll) and she will wake up when we remove her small blanket from her.  She sleeps in a wearable blanket with no bumpers or bedding. She does have a Dr. approved small wedge under her mattress that slightly elevates her. My question is do you have suggestions for how to help her adjust to the crib without her blankie. When it’s given to her she calms down and falls asleep. Then, she wakes up when it is removed, which we always do. Suggestions would be greatly appreciated by this tired working mommy of a very smart baby girl!


ANSWER:
  Thank you for your question. Quite a dilemma! Here is my suggestion. What if you start cutting the blanket down a little bit at a time (I hope it is a light-weight one) so that the baby ends up with only a very small, but sufficient, swatch  to  soothe her. Sometimes all the baby needs is the smell or feel of the object to achieve the comforting effect. Hopefully the piece you end up with will be small and light weight enough to not pose any threat for suffocation.

I hope this works!

Eileen Tyrala, MD FAAP
Medical Director, Cribs for Kids®

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October 3, 2013
Subject: Newborn Nappers/Wrapping Opinion

QUESTION:  I am planning on using a Pack ‘n Play® for our son’s first months before transitioning him to a crib in his own room.  I have been looking at a Graco playard with a newborn napper station, mainly because (from my standpoint) it looks more comfortable for a newborn to be confined to a smaller napping space.  The napper is made with a micro-fleece material.  If using a Pack ‘n Play® as a primary sleeping device, would you recommend putting the baby in a newborn napper such as this after birth or simply putting him directly on the playard mattress as a newborn?

Also, I currently live in a country where mattress wrapping is the norm.  I was planning wrapping the playpen mattress with an approved BabeSafe wrap.  Do you have any opinions regarding this process?

Thank you in advance for your time and assistance!

ANSWER:
  I do not recommend the Newborn Napper station that is sold on some of the Pack ‘n Play® models.  All sleep environments for infants, whether for sleeping or for napping, must meet all of the requirements for a safe sleep environment for infants. Infants for sleep should be placed on their back, on a flat and firm sleep surface (such as a safety-approved mattress) that is not cluttered with soft cushiony objects such as blankets, pillows or stuffed animals. My first concern with The Newborn Napper is that it places the infant on an incline. Many infants lack the necessary strength and muscle tone to keep their bodies in an upright position while seated in inclined devices. They tend to slump downward, putting extra pressure on the diaphragm and the abdomen, the two major organs of respiration in infants.  In addition, the neck can fall forward leading to occlusion of an infant’s soft and pliable airway.  All of these factors  contribute to potentially making breathing more difficult for an infant while in this device.  I am also concerned about the proximity of the soft materials that are positioned so close to the baby’s face. It would not take much for an only slightly active infant to get his nose caught up against these surfaces, creating a suffocation hazard, similar to what has been identified with bumpers and all of the traditional items that used to be found in infant cribs such as stuffed animals,  pillows and soft quilts. My recommendation is to stick with the play yard mattress from the beginning and not use the Newborn Napper Station at all.

The hypothesis of SIDS causation that proposes that exposure of infants to toxic chemicals coming from their mattress has not yet been proven. We do know that close to 90% of infants who die suddenly and unexpectedly while asleep do so while in an unsafe sleep environment. That is what I would focus on. If you were to purchase a mattress wrap (are you in New Zealand?) just be sure that it fits your mattress perfectly and that it does nothing to alter the firm surface that the baby is supposed to sleep on. Also, make sure there is no bunching of the wrap such that it could create any crevices on the sleep surface where the baby might wedge his nose or face.

Eileen Tyrala, MD FAAP
Medical Director, Cribs for Kids®

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September 27, 2013
Subject: SIDS and wool

QUESTION:  I just purchased a new organic wool and cotton mattress for our bed and the crib for a new baby due in a few weeks. It also has a wool pad for the top of the mattress to absorb moisture. Then I read a few things about a link between sheepskin or lambswool and SIDS. Should I be concerned about the baby laying on layers of wool?

Hello Esther,

ANSWER:  To ensure the firmness of the sleep surface your baby is sleeping on, he or she should  sleep directly on the mattress with only a crib sheet in between the baby and the mattress. Anything, particularly a wool pad that would create a softer, thicker environment that would make it harder for the baby to lift his  head and face  away from, is potentially hazardous.

Is your crib mattress safety approved? I am not familiar with wool and cotton mattresses for infant cribs. Check that as well.

Hope this has been helpful.

Eileen Tyrala, MD FAAP
Medical Director, Cribs for Kids®

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September 27, 2013
Subject:
Pack ‘n Play Mattress

QUESTION: Our 4 month old son sleeps in a Pack ‘n Play.  Is it safe to buy one of those additional mattresses that you can find through Amazon instead of the padded mat that comes with the pack n play?

ANSWER:  Thank you for your question. My first recommendation is to use the mattress that the Pack ‘n Play comes with. This way you will be assured of a product that fits exactly ( which is extremely important)  and is known to be completely safe.

Graco does NOT make its own mattress product for the Pack ‘n Play, however, in looking on Amazon’s web site I see they offer a variety of alternative mattresses  for the Pack ‘n Play.  I do not recommend that you use an supplemental mattresses in a Pack ‘n Play or Playyard.

In reading the reviews of many of the products advertised on Amazon, parents describe how cheaply made some of the products  are and how, after only a few days use, there are indents in the mattress where the baby has slept! Not a good idea! Remember an infant mattress is not supposed to be soft and cushy. Baby’s don’t come knowing anything about plush surfaces to sleep on. That is all learned behavior. Don’t be fooled into thinking that soft is better. It is not and could be dangerous.

I hope this has been helpful,

Eileen Tyrala, MD FAAP
Medical Director, Cribs for Kids®
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September 21, 2103
Subject:
 Infant Movement During Sleep

QUESTION:  My son is 4 and a half months old. He has started rolling from his back to his stomach frequently (including during the night), but he hasn’t quite figured out how to roll from his stomach to his back yet. I am concerned about the risk of suffocation if he ends up sleeping for part of the night on his tummy after rolling over at some point. We don’t have blankets/quilts/stuffed animals etc. in the pack n play that he sleeps in, but it worried me when I went into his room one night and he had rolled over and was sleeping face down (he was still breathing but he did have his nose and mouth straight down). I rolled him over onto his back, but he likes to sleep on his side and will automatically curl up and turn onto his side when I put him on his back, then sometimes he rolls completely onto his tummy like he did the other night. Should I try to get him to sleep flat on his back or is this kind of behavior OK for a baby his age. He has LOTS of tummy time during the day and has even started using a jumpy chair so his neck/back/shoulder muscle control is excellent. I would appreciate any advice that you have.

ANSWER:  It sounds as if you have done everything right! Lots of tummy time, lots of activities to develop his neck, back and shoulder muscles and as a result he is able to roll from his back to his tummy with ease.

I would say that you have nothing to worry about. If his breathing was really compromised from being in that face down position, because he is on a firm sleep surface and because his neck muscles are so strong, he would turn his head to the side and just continue breathing in a normal fashion. I would not worry!

I hope this has been helpful,

Eileen Tyrala, MD FAAP
Medical Director, Cribs for Kids®

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September 3, 2013
Subject:
Mesh Crib Bumpers

QUESTION: I know that traditional bumpers are a risk for SIDS, but what about the new mesh “breathable” bumpers? Have those been tested/approved by the FDA?

ANSWER: Thank you for your question. Currently the “breathable” bumpers are still considered to be bumpers and are not recommended for use. Thus far, the Consumer Product Safety Commission or CPSC ( not the FDA or Food and Drug Association)  has not made any specific statements about the safety of breathable bumpers. Remember, however, even the old fashioned crib bumpers which have been implicated in the suffocation deaths of many infants have not been officially recalled and are still readily available for purchase.

My best recommendation is to not use any bumpers in your baby’s crib! He or she will be just fine without them!

I hope this has been helpful,

Eileen Tyrala, MD FAAP
Medical Director, Cribs for Kids®

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September 3, 2013
Subject
: Graco Pack ‘n Play® Napper Attachment

QUESTION:  Thank you for all your answers.  I read thru all of them and saw several that mentioned pack n play bassinets, but none addressed the napper attachment that comes with some of the models.  http://www.toysrus.com/product/index.jsp?productId=15262786&CAWELAID=1785323171&cagpspn=pla&pla=plab&camp=PLAPPC-_-PID13815325&KPID=13815325.

I attached a link so that you can see what it looks like.  I have a 3 week old and he occasionally naps in the the napper, but I usually try and get him in his crib because I’m concerned with the safety of the napper.  It is fleece and semi prone with a head positioner.  My baby does not seem able to move at all in the napper at 9lbs but I’m concerned with it being softsided/softbottomed (hangs like a hammock versus a rigid bucket) and fleece.  I think I will probably just remove it and have him sleep on his back on the regular Pack ‘n Play® bassinet, but I would like to know what you think about the safety of this attachment that comes with many pack n plays now.  Thank you,

ANSWER:  Thank you for your question.  I do not recommend any sleep surfaces that place a baby to sleep on an incline. Babies do not have the strength and tone in their upper body to keep them in the upright position. Many infants will slump down while in these devices, putting extra pressure on their abdomen, thus making it harder for them to breath. In addition, an infant airway can get kinked while in this position  also making it harder for them to breath.  The head support  comes too close to the baby’s face and nose and is a suffocation risk. The soft fleece sides, as you point out, are a problem  even if they are “breathable”.  Hence, I do not recommend this product and have expressed my concerns about it to Graco. Your decision to move him to the regular Pack ‘n Play® is a good one which I heartedly endorse!

I hope this has been helpful,

Eileen Tyrala, MD FAAP
Medical Director, Cribs for Kids®

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September 2, 2013
Subject: Two-sided crib mattres
s

QUESTION:  We have a two-sided crib mattress (infant/toddler). Is it safe for my 5 month old to sleep on the toddler side? The toddler side is less firm, and I wonder if it would help my son sleep better. he currently wakes usually  3-5 times during the night. He moves around a lot in his sleep, and although we place him in the crib on his back, he almost immediately flips to his stomach. He is able to raise his head when on his stomach. Thank you!

ANSWER:
Thank you for your question. No, I do not think it is safe for your 5 month old to sleep on the toddler side of this dual mattress product. As you observed yourself, it is  softer than the infant side and that is precisely the point.  Infants, (particularly ones who can flip onto their tummies!)  need  a firm sleep surface that they cannot sink into and will also make it easier for them to move their heads out of the way if their face were to go straight down into the mattress.  Therefore, your son’s original infant  mattress is the product to stick with until he is one year of age.

And by the way, if your son is already flipping over onto his stomach and can hold his head up, you need not worry as long as he remains on his firm infant mattress!

I hope this has been helpful,

Eileen Tyrala, MD FAAP
Medical Director, Cribs for Kids®

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September 1, 2013
Subject: Wooden Cradle

QUESTION: My mom gave me a wooden cradle that was used when I was little. I’m not sure what the brand is but the base of the cradle is wide and sturdy. The spindles are no more than 2 inches apart and the mattress seems firm. It does come with bumpers but I plan to remove those. I really want to use it because I want my baby in my room but my husband is nervous about it and thinks we should just put her in her room to sleep in her crib. Do you think it will be safe to use this cradle? It rocks east to west and does not rock on its own.

ANSWER: If you are describing an old fashioned wooden cradle that sits low to the floor and has no screws or bolts that could have come loose or have been lost, then I think the structural part of the cradle is probably OK. The slat distance is fine at less than the recommended  maximum of 2 3/8 inches. My only real concern is with the mattress. Can you be certain that the mattress doesn’t have any mold in it?  After 25  years, is it still firm enough? These are the questions you would have to consider before using it for your baby. It would probably be  impossible to find another mattress that would fit the cradle properly if you tried to replace it.

Beautiful older pieces like this can always be used to display those adorable stuffed animals  until the baby is old enough to play with and appreciate them (at greater than one year of age).

It is best to have her sleep in your bedroom until she is at least 6 months of age, rather than in her own room.

I hope this has been helpful,

Eileen Tyrala, MD FAAP
Medical Director, Cribs for Kids®

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August 30, 2013
Subject:
Can a Toddler Sleep Too Much?

QUESTION: My 2 1/2 year old grandson sleeps more than 12 hrs a night.  Is this normal? On several occasions, he has to be woken up.  He stays up past 10 pm since his mother works nights, but goes to bed 11ish.  He usually doesn’t wake up until after 12 pm or 1pm the next day! This can’t be normal.  He is a happy toddler, and seems to progress normally. However, he is not potty trained, parents partly to blame, and his speech is not real plain.  He does speak, but some of his words are hard to understand. He is also terrified of loud noises, like a dog bark, anything loud.  If you could give me some ideas, that would be great.

ANSWER:  Toddler’s of your grandson’s age need between 11 and 12 hours of sleep per night so the length if  his night time sleep is right on target. Unless and until he has to be up by 7 AM the next morning to be off to day care or school, there is really no problem  with this schedule as far as his sleep needs are concerned. His sleep schedule also has nothing to do with his potty training or his speech development. Only about 50%  of a 3 year olds speech is readily understandable, and even less for a 2 1/2 year old. If there are real concerns about his speech or other aspects of his behavior, however,   I would suggest that it be discussed  with his pediatrician or health care provider.

I hope this has been helpful,

Eileen Tyrala, MD FAAP
Medical Director, Cribs for Kids®

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August 28, 2013
Subject: Naps

QUESTION: My three month old will only take 30 minute naps in her crib. She will sleep there all night, although she does still wake at least two times for feedings. Do you have any advice to help her sleep longer for naps so she gets the sleep she needs?

ANSWER: My first question to you would be are there any factors in the environment that may be disturbing her nap time sleep? Any noisey dogs or the sounds of other children playing? If there are, try to minimize that effect and in addition,  I would  provide some “white noise” in the room such as static from the radio or the hum of a fan. (There are  free apps you can download onto a smart phone that can provide even better sounds than these! ) White noise in and of itself can be very soothiing to infants promoting “the calming reflex”, as described by Dr Harvey Karp, in his book ” The Happiest Baby Guide to Great Sleep”.

Next, try to make the room as dark as possible. Light is a stimulant to the brain to stay alert so see how much of this factor you can eliminate.

A hallmark of establishing good sleep habits is to put a baby down to sleep while she is still awake. It is important that infants learn from early on the important skill of how to fall asleep on their own without needing to be fed, held or cuddled prior to being placed in their crib. If you have been doing any of this, start to adjust your routine and see if this works.

It is quite normal for a 3 month old baby to awaken 2 times during the night for feedings so I wouldn’t be at all concerned about that. Many infants don’t sleep through the night until they are 6 (or more) months old!

Hope this has been helpful,

Eileen Tyrala, MD FAAP
Medical Director, Cribs for Kids®

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August 27, 2013
Subject: Fisher-Price Rock ‘n Play Bassinet

QUESTION: I am expecting within a few weeks and SIDS is a re-occurring worry as my husband’s sister lost her second child to it. I can meet all the SIDS Foundation recommendations for safety, except for one: Neither a crib nor a Pack ‘n’ Play will fit in my room for the baby to sleep in at night for the first six months of his or her life. Some people have suggested I purchase a bassinet, but I have not seen any with mesh sides and the mattresses on friends’ bassinets don’t seem to lay flat once a fitted sheet is added. This week at Target, I saw the Fisher-Price Rock ‘n’ Play Bassinet that has mesh sides and feet that lock so it doesn’t rock, but I can’t find any safety information about this as a sleeping option. So my question is: Would it be safer for my child to sleep in his/her own crib in a room directly adjacent to ours (I would be about 8 feet from the baby while sleeping) or buy the Rock ‘n’ Play Bassinet to put in our room? Thanks!

ANSWER:
 I am not a fan of the Rock ‘n Play Bassinet. All sleep surfaces for infants should be flat, not inclined, as the Rock ‘n Play is.  Infants lack the necessary muscle tone and strength in their upper body to sustain even a semi-reclined position without the risk of slumping downward. This position also makes it more likely that their neck will flop forward and potentially cause an obstructed airway. I also don’t like the base that it sits on as it seems too flimsy with the risk of a tip over. I do not recommend this product.

I would look a little harder for an acceptable bassinet product that fits in your room. In the mean time, are you sure that you can’t rearrange the furniture to make room for a Pack ‘n Play?

Eileen Tyrala, MD FAAP
Medical Director, Cribs for Kids®

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August 26, 2013
Subject: Pack ‘n Play, Newborn Napper

QUESTION: Your Question: Is it better to have your newborn sleep in the pack n play or can/ should you use the newborn  “napper” add-on? If we put the crib in our room, could the baby just sleep there from day one? Thank you!!

ANSWER:  The sleep product (the Napper) is not OK!!!! I do not recommend any sleep surfaces that place a baby to sleep on an incline. Babies do not have the strength and tone in their upper body to keep them in the upright position. Many infants will slump down while in these devices, putting extra pressure on their abdomen,  making it harder for them to breath. In addition, their airway can get kinked while in this position  also making it harder for them to breath.  The head support is  a suffocation risk in and of itself as it comes too close to the baby’s face and nose. The soft fleece sides can also be a suffocation risk, even if they are “breathable”.  Hence, I do not recommend this product and have expressed my concerns about it to Graco.

I hope this was helpful,

Eileen Tyrala, MD FAAP
Medical Director, Cribs for Kids®

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August 20, 2013

Subject: Vintage Baby Item Safety

QUESTION: My first baby is due any day now, and my mother-in-law is very excited for him to use some of the same things her children (as well as other family members) used as infants.  I can understand her sentimental feelings, but I don’t want to put my baby at risk for the sake of nostalgia.  My concerns are that the vintage bassinette and play yard may not meet modern safety standards.  The bassinette in particular has been painted several times, and I don’t know if any of the layers had lead in it.  It is not as deep as modern bassinettes, and the mattress is not as firm.  It can sit on a stand that is not attached to the basket at all.  The stand has wheels without brakes.  Alternately, it can sit on the floor or a raised surface like a table or bed.  I have not actually seen the play yard, but I know it is quite old.  (I would say MORE than 30 years old, since it was not new when my husband was in it as a baby.)  They can’t find a model number on it for me to do much research.  I know they come out with new safety standards on play yards regularly.  What is your opinion of the safety of these items?

ANSWER:  I think the ideal use for these precious family heirlooms is to use them to decorate the baby’s room or for storage. I would  not use them for baby care at all.  The old bassinet sounds like a wonderful place to store all those adorable stuffed animals that can’t go in your new son or daughter’s crib! Could the play yard store toys or other baby paraphernalia that can’t seem to go anywhere else and needs to be readily at hand?  My reasoning is that they just sound too old and warn and why take the chance that the mattress isn’t firm enough or the railing of the play yard collapses. It just isn’t worth it!

I am confident your mother-in-law will understand once you explain these safety issues to her. Good luck!

Eileen Tyrala, MD FAAP
Medical Director, Cribs for Kids®

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August 19, 2013
Subject: Swaddling

QUESTION: We have been swaddling our son since we brought him home from the hospital, and he sleeps very well at night. Now that he’s 3months old and it’s time to stop swaddling him, we have found that he is unable to stay asleep without the swaddle. Can you offer any suggestions on how to transition from the swaddle?

ANSWER:  Thank you for your question. At 3 months, it is definitely  time to get him out of the swaddle!  Keeping an infant’s arms tucked to his body as he develops his motor skills can be dangerous as we don’t want him flipping over onto his stomach while swaddled!

The first thing I would suggest is to loosen his arms, perhaps one at a time, so that they are no longer restricted.  Once he tolerates the arms being free, it should be easy to release his legs and to transition him to a sleep sack.

Hope this works!

Eileen Tyrala, MD FAAP
Medical Director, Cribs for Kids®

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August 12, 2013
Subject: Grandson

QUESTION: Hello. My grandson pounds his face into his mattress when it’s time for him to go to sleep, sometimes for hours. It looks so painful. Could you hopefully help me to understand why he does this?

ANSWER:  Thank you for your question. It is difficult for me to answer your question without more information and without actually seeing the baby.   My best recommendation is to have his mom or dad bring this to the attention of his pediatrician. In this way the behavior can be evaluated in the context of a broader history and the overall developmental status of the infant.

Best regards,

Eileen Tyrala, MD FAAP
Medical Director, Cribs for Kids®

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August 8, 2013
Subject: 4Moms Breeze

QUESTION: My wife and I are thinking of using the 4Moms Breeze as our main bassinet. Do you know if the bassinet attachment for the Breeze will be suitable for firmness and safety?
http://www.amazon.com/4moms-4M-009-01-000601-Breeze-Playard/dp/B0088JRAFI

ANSWER:  Thank you for your question. When I clicked onto the link in your email, I was shocked to see how expensive the Breeze Playard is! $299! The item looks very much like a Pack ‘n Play which is a lot less expensive. The other feature of the Pack ‘n Play which makes it very attractive to me  is that Graco has a patent on the locking device for the railings. We know it to be an extremely reliable product for which there have been no reports of the railings collapsing as there have been with similar products. I do not know if this has ever been an issue with the Breeze Playard. You could check with he Consumer Product Safety Commission to see if they have any reports of problems with this particular unit.

To answer your question specifically, however, the bassinet area looks fine with regards to firmness of the sleeping area and openness of the sides. I would recommend, however, that you go with the Pack ‘n Play which has a stellar record for safety.

I hope this has been helpful.

Best regards,

Eileen Tyrala, MD FAAP
Medical Director, Cribs for Kids®

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July 26, 2013
Subject: Baby Hitting Head

 

QUESTION: My 7 month old is crawling and pulling herself up to stand. When I put her in crib to nap or sleep at bedtime she pulls herself up constantly. Atleast a couple times before finally sleeping. My problem is she keeps falling and hitting her forehead and face constantly. I’m worried about the head hitting as I read it could cause problems later without thinking another thing about it. She hit her head 2 times today on crib and crawling in living room and I’m worried sick but she seems fine. I started putting her in the pack n play instead of letting her crawl around the floor and pull up on furniture but i dont want to trap her up in it constantly. I’m not sure if I just need to let her sleep in there instead of crib. Also I just switched ftom breathable bumper to normal one hoping it would help but doesn’t. I just want to be sure she will be ok because she is so active.

ANSWER:  It sounds as if your baby is very active and I bet will crawl and walk very early!

A 7 month old, however,  should not be able to pull herself up very high in the crib, so any “fall” (if I would even call it that) would be very minor and should not be of any concern for injury. The bumper on the other hand is a real cause for concern as we know that babies once they start to move around can get their nose and faces stuck up against and into bumpers  which can cause suffocation. I would strongly recommend that you remove the bumpers from your babies crib! If you are still concerned about her hitting her face then the Pack N’ Play should solve that problem.

It is not necessary to always keep your infant confined  but as you are learning, babies do require  constant watching to keep them out of harms way!

Best of luck to you!

Eileen Tyrala, MD FAAP
Medical Director, Cribs for Kids®

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July 21, 2013
Subject: Sleeping in a Halo Sack

QUESTION: Is it safe for a baby to sleep in an arms free halo sack if they are rolling over?

ANSWER: Thank you for your question. It is absolutely safe for an infant to sleep in a Halo Sleep Sack whether they are rolling over or not. The Halo Sleep Sack offers all of the advantages of providing both warmth and an uncluttered sleep environment for an infant. Both I and  Cribs for Kids endorses its use.

I hope this has been helpful,

Eileen Tyrala, MD FAAP
Medical Director, Cribs for Kids®

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July 20, 2013
Subject: Rock ‘n Play

QUESTION: Can my baby sleep at night in a rock n play? It has a slight incline but I’ve read that thi is good for baby to keep them fromn gagging or if they have acid reflux.

ANSWER:  Thank you for your question. I do not recommend the Rock N’ Play as a place for an infant to sleep. This product actually was recalled by the Consumer Product Safety Commission last year but not for the reason that I object to it. (It was recalled for a mold problem).

Babies are not meant to sleep on an incline. They do not have the muscle tone and strength in their upper body to support themselves and their neck in particular and could develop an obstructed air passage as a result. In addition, the sides of the Rock ‘N Play come very close to the sides of the baby’s face. As soon as the baby is capable of moving at all, this could create a potential suffocation risk. In addition  the legs of the product can easily be dislodged by a passing human foot or animal (dog), causing it to collapse. Hence, I do not consider the Rock ‘N Play a safe place for an infant to sleep.

Unless an infant has severe (and I mean severe aid reflux), the inclined position for sleeping carries with it far more real hazards than any potential benefits.

I hope this has been helpful,

Eileen Tyrala, MD FAAP
Medical Director, Cribs for Kids®

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July 14, 2013
Subject: Safety of Pack ‘n Play

QUESTION: Are there any statistics that indicate a full size crib is a safer option for families than a Pack ‘n Play?

ANSWER: I do not know of any studies that show that full-sized cribs are safer than Pack ‘n Plays and vice versa.  The important thing to remember is that a baby should be on its back in an uncluttered crib (or Pack ‘n Play).  In the past many cribs were recalled due to deaths occurring because the crib was not assembled properly and babies were becoming entrapped (especially in drop side cribs).  Around that same time the American Academy of Pediatrics came out with the directive that babies should room share with the mother but not bed share.  The Pack ‘n Play was then adopted by Cribs for Kids as our ‘crib’ of choice  to alleviate the problem of improper assembly resulting in deaths and also because of its size which fits next to the Mother’s bed in the same room.  If used properly (using the mattress that comes with the unit and not putting the baby on soft bedding on top of the mattress) it is as safe as a full-size crib.  Taking into consideration the human error factor in assembling a full-sized crib, we believe the Pack ‘n Play is safer.

I hope this has been helpful,

Eileen Tyrala, MD FAAP
Medical Director, Cribs for Kids®

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July 12, 2013
Subject: Pack ‘n Play sheets

QUESTION: I’m curious about the quilted sheets that are sold for the pack ‘n play. Everything I’ve read says to use firm surfaces and that the idea of soft bedding is a learned comfort, yet they sell a fitted sheet for the pack n play that is quilted. They also sell regular fitted sheets for it. Is it safe to use the quilted one or should I stick with the basic sheet? Thank you!

ANSWER: I would suggest that you stick with the regular fitted sheets and stay away from the quilted ones.  It is all about the perception that something that is quilted is softer which  makes it more comfortable and therefore  better than something that is perceived as being less soft!  If the baby is never exposed to anything other than a firm sleeping surface she or he will never know the difference! I would stick with old reliable and not take any chances!

I hope this has been helpful.

Eileen Tyrala, MD FAAP
Medical Director, Cribs for Kids®

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July 3, 2013
Subject:  Crib vs. Playyard

QUESTION:  I recently purchased a pack n play with a bassinet attachment for my new born to sleep in. she’ll be next to me for the first few months and then in her own room afterwards. Her room was a guest room previously so it’s already furnished. To save space, is it a good idea to use the play yard as a crib until she is old enough to sleep in the bed? Is an actual crib necessary?

ANSWER:  Thank you for your question. The Pack ‘n Play can safely hold a child up to 30 pounds. It is perfectly fine to keep your child in the Pack ‘n Play until they reach that size. It is really up to you if you want to go through the crib stage but she should be fine to transition from the Pack N, Play directly to a toddler bed.

I hope this has been helpful.

Eileen Tyrala, MD FAAP
Medical Director, Cribs for Kids®

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June 30, 2013
Subject:  Pet crib protectors

QUESTION: I am a prenatal class instructor, and you have helped me in the past.  I had a question about cats and keeping them out of a crib in first aid class.  Also, if tents sold commerciallly for this purpose are safe to use over a crib? I did not have any information other than to refer the couple to CPSC website for recall information.

ANSWER:  Thank you for your question. It is not a good idea to ever allow a cat to have access to the sleeping area of a baby.  As a cat is capable of jumping up onto the crib railing and then into the crib where the baby is either sleeping or will soon sleep, it is either a hazard for safe sleep if the cat’s body were to come in contact with the baby’s face,  or a sanitation risk if cat feces were to be deposited in the bed!

Cats can be heavy, so ordinary mesh products designed to keep out insects or rodents would not be helpful.

I have no personal experience with the tents that you are describing and that I have seen on line. One question that I would have is would the mesh on the slanted  “roof” of the tent hold a 12  pound (or more) cat or would it cave in? Ventilation issues are always crucial as well. As I don’t think there are definitive answers to any of these questions, I would recommend that the cat not be allowed in the baby’s room at all!

I hope this has been helpful.

Eileen Tyrala, MD FAAP
Medical Director, Cribs for Kids®

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June 26, 2013
Subject: Vibrating Bassinet

QUESTION: is it safe for infants to sleep in a vibrating bassinet or chair?  My 2 week baby won’t sleep if she doesn’t feel the vibration.

ANSWER:  Thank you for your question. I would have no problem with the use of a vibrating bassinet for your daughter if it helps her fall asleep. Remember, babies can get very dependant on these types of sleep aids and she may have trouble adjusting to a non-vibrating sleep environment when she can no longer sleep in the bassinet!

I would not place her in an infant chair for sleep, however, vibrating or not. She is far too young to be able to be placed safely to sleep  in any position other than flat and on her back. Babies at her age lack the necessary muscle strength and tone to be able to keep themselves in an upright position. This would make it harder for her to breathe, something we certainly don’t want!

I hope this has been helpful.

Eileen Tyrala, MD FAAP
Medical Director, Cribs for Kids®

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June 24, 2013
Subject:
Raising the Level of the Cot

QUESTION:  Hi there, I have a cot that does not have an adjustable base. Can you tell me whether it would be okay to use extra pieces of firm foam (the same size as the mattress) under the mattress to heighten the level of the mattress?

Thank you

ANSWER:  Thank you for your question.  I am not sure, however, what situation you are describing. What do you mean by “a cot without an adjustable base”. Is this a sleeping arrangement for an infant or an older child? Please send me more information about this particular sleeping product and who it is intended for and I will be happy to try to answer your question.

I hope this has been helpful.

Eileen Tyrala, MD FAAP
Medical Director, Cribs for Kids®

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June 14, 2013
Subject: Stuffed animal in crib

QUESTION: My son is almost one year of age and my pediatrician does not suggest letting him sleep with a stuffed animal even at the one year mark. He is very healthy and active, so this recommendation is very confusing to me. During the night he still wakes up once or twice, and I’ve been having to wait until he falls back asleep each time to remove his stuffed animal because he clutches it so tightly for comfort. Is my pediatrician just being overly cautious for reasons of malpractice  claims? She refuses to even give me a timeframe when my child can start keeping a stuffed animal in bed. Please help, I am beyond exhausted from the long nights and constant worrying

ANSWER:  Thank you for your question.  Let me start out by asking you a few questions about your son. Does he have any medical problems or developmental issues that might make your pediatrician more conservative in her recommendations to you about his sleep environment?  She obviously knows more about him than I do and it would be inappropriate for me to make a recommendation without knowing all of the facts!

Generally, however, I do not see any problem with a reasonably sized and weighted stuffed animal being in the same sleep environment with children aged one year and above. I would urge you however, to go back and discuss this issue again with your pediatrician at the one year visit.

I hope this has been helpful.

Eileen Tyrala, MD FAAP
Medical Director, Cribs for Kids®

________________________________

June 14, 2013
Subject: Sleeping Safety

QUESTION:  Hi, I have a 3 month old (15 weeks) baby girl and we are currently using the Graco Pack ‘n Play for her to sleep in regularly. She is very active, always rolling onto her belly while sleeping, and scooting around on her belly. And I was wondering if this is safe place for her to be sleeping even though she is rolling. I don’t have any lose bedding, stuffed animals in there with her, and I always put her to sleep on her back. But I’m worried about her moving to the sides of the playpen and shoving her face in between the mattress and the fabric that is attached to the mesh. Should I be worried? or should I buy a crib for her?

ANSWER:  Thank you for your question. It sounds as if you have a very active baby who is demonstrating wonderful motor skill!  Because of her abilities, it is especially important that all of the principles of safe sleep be followed as it is when babies start to move around that they can get themselves into some real predicaments in their sleep environments.

I would not worry, however, about the Pack ‘n Play. To date there have not been any reports that the interface between the mesh and fabric in the Pack ‘n Play poses an environmental hazard  for sleeping infants. If you are  worryed about this, however, then you should consider switching over to a crib.

I hope this has been helpful.

Eileen Tyrala, MD FAAP
Medical Director, Cribs for Kids®

____________________________________

 

June 7, 2013
Subject:
 My Baby Granddaughter

QUESTION:  I have four grand children, the youngest just turned 12 months old this Tuesday just past. She was only a week early born, although breech including foot out and emergency caesarian but all ok 5lb 5 oz.
She has not developed at a fast rate, could not suckle well, seemed to have poor muscle tone until about 8 months of age, she is a delightful little girl and can happily stand on tip toes or outward splayed feet in her play chair etc.. I’m concerned as I care for her three or four days a week and although she is now ‘bumming’ it along the floor..she will not and cry’s when you put her on her tummy..seems it’s hard for her to get up on all fours..can’t seem to fall forward from bum/sitting to all fours etc and cannot pull herself up from lying on back in the cot..she can spin around using one leg to pull herself around and arching her back etc but will not or cannot reach over and grab cot rails nor pull herself up..she will just lay there and spin on her back etc I’ve tried encouraging her to lean over from her back and entice with toys etc but she gets frustrated and really seems like she ‘cant’ rather than wont attempt to grab and pull herself up etc..any thoughts or offerings would be helpful.

ANSWER:  
From your description, it sounds as if your granddaughter has not achieved some developmental milestones that would have been expected by now. If you have not done so already, I would encourage you to share your concerns with your daughter. The next step is for your daughter to bring these concerns  to the attention of her baby’s doctor or health care provider. If the baby is receiving regular check-ups, I would imagine that the health care provider is already concerned about these issues as well. These features are readily demonstrated on physical examination and are also usually elicited from routine developmental questions that are asked at the time of each visit.  If all of these findings are confirmed, the next step would be a referral for early intervention services for a complete developmental evaluation and or other evaluations as deemed appropriate.

I hope these suggestions have been helpful.

Eileen Tyrala, MD FAAP
Medical Director, Cribs for Kids®

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June 5, 2013
Subject:  Rock and Play Sleeper

QUESTION: Is the rock and play sleeper good for overnight?

ANSWER: I do not recommend the use of the Rock and Play sleeper, day or night.  Although the product was recalled by the Consumer Product Safety Commission in January of 2013 for a mold problem, I have many other objections to its’ use as a sleep environment for infants. The Rock and Play keeps the infant in a semi-reclined position, not flat on their back. Many infants lack the necessary tone in their upper body to keep them upright while in this position and they may end up  with the neck and trunk slumped forward. This position can compromise the airway making it harder for a baby  to breathe.

In addition, the upright position puts more pressure on the baby’s abdomen, also making it harder for them to breathe.

 The sides of this device  come very close to the infant’s face. Once the child is minimally active they may be able to get their face too close to the soft cushy side wall of the product, creating a suffocation risk. I am also aware of a case where an infant was able to flip himself over while in the device and suffocated in the face down position.  

I would choose another type of sleep environment for your baby such as a safety approved crib or the Pack ‘n Play.

I hope this has been helpful.

Eileen Tyrala, MD FAAP
Medical Director, Cribs for Kids®

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June 5, 2014
Subject:  Standing in Crib

QUESTION:  I have a 7 month old who just discovered holding onto the crib rails and standing up. She stands for awhile and then falls when she gets tired.  Does this mean I need to put the mattress on the lowest level? Are there any guidelines on a baby’s safe height over the crib rail?  My concern is both her falling out if the mattress is too high and also hurting herself on the rails if I the mattress is too low? What is the safe point?

ANSWER:  Thank you for your question. Once an infant is able to stand (as your baby is obviously already doing), it is time to lower the mattress to the lowest level.  Once a child is over 35 inches ( a height which is generally not achieved until they are between 30 and 36 months of age) you must move them  to a toddler bed as the child is probably capable of climbing out and the crib is no longer a safe environment for them. If the child climbs out before he or she is this tall, it is time to move them out anyway, regardless of their height! Although it is true that an occasional baby’s arm or leg has been known to drift through the rails of a crib, get stuck and cause a bruise, this is unlikely and generally would only cause a minor injury. The crib is the safest place for your baby to be!

I hope this has been helpful.

Eileen Tyrala, MD FAAP
Medical Director, Cribs for Kids

___________________________________

May 26, 2013
Subject:  Sheets and Pads for Play Yards

QUESTION:  Like many of the parents on your site, I am planning to use a Pack and Play in my room as the initial sleeper for my newborn son. What I am stumped about is what kind of sheets/mattress pad is necessary or appropriate. I had looked at an organic quilted mattress pad to protect the play yard from messes and the baby from whatever plastics, etc. are in the play yard. But it is probably unnecessary and perhaps too squishy for safe sleeping? Another possibility would be to place two fitted sheets on the regular play yard mattress so that one could be removed easily in case of a mid-night mess. Any thoughts on that? Or alternatively, placing a thin diaper cloth under the tight play yard sheet, again to protect both?

Your thoughts would be appreciated, as I can’t find any professional recommendations on this anywhere.  Thanks

ANSWER:  The best thing to do with the pack and play is to purchase the fitted sheets specifically for the pack and play and only use one.  A pad or extra pads/sheets can be too soft or as you said, squishy.

If the baby spits up, it is very easy to change the sheet—so buy extras!

I wish you the very best as you prepare for your newborn son’s arrival. 

I hope this has been helpful,

Eileen Tyrala, MD FAAP
Medical Director, Cribs for Kids®

_____________________________________

May 16, 2013
Subject:  Mesh Crib Bumpers

QUESTION:  I understand the risk of fluffy crib bumpers, but what are your thoughts on the mesh crib bumpers? I’m planning on putting baby in a Pack ‘n Play in my room for the first 4 months and then moving to a crib in the nursery. Are the mesh bumpers safe? Necessary? Also, is the safest sleeping material a sleep sack that is the correct size? I’ve read all of the questions here and it seems there is some risk involved with swaddling, but not much (besides improper sizing) with the sleeper sacks. Thank you!

ANSWER:  Thank you for your question. The official pronouncement from the 2011 American Academy of Pediatrics Task Force on SIDS risk reduction, recommended that bumpers should no longer be used in cribs. This would include the mesh ones. They reviewed all of the available data on the topic and came to this conclusion alter a comprehensive review of all of the current and relevant information. I would not stray from this advise and recommendation and not use any type of bumper for your crib. Your baby will be fine.

I think your assessment of the situation with swaddling and sleep sacks is correct. If swaddling is not done correctly or used for a baby who is capable of flipping over, it can be hazardous.  If done properly and only for younger babies (under 2-3 months of age) I still recommend it.

The sleep sacks would appear to have few if any  hazards. unless, as you say, the infant is placed in an oversized garment.

I hope this has been helpful.

Eileen Tyrala, MD FAAP
Medical Director, Cribs for Kids®
___________________________________

April 15, 2013
Subject:  Used Pack ‘n Play

QUESTION:   Is it OK to buy a used pack n’ play or can this increase the risk of SIDS? Thank you in advance.

ANSWER:  Thank you for your question. Generally we say no to the use of second hand cribs because of the issue of recalls, lost instructions, screws, hardware, etc.  The Pack ‘n Play is different, however. There are no hardware issues so nothing can be lost and the instructions are written on the bottom of the product. Assuming it is in good condition, without rips or tears and the locking mechanism that keeps the rails in place is in good working order, I can’t see why it wouldn’t be OK to use it.

I hope this has been helpful.

Thank you,

Eileen Tyrala, MD FAAP
Medical Director, Cribs for Kids

___________________________________

April 8, 2013
Subject:  Sleep in Pack ‘n Play

QUESTION:  : I am currently pregnant with my second child. I’m debating buying another crib for this baby. I plan on allowing the baby to sleep in a pack and play in the raised setting or in the bassinet attachment until th child can roll over or needs to be lowered. When the time comes that they would need to be lowered is it still ok to allow them to sleep in the bottom of the pack and play? Is it ok to allow them to sleep in pack and play instead of a crib 100% of the time until they move into a regular twin bed? Is it firm enough? Safe? Any issues?  I ask because my first son sleeps very well. Naps great and slept through the night at 1 month. But when we travel or are away from home during naptime he doesn’t sleep good because he’s not in his crib. So if I can make the pack and play the typical sleeping spot it will make nap time away from home easier.

ANSWER:  Thank you for your question. Yes, it is totally fine to use the Pack ‘n Play as your baby’s exclusive sleep environment until he exceeds the 30 pound upper eight  limit! The pad in the bottom meets all of the safety recommendations for sleep surfaces for infants and the unit is officially approved for use by the US Consumer Product Safety Commission.

I hope this has been helpful.

Thank you,
Eileen Tyrala, MD FAAP
Medical Director, Cribs for Kids

____________________________________

April 8, 2013
Subject:  Rock n’ Play & Newborn Napper

QUESTION:  Hello, I have found the information you’ve posted regarding sleeping options very helpful! My question is about napping in either the Rock ‘n Play or Newborn Napper that came with my Pack ‘n Play. I understand that the best sleep environment is obtained with the baby sleeping flat on a firm mattress. I have read that it is helpful to separate daytime sleeping environments from the nighttime environment. My child will be sleeping in her Pack n’ Play for nighttime sleep up to the first year. My question is about where she should sleep the rest of the time…Is it okay to use the Rock n’ Play or Newborn Napper for daytime sleeping or would you recommend using the Pack n’ Play itself 100% of the time?  Thanks in advance!

ANSWER:  Thank you for your question. If you already have a Pack ‘n Play, I would use that exclusively for sleeping, nap time or overnight sleeping. It is approved by the CPSC as a safe sleep environment for infants and has a strong track record for safety.  In looking at the Newborn Napper, I would be concerned that it is too small of a sleep environment and that the infant could easily get too close to its’  “cushy” sides. The manufacturer’s description of it actually highlights its “soft cushy fabric” which is something we are trying to avoid in an infant sleep environment! Hence, I would not recommend this product either.

I do not recommend the Rock n’ Play at all. Fatalities have been reported with its use.

I hope this has been helpful.

Thank you,
Eileen Tyrala, MD FAAP
Medical Director, Cribs for Kids®

______________________________________________

March 31, 2013
Subject:  Lowering a Crib Mattress

QUESTION:  I am a nurse and Childbirth educator. I received a question by one of my parents recently and have not been able to find an official answer on the internet. Is there an age guideline or developmental guideline as to when to drop a crib mattress down for infant safety, and what would the measurement from the top of the crib rail be? I know drop side cribs are unsafe, but I believe that cribs currently on the market have the capability for the mattress to be at several levels.

ANSWER:  Thank you for your question. The answer  is related to the acquisition of specific developmental milestones by the infant. Once an infant is able to sit, which generally occurs between 5 and 7 months, it is time to lower the mattress to at least the next lower level. When an infant is getting ready to stand, which generally occurs between 8 and 9 months of age, it is time to lower the mattress to its’ lowest level. Once a child is over 35 inches, a height generally not achieved until they are between 30 and 36 months of age, you must move them to a toddler bed. At this height, the mattress can no longer be adjusted to assure that the child cannot climb out and the crib is no longer a safe place to be. If an infant has superior motor skills and shows signs of being able to climb out before this height is reached then it is time to move them to a toddler bed as well.

I hope this has been helpful.

Thank you,
Eileen Tyrala, MD FAAP
Medical Director, Cribs for Kids®

____________________________________

March 26, 2013
Subject:  Heated towel under fitted sheet

QUESTION:  Hi, I was wondering what you thought about the idea of heating a towel in the dryer for about 20 mins and placing it under the fitted sheet in a crib before putting baby to sleep. My son is six months and always cries when we put him in his crib before sleep. We heard about this idea and tried it and he sleep through the night. Any harm in this technique to warm the crib and baby during those cold winter months? Thanks!

ANSWER:  Thank you for your question. The whole issue of what is a safe  sleep surface for an infant relates to the firmness or distensibility of that surface.  Scientists have actually defined this and for a bedding surface to be considered as safe for an infant, it must have a low distensibility index.  The idea is that any surface that allows an infant to “sink” into it makes it harder for the baby to lift his face up and away from that surface, increasing his risk of suffocation. Even if an infant is properly placed on his or her back for sleeping, at some point they will turn over. This is a normal developmental milestone that occurs between 4 and 6 months of age. If their neck muscles are not strong enough to allow them to lift their head completely out of the way, particularly if the surface is too distensible, it can increase their risk of suffocation. (This is one of the reasons that Tummy Time is stressed so much !)

I don’t know how much you’re placing the towel under your son changes the firmness of his sleep surface, so I cannot officially recommend this practice. As an alternative, could you warm up the fitted crib sheet in the dryer and possibly achieve the same effect?

I hope this has been helpful.

Thank you,
Eileen Tyrala, MD FAAP
Medical Director, Cribs for Kids®

_____________________________________

March 24, 2013
Subject:  Newborn sleeping on vacation…

QUESTION:  We’re going on vacation in two weeks. Our youngest is only going to be 2 months. I purchased a rock n play sleeper for her to sleep in on the trip, but now I see it’s not recommended. I only plan on using it at night; probably for about 5/6 hours. Is it still a problem? Everything I’ve read says “16” hours.  Also, our drive is 17 hours. We will not be stopping.  will she be okay in her seat that long? We will be stopping for feedings, but not stopping overnight. We will be leaving around 6pm and arriving around like 10am or so.   I’m just paranoid cause someone told me carseats raise the SIDS risk.   Thanks in advance!

ANSWER:   Your instincts are correct.  The napper is not recommended by Cribs for Kids.  The safety of that feature has not been proven.  Your baby would outgrow it in a short period of time, also.  The ‘Day 2 Night’ system is also not recommended.  You are so correct.  The padding surrounding the bassinet is basically a bumper pad which, as you might know, are not recommended by the American Academy of Pediatrics.

What we do recommend is the Graco Pack ‘n Play with the bassinet feature which can be viewed at http://cribsforkids.org/safe-sleep-products/ .  The bassinet feature on this unit is made of mesh and your baby can sleep in it up to 15 pounds.  Once the bassinet is removed the mattress can be put on the bottom of the P’nP and your baby can use it until 30 pounds and 35 inches tall.  It can also be found at retail stores in a variety of patterns and colors. 

I hope this has been helpful.

Thank you,
Eileen Tyrala, MD FAAP
Medical Director, Cribs for Kids®

_____________________________________

February 24, 2013
Subject:  Leg Caught

QUESTION: My daughter is 15 months old and recently discovered climbing. We have her mattress set at the lowest setting however, yesterday evening she tried to climb out of her crib. She hadn’t even been in her crib for one minute before I heard her screaming and crying. When I got there she gotten her leg caught in between the top two horizontal bars. Thankfully she fell back into the crib and ths mattress caught her. If she had gone the opposite way I can only assume her leg could have been broken among other things. She was not injured just a small bruise/sore area.

ANSWER:  Thank you for your question and concern about the safety of the crib that your daughter is using.

The US Consumer Product Safety Commission is the appropriate place to report this. They have a toll free hotline at 1-800-638-2722 where injury reports related to consumer products are taken (8-5:30 PM ET) . They also have a website (www.Saferproducts.gov) where you can not only report the incident but where other consumers can see your information as well.

I hope this has been helpful.

Thank you,

Eileen Tyrala, MD FAAP

Medical Director, Cribs for Kids®

________________________________________

February 23, 2013
Subject:  Blankets as a Base on Mattress

QUESTION: If my child is a big baby who seems to be developmentally further along at 22lbs 30 inches but still under 1 year of age, is it still important not to have blankets under him while he sleeps in the crib? We place some blankets between him and the mattress for added warmth. He cries whenever he rolls onto his stomach so we feel it should be fine. What do you think? He can crawl as well.

ANSWER:  From your description of your baby’s motor skills, it sounds as if he is between 7 and 8 months of age. Although the peak risk of SIDS and SUID deaths is between 2 and 4 months, there are still enough babies who suffocate in their sleep environment beyond that age that I don’t think you should be letting your guard down with regards to creating a safe sleep environment for him. Remember, the  more active he gets, the more he can get himself into spaces and positions you never  thought possible! He might even be able to pull the blanket up and around his face and not be able to move away from it creating a suffocation risk.  I would remove the blankets from underneath him and keep him on a firm, flat surface until his first birthday.

I hope this has been helpful.

Thank you,

Eileen Tyrala, MD FAAP
Medical Director, Cribs for Kids®

________________________________________

February 21, 2013
Subject:  Sister is Sleeping with Baby

QUESTION: My sister has a four week old beautiful baby girl. I am concerned because my sister sleeps in a rocking chair (it is a very large leather reclining chair) with the baby on top of her. Is this safe? She will not listen to advice and says she does it to make it easier to nurse. They have slept like this every night since getting home from the hospital. I don’t want to overstep my bounds but I have a feeling this isn’t very safe. Am I wrong, is this an okay sleeping situation? If not what are some reasons I can tell her it’s bad to get her to put her in the crib?

ANSWER:  I certainly understand your concern about the sleeping arrangement that your sister has chosen for her new baby. This is  unsafe on so many levels! First of all, the baby is in real danger of falling onto the floor. I have seen this happen many times with disastrous consequences for the infant (fractured skull!).

More commonly however, the baby is at risk because she is on her stomach and could get her face wedged in her mother’s chest or breasts and wouldn’t be able to breathe. I have seen this happen in the hospital setting with fatal consequences. If mom or baby were to move at all, the baby could fall down and get wedged in a crevice in between mom’s body and the arm of the chair. This could  lead to the baby getting crushed and/or being unable to find good air to breathe and dying as a result.

Please do everything that you can to discourage your sister from this practice. As this could be a difficult situation for you, what if you ask her to discuss it with her pediatrician or whom ever she takes the baby to for well child care. If you think that I can be of help in any way, please do not hesitate to get back to me.

I hope this has been helpful.

Thank you,

Eileen Tyrala, MD FAAP
Medical Director, Cribs for Kids®

________________________________________

February 21, 2013
Subject:  Baby Active in Sleep

QUESTION: Hi my 6 month old is very active in her sleep and has been for the last 2 months.  She is very strong and started crawling already.  She constantly rolls over, kicks her legs, waves her arms around, and even crawls around in the crib in her sleep – so she is constantly waking up (and waking us up!) every 1-2 hours.

The only was we have found to stop this is to put her on her back  on a pillow, where she is nice and snug and then she is able to sleep for 10-12 hours without waking herself up (apart from the need for her pacifier every now and then).

Is there an alternative to a pillow?  We are so worried about her sleeping on the soft pillow but whenever we try and move her on to the crib mattress (and we have tried at various times during the night) she is waking herself up all over again, no matter what position she sleeps in.  She is fine on the crib mattress for her 45 min naps during the day (although she will only nap lying on her side).

ANSWER:  Wow, it sounds like you have a very precocious and active baby! I bet she walks by nine months!

Unfortunately I cannot endorse the use of a pillow as a sleeping surface for her. Precisely because she is so active, she could end up in a very compromised position, either from turning on to her side or even flipping herself over into the pillow, compromising her ability to breath.

I have a few suggestions for you on how to get her to settle down, however. First of all, if she is still in your room, move her to her own room. You may want to acclimate her to the new environment during her day time naps and then try moving her for her night time sleeps. Having other people in the room can be very distracting to a baby who is trying to sleep!

Make sure her sleeping room is dark. Light stimulates the brain to arouse. Prior to bedtime, you may want to dim the other lights in the house to prepare her for sleep.

Try a soothing bath and massage prior to bed time. If these activities energize her, then it is not good idea but it is worth a try!

Make sure all potential sources of noise in her environment are turned down or off such as video games, TV, etc. Try using some type of white noise in her room such as static from a radio at about the sound level that a light shower would make. There are also white noise CD’s and even mobile phone apps that play white noise (highly recommended!). The idea is that we want her to associate sleep with the soothing sound. Even if she wakes up, she hears the soothing sound and associates that with sleep.

I recommend that you take a look at the book, “The Happiest Baby Guide to Great Sleep” by Dr Harvey Karp. Although I don’t agree with everything he recommends (he says it is OK to swaddle up to  7 months of age which I vehemently disagree with!) and even worse, he says it is OK to bed share after 4 months of age (DEFINITELY NOT!!!) . With that aside, he does have a number of helpful hints and suggestions about helping babies to fall and stay asleep!

I hope this has been helpful.

Thank you,

Eileen Tyrala, MD FAAP
Medical Director, Cribs for Kids®

________________________________________

February 9, 2013
Subject:  Swaddling

QUESTION: Is swaddling recommended or should one swaddle their infant?  If so until what age should you stop swaddling an infant?

ANSWER:  Thanks for this important question. I do recommend swaddling as  a great way to soothe an infant, although not all babies need  or want it!   I  routinely show all of my new mothers how to correctly swaddle their infant if it is a technique that is helpful and works for them.

Swaddling should no longer be done, however, when a baby develops sufficient motor skills that would allow them to roll from their back to their stomach. Very few babies do this before four months of age. HOWEVER, to be on the safe side, I would not recommend swaddling past 2 1/2 to 3 months of age.  A swaddled, face down infant is in an extremely compromised position that would make that infant at very high risk for suffocation.

I hope this has been helpful.

Thank you,

Eileen Tyrala, MD FAAP
Medical Director, Cribs for Kids®

________________________________________

January 19, 2013
Subject:  Reflux and Safe Sleep

QUESTION: I am a nurse in a NICU and have been working on promoting safe sleep positioning. The main issues I am encountering involve positioning of infants with complex conditions that have required surgery such as tracheoesophageal fistulas, gastroschisis or congenital diaphragmatic hernias. Often they have significant reflux and the surgeons want them at a 30-45 degree elevation. Do you have a safe recommendation to achieve this at home? Is there any evidence that this angle improves reflux for these infants?

ANSWER: You are describing some of the most complex groups of infants whom we care for in neonatal intensive care units. As you know all too well, they also present some of the greatest care challenges! Pre-op, because the infant’s stomach contents may have direct access to the lungs if a distal fistula is present, it is standard practice that the infant be placed as upright as possible prior to surgery. If surgery cannot be done relatively soon after the diagnosis is made, a gastrostomy tube may even be required to drain both air and gastric contents from the stomach to prevent further complications.    Post-op. however there is not good evidence to show that placing the infant at an elevated angle decreases reflux and it may actually increase it.  It goes without saying, however that each infant’s care must be individualized.  In addition, what works in the NICU may not work in the home environment where the infant will not have professional nurses watching him or her every minute of the day and night. The use of any position other than the supine, flat position will carry with it an increased risk of a SIDS/SUID type death. The possible advantage of another sleeping position in the home environment must be carefully weighed against these known risks and hazards. My opinion is that in general, before the infant is discharged to home,  the baby should be able to tolerate a supine and flat sleeping position.

I hope this has been helpful.

Thank you,

Eileen Tyrala, MD FAAP
Medical Director, Cribs for Kids®

________________________________________

January 18, 2013
Subject: Pack ‘N Play vs. Crib

QUESTION: We are considering using a Pack ‘N Play solely as our new babies bed until she goes into her toddler bed.  We used a crib with our first, and then turned it into a car for the toddler bed.  I have been trying to do some research on this subject as to whether or not it would cause any kind of back problems.  I thought asking a pediatrician would help.

ANSWER: Thank you for your question. There is no problem using the Pack ‘N Play as the primary sleeping surface for your baby until the upper weight limit of 35 pounds is reached or until he or she can climb out. I have never heard of any back problems in infants who sleep in the Pack ‘N Play until they graduate to a toddler bed.

By the way, I recommend keeping babies in cribs for as long as possible because at least, you always know where they are!

Hope this has been helpful.

Thank you,

Eileen Tyrala, MD FAAP
Medical Director, Cribs for Kids®

________________________________________

January 11, 2013
Subject:  Pack ‘N Play vs. Crib

QUESTION:   The Pack ‘N Play unlike his crib mattress is really hard and we don’t want him in his crib yet because I am still Breastfeeding all throughout the night and his room is far from our bedroom… Is that okay to not have large blankets on the bottom of his play n pack despite the cold temperature down there low in the Pack ‘N Play and the very hard mat that’s in the play n pack?  I’m worried about him overheating or it being too soft with him on top of the blankets, but at the same time, I am worried about the mat in the play n pack being too hard, and it being too cold without the blankets as a pad beneath him.  I am not using the blankets at all to cover him, he just sleeps in his sleep sack, on top of the blankets as pads, is this still not advisable?

ANSWER: I would not worry about the firmness of the sleeping pad in the Pack ‘N Play. Remember the baby does not know about soft bedding! That is learned behavior and preference. He will be fine!

If you think he will be cold, can you increase the temperature in the room? We recommend that the room be between 68 and 72 degrees.  Blankets as a primary sleeping surface or even underneath the mattress are not a good idea. The environment you want to provide for him is a firm sleep surface into which his body cannot “sink” at all! He must always have full access to good fresh air and never have that compromised. Hope this has been helpful.

Thank you,

Eileen Tyrala, MD FAAP
Medical Director, Cribs for Kids®

________________________________________

January 11, 2013
Subject:  Sleeping Safety

QUESTION:  My 2 month old who does not roll over yet sleeps in our room with us in his play n pack play pen at the bottom of it because he already passed the 15lbs top part limit. He’s a big baby.

My husband and I noticed that his hands get like icy cold at night down there so I put socks on his hands… Is this safe/okay?

Also we folded 2 very large blankets to make the base of the bed higher up for him. We placed these under him. Is this safe/ okay?

He sleeps on his back.  He also wears a halo sleep Sack.

ANSWER:  Thank you for your question. For the first part, yes, I think it is fine to put socks on his hands if they seem to be getting cold. That is a very good solution to that problem!

As for the second question, I don’t think that the blankets are a good idea. If he is sleeping on the soft blanket surface rather than the firm pad that comes with the Pack ‘N Play, the blankets are negating the protective effect of sleeping on a firm surface and are potentially hazardous.  I would not recommend doing this.

Hope this has been helpful

Thank you,

Eileen Tyrala, MD FAAP
Medical Director, Cribs for Kids®

________________________________________

January 07, 2013
Subject: Bassinets

QUESTION: Are bassinets safe for newborns if they don’t had mesh sides? Is there really enough airflow?

ANSWER: Thank you for your question. It is one that I have often wondered about myself.  Although many different products are called bassinets, each individual product can be very different, some with mesh sides, some without. Many newborns are placed in these types of smaller, more compact sleeping devices in the early months of life as they are readily adaptable to placement in a parent’s sleeping area, which a full size crib is not.

Most newborns are not able to move around in their sleeping area to any significant degree in the first two months of life. Once an infant shows signs of being able to do so however, (which for some infants may be before two months!) if the bassinet does not have mesh sides, I think it is time to place the infant in a sleeping environment that does not have any type of obstructive surface that the infant’s nose of face can come in contact with. This includes the stiff side of a bassinet.

Most bassinets that I have seen do not have mesh sides.  I agree with you that mesh sides on all bassinets would be ideal.

Thank you,

Eileen Tyrala, MD FAAP
Medical Director, Cribs for Kids®

________________________________________

January 06, 2013
Subject: Rock and Play Sleeper

QUESTION: My daughter has been leaving her newborn in the rock and play sleeper all day and night.  nap and bedtime. The baby is six weeks old and was born three weeks early and weighed 6 lbs 13 oz at birth.  She is currently 8.2 .  She can’t get the baby to sleep in the cradle. She and her husband said she fusses all night.  I have asked her to keep trying, but lack of sleep with new parents seems to gravitate them to whatever is easy.  I read the reviews and pros and con’s on this device and am very concerned.  At six weeks she had a normal check up, but my daughter didn’t mention the baby was still sleeping all night in this sleeper to her pediatrician. Early on the pediatrician recommended to slowly try and move her into the bassinet at night.   Is there a chance the development of her spine and neck has already been compromised?  If she stops using this for long periods of time now, will the baby develop normally since she is only 6 weeks old?  As a grandparent, I try not to be too pushy, but I have emailed her some of the articles and reviews.

Lastly, she has a medium size cradle but needs bumper pads to close off the open areas where spindles surround it.  I know the new guidelines deter bumper pads, but if the baby scoots or rolls and her arms and legs get caught in them, how safe is that?

ANSWER:  Hello, and thank you for your question. You are correct that we do not recommend that babies sleep on a regular basis in the rock and play sleeper. We prefer them to be flat on their backs in their own uncluttered crib or bassinet. However, that concern has nothing to do with the development of a baby’s spine or neck. You need not fear that there has been any damage or harm done to her because of the use of this device. Is she getting tummy time on a regular basis? I suggest that she be placed prone on a mat on a firm surface at least 4-5 times per day for 5-10 minutes at a time to exercise and strengthen her shoulder, arm and neck muscles. This is important for her development!

In answer to your question about the cradle and the spindles, the gap between the spindles should be no more than two and one half inches which is the width of a soda can. As long as the spindles are not any wider apart than this, she is not at any significant risk of injury. Although it is true that an occasional arm or leg could find their way through the spindle opening, it is too small of a gap for the head to fit through which is what we really worry about. The risk of asphyxiation with the use of bumper pads is the real threat and to be avoided at all costs!

I hope this has been helpful.

Thank you,

Eileen Tyrala, MD FAAP
Medical Director, Cribs for Kids®

________________________________________

January 5, 2013
Subject:  Baby Sleeping

QUESTION:  I have my baby in a sleeper bassinet.  He is 7 weeks old the other night I went to go check on him and he was turned on his side and his face was very very close to the side wall.  Do think this caused him to stop breathing at all in middle of the night and do u think I have to worry about brain damage?  When I felt his stomach he was breathing…

ANSWER: Thank you for your question. First of all, let me reassure you, that I do not think that anything bad happened to your baby and I am confident that he is fine!

However, even though he is only 7 weeks old, it  seems that he might be getting too big or is too active for the bassinet!  I would say that it is time to put him in a larger sleeping area, such as a Pack ‘N Play or a full size crib. Since it would be ideal if he could stay in your room until he is 6 months of age, I would suggest the Pack ‘N Play.

Thank you,

Eileen Tyrala, MD FAAP
Medical Director, Cribs for Kids®

________________________________________

December 12, 2012
Subject:  Hammock Sleeper

QUESTION:  I am a prenatal class instructor.  I recently had a question about Hammock sleepers for infants.  Since this is not a firm flat surface, my instinct would be that this would not be a safe environment, but I wanted to ask for specifics of known dangers of these.

ANSWER:  I would definitely not recommend the use of hammock sleepers for infants for the following reasons:

These devices foster positioning of the infant in a “curled up” position that can compromise infant respiration in a variety of ways.

First, infants primarily use their abdominal and diaphragm musculature for breathing.  Any situation or device that makes it harder for an infant to effectively use either of these muscle groups makes breathing harder. The “curled up” position that the hammock sleeper promotes makes the abdominal cavity smaller decreasing downward excursion of the diaphragm and hence limiting lung volume expansion. This position also limits the effectiveness of the abdominal muscles to increase thoracic volume, a vital part of the breathing process.

Second, depending on the stiffness of the material used to make the hammock, the infant’s nostrils could become pressed flat against the side of the device and create an obstruction to air intake right at the nostril. All of these factors are potentially extremely hazardous to the sleep environment of an infant!

Hope this answers your question.

Thank you,

Eileen Tyrala, MD FAAP
Medical Director, Cribs for Kids®

____________________________________

December 6, 2012
Subject:  Newborn Sleeping Environment

QUESTION:  I’m a first time mom and my baby is due during this winter and I’m curious to know, if it is safe for my baby to sleep on top of her comforter set to ensure more warmth???? Her mattress is firm n crib is safe.

ANSWER:  The answer is no, it is not safe for your new baby to sleep on top of her comforter. It is best to place her directly on top of a tightly fitted crib sheet which covers her crib mattress. The reason for this is that the comforter, by its’ very nature is soft and plushy. If she were to sleep on this type of surface and her face were to come in contact with it, it would be more difficult for her to lift her face and head out of the way to assure adequate breathing than if she were sleeping directly on a firm crib mattress. Sleeping on soft surfaces increases the risk of suffocation.

For warmth, I recommend the use of a blanket sleeper. They are great for keeping babies warm!

Best wishes for you and your new baby!!

Thank you,
Eileen Tyrala, MD FAAP
Medical Director, Cribs for Kids®

____________________________________ 

October 10, 2012
Subject:  Bassinette Verses Pack ‘n Play

QUESTION:  I was wondering what you recommend that the baby sleeps in while sleeping in our room for the first few months? As far as SIDS goes, are bassinets safe? Or as for a Pack ‘n Play, are they ok to use every night?

ANSWER: It is more than OK that the baby sleeps in the Pack ‘n Play every night. It is a very safe sleep environment as long as he/she is on their back and the sleep environment is not cluttered with pillows, blankets and stuffed animals!

Bassinets are generally regarded as safe but make sure that the sleeping surface in the product you choose is very firm. Also, be mindful that as the baby grows and begins to move around, it gets easier and easier for them to get closer to the sides of the sleep area where they could become lodged. Babies generally outgrow these sleep areas long before the weight recommendations are reached!

I hope this has been helpful.

Thank you,
Eileen Tyrala, MD FAAP
Medical Director, Cribs for Kids®

____________________________________ 

October 10, 2012
Subject:  Sleeping Habits

QUESTION:  I have a 7 month old baby girl. She was born in March of 2012 and I am currently pregnant again with a little boy who will be born this March of 2013! My 7 month old sleeps in a sturdy wood Graco crib next to my husband and I’s bed each night and during the days for naps. She loves her crib a lot and doesn’t put up a fuss if I lay her in it. But I have both a question and a concern: My question is she wakes up anywhere from 2 to 3 times a night for bottle feedings, will that change before my next babies arrival   and will she sleep throughout the night by the time she’s a year old and my concern is will it be ok to have 2 babies in 2 separate cribs sleeping in our room at night? I just don’t feel comfortable with letting my daughter sleep in a big old room by herself at a small age.

ANSWER: Thank you for your question. I would certainly hope that your current seven month old will be sleeping through the night by age one. Have you spoken with your pediatrician about ways of trying to extinguish these night time feedings?  She may just be getting up because she is aware that you are in the room and wants to get some attention.  Most of the time babies don’t actually need the food at night at this age but check with your pediatrician to see if that is the case with your daughter.  In these situations, I usually suggest  putting less and less volume  in each one of the bottles slowly over time (about two weeks) and see if you can extinguish her frequent night awakenings by having less and less of a reward for her each time she gets up. Ultimately she (and you) may sleep better if she is in her own room. I don’t think you want two babies waking each other up at night!

Thank you,
Eileen Tyrala, MD FAAP
Medical Director, Cribs for Kids®

____________________________________


October 05, 2012
Subject:  Bassinet vs. Pack ‘N Play

QUESTION:  Is mattress in bassinet safe for newborn baby sleeping?  People have told me that you can sleep the baby in the pack n plays, but they do not seem to be firm and have a material cover, is that safe?

ANSWER:  Let me start with the Pack ‘N Play. The sleep surface for the Pack ‘N Play meets all the requirements of a firm sleeping surface for an infant. (Many people complain it is too hard!) The cloth sheet that comes with it is designed specifically to fit snugly fit over the corners of the sleep mat, and when applied correctly, should not become loose bedding in the sleep area. I think the Pack ‘N Play is an ideal sleep surface for an infant. I am not sure I can say that about all bassinets as there are so many different varieties of them out there! What you should look for is a product that has an adequately sized sleep area for the baby (so the baby is not forced to be too close to the sides) and that it has a firm sleep surface. Because they are generally relatively small in sleep area, most infants outgrow them fairly quickly even if the upper weight limit for the product suggests otherwise.

Hope this has been helpful.

Thank you,
Eileen Tyrala, MD FAAP
Medical Director, Cribs for Kids®

____________________________________

September 9, 2012
Subject: Swaddling & Vibration

QUESTION:  Iwould like to know if there is an age limit for baby to be swaddled safely? Especially without them accidentally roll over.

I am using a vibrating mattress to soothe my baby occasionally but found the buzzing emits by the vibration unit fairly audible. I am concern if that will actually affect his hearing as he tends to sleep with his head turns to the side.

ANSWER:  Thank you for your question. It is an important one.   Swaddling should no longer be used when a baby develops sufficient motor skills that would allow him or her to flip over from their back to their stomach. Very few babies do this before 4 months of age. HOWEVER, to be on the safe side, I would not recommend it past 2 and 1/2 to 3 months of age. A swaddled, face down baby is in an extremely compromised position and would place that infant at very high risk for suffocation.

Contrary to what most people think, the human uterus is not a quiet place! Studies have shown that the average sound level inside the uterus is about 75 decibels which is equivalent to what we might hear riding inside of a car with the windows rolled down. The inutero fetus has been listening to the constant beat of his mother’s heart and the sounds of gas moving through her intestines throughout most of the third trimester. Sounds that come through the abdominal wall from the outside world only add to this already rich auditory environment. I would not worry about the vibration sounds from your vibrating mattress unless it is so loud that it drowns out normal conversational tones! Then maybe I would say it is too noisy!

Thank you,
Eileen Tyrala, MD FAAP
Medical Director, Cribs for Kids®

____________________________________

August 24, 2012
Subject: Sleep Positioners for Reflux Babies

QUESTION:  Many parents of babies with acid reflux swear by the Fisher Price Rock n Play.  I see that you don’t recommend the product.  What do you recommend to help infants with reflux sleep better? It is suggested that their sleep surface be elevated 30 degrees.  My 6 week old has reflux and cannot lay flat on his back.  Any suggestions?

ANSWER:  If you have not done so already, I would suggest that you have a complete discussion with your baby’s health care provider about this issue. He or she is in the best position to give you the most appropriate advice that best suits your baby’s individual needs.

My general suggestions to parents of infants who have reflux are the following:

1. Feed the baby smaller amounts of milk but more frequently (perhaps as often as every three hours) 2. Keep the infant upright for one half hour post feeds 3. If absolutely essential (but I don’t usually find this to be necessary) place a towel under the baby’s mattress to slightly elevate the trunk of the baby after he or she has been laid down.

I do not recommend any devices to aid in positioning an infant for sleep in the crib regardless of their reflux status.

Thank you,
Eileen Tyrala, MD FAAP
Medical Director, Cribs for Kids®

____________________________________

July 25, 2012
Subject: Mini-Crib vs. Pack ‘N Play

QUESTION: Our newborn will be sleeping in our room in our small New York City apartment.  We currently have a Pack ‘N Play and mattress that we’ve used for traveling with our toddler.  Can we use this as a full time crib (we’ll hopefully move into a house when our second child is 7 months old) or do we need to invest in a mini crib?

ANSWER: Thanks for your question. You absolutely can use the Pack ‘N Play as a full time crib for your infant. It is the perfect solution for a safe place for an infant to sleep when space is tight!

Thank you,
Eileen Tyrala, MD FAAP
Medical Director, Cribs for Kids®

____________________________________

July 14, 2012
Subject:  Pack ‘N Play vs. Crib

QUESTION: My grandson sleeps in his crib at my house.  The judge has recently ordered that the father is to have parenting time from Saturday 7pm through Wednesday 10am.  Thus meaning my grandson will sleep at his father’s home for 4 nights.  The father was court ordered to provide a crib, but does not.  He uses a Pack ‘n Play instead. I also have a Pack ‘n Play which we have used when traveling or at someone else’s house for naps, but not as his permanent bed.  My concern is my grandson is being taken out of a crib and put in a Pack ‘N Play for 4 nights & 3 days not only for his naps but also his entire nights sleeping.  Please explain how this can be any good for my grandson’s body physically. Also, did I mention that my grandson has several health problems and the father has three dogs inside the house? I would think this alone with the Pack ‘n Play basically on the floor as opposed to a crib several feet off the floor would be alarm enough.

ANSWER:  Thanks for your question and obvious concern for the welfare of your grandson. I do think, however, that the use of a Pack ‘n Play at the father’s house is fine. This product has been shown to be very safe and to be just as good as a crib to provide a proper sleep environment for the baby. Has Dad been instructed in all of the principles of creating a safe sleep environment for the baby? If not, you could download one of the brochures from the Cribs for Kids web site and go over it with him.

The dog situation is another issue. Dogs should not have direct contact with infants.  The Pack ‘n Play should provide enough of a barrier between the baby and the animals, however if they are in the same room. Most dogs are only curious about new babies and generally leave them alone. Many families tell me that the dog actually comes to get them when the baby starts to cry! If the animals are vicious or otherwise threatening to the baby, then they must be kept away from the baby at all times.

I hope I have been able to ease your concerns.

Thank you,
Eileen Tyrala, MD FAAP
Medical Director, Cribs for Kids®

____________________________________

July 13, 2012
Subject:  Baby Bedding

QUESTION:  I am involved with a group at our church that supports expectant Moms.  Specifically, we provide them with (gently used) baby clothes and baby equipment.  We check the equipment for recalls before we let it leave our storage shed.  I have read recent information about crib bumpers, and in light of that, feel that we should not provide crib bumpers any more.  I have also read recent information about blanket use for babies younger than 12 months.  I can’t see us refusing to provide baby blankets to these families, but I am concerned that the Moms might not be using them correctly (just over the baby’s lower body).  I have read several comments that recommend using only 100% cotton blankets.  I would appreciate any advice you would have for our group and the Moms we help.

ANSWER:  It sounds as if you are doing a lot of great work to help out these expectant moms.

Although I know this may be difficult, we don’t recommend that you give out any used cribs or bassinets. Cribs, if not assembled properly or if they lack the original hardware, can pose a major safety risk for the baby. Many second hand products lack instruction manuals, have lost screws, etc, etc, and unfortunately have a reputation of being extremely hazardous. Is there a Cribs for Kids® program in your area with whom you could partner and who could provide your clients with Pack ‘N Play’s? I think that would be the perfect solution.

I would totally agree with you that you should not be providing the crib bumpers anymore. I would explain to each person, however, why you are not providing them as many mothers may think that they are necessary to protect their baby from the crib slats and will purchase them on their own.

The ideal sleep blanket for an infant is a wearable blanket such as a sleep sack. I realize that these products are not cheap and frequently are out of reach of many low income families. Once again, affiliating with a local Cribs for Kids® program could be helpful as they do provide each participant with a Halo sleep sack. If blankets are to be used, then I would recommend the thin cotton ones that are not fluffy and bulky.

I would also suggest that you provide each of your expectant moms with one on one education and written information about creating a safe sleep environment for their infant.  All of the members of your group could become safe sleep educators!  You would not only be providing new families with desperately needed items for their new baby but also helping to decrease unnecessary and tragic infant deaths from accidental suffocation from being in an unsafe sleep environment. Contact Judy Bannon, Executive Director and Founder of Cribs for Kids® for more information about this.

Hope this information has been helpful.

Thank you,
Eileen Tyrala, MD FAAP
Medical Director, Cribs for Kids®

____________________________________
July 13, 2012
Subject:  Pack ‘N Play

QUESTION:  I’m due with my second child in 2 months and I still can’t decide whether it is safer to get a crib or a Pack ‘n Play.  With my firstborn son I received the all in one Graco Pack ‘n Play with the baby napper, changing table, bassinet, crib/ playard and he slept in his bassinet than crib feature until he was a few months old (learned to roll over on his own) when I transferred him over to sleep with me fully at night time with him lying on top of my arm stretched out so if he rolled over I’d wake up instantly and feel it (no blankets or sheets).

With my next baby however I’ve been considering a crib because everywhere I read it says that the safest place for a baby to sleep is alone in his/her crib and also because I’m just in love with all the crib bedding for a little girl!

I personally don’t see how a crib is safe with the rails that the baby can get trapped on, or a manufacturer error or the latches come undone and it just makes me very nervous.  But at the same time I’ve also read about Pack ‘N Plays not being recommended but I can’t find any reasons why except for the mistakes that could be prevented (removing napper and changing station fully except when needed/ no bumpers etc) and I think they’re safer personally because of the mesh sides, when they roll over the mattress isn’t thick and cushiony like a cribs but that’s just my personal opinion.  But even then I didn’t trust the napper/ bassinet fully and I used it during the daytime but had him sleep in his bouncer without the cushion part to make sure he wouldn’t suffocate and I would have him on the floor sleeping right next to me that way if he made one sudden movement mommy would wake up to his every need.  I realize some accidents with Pack N Plays and crib incidents are also faults of parents who’ve put soft padding/ stuffed animals/ etc;. But I still feel nervous.

I’ve been so excited about having a baby girl and now that I’m remembering all of these safety precautions.  I’m not very religious but the way I see it, god created mommy and daddy to nurture a baby but humans created cribs/ playards/ bouncers etc and we make mistakes! I’m scared to have her anywhere except in my arms!!  What would you recommend?  Is a Pack ‘n Play just as safe as a crib?  Or is a crib still the safest? How about some nights in a bouncer when the baby is between 0-2 months and can’t roll over (no blankets, or the inserts for bouncers)?

Also one more question, I know the recommended way to have a baby sleep is on their back.  However when I was in the hospital right after delivery they had my son bundled up in his bassinet on his back but with a rolled blanket underneath one side so he was a bit on his side, not much though.  Is that a safe way for a newborn to sleep? I’m worried about when an infant spits up and chokes.  We did it just the way the hospital did it for our firstborn but now that I know better I just want to make sure it was a good idea.  I’m sorry if I sound confusing :/

ANSWER:  Congratulations on your wonderful news of expecting a baby girl! It can be so much fun shopping for all of those adorable things that can make her room so pretty!

I would warn you against purchasing the quilt and bumper sets, however. Both the bumpers and the quilts have been shown to be suffocation risks when placed in an infant’s cribs. You could use a quilt to decorate the baby’s room, say draped over a chair or even on the wall. She can use it for sleeping after her first birthday when it is no longer a suffocation hazard. The bumpers you should pass on all together. (They shouldn’t even be selling those things anymore!) Although it is true that injuries can occur if an infant were to get an arm or leg caught in between the slats, they are minor compared to the risk of suffocation if the baby were to get her face pushed up against the cushy bumper surface.

Many of your concerns seemed to be about the safety of cribs and Pack ‘n Plays.  Last year the Consumer Product Safety Commission banned the manufacture of all drop side cribs, eliminating the possible hazard of a crib side falling down. Hence there will be no moving parts on cribs, making them safer than ever. The Pack ‘n Play has no moving parts and is completely mesh around all of the sides. The Pack ‘n Play  is a completely safe place for a baby to sleep as long as it is not adorned with blankets, pillows and stuffed animals! (The same goes for cribs!) When you said that you slept with your first child on your arm after he was a few months old, I must tell you that a shiver went down my spine. There is a forty fold greater chance that an infant will have a sleep related death from suffocation  if she is sleeping on an adult mattress with another adult as compared to a baby who sleeps alone, on their back  in an uncluttered crib. I would urge you to rethink this practice and to not do it with your daughter.

It is not recommended that infants sleep in bouncers or chairs at all as it makes it more difficult for them to breathe when placed in these devices. Infants use their abdominal muscles to breath. When they are placed in a more upright position it puts pressure on these muscles making it harder to breath. Hence, only the flat (and back) sleep position is recommended.

It is recommended that infants only be placed to sleep on their backs. Since we started instructing parents to do this almost 20 years ago, the incidence of infants who die while asleep has decreased by 50%, saving over 30,000 babies lives. If you witnessed nurses in the hospital placing infants to sleep on their sides, they were not doing a very good job of modeling a good sleep environment for you!

The concern about infants aspirating (taking food into their lungs) if they were to spit up while on their backs has not been shown to be a risk. Anatomically, the airway is on top of the esophagus. If stomach contents were to come up from the esophagus it would fall by gravity away from the airway, decreasing the chances for aspiration. This has been borne out by 20 years of experience of placing infants to sleep on their backs.

It is absolutely OK to use the same or a new Pack ‘n Play for your newborn. The Pack ‘n Play has an amazing safety record and fulfills all of the criteria for allowing you to create a safe sleep environment for your infant. Just remember to place your baby on his back, and keep the sleeping area uncluttered (without pillows, stuffed animals, etc) and smoke free! We highly recommend the use of sleep sacks to keep all blankets out of the sleep area as well.

I hope I have answered most of your questions! I wish you all the best as you await the arrival of your new daughter!

Thank you,
Eileen Tyrala, MD FAAP
Medical Director, Cribs for Kids®

____________________________________

June 05, 2012
Subject: Rolling over in sleep

QUESTION: My 5 month old son will not sleep flat on his back he constantly rolls to his side and puts his face into the mattress. I am getting no sleep because I am up all night constantly flipping him back over.  As soon as I put him on his back he rolls right to his side and his face into the mattress and sometimes rolls onto his stomach. I have been reading a lot on SIDS and babies breathing in there carbon dioxide and it really freaks me out I’m afraid his face being in the mattress he will be breathing in the carbon dioxide. I have tried to swaddle but he does not want any parts of that. What can I do? Is it ok if he sleeps like this?

ANSWER: As you are observing, infants between the ages of 4 to 6 months begin to gain significant mobility and start acquiring the ability to turn from their stomach to their back and from their back to their stomach. If they start from the back position, they usually end up on their sides first before they flip forward onto their stomachs. It sounds as if your son is in this situation.

The first question I would ask you is, is your son able to pick his head and shoulders up high off the crib surface when he is placed on his stomach? (If he has been getting his tummy time on a regular basis, the answer to this question should be yes unless he was premature.  If you are uncertain of this, double check with your pediatrician.) Babies can generally do this pretty well at about 4 months of age.  The “risk” of someone PLACING an infant onto his or her side before they are able to do it themselves is that they can flip forward onto their stomach, and since they didn’t get their under their own steam, they may not be able to lift  their head up and away from the mattress. That does not sound like what is happening to your son. As a general rule, if an infant is able to get himself onto his side or tummy on a regular basis (i.e. it is a regularly occurring event), then it is generally safe for them to be in that position for sleep and I would not worry about it. I would, however, continue to place him on his back for sleeping when you put him down. From here on out, he will end up sleeping where and how he wants!

Thank you,
Eileen Tyrala, MD FAAP
Medical Director, Cribs for Kids®

____________________________________

May 08, 2012

Subject: My Little Sweetie Deluxe Newborn Rock ‘n Play

QUESTION: I am a RN in a neonatal unit.  A lot of the parents are discussing/using “My Little Sweetie Deluxe Newborn Rock ‘n Play Sleeper”.  I am wondering about the safety of it.

ANSWER: Thank you for bringing this product to my attention.  After reviewing the photos and description of the “Deluxe Newborn Rock n’ Play Sleeper” on the manufacturer’s web site, I emphatically do not recommend this product as a safe place for infants to sleep! The baby is placed in a semi-reclined position which is not a recommended sleep position, particularly for preterm infants. Many infants (and particularly preemies) lack the necessary truncal tone to keep themselves from sliding down in these types of devices, placing extra pressure on their abdomen and therefore compromising critical muscles of respiration. The sides of this device also come very close to the baby’s face. It would not take much for a minimally active infant to turn their body and/or head, find their face right up against the soft, cushy surface and become a suffocation risk.

I think we all need to band together and ask the manufacturers of infant products to review all of their products for safety and remove the ones from the market that put infants at risk!

Thank you,
Eileen Tyrala, MD FAAP
Medical Director, Cribs for Kids®
____________________________________

May 3, 2012
SUBJECT: Safe sleep for multiple babies

QUESTION: What Safe sleep advice would you give to women with multiples?  Twins, triplets, etc.

ANSWER: Part of the recommendations that were included in the 2011 AAP SIDS Task Force statement included the avoidance of co-bedding of twins and higher order multiples.  As a neonatologist, I know how common it has been to see twins in particular, co-bedded in the same crib in either the well baby nursery or the NICU setting.  Because twins are frequently born prematurly and/or at low birth weight it is usually physically possible to place twins together inside a typical  hospital infant crib.  The arguments that were given for doing this was that “twins shouldn’t be separated” and “don’t they look cute?” (I am not kidding!).

Most of the studies that have been done studying the safety of co-bedded infants were done in the NICU setting and could
find neither benefit or risk associated with the practice.  The real harm, however, was in modeling co-bedding for parents to mimic in the home environment.  It  has been shown in several studies that multiples who were co-bedded in the hospital were more
likely to be cobedded at home for significant periods of time.  Although the risk of a sudden and unexpected death in co-bedded infants is not known, many multiples are already at increased risk of a SUID because of their prematurity.  Compared with multiples who sleep in separate beds, they are theoretically at increased risk of death due to overheating, rebreathing each other’s carbon dioxide, and, because of discordance in size, an increase in  the risk of accidental suffocation.  In addition, most co-bedded infants are placed on their sides.  All of these factors, led the SIDS Task Force Committee to recommend separate sleep areas
for twins and higher order multiples in both the hospital and the home setting.

Hope these comments have been helpful.

Sincerely,
Eileen Tyrala, MD FAAP
Medical Director, Cribs for Kids®

 ________________________________________

April 26, 2012
Subject: Cribs

QUESTION: I got a used crib from a friend of a friend. When we recieved it it had all the hardware attached, however it all got lost in storage. I don’t know what type of crib it is, so I can’t re order hardware, so I was wondering if its safe to use self drilling screws to assemble it.

ANSWER: The situation you are describing with the gift of this used crib  is classic.  Frequently the original instruction manual has been misplaced or the original hardward cannot be found. I was going to suggest that you go on the manufacturer’s web site to download the instruction manuel and to get the specs for the hardware.  If you can’t do this, however, and satisfy yourself that the crib can be guaranteed to be 100% safe,  I would not recommend that you use this crib!

Sorry!

Sincerely,

Eileen Tyrala, MD FAAP
Medical Director, Cribs for Kids®

 ________________________________________

Apr. 12, 2012
SUBJECT:
 Getting an infant to sleep in his/her crib

QUESTION:  My son has started to grab things and stand.  When I put him in his crib he grab the rails and stand.  So many times I am worried that his hand stuck between rail (2 inch wide) or when he is sleeping the same thing happens.  When he hold and stand with crib’s rail, he sometimes fall and his head or other part of his body hit the rail.  What should I do?  I am first time mom and dont know any product or recommendation out in market.

ANSWER: The first thing I would suggest to try to solve this problem is to swaddle her. Babies have a primitive brain stem reflex that if their arms go out to the side (as they very well might  when she is on her back) they will arouse and cry.  This may be what is awakening her.  You can either use a swaddling blanket or a commercial swaddling device.  There is a wonderful demonstration of how to swaddle a baby using a 40 inch sqaure blanket on U-Tube called “How to Swaddle Your Baby” that I recommend you watch.  You will be a pro in no time.   There are also commercially sold  swaddling devices that use velcro straps to hold the arms close and firmly  to the body to accomplish the same thing.

Swaddling is one of the five “S’s'” that Dr. Harvey Karp describes in his book and video, “The Happiest Baby on the Block”, whose purpose is to soothe the crying, fussy baby.  The other S’s are sucking (as in a pacifier), swaying (do you have one of those vibrating infant beds?), shooshing (as in a white noise sound made close to the baby’s ear to mimic what she heard inside mom), and soothing which is a combination of swaddling and rubbing the infant’s back.  The techniques most amenable to your situation are the use of a pacifier, the vibrating bed and creating some white noise in the room (static on the radio, vacuum cleaner, etc).

Hope these techniques are useful to you!

Sincerely,
Eileen Tyrala, MD FAAP
Medical Director, Cribs for Kids®

_____________________________

Feb. 26, 2012
SUBJECT:
Crib Railings

QUESTION:  My son has started to grab things and stand.  When I put him in his crib he grab the rails and stand.  So many times I am worried that his hand stuck between rail (2 inch wide) or when he is sleeping the same thing happens.  When he hold and stand with crib’s rail, he sometimes fall and his head or other part of his body hit the rail.  What should I do?  I am first time mom and dont know any product or recommendation out in market.

ANSWER:  Thank you for your question and obvious concern for the safety of your son.

It sounds as if your son must be at least nine to ten months old if he is able to pull himself up to stand by grabbing on to the rails of his crib.  As you are seeing, he isn’t necessarily going to be able to hold that position for an extended period of time and he will eventually fall back down to the mattress.  It is true that sometimes his head might touch the rails on his way down. Remember, however,  it is not as if he is falling from a height where he would have gained momentum and speed and could do himself real harm.  I don’t think you should worry too much about any risk of a significant injury from this type of activity.  It is true, however, that an infant’s hand or arm can get caught in between the bars of the crib rails.  Bumper pads were originally made for the purpose of trying to prevent these types of injuries.  We have now become aware of  the very real and serious problem of suffocation if an infant’s face were to become wedged next to the bumper, so we no longer recommend their use.

Given the potentially fatal consequences of using a bumper pad versus the risk of an occassional bruise on the arm, I recommend  that you not use bumper pads at all!  Make sure, however, that your mattress fits tightly into the frame of the crib so that your son’s arms can’t  get caught between the mattress and the side of the crib creating another risk for limb entrapment.

Sincerely,
Eileen Tyrala, MD FAAP
Medical Director, Cribs for Kids®

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Feb. 7, 2012
SUBJECT: 
Halo Sleep Sacks

QUESTION:  What does Cribs for Kids think about the new Halo Swaddle Sleep Sack.  I heard about them last week and went to look at them at Target.  Although the package does have a warning about not leaving the swaddling tails loose as they might get tangled around the infant and I am afraid over his face, they do not give any recommedations about how long an infant should
be swaddled.  These things are like striagthtjackets in that the infant cannot move his arms.  My fear is that parents might leave an infant like this for hours.  The infant could also get hot in the sack.  Removing it after the infant is soothed seems to defeat the purpose of swaddling.  What do you think?

I have tried to search the AAP site and the internet for information regarding this scenario without sucess. If there are any references you could recommend I would appreciate it.  Thank you for all that you and CFK do to help us to keep our families safe and happy!

ANSWER:  As the Medical Director for Cribs for Kids, your question was passed along to me to respond to.  Recenly I have been receiving many queries about the swaddling issue  so your question is very timely.  It is not just the commercial swaddling devices that are “like straight jackets” as you so aptly describe them.  In reality  it is all types of swaddling including the swaddling done with infant receiving blankets in the hospital nursery setting, that could be labeled as “straight jackets”.  Pulling the arms close and  tight to the body is the very essence of swaddling no matter how it is done.  Only in this way will the Moro reflex,  which is stimulated when the arms flail out to the side and secondarily cause the baby to cry, be limited.  Nursery nurses have used this technique for as long as I can remember using infant receiving blankets to swaddle babies to achieve the goals of warmth, calming and sleep for the infant.  Indeed many parents put their infant to sleep swaddled and the infant does stay in this position for the duration of their sleep.  I do not think that that is inherently a bad thing.  However, (and this is a big however!) inappropriate use of swaddling can be a dangerous thing!  The thermal environment of the infant needs to be monitored as you correctly point out. The infant in the home or hospital setting who is swaddled wearing only a cotton  tee shirt or onesie who is then swaddled with
receiving blankets is in very little danger of over heating (unless Mom’s room is stiffling hot).

Until relatively recently, there were no comercial devices available to promote swaddling.  Now that there are, it is appropriate to bring up the issue of how hot an infant can become especially if the swaddle mechanism is also coupled with a sleep sack. The materials that are used for the Halo sleep products receive a tog score that reflects the ability of the material to retain heat. Depending on the material and the number of layers of the garmet, a tog score is calculated.  The goals is to keep the score below 4.  All of the Halo products meet that criteria.  It is true that bringing an infant’s arms close to the body, as occurs by definition during swaddling, may further increase theretention of body heat. As is always true it is prudent for a parent to be aware of their infant’s thermal environment under all environmental circumstances, not just swaddling. and adjust it accordingly.

Thanks for your question.

Sincerely,
Eileen Tyrala, MD FAAP
Medical Director, Cribs for Kids®

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Dec. 14, 2012
SUBJECT: 
Positioning in isolettes

QUESTION: What are your thoughts on positioning full term newborns in isolette’s for phototherapy? We often have triple phototherapy ordered which we attain by placing the newborn on his back on a blanket therapy (wallaby or biliTx), in an isolette with a Neoblue on ‘high’ abovve the isolette. We recently had a baby that was very difficult to keep on the blanket and from “scooting” all over the isolette. Staff were very concerned about his safety and ended up putting rolled blankets to position him while on a CR monitor. My concern with this was that we are teaching parents to not use monitors because they do not prevent SIDS/SUID, but would this practice put us at risk? If the necessity of positioning for maintaining the phototherapy requires us to use positioning blankets is this acceptable? In hind-site I wondered if we had used a crib instead of the isolette and olympic “bank” lights (heat producing) over the crib with the blanket under, if that might have helped this particular baby. He did improve and was discharged  home safely with his parents. We’re not sure if this is something that we will encounter more often and want to be sure we are best-serving our little patients and their families.

I have tried to search the AAP site and the internet for information regarding this scenario without sucess. If there are any references you could recommend I would appreciate it.  Thank you for all that you and CFK do to help us to keep our families safe and happy!

ANSWER:  For the infant who requires phototherapy, the need to provide an environment where the infant receives the maximum amount of cutaneous light exposure in order to reduce the serum bilirubin level in the shortest amount of time is the paramount goal.  When this is achieved the baby can go home and the family and infant can be reunited. Something everybody wants! Babies potentially have alot more squirming room in an isolette than in a typical, confining hospital infant crib, hence the problem.   Many times open cribs can’t be used because the baby gets cold as he/she must be undressed for the therapy to work. Hence, an isolette may be the only choice but I think your comment that perhaps you could have tried an open crib first would be a
reasonable thing to do.

But more to the point, the reality of the situation is that many times you will have  to use the isolette and devise strategies to deal with the squirming infant.

When we are caring for an infant with a medical problem in the hospital setting, our thinking has to be comprehensive. Although creating a safe sleep environment is important, sometimes other more  pressing issues such as concern that the baby would get stuck in a crevice of the isolette (something we all have seen) is equally concerning. I would readily agree with you that we don’t have a device that would pass the safe sleep test for use in this situation, hence we have to do the best that we can (I always worried about the bili masks as a source of suffocation for all babies under photo therapy as they would so often slip down over their noses). Until something better comes along (the breathable blanket?) I think you did the best you could including the use of a monitor as an extra crutch. It would be important to explain to Mom that what is done to achieve a specific therapeutic goal in the
hospital frequently bears no resemblance to infant care practices at home. We know that families view infants who received  phototherapy alone and no other medical intervention while in the hospital are viewed by their parents for many months as more vulnerable and fragile than their non-phototherapy controls. I would use this knowledge to impress upon the parents that what you are doing in the hospital to keep the infant in a more confined space is not proper care for an infant in the home setting and should not be done at home, including the monitor!

Thanks for this interesting question.

Sincerely,
Eileen Tyrala, MD FAAP
Medical Director, Cribs for Kids®

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Nov. 4, 2011
SUBJECT:  
Swaddling and newborns

QUESTION:  Are you aware of any studies that suggest that swaddling of newborns increase risk of SIDS?  What age is it appropriate to allow a small, breathable blanket to an infant?Thank you!

ANSWER:  There are several studies that discuss the relationship between swaddling and the risk of SIDS.

Ponsonby AL et al. (NEJM 1993;329(6):377-382), suggest that there is a decreased incidence of SIDS if the infant is swaddled and in the supine position but an increased risk if the infant was swaddled and placed in the prone position. (Having personally witnessed a swaddled infant in a well baby nursery who had been placed on his side, then  flip onto his stomach and turn purple, I can attest to the danger of both the side and the prone position to the swaddled infant.) The physical restraint associated with swaddling may prevent an infant placed supine from rolling to the prone position and in that way may actually reduce the risk of SIDS. The devil (as usual) is in the details, however. One must be very careful not to overheat the swaddled infant and create an additional risk factor for SIDS.

We also know that swaddling promotes sleep and decreases the number of awakenings in infants.  (Franco P et al. Pediatrics, 2005;115(5):1307-13110. Its’ effect on arousabilty, another area of concern, particularly for the already vulnerable infant, has yet to be fully defined. Some studies have shown increased arousal thresholds of swaddled infants (Richardson HL et al, J Pediatr: 2010;157(1):85-91) and others decreased arousal thresholds to external stimuli (Franco P,Sleep.2004;27(8(:1527-1532).

Hope these references and comments have been helpful.

Sincerely,
Eileen Tyrala, MD FAAP
Medical Director, Cribs for Kids®

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Oct. 24, 2011
SUBJECT:
Comfort

QUESTION:  Safe sleep is very important.  However, some parents are still concerned their infant does not have any comforting items in the crib.  No blanket, stuffed animal, and even no swaddling.  Besides telling a parent they are safest without anything in the crib what else can be said to a parent who may not listen to the recommendations because they believe the infant needs to be  comforted.

What age is it appropriate to allow a small, breathable blanket to an infant?

Thank you!

ANSWER:  It is true that the safe sleep environment does exclude the presence  of  any items that we adults associate with  cuddly and soft. I emphasize,”we adults” as I think the baby really doesn’t care one way or the other!  All of us have been influenced by the traditional imagery of infant cribs with all of the soft, cute, fluffy stuff that makes us feel “warm and fuzzy”.

An infant really isn’t able to appreciate the cuddliness of stuffed animals and soft blankets until they are able to grab on to  objects, hold on to them and bring them to their bodies. This requires the acquisition of several  developmental milestones which most babies do not achieve until the end of the first year of life, not before. What I would tell parents is that their most important responsibility to their baby during the first year of life is to provide them with a loving, nurturing, caring and safe environment. One of the ways a parent can show their love for their baby is to consistantly create a safe sleep environment! Encourage them to decorate the baby’s room to show their love, not the baby’s crib!

I am not aware of any specific information about the safety of breathable blankets. I  think that wearable blanket sleepers are the best and safest way to keep a baby warm both warm and safe so I recommend their use over any other products.

Hope this has been helpful.

Sincerely,
Eileen Tyrala, MD FAAP
Medical Director, Cribs for Kids®

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Oct. 18, 2011
SUBJECT:
Sleeping w/pillow & blanket

QUESTION:  After 12 months of age, is it OK for a child to sleep with a pillow and/or loose blanket?

ANSWER:  The bedding environment for children with no neurodevelopmental risk factors beyond one year of age can be expanded to include blankets, stuffed animals, etc. I would still use my judgment, however, with regards to pillows (I would keep them small and kid size) but generally they should be OK.

Sincerely,
Eileen Tyrala, MD FAAP
Medical Director, Cribs for Kids®

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Oct. 18, 2011
SUBJECT:
C
o-bedding equipment and Pack ‘n Play vibration

QUESTION:  I work in Public Health and do a lot of work on safe infant sleep. I have two questions that I haven’t been able to find answers for:

1. I am not an advocate for bedsharing at all, however, sometimes parents will ask me about the bedsharing equipment available and I’d  like a good answer to give them. One in particular device is a small little bed that you put in the parent’s bed. I’m not sure how to describe it well, so here is a link for one of them:  http://www.bedbathandbeyond.com/product.asp?sku=18321947&utm_source=bing&utm_medium=organic&utm_campaign=shopping

2. What are your thoughts on having babies sleep in pack ‘n plays with the vibration pads on? Is that good for infants? Should there be a time limit for use of it?

Thank you!

ANSWER:  The answer to any questions about devices that are marketed to make bed sharing safe and hence reduce the risk of  SIDS or a sleep related death ( as I am sure  is the case with this product) is an emphatic no, it is not safe. In order for a product to be able to make that claim it must be so certified by the Food and Drug Administration. To date, the FDA has not certified any products as capable of reducing   the risk of SIDS or any type of sleep related death. Going beyond that however, look at the padding on the sides of this device. It is a surface  that if an infant were to get their face up and against, it could create a suffocation risk. In addition, if the baby were to scoot down or be placed below the padded sides (say after a breast feeding) the baby could easily find herself in the parents’ bed.

I say no to any of these devices!

As far as the vibrating Pack and Play, I say what will they think up next??? I don’t think it is necessarily bad for babies and may
encourage some of them to go to sleep! I would suggest, however,  not to use it all the time (the baby may decide she needs it as a sleep aid and can’t sleep without it!)  and I would definitely turn it off once the baby was asleep. Just my thoughts on this one as there is no real data!

Thanks for your questions!

Sincerely,
Eileen Tyrala, MD FAAP
Medical Director, Cribs for Kids®

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Oct. 14, 2011
SUBJECT:
Receiving blanket

QUESTION:  Is it safe to have an infant sleeping in a crib or bassinet while wrapped in a receiving blanket?

ANSWER:  The answer to your question depends to some extent on what you mean by “wrapped in a receiving blanket”.

If you mean swaddled, then the answer to “is it safe to wrap a baby in a receiving blanket” is we don’t know for sure.  Swaddling can be an effective technique to help calm infants and promote sleep.  It is known to be a dangerous practice, however,  if it is not done properly.  That means that the baby must always be placed on his or her back. The side and prone positions are extremly
hazardous to the swaddled infant as the baby would have limited ability to help himself if he were to find himself face down with his nose  pressed into the sleeping surface.  In addition, if the swaddling blanket were to come up over the babies face this could create a suffocation risk.  If the baby is wrapped too tightly, there is risk for overheating and for compromise in the infant’s ability to breathe. There are also studies that suggest that swadddling decreases arousability of the sleeping infant, another possible risk factor for SIDS, particularly in an already vulnerable infant.

So, although I am generally a fan of swaddling as it does seem to soothe many fussy babies, I am also aware of its potential risks and pitfalls if not done properly.

The new AAP Task Force Policy Statement, does not specifically address swaddling in its formal recommendations but does discuss it in its accompanying technical report.  I refer you to it for more information and references. It will be published in the November issue of the journal Pediatrics.

Thank you,

Eileen Tyrala, MD FAAP
Medical Director, Cribs for Kids®

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Sept. 10, 2011
SUBJECT:
Swaddling with receiving blanket vs sleep sack

QUESTION:  Could you please address pros and cons of both and does AAP have a position one way or the other? I understand that many hospitals are switching to the sleep sack for safer sleep reasons. Should this be the best practice teaching re safe sleep for infants?

ANSWER:  The primary purpose of swaddling an infant with a receiving blanket (or a commercial device designed to achieve the same end) is not only to provide a source of warmth, but to soothe a crying baby and to promote sleep. In the hospital setting it achieves all three goals but its’ primary practical purpose is generally heat retention as it obviates the need for additional clothing for the infant other than the traditional hospital undershirt of course! .

The purpose of a sleep sack, on the other hand , is only to provide a source of warmth for the infant as a wearable blanket. It’s only downside would be if the sleep sack were too large for the infant (as can be an issue with smaller infants, either term or preterm). If the baby were to slip through the neck opening and end up with the sack over their nose and face this could compromise their ability to breath “fresh” air. I am not aware, however, of any reported cases of suffocation in an infant due to the use of a sleep sack. Correct sizing of the sleep sack for the infant should eliminate this as an issue, however.

Swaddling, when applied correctly, done with the right type of blanket (40 inch square, made of thin, cotton material ), and with the infant placed on their back to sleep, can safely achieve the three goals: warmth, soothing and sleep. The concerns with swaddling arise if the swaddling is not applied correctly or if the infant is placed on its’ side. Many still erroneously believe that side positioning of an infant in the first 12 hours of life is necessary to promote clearing of fluids from the airway post birth. If a swaddled infant were to fall forward from the side position into the prone position (as I have witnessed many times) it would create an extremely hazardous situation for the infant (baby now both prone and unable to move) that could result in suffocation. In addition, if the swaddling material were to make its’ way up and around the baby’s face a potentially hazardous breathing situation could be created. In my experience most nursery nurses are experts at swaddling and know how to avoid the pitfalls that I have described above.

The issue of swaddling was not addressed in the 2005 statement of the AAP Task Force on SIDS. A new statement will be released in October at the annual meeting of the American Academy of Pediatrics. My understanding is that this issue will be addressed in the new statement. We shall look forward to their recommendations.

On a personal note, I do teach my new Mom’s to swaddle their babies as both a comfort technique and to promote sleep, both extremely important issues in the life of a new family!

Hope these comments have been helpful.

Sincerely,
Eileen Tyrala, MD FAAP
Medical Director, Cribs for Kids®

 

 

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