By Karen L. Crilly, PT, MAPT, DPT

This is an exciting month, it is physical therapy month. Just like many physical therapist across American and the world the one component that is always on our radar is prevention. Thinking of prevention, I want to provide therapist and the parent in your community with a resource that they can quickly glance and use as reminders. Stay tune to get the information.

I belong to a community group and recently a question came up in regards swaddling or not swaddling the baby because the baby cries a lot. This was a topic that interested me as it involved a safety aspect on the care of a young baby. The mother mention that her pediatrician told her to stop swaddling her baby as the baby is now 6 months old. She was taken back as this was something she greatly relied on in order to help her baby soothe to sleep.

As heath care professionals safe sleep is an area that we must feel comfortable with in order to educate the families. The back to sleep campaign was put into effect in 1992 when providers asked parents to lay they baby on their back to sleep and not on the side anymore. At that time the incidence of death from Sudden Infant Death Syndrome declined dramatically. But new reports on sleep related infant death arise due to suffocation, entrapment and asphyxia. Because of these new issues in 1997 an expansion to the recommendations relating to the sleep environment of the children was put into place. The article was published in November 2011 and put online on October 18 of the same year.

I have placed a short and simple table that you can use as a daily guide, which summarizes the recommendation. For more details please refer to the article. The recommendations are based on the US Preventive Services Task Force levels of recommendation.

Environmental Recommendation Tips
Back to sleep for every sleep Recommended to be done until the first year of life.
Use a Firm Sleep surface Make sure that your crib, bassinet, portable crib/play yard follows the Consumer Product Safety Commission and ASTM International (formerly the American Society for Testing and Materials) standards for safety.
Room-sharing without bed-sharing is recommended It has been reported that placing the baby on his/her own bed reduces the risk of SIDS by 50%.
Keep soft object and loose bedding out of the crib. Make sure that the sheets are nice and snug on the mattress to decrease the risk of entrapment or suffocation, same thing with lose toys on the bed. Make sure the clothing of the baby is not too loose and falls on the face of the baby.
Pregnant women should receive regular prenatal care. There is evidence that supports lower risk of SIDS of mothers that received regular prenatal care.
Avoid smoke exposure during pregnancy and after birth There is evidence of major risk for SIDs for infants of mothers that smoke during pregnancy and there is smoking on the environment of the infants after birth.
Avoid alcohol and illicit drug use during pregnancy and after birth Parental use of alcohol and illicit drugs places combined with bed sharing places the infant at high risk for SIDS.
Breastfeeding is recommended There is evidence that show how breastfeeding reduces the risk of SIDS. NO particular length of time is recommended just any breastfeeding is better than no breastfeeding at all to reduce the risk of SIDS.
Consider offering a pacifier at nap time and bedtime Research have shown that the sucking motion causes a protective effect against SIDS. But remember not to force the baby to take the pacifier, or do not hang the pacifier on a ribbon or a stuff animal as these can cause suffocation.
Avoid overheating A good general rule is to have the baby dress with no more than one layer than the adult would wear. This would prevent overheating and will allow the baby to be dress appropriately for the environment.
Do not use home cardiorespiratory monitors as a strategy for reducing the risk of SIDS. Although this equipment is used in some homes for cardiopulmonary purposes, there is no evidence that the monitor can prevent the risk of SIDS.
Expand the national campaign to reduce the risks of SIDS focusing on the safe sleep environment. We all must be active participants on this campaign. Especially in this time where the early intervention program is a predominant style of intervention across the United States, and we as therapist, teachers, nurses and many other different providers visit the families and encounter real life family environments.

Additional general recommendations:

Infants should be immunized in accordance with recommendations of the AAP and Centers for Disease Control and Prevention.

Avoid commercial devices marketed to reduce the risk of SIDS.

Supervised, awake tummy time is recommended to facilitate development and to minimize development of positional plagiocephaly.

Health care professionals, staff in newborn nurseries and NICUs, and child care providers should endorse the SIDS risk-reduction recommendations from birth.

Media and manufacturers should follow safe-sleep guidelines in their messaging and advertising.

Continue research and surveillance on all the different areas.

Remember prevention is a team effort we all can help keep a baby safe.


Rachel Y. Moon, MD. SIDS and Other Sleep-Related Infant Deaths: Expansion of Recommendations for a Safe Infant Environment, Task Force on Sudden Infant Death. Pediatrics. October 2011: 2011-2284.

Click here to check out Karen Crilly’s course on pediatric neurodevelopmental disorders!