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Safety Commission) approved firm mattress when I could not even reach it by
leaning over the side. Finally, I had to ask.
The answer was brilliant. The cribs were
designed with several settings for the mattress position. The highest position was for
the young baby and as she grew the mattress would be repositioned downwards.
Drop-side had been out for years. Even in
2009, though, all these new, safe, beautiful
cribs were adorned with bumpers carefully tied with ribbons along the side. In the
2016 recommendations, bumpers are out.
The spaces between the slats in the side
of the crib should measure less than 2 3/8
inches. The mattress itself should fit tight
to the sides and corners of the crib and the
fitted sheet - the only item allowed in the
crib with the baby - should fit snugly over
the mattress with enough underlay that it
cannot ride up the side if the baby moves
about. Well, at least in 1977 I got the solitary baby, the mattress and the mattress
cover right.
Many of the updated recommendations
are clearly important for the general safety, health and well-being of the baby as
well as risk reduction for SIDS. Two that
I believe will be open to discussion between parents and pediatricians are #3;
that babies are fed breast milk exclusively
for at least six months; and #4; that babies
sleep in the same room as their parent(s)
for at least six months and preferably for
one year. With regard to recommendation #3, the actual wording seems rather
strict. It reads as follows, “Breastfeeding
is associated with a reduced risk of SIDS.
Unless contraindicated, mothers should
breastfeed exclusively or feed with expressed milk for six months.” I can think
of a number of scenarios where this is just
not possible. For example, the birth mother is a surrogate, the baby is adopted or
the baby is being raised by a grandparent
or other family member. Currently there
are national and local organizations that
accept and process human breast milk for
donation or sale. The movement started
altruistically in an attempt to get fortified
human breast milk to sick and premature
infants in NICUs nationwide. (3,4) Now
some of the sites suggest a primary com28
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mercial goal. (5) Could recommendation
#3 lead to an increased market for breast
milk or breast milk banks? What kind of
regulations would this entail? Perhaps the
word “contraindicated” means something
to me that the authors did not intend. I
think clarification is needed.
With regard to recommendation #4, the
wording is as follows. “It is recommended that infants sleep in the parents’ room,
close to the bed, but on a separate surface
designed for infants; ideally for the first
year of life, but at least for six months.”
My instinctive reaction to this is that most
parents, including mothers, have to get up
and go to work before the baby is 6-weeksold, let alone 6-months-old. In reviewing
the references on which this particular
guideline is based, I noted that six of the
studies were conducted in European countries and one in New Zealand. I wonder if
there is a way to parlay this recommendation into U.S. public policy regarding
parental leave and job preservation for all
involved parties. On a more intimate note
new parents need a little private time together.
Another recommendation, #6, is perhaps a little less weighty but merits some
scrutiny. It reads as follows: “Consider offering a pacifier at naptime and bedtime.”
The explanation starts out well-intentioned but becomes somewhat confusing.
“Although the mechanism is yet unclear,
studies have reported a protective effect
of pacifiers on the incidence of SIDS.”
Thereafter we are advised that the pacifier should be given as the baby is going to
sleep. Apparently if the pacifier falls out
of the baby’s mouth it should not be reinserted. If the baby refuses the pacifier it
should not be forced. Also, if the baby is
being directly breastfed the pacifier should
not be introduced until breastfeeding is
well established. If the baby is being (bottle) fed expressed milk, the pacifier can
be introduced at any time. Clearly pediatricians are going to have to shed light on
this recommendation and of course advise
parents on the flexibility of #3 and #4.
I have no doubt that these guidelines
are necessary and that parents and caregivers will do their best to comply. I was
pleased to see the emphasis that is placed
on ensuring that baby’s sleep furniture,
crib, portable crib, bassinet, play-yard (in
British English play-pen) should not have
been broken/modified and repaired, and
should always meet CPSC standards. At
the same time, I feel for new grandparents
who have faithfully guarded those wonderful family heirlooms, often handmade
by family members, in the hopes that a
new generation would sleep soundly and
safely in them. Let’s fill them with all the
soft toys, animals, blankets and q