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Several infant in-bed sleepers meant for bed-sharing with an adult caregiver are linked to at least 12 deaths that occurred between 2012 and 2018, according to a Consumer Reports investigation. The findings are based in part on incident data that CR received from the Consumer Product Safety Commission, which inadvertently disclosed information about the specific products involved in the incidents.
CR first reported on findings from this CPSC dataset in April 2019, when we found that inclined sleepers—a different type of baby sleep product that includes the Fisher-Price Rock ’n Play Sleeper and Kids II rocking sleepers—were linked to dozens of infant deaths. Since then, the reported number of deaths related to these products has risen.
Last week, the CPSC released a report acknowledging at least 73 infant deaths associated with inclined sleep products—up from the 54 CR reported earlier this month. The updated count includes fatalities linked with inclined products such as hammocks, six of which were recalled, and nonrocking inclined products, such as the Nap Nanny, an inclined foam sleeper that was fully recalled in 2013 and has been tied to six fatalities.
In-bed sleepers are appealing to many new parents who want to keep their babies close to them at night, to help the baby sleep or to make nighttime feedings easier. Unlike inclined sleepers, they typically do not put a baby on a substantial incline—a position that could cause an infant’s head to slump down, chin to chest, and compress the airway, potentially leading to suffocation.
But in-bed sleepers do not currently have their own federal safety standards, and they have other potentially dangerous design elements. Notably, some feature padding and soft surfaces, which can block airflow if a baby’s face comes into contact with the fabric. And by their nature they encourage bed-sharing, a practice that itself increases the risk of infant death.
“We know that padding is a suffocation risk” when it’s close to a sleeping baby, says Roy Benaroch, M.D., an associate adjunct professor of pediatrics at Emory University in Atlanta.
CR identified the following fatalities in the CPSC data:
CR also found five additional deaths, linked to unidentified in-bed sleepers, in separate data released by a committee convened by ASTM International. That’s an independent organization that helps develop voluntary safety standards for products. (CR is a member of the ASTM committee.)
We reached out to all three brands about the incidents. SUMR Brands said its SwaddleMe By Your Side Sleeper “is not responsible for any deaths. Independent medical examiner reports of two incidents where a Summer in-bed sleeper was present in 2014 and 2015 concluded the in-bed sleeper was not a contributing factor to a child’s death.”
Baby Delight said that its Snuggle Nest was not the cause of the fatalities and that inappropriate and dangerous sleep practices and misuse likely caused or significantly contributed to the deaths.
Both of these companies reinforced safety as their No. 1 priority and said they had received no incident reports other than the ones we identified.
DockATot declined to comment. The company website says that the product is “ideal for co-sleeping” but also notes that if consumers choose to use a DockATot for co-sleeping, they should consult with their pediatrician and follow several precautions, such as placing the product on a firm mattress with no extra pillows or covers nearby.
The incidents in the CPSC data are reported as narratives, and most of them are eerily similar and equally heartbreaking. In the majority of cases, they tell the stories of parents who put their baby to sleep in one of the products, positioned next to them in their adult bed for the night. The parents later woke up to find their baby unresponsive and cold to the touch.
Other factors may have contributed to some or all of the fatalities. Still, CR’s safety experts believe that none of these products have been adequately safety-tested and none adhere to safe sleep recommendations from the American Academy of Pediatrics and other health agencies. Infant sleep guidelines state that babies should sleep on their backs, alone, unrestrained, on a firm, flat surface, free of padding, bumpers, and other soft bedding.
Unlike cribs, bassinets, play yards, or bedside sleepers, in-bed sleepers are not regulated by the CPSC with a mandatory standard and pose “an immediate and constant risk to a child sleeping in one of them,” says Ben Hoffman, M.D., chairperson of the AAP’s Council on Injury, Violence, and Poison Prevention’s executive committee.
“When my own kids were young, my wife and I struggled with getting enough sleep,” Hoffman says. “I know that parents are desperate.” And many assume that these products have been thoroughly safety-tested before being made available for sale, he says. “But I cannot think of a safe way to use these products.”
Chance for Regulatory Change
CR’s findings come on the heels of a proposal, released last week, by CPSC staff to close a gap in federal safety rules and ensure that all infant sleepers must meet strong safety requirements.
The proposal was prompted by the growing death toll tied to infant inclined sleepers and the recall of 13 such sleepers, totaling more than 6.5 million products, from May 2000 through July 2019. The CPSC’s recommendations were also informed by a new study it commissioned that compared how infants move and use their muscles when placed in various scenarios: on a flat mattress, on an inclined mattress of varying degrees, and in several selected inclined sleepers.
The analysis, led by Erin Mannen, Ph.D., a biomechanics researcher and assistant professor of orthopedic surgery at the University of Arkansas for Medical Sciences, concluded that “none of the inclined sleep products that were tested and evaluated as part of this study are safe for infant sleep.” And while inclined sleepers can have up to a 30-degree incline, the study noted that even a “20-degree incline puts infants at risk for muscle fatigue” and suffocation. The CPSC staff ultimately determined that "a flat surface that does not exceed 10 degrees offers the safest sleep environment for infants."
The CPSC staff’s key recommendations include the following: that all infant sleepers that don’t currently meet an existing CPSC standard for cribs, bassinets, play yards, or bedside sleepers would have to meet the agency’s bassinet standard; that infant sleepers should no longer be able to have a seatback angle greater than 10 degrees, which would effectively eliminate inclined sleepers; and that the category currently called “infant inclined sleep products” should be renamed “infant sleep products” and encompass a broader range of baby sleepers.
“The proposal essentially would ban the infant inclined sleep products currently on the market,” says William Wallace, CR’s manager of home and safety policy, who welcomes the recommendations. “And it would help keep other risky infant sleepers from entering the market in the future. We urge the CPSC to keep this strong proposal moving forward.”
The AAP’s Hoffman also welcomes the proposal. “We need to put the burden of proof on the manufacturers and the regulatory system to demonstrate that something is indeed safe before it’s unleashed on vulnerable babies,” he says.
Sara Thompson, whose infant son died in the Rock ’n Play Sleeper in 2011, says that when she learned about the CPSC staff’s proposal, she was overwhelmed with both grief and hope. “I cried,” she said. “For my son, and for all those other babies who needlessly suffered and died; it shouldn’t have taken more than 70 babies’ deaths to acknowledge that inclined sleepers are unsafe.”
“But hopefully this will put an end to all the people who shamed and blamed the parents whose babies died in these products,” Thompson adds. “We were not negligent. The parents whose babies didn’t die in the products were just damn lucky.”
The juvenile product industry, consumer groups (including CR), advocates, and other key stakeholders will discuss the CPSC’s recommendations today at a meeting on inclined sleep products convened by ASTM International. The agency’s five commissioners are set to vote on moving forward on the proposed standard this week.
The Dangers of In-Bed Sleepers
Medical experts say there are several factors that make these infant sleep products risky. But one of the most obvious problems is extra padding. “An infant’s mouth can get pressed up against the soft surface, and you don’t want the baby rebreathing their own carbon dioxide, because the baby could asphyxiate,” says Benaroch, at Emory.
And while parents may think that in-bed sleepers with a firmer structure and mesh-lined sides (like the Snuggle Nest Infant Sleeper and the SwaddleMe By Your Side Sleeper) might not impede airflow, making bed-sharing safer, this has not been proved. “The American Academy of Pediatrics has not made a recommendation for or against the use of in-bed sleepers … because there aren’t studies examining the association between these products and sleep-related deaths,” says Ashley Hirai, Ph.D., senior scientist with the Health Resources and Services Administration’s Maternal and Child Health Bureau.
Benaroch says that “if the sides are soft, it would be very easy for an exhausted parent to roll over onto” the product and the baby.
Nancy Cowles, executive director of Kids In Danger, a child safety advocacy organization, adds that in-bed sleepers may even give parents a false sense of security.
“We don’t have data that [in-bed sleepers] make co-sleeping any safer,” Cowles says. And “with in-bed sleepers there is so much the product can’t control for.” For instance, the firmness of the adult mattress that the product is placed on, or the movements of the adults in the bed, could cause the product to shift or perform differently. Also, “if a man weighs twice as much as his wife, when placed on a mattress or other soft surface the in-bed sleeper is probably going to tip toward him,” Cowles says. This could cause the infant to roll and press up against the sleeper, the parent, or other bedding.
And as the CPSC data revealed, precarious scenarios do happen, far too often. “It’s not just a theoretical problem,” Hoffman says. “More infants die in their sleep in the first year of life than all kids die of cancer every year.” And research shows that the risks of sleep-related infant deaths increase when babies are put to sleep in unsafe products.
“We have substantial room for improvement when it comes to safe sleep practices,” says Hirai, the scientist from the Maternal and Child Health Bureau. She is also the lead author of a study published today in the journal Pediatrics that looked into how mothers put their infants to sleep. The research found that only a third of mothers reported always putting their child to sleep in a product that is recommended and approved for infant sleep, such as a crib, bassinet, or play yard. And “most mothers also reported using soft bedding, like blankets, pillows, and crib bumper pads, which are frequently found in sleep-related infant death cases,” Hirai says.
That these tragedies continue to happen underscores how important it is for doctors to “talk with families, to acknowledge how hard sleep is, then to talk about the practices we know to be safe, in order to help parents get as close to that as they possibly can,” says Hoffman, at the AAP. That includes “eliminating a potentially dangerous product that we fear will put babies at additional risk.”
What Parents Can Do
CR urges parents to stop using inclined sleepers or any sleep products—including in-bed sleepers—that do not meet federal safety requirements related to infant sleep. Parents should put their babies to sleep in a bassinet, crib, play yard, or bedside sleeper—and ask their pediatricians for help with infant sleep, when needed.
“Families should, hopefully, have a pediatrician that they can communicate with honestly” about how they are putting their baby to sleep, says Ian Paul, M.D., chief of general academic pediatrics at Penn State College of Medicine. “I know sometimes parents worry that they’re just going to get ‘the speech’ and they don't want to hear it, so they don’t tell the pediatrician the truth,” he says. “But they should be able to communicate, because pediatricians want the same things as parents: thriving children.”
Paul acknowledges that some parents bed-share without telling him, but he’d rather know so that he can help them reduce their risk of harm. He tells parents, “Bed-sharing is not something I support, but if you're going to do it, I can go over the things you need to know to do it as safely as possible.”
Michelle Collins, Ph.D., a professor of nursing at Rush University College of Nursing in Chicago and a spokesperson for the American College of Nurse-Midwives, says, “There are cultural and personal reasons that people will want to bed-share, and the onus is on us to give people information.” The ACNM offers best practices on bed-sharing that include guidelines such as:
Safe Sleep Guidelines
The AAP does not recommend bed-sharing, but does recommend room-sharing. These tips, from pediatricians, can help infants sleep while keeping them safe:
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- Three deaths that involved the Baby Delight Snuggle Nest Infant Sleeper, which has a flat mattress but includes a removable 1.5-inch molded incline wedge that puts babies at an incline of about 12 degrees. It also has low sidewalls consisting of mesh and fabric.
- Two deaths that involved the SwaddleMe By Your Side Sleeper, which is made by SUMR Brands and has a flat mattress and low mesh sidewalls.
- Two deaths that involved the DockATot, which is pillowlike and has a soft side bumper.
- Place the infant to sleep next to the mother and not between parents; you may attach a side-railing to the bed to prevent falls as long as there is no gap between the railing and the bed.
- Place the infant on his or her back when sleeping.
- Never leave your infant alone while asleep in an adult bed.
- Remove pillows and heavy blankets from the bed.
- Make sure that there are no spaces between the mattress and the wall or headboard.
- Do not bed-share if you’re overly tired or under the influence of drugs, alcohol, or sleep aids.
Have at least one parent sleep in the same room as your baby for the first six to 12 months.
Have reasonable expectations. “Newborns are nearly always more wakeful at night, and it will take at least a few weeks to flip that initial day-night confusion,” Benaroch says. And remember that young babies are supposed to wake frequently to eat.
Consider swaddling. To do so safely: Leave the legs and hips loose, so your baby can stretch and move. “Swaddling should typically stop around 2 months of age because as older babies start to wiggle and move, the swaddling can impede their development and possibly be a hazard if they get entangled in the swaddling blanket,” Benaroch says.
Try a white noise machine, which makes the same kind of comforting sounds babies hear in the womb. And to avoid strangulation, make sure the machine’s cord is nowhere near the baby.
Offer your baby a pacifier. Many babies have a strong sucking reflex and find sucking on a pacifier soothing. Research shows that pacifiers are safe for infants and may reduce the risk of sudden infant death syndrome (SIDS).
Learn the “5 S’s,” created by Harvey Karp, M.D., author of “The Happiest Baby on the Block.” The approach simulates certain aspects of the womb, which can calm babies and lull them to sleep. The S’s are: swaddling, shhshing sounds (made with your mouth or a noise machine), sucking on a pacifier, swinging your baby rhythmically, and holding him in a side-lying position.
Don’t attempt to force your baby into a sleep schedule too early. “As babies get older and gain weight, you may nudge them toward longer stretches of sleep by not jumping to respond to every noise and movement they make,” Benaroch says. You can also start putting your baby to sleep while he’s still awake, so he can learn to fall asleep without your help.
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