Recently, the Food and Drug Administration (FDA) issued an alert recommending parents and caregivers not to use pillows to shape infants’ heads, as they can create an unsafe sleeping environment for infants and may increase the risk of suffocation and death.
According to the FDA, pillows have not has been shown to be safe or effective in preventing or treating flat head syndrome or positional plagiocephaly. This is when specific areas of a baby’s head develop an abnormally flat shape from lying on one side for an extended period of time.
With this safety alert, recent product recalls, and new safe sleep laws, it can be difficult for parents to figure out how to create a safe sleep environment for their baby. Rajashree Koppolu, CPNP-PC/AC, MSN, RN, MSL, NPD-BC, Nurse Practitioner in the Pediatric General Surgery and Trauma Team, and Stephanie Choi, CPNP, MS, RN, Nurse Practitioner in Pediatric Neurosurgery , collapse what parents need to know.
“Return is better”
New safe sleep guidelines from the American Academy of Pediatrics reinforce the need for infants to sleep on their backs on flat, firm, non-inclined surfaces. Approximately 3,500 infants die each year from sleep-related infant deaths each year in the United States. Research has shown that the risk of SUIDS, or Sudden Unexpected Infant Death, increases in an unsafe sleeping environment. SUID can be caused by accidental suffocation, entrapment, or strangulation during sleep.
“Most SUID-related deaths occur between 1 month and 4 months. However, safe sleep guidelines are recommended for the first year after birth,” says Koppolu.
A good rule of thumb to reduce risk is to follow the ABCs of safe sleep: Aalone, on their Back, and in a VSrib or cradle.
Alone means no bed sharing, but Koppolu adds that having that bassinet or bassinet that upholds Consumer Product Safety Commission (CPSC) safety standards in the same room as parents or caregivers for at least 6 months has proven beneficial. The sleeping area should also only have a firm, level surface with a tight fitted sheet until at least one year old.
“It’s important that the bed be clear of everything – stuffed animals, blankets, pillows – anything that may pose a risk to their ability to breathe safely,” advises Koppolu.
Parents can consider dressing their baby in a sleeping bag that fits over pajamas and provides warmth. Swaddling should no longer be used once the infant shows signs of starting to roll over. Choi points to data showing that objects such as positioners, bumpers and pillows can clog an infant’s nose and mouth, leading to accidental choking. This is also the problem with baby head pillows.
“There are many other safe treatment options for flat head syndrome that can be discussed in more detail with your pediatrician or any head shape specialist,” Choi says. “We recommend families first try two months of active repositioning at home, such as tummy time while awake, which can be supplemented with physical therapy. If that doesn’t improve fitness of the head, we will recommend to proceed with helmet therapy.
This technique, cranial reshaping therapy, involves wearing a rigid helmet for four to eight months. The helmet helps guide the growth and remodeling of the skull over time, requiring periodic adjustments to allow for continued head growth.
There is also evidence to show that when an infant is raised above 10 degrees, it does not help the baby’s oxygen flow because their head is disproportionately heavy.
“From a developmental perspective, young infants have impaired wakefulness and develop cardiorespiratory and autonomic responses. When associated with an unsafe sleep environment, they may be at risk for sleep-related deaths. When babies are on their backs, their airways are above the feeding tubes, so their airways come more from suction,” says Koppolu.
But what happens when your baby falls asleep on the road, strapped into their car seat? Be sure to place them on a firm, level surface to sleep on whenever safe and convenient and never leave baby unattended.
Do not forget the other protective measures
Besides where the baby sleeps, Koppolu reminds parents to think about overall safety around the house.
- Don’t over wrap the baby and keep the room at a comfortable room temperature
- Maintain a regular vaccination schedule
- Get regular prenatal care
- Breastfeeding associated with reduced risk of SIDS for at least the first 6 months
- Do not smoke or use nicotine, alcohol, opioids, during pregnancy and after your baby is born
- Ensure caregivers are trained in infant CPR and have all necessary emergency phone numbers
Find help in the community
The Stanford Children’s Health Childhood Injury Prevention Program provides safe sleep and other forms of education for families at Stanford’s Lucile Packard Children’s Hospital, whether through a virtual one-to-one hour or at the patient’s bedside. The team also reaches out to the community through nurse-family partnerships, where specially trained nurses will visit first-time moms-to-be and provide free car seats, home safety kits, window locks, Pack ‘n Plays and sleeping bags.
Parents concerned about the shape of their child’s head should contact their pediatrician. Referrals can be made to the Stanford Children’s Plagiocephaly Clinic to determine age-appropriate treatment.
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