When new parents put their child to bed, it’s time for them to exhale and catch up on some rest of their own. That’s why it’s important to have peace of mind that your baby is sleeping safely. Tiffany Waters, a birthing center charge nurse at OSF HealthCare, has a checklist – whether it’s nighttime sleep in a crib or some bonding time in a recliner.

“Everybody should be educated on this,” Waters says. “Parents, grandparents, friends and your daycare.”

The guidelines

• Back vs. stomach: Waters says the American Academy of Pediatrics (AAP) guidelines say the child should sleep on their back.
  
  “When your infant is on their stomach and unable to roll over, it can create a pocket of carbon dioxide. We all know we want oxygen in and carbon dioxide out,” Waters explains. “That little pocket can mean your baby is re-breathing the carbon dioxide.”
  
  Waters adds that at around four months, babies may learn to roll onto their stomach during sleep. It’s fine to leave them that way, but Waters says sleep time should always start with the baby on their back.
   
• Flat vs. inclined: A flat surface is the standard. But, Waters acknowledges that babies fall asleep in other places. For example, if a child drifts off on a car ride, that’s fine. Just make sure they are properly strapped into a car seat.
   
  Parents may also sit in the recliner with the baby on their chest as a bonding moment. Do this carefully, Waters says.
  
  “It’s easy for a baby to slip down toward the arm of the chair. Or they could get in a position where instead of an open airway, they’re hunched over and not allowing for breathing function as it should,” Waters warns.
  
  So for recliner time, make sure the adult is fully awake. And in either case (car seat or recliner), the sleep time shouldn’t be long. For example, when you get home from the car ride, take the baby back to their crib for the remainder of the night’s rest.
   
• Firm vs. soft: A firm, fitted sheet to lay on is best.

• The crib: Loose objects such as pillows, blankets and stuffed animals are OK in the crib for those precious photoshoots. But when it’s sleep time, remove them.
  
  “Those are additional suffocation and entrapment risks,” Waters says. “They can press up against the baby’s face. The baby doesn’t have great neck control. They can’t move away like older babies can.”
  
  The crib itself should be scrutinized, too. Be wary of hand-me-down cribs that don’t meet the latest safety regulations. For example, Waters says cribs with bumpers – fabric that attaches to the inside walls – are no longer in favor. She says the baby can plant their face in the bumper and suffocate. Instead, look for cribs with space between the slats about the size of one of those oversized pink erasers.
  
  “It doesn’t have to be a super fancy crib or cost a lot of money. It needs to be newer so you know it abides by current recommendations for those slat spacings,” Waters says.
   
• Clothes and overheating: There’s no magic temperature to keep your child’s room at to foster good sleep. Waters suggests whatever room temperature is appropriate for that season should work.
  
  What’s more important: making sure the child isn’t wearing so much clothing that they overheat.
  
  “If you dress a baby for warmth, it’s one additional layer from what you have on,” Waters explains. “So if you have a T-shirt on and you’re comfortable, maybe a long sleeved sleeper onesie would be appropriate for the baby.”
  
  Waters adds that once the baby comes home from the hospital, they typically don’t need to wear a hat to keep warm while sleeping. Pop the hat on when they are outside in cold weather, she says.
   
• Smoking: Whether in the bedroom or any room, infant sleep and their overall health can be disrupted from smoke. This includes smoke from cigarettes, cannabis or just smoke from your environment (like pollution). So, don’t smoke around your child, and keep your home well ventilated.
   
• Same bed vs. same room: Some parents sleep in the same bed as their infant as a bonding experience. Bad idea, says the AAP. And Waters agrees. She says you could roll over onto your child or toss your pillow onto them and smother the kid. Instead, try bringing the child’s crib into your room. You can meet the youngster’s needs, like being close by when they cry, but keep them safe.

Learn more

Read more about how to have a successful pregnancy on the OSF HealthCare website.

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A big one is when to make the switch from rear to front facing. 

There's no one-size-fits-all answer. But Cindy Hamilton, the Child Passenger Safety Program Coordinator at the OSF Children's Hospital of Illinois, has some consistent guidelines parents can follow. 

First, the child should max out the height and weight for the rear-facing seat they're in, which is going to differ based on the manufacturer. 

The State of Illinois requires children to be rear facing at least until they're two years old.

However, the National Traffic Highway Safety Administration recommends keeping kids rear facing until they're three. 

Hamilton says if you're in a crash, the shell of the body of the rear-facing seat will absorb the shock. It protects the head, neck and spine more than when your child is front facing.

"A lot of parents might say 'well my child is uncomfortable, their legs are long, but they're still not two,' or they're low in the weight range. Our best advice is that you can heal from a leg injury. A spinal cord, neck or brain injury, maybe not. So that's a key determiner of keeping them rear facing,” Hamilton says.

When you make the switch from rear to front facing, Hamilton says to make sure your child has full control of their head and neck.

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Is my child too tall? What weight should they be? What’s the safer option? 

These questions run through parents’ minds when it comes to their child’s car seats. There’s no one-size-fits-all answer, but Cindy Hamilton, the Child Passenger Safety program coordinator at OSF HealthCare Children’s Hospital of Illinois, has some consistent guidelines parents can follow.

Pay attention to the car seat manufacturer’s guidelines

"The child wants to max out the height and weight for the seat they are using, which is going to be different for every seat based on the manufacturer. So, if this seat goes 40 pounds rear-facing; when they're 40 pounds, we want to turn them around then,” Hamilton says.

How do height and weight play a role?

"A lot of parents might say 'well my child is uncomfortable, their legs are long, but they're still not two,' or they're low in the weight range. Our best advice is that you can heal from a leg injury. A spinal cord, neck or brain injury, maybe not. So that's a key determiner of keeping them rear facing,” Hamilton says.

Illinois state law requires infants to remain rear facing until at least two years old. But Hamilton says, “rear facing longer is always best,” which is also advised by the National Highway Traffic Safety Administration, which recommends keeping kids rear facing until they’re three.

"When you're in a crash, the shell of the body of a rear-facing seat will absorb the shock. It protects the head, neck and spine more than when you are forward facing," Hamilton points out. 

When it comes to forward facing, Hamilton says you want to make sure your kids have full control of their head and neck. This is another “milestone” you can add to your list when you consider making the switch.

Steps to safely secure car seat

When you install the car seat rear facing, install with the seat belt or the seat’s anchors, but not both. Always check both the manufacturer guidelines and the vehicle owner’s manual which lists the locations of the car’s anchors and tethers for car seats.          

Make sure the harness is fitted to the child securely.

Clip the chest clip at armpit level. The lower clip should be snug across the area where the diaper is.

You don’t want to be able to pinch any fabric around the child’s neck and shoulders, Hamilton says.

The rear-facing seat should have a recline angle indicator. You want to make sure that whatever the indicator is, it’s aligned and level with the seat.

If your child has made the switch to forward facing, make sure they can hold their head up and they’re sitting more upright. Connect the top tether to hold the seatback to the seat and install with either lower anchors or seat belt. If you do choose the seat belt, Hamilton says make sure the seat belt is properly locked, which can be done by pulling all the webbing out from the retractor. You can find these locations in the owner’s manual as well.

“We don't put coats or blankets under (the straps) for safety. With a child that's rear facing, we want the straps at or below (the child's shoulders) because that's how they're crash tested,” Hamilton says. “With forward facing, all the same with the harness, but we want the strap at or above (the child's shoulders).”

OSF HealthCare offers a low-cost car seat program. Families who need a car seat can call 1-877-277-6543. There are also community car seat checks and free car seat installation checks held throughout central Illinois.

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