Bad advice on bed-sharing

Sept. 22, 2016

To the editor
: The risks of sharing your bed with your infant are not “imaginary,” contrary to the opinion expressed by Robert LeVine and Sarah LeVine.

An adult bed poses very real risks of sudden infant death syndrome (SIDS), unintentional suffocation, strangulation or entrapment to an infant. Sleep-related infant deaths claim more babies between 1 month and 1 year of age than any other cause.

( “It’s more than OK to sleep next to your infant,” Opinion, Sept. 18)

Multiple studies bear this out. That’s why the American Academy of Pediatrics advises against bed-sharing.

The safest place for an infant to sleep is in a separate crib or bassinet with a tight-fitting sheet and nothing else, preferably in the parents’ bedroom for up to a year.

Benard Dreyer, MD, Elk Grove Village, Ill.
The writer is president of the American Academy of Pediatrics.


To the editor: The opinion piece cites the work of James McKenna, who suggests that bed-sharing is not dangerous, but even beneficial.

This goes against official recommendations of the AAP, which have been comprehensively researched, and which recommend room-sharing, but not bed-sharing.

This article gives dangerous advice, which may increase the number of babies dying of SIDS, suffocation or asphyxiation.

Thomas G. Keens, MD, Los Angeles

The writer is chair of the California SIDS Advisory Council.


To the editor: As a pediatrician and public health professional, I am deeply troubled by this opinion piece.

The AAP and the National Institutes of Health offer expert guidance that bed-sharing is in fact a significant risk factor for accidental suffocation, sudden unexpected infant death (SUID) and SIDS.

I do not think this risk is adequately reflected in the opinion.

Aside from the risk of accidental layover by the parent, bed-sharing also introduces blankets and pillows, which further increases the risk of accidental infant suffocation.

Parents need to understand that this practice is not risk free.

It is also erroneous to equate the infant sleep environment in Japan (typically a firm mat or futon bedding) with the U.S. (fluffy mattresses, pillows and blankets).

David L. Nunez, MD
Seal Beach

The writer is the Maternal Child and Adolescent Health Medical Director, Orange County


To the editor: As a board-certified forensic pathologist and medical examiner practicing in Florida, I am dismayed by the op-ed advocating bed-sharing with infants.

I have performed multiple autopsies on infants who were co-sleeping with their parents or siblings.

Many times, these infants end up face down, wedged into soft bedding or the cushions of a couch, or between the mattress and the wall, just to name a few situations.

Rollovers can also be a cause of asphyxia.

The risks are not to be underestimated.

Kelly Devers, MD, Tampa, Fla.

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Your Favorite Nursing Pillow Could Be Deadly

When you use it wrong, it puts your baby at serious risk.

Many new moms use crescent nursing pillows to help support their baby during feedings. But a coroner from Pennsylvania has take a very public stance against the popular baby registry item, claiming they may be involved in several recent infant deaths.

Three babies, all under six months of age, have been pronounced dead from similar medical causes at Penn State Hershey Medical Center since January, and Graham Hetrick was the coroner on each case, PennLive reports. After autopsies and x-rays, he attributed each of the deaths to cerebral asphyxia, or lack of oxygen to the brain.

In a recent press conference, Hetrick said that parents of all the babies had been using the same type of pillow, similar to adults’ U-shaped neck travel pillows, in their cribs or bassinets, and the children may have been napping in them. Hetrick explained that using the nursing pillows for sleeping — which is completely incorrect — and leaving babies unsupervised is very dangerous.

“It is possible for the baby to move around enough that their shoulders slip down, and the head to be pushed toward the chest,” he said, which can lead to death in minutes. “If [the pillows] are used in the sleeping area, I would caution, when they are not being observed, that this could be a potential.”

Though he can’t say 100% that the deaths resulted from the pillows (and he declined to list any specific products), Hetrick noted, “I’m not a great believer in coincidence.”

The Boppy Company, the manufacturer of the most popular line of these kinds of pillows, promotes safe sleep practices on their website — and both the products and the website have repeated warnings  to “Remove all soft bedding, toys, and pillows from your baby’s sleep area. This includes all Boppy Pillows.”

Even without conclusive evidence, Hetrick is voicing a very important reminder. Your child may look cozy in the pillow, but it is not meant for sleeping.

Link to Original Article:

Why? Because There are Better Options than Cardboard Boxes


Graco Pack 'n Play meets CPSC Safety Standards

Graco Pack ‘n Play meets CPSC Safety Standards

At Cribs for Kids® National Infant Safe Sleep Initiative, our commitment to providing safe sleep environments to infants — UP TO ONE YEAR OF AGE — has been our focus since 1998.  For safe sleep, we have chosen to provide our partners and clients a Graco® Pack ‘n Play® portable playyard unit that is designed and manufactured specifically for our program, along with the Safe Sleep Survival Kit, which includes a Halo® SleepSack® wearable blanket, Philips Soothie pacifier, safe sleep educational DVD, Pack ‘n Play® assembly video, Charlie’s Kids Foundation “Sleep Baby Safe And Snug” book, and other educational materials about the ABCs of safe sleep, and room temperature and smoking around babies. We vetted other products and chose to use the Graco® Pack ‘n Play® due to its safety record, longevity of use, and low cost.  We have elected not to use the Baby Box unit for our infant safe sleep initiative based on the following safety concerns and quality comparisons:


Below are product safety warnings offered by a company that is recommending cardboard boxes for babies, followed by Cribs for Kids’ responses concerning potential hazards that could occur if a parent  uses a cardboard box as a temporary sleeping environment.  A primary safety concern is that babies will outgrow the cardboard box between two and four months of age, which is the age range during which a majority of babies are dying from accidental, sleep-related death and sudden unexpected infant death. (See CDC graph-Length-for-age and Weight-for-age percentiles). When the baby outgrows the box, it will most likely end up in bed with the parent(s) or on another unsafe surface. (See #2. Longevity below) )We advise to use the cardboard box unit at your own risk.

Below, in red, are a cardboard box company’s warnings for their unit followed by Cribs for Kids’ responses:

“Always keep the cardboard box on the floor or on a sturdy wide surface such as a coffee table. Setting a cardboard box on a narrow and/or [unsturdy] surface presents a falling hazard.”

C4K Recommends:  A box placed on the floor can be a dangerous place for a baby to sleep. Items can fall into the box, injuring or covering the baby; young siblings and pets could have easy access inside the box; and unintentional injury can occur if an adult would accidentally trip over, or step into the box. Recently, a baby died when the owner’s pet attacked him while in a make-shift bed on the floor, said to be a laundry basket. The baby’s mother was sleeping near him on the couch.  “[A] coroner plans to rule the death of a three-day-old baby boy in Youngstown, Ohio, as accidental. The newborn, identified as Aiden Grim, died after he was bitten on the head by one of his family’s five dogs. According to Dr. Joseph Ohr, the Mahoning County Forensic Pathologist, the dog, a Labrador retriever/shepherd mix, bit the baby, but did not maul, or even shake him.”

In addition, it is undetermined by the cardboard box company which type of surface is deemed ‘sturdy’ and wide enough to safely hold the unit.  A cardboard box could be knocked off a coffee table, couch, dresser, or other raised surface. The CPSC guidelines regarding the use of a portable crib / play yard / bassinet are that it must have: (1) a sturdy bottom and wide base; (2) smooth surfaces without protruding hardware; (3) legs with locks to prevent folding while in use; and (4) a firm, snugly fitting mattress. Unlike the Pack ‘n Play®, or a full-size crib, a cardboard box has no legs to raise the unit off of the direct surface of the floor.

“Never use the lid while baby is inside.”

C4K Recommends:  It is concerning that many parents would even consider placing the lid back on top of a cardboard box while the baby is in it.  A cardboard box itself does not allow for reasonable airflow for an infant, unlike the Pack ‘n Play® which has air-permeable mesh sides.  Putting the lid on a cardboard box would dangerously decrease the amount of oxygen in the unit and could lead to suffocation.

“Parents should cease using a cardboard box as a primary sleep space once they [babies] can pull themselves up independently. “

C4K Recommends:  A cardboard box should not be used once the baby is crawling, let alone before they can pull themselves up independently risk tipping the box.  Even a baby that is able to roll over could potentially cause a cardboard box to become unbalanced and tip over.  If a cardboard box is placed on a raised surface, this could cause severe head trauma or a life-threatening injury to the baby.  With the Pack ‘n Play® there is no risk of the baby toppling over the Pack ‘n Play® unit, long after they can pull themselves up.

“Never lift a cardboard box with baby inside once he or she exceeds 15 lbs.”

C4K Recommends:  The baby’s weight can change between doctor visits.  The ability to know when the exact time would be to stop lifting the baby while he/she is still in a cardboard box may not be feasible.  The bassinet feature of the Pack ‘n Play® can be used for a baby weighing up to 15 lbs and unable to push up on hands and knees,  and the second level (bottom level) of the Pack ‘n Play® will hold a baby up to, but not exceeding, 30 lbs or 35 inches tall.  In addition, the Pack ‘n Play® can be moved from place to place because it has wheels which provide for easy mobility.

“Keep a cardboard box away from open flame.”

C4K Recommends:  CPSC is committed to protecting consumers and families from products that pose a fire, electrical, chemical or mechanical hazard. CPSC’s work to help ensure the safety of consumer products – such as toys, cribs, power tools, cigarette lighters and household chemicals  contributed to a decline in the rate of deaths and injuries associated with consumer products over the past 40 years.  A cardboard box unit is a cardboard box and not a crib.  Therefore, it has not, yet, been researched by the CPSC as a product that should be used for sleeping infants.

The foam in the mattress of all Pack n’ Play® is fire retardant and meets the Federal Flammability Standards” years.  The Pack ‘n Play® is not cardboard and will not easily burn when near a flame or heater.

“Do not get the box wet.” 

C4K Recommends:  If the cardboard box company recommends that the cardboard box unit should not get wet, it poses a great concern about the durability of the unit for babies who may vomit, have leaky diapers, or spill water or milk in it. It is also recommended that a cardboard box not be used in areas with higher humidity, as it degrades the sturdiness of the cardboard.  You can completely wash down the Pack ‘n Play® and no part will be damaged.

“Do not transport a cardboard box while the baby is inside if any tripping hazards are present in the room (stairs, toys, rugs, etc…)”

C4K Recommends:  There is no fear of a fall hazard head injury with the Pack ‘n Play®.  Also, since it is likely parents may try to transport a baby in the box, they might be tempted to use the box in a car.  If the baby is asleep and you need to go somewhere, you might decide to just leave the sleeping baby in the box instead of strapping him/her into a car seat.


 “How long will the baby be able to use a cardboard box?

C4K Recommends:  On the website of one cardboard box company, the company recommends that “[M]ost babies are comfortable in their Baby Box until 8 months of age.”

A more accurate estimate is 2-4 months. Some newborns will actually roll onto one side to sleep in their very first days, but most babies seem to lose the ability to roll onto their sides independently within the first month. By 4 months of age, babies can develop sufficient upper body strength to use his/her arms. By 6 months old, most babies have mastered not only the belly-to-back roll but also the reverse back-to-belly maneuver.  A cardboard box may not be able to handle the weight shift caused by a baby rolling over.CDC_GrowthChart

A typical cardboard box unit measures as follows: 26 3/4 X 16 3/4 X 11 1/2 inches.

Average length of baby at 3 months – 23 – 24.7 inches

Average weight at 3 months – 11.8 – 14 lbs

Average length of baby at 6 months – 25.3 – 27.2 inches

Average weight at 6 months – 14.8 – 18.8 lbs

* World Health Organization:
Centers for Disease Control and Prevention:

According to an article published in The Washington Post, November, 2015, “Finnish babies sleep in boxes for the first three to four months.”  This is a remarkable variance from 8 months, as suggested by a cardboard box Co.

Noack, Rick (2010, November 10). Why babies should sleep in cardboard boxes, explained in 2 charts. Retrieved from

Most sudden unexpected infant deaths that occur in the first year are attributed to unsafe sleep environments. Babies can safely sleep in the Pack ‘n Play® up to 30 lbs and 35” which is well over one year of age.

3. COST:

A cardboard box unit (just the box $25-$35) will likely cost less than the Pack ‘n Play® ($49.99), but a cardboard box can only be used for approximately three to four months.  The Pack ‘n Play® can be used for babies up to 30 and 35” and more than one year of age.  Regardless of the slight cost difference, babies need a safe sleep environment throughout their first year, not just the first two to four months.  When the baby outgrows the box, another SAFE sleeping environment will need to be provided. Otherwise, the baby will likely be placed in bed with the parents, siblings, or on other unsafe surfaces, such as couches and car seats.

4. RESEARCH: Cardboard box companies have implied that Finland has a low infant mortality rate due to the distribution of boxes to all Finnish mothers. Finland’s low infant mortality rate is due to a combination of accessibility to healthcare (socialized medicine), education, and economic resources to provide for the family after the baby is born. Maternity leave is 105 week days, of which the mother receives 90% of her pay and then over 70% of her pay for the remaining maternity leave. Paternity leave/parental allowance may occur when maternity leave ends, which could potentially result in close to an entire year of parental care for the infant without significant financial hardship to the family.

A literature search was done for research that has actually studied the [cardboard] box to document any independent effect it has had on infant mortality.  There are NO studies available to support the claims being made about the box or even the frequency with which they are actually used as a sleep surface.  The media reports the success of the box in reducing infant mortality rates over a 70 year period, but they don’t offer comparisons from other countries.  Almost all countries have dramatically decreased infant mortality because of better sanitation, housing, health care, vaccinations, medications. improved standards of living, etc.  Here is a comparison of the graph quoted by companies selling cardboard boxes as safe sleeping units vs. infant mortality in the US, where boxes were never used…. the graphs are strikingly similar.FinnishInfantMortalityGraphs


  • Its safety record is UNMATCHED
  • The Pack ‘n Play® is compact, easy to assemble, and easy to transport in its carry case, making it easy to take on the go any time needed.
  • When space is an issue the Pack ‘n Play® serves dual purposes;  it can be used when the baby is sleeping, or as a playpen for the first year of life.
  • Cribs for Kids® can send Pack ‘n Play® to many mid-Atlantic and mid-west states served by Ohio Pitt Express.


Every year in the United States, more than 3,500 infant deaths occur due to accidental suffocation, asphyxia, or undetermined causes during sleep. Since 1998, Cribs for Kids® National Infant Safe Sleep Initiative has been making an impact on the rate of babies dying of sleep-related death in unsafe sleeping environments.  Cribs for Kids® is a 501 (c)(3) organization whose mission is to prevent these deaths by educating parents and caregivers on the importance of practicing safe sleep for their babies and by providing Graco® Pack ‘n Play® portable cribs to families who, otherwise, cannot afford a safe place for their babies to sleep.  All proceeds from it’s national infant safe sleep init

Cribs for Kids® offers parents and caregivers a wealth of infant safe sleep information on its website at, including an “Ask the Pediatrician” link for parents, educators, and caregivers who require more detailed answers to their questions.

On a national level, Cribs for Kids’® 690+ partners across the country have forged a coalition of organizations that view success for one, as success for all. Cribs for Kids® partners do not exist in a hierarchical structure but as collaborators, whose ideas and materials are shared by all of the partners. Partners agree to adhere to certain infant safe sleep standards and, giving them the right to use Cribs for Kids’® standardized forms, Cribs for Kids® name and logo, and safe-sleep materials at our discounted prices.  Cribs for Kids® offers a free Toolkit to organizations interested in the collaboration which includes safe sleep educational material in English and Spanish, hold harmless agreements, parental guidelines, pre and post tests for evaluation purposes, and grant writing materials.  Safe Sleep Brochures, DVDs of Public Service Announcements, and educational powerpoint presentations with up-to-date statistics will help partners spread the infant safe-sleep message in their communities.  All of these materials save new partners from ‘reinventing the wheel’ and assure that a consistent safe-sleep message is being spread throughout the country. –

Partners can call Cribs for Kids® for assistance on anything from getting started with their program, to raising funds, writing grants, and creating boiler-plate policies and forms that can be modified for their individual programs.  Cribs for Kid is not a “crib giveaway” program; it is a national infant safe sleep education program that provides safe sleeping environments for families who, otherwise, could not afford safe places for their babies to sleep.  We readily share our program and welcome others to join in our mission to Help Every Baby Sleep Safer.

Nassau County Department Of Health Receives National Awards

County Executive
Posted on: July 20, 2016mangano_infoadv

One of 19 Local Health Departments Nationwide To Receive Prestigious Model Practice Award

Today the Nassau County Department of Health was honored with a Model Practice Award at the National Association of County and City Health Officials (NACCHO) 2016 Annual Conference. A Safe Place to Sleep was one of 19 local health departments’ programs across the nation to receive this prestigious award for implementing a program that demonstrates exemplary qualities in response to a local public health need. Nassau County Department of Health’s Bureau of Environmental Engineering was also honored with a Promising Practice Award for the Environmental Health Toxic Emissions Program.

“I am extremely proud of the Department of Health and I congratulate Commissioner Dr. Lawrence Eisenstein and his team for being national leaders in public health,” said County Executive Mangano. “The Nassau County Department of Health has consistently been recognized as a national leader for developing responsive and innovative programs that promote and protect the health and safety of the residents of Nassau County.”

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Graco Pack ‘n Play – Air Permeability Statement

Cribs for Kids® wants to remind all of our partners and clients that we hold safety to the highest standard.  We are contacting you in light of the recent news about the trial concerning baby Abigail, who tragically died in an Evenflo BabyGo playpen due to the breathability of the mattress pad cover.  Please be assured that the Graco® Pack ‘n Play® portable crib mattress pad cover is one of the most air permeable and, therefore, safest units available.

When we started the Cribs for Kids® initiative we vetted all other playards and chose the Graco® Pack ‘n Play®, as it proved to be superior in quality and safety.  We stand by our commitment to this product based on Graco’s safety record that includes zero recalls.

The ‘Karow vs. Evenflo air permeability of sleep surface study’ below further supports our selection of the Graco® Pack ‘n Play® as our program’s standard unit. (The Cribs for Kids Graco® Pack ‘n Play® is listed as ‘Graco Unknown’ on the chart below.)  The  Evenflo mattress was revealed to have little to no air permeability, while the ‘Graco Unknown’ has the highest air permeability on the chart.  The superior air permeability of the Graco mattress is just one of the reasons why we choose to continue to use the Graco® Pack ‘n Play®.  We believe that our product is the safest for our clients.

KarowVSEvenflo_AirPermChartWe are often asked by our clients about the thickness of our mattress and the use of a supplemental mattress pad.  Our mattresses are designed to be thin and air permeable for safety reasons.  To further ensure the safety of our clients, we remind you that Graco Children’s Products does not make or sell a supplemental mattress pad for use in the Pack ‘n Play.  Some supplemental mattress pads are marketed as “fitting most Graco Pack ‘n Plays”; however Graco does not sell, nor do they advise use of any supplemental mattresses.  The Graco® manual included with every portable crib that all of your clients receive recommends never adding anything to the Pack ‘n Play® that is not included in the original packaging.

This statement from Graco® manual warns that the use of a supplemental mattress is not recommended, or supported, under any condition: “Unlike cribs that have rigid sides, the playard has flexible sides.  As a result, the playard mattress/pad is specially designed to prevent suffocation.  The playard mattress/pad has a solid base, a certain length and width, and is less than one inch thick in order to meet safety standards.  Using a thicker or a different sized mattress/pad may allow a child’s head to get between mattress/pad and the side of the playard causing suffocation.” 

At Cribs for Kids®, our mission is to keep babies safe while sleeping, and to provide safe sleep environments to those in need.  As safety remains our focus through education and support that we provide to all of our partners and clients, you can be confident that the Graco® Pack ‘n Play® is the safest unit available.

If you have any questions or concerns, please contact us at

Milwaukee health department raises awareness about Cribs for Kids program

MILWAUKEE, WI Feb 16, 2016 – A one-year-old girl sleeping with two adults on the north side is found dead Tuesday morning.

The Milwaukee County Medical Examiner’s office believes it’s a co-sleeping death. Initial reports state the girl was on a partially inflated air mattress with the adults at a home near 15th and Nash.

This is the third co-sleeping death in the City of Milwaukee this year, and there’s a desperate attempt to get the word out about resources for families who don’t have a crib or separate bed for their child. Health officials said an average of 10-15 babies die a preventable death because of unsafe sleeping environments.

“The most common risk factors that we see are soft bedding, soft mattresses, pillows, blankets,” said Jill Radowicz, City of Milwaukee Health Department nurse.

She said sharing a bed with a parent or sibling is dangerous too.

“Obviously an adult is a lot heavier than a small infant and when the air mattress sinks down, that infant rolls underneath the parent,” said Milwaukee Police Officer Dan Pierce.

Families in need can get the proper baby sleeping tools through the city’s Cribs for Kids program. After education and training, they get a pack and play for free, complete with a firm mattress, fitted sheet and a halo sleep sack.

“It’s a blanket that won’t cause a suffocation risk because it won’t go over their face,” she said.

CBS 58Tuesday, the health department expanded the program with the help of Milwaukee police.

Officers in districts two and three received training, so when they respond to calls, they can refer families who need a crib. The effort is already underway in district seven. Officer Nat Tharpe recalled a previous case.

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