Here’s what we do know: between 2005 and 2008, 88 babies in the Milwaukee area died from accidental overlay, suffocation or sudden infant death syndrome. These cases involved boys and girls of all socioeconomic classes and races – 37 percent were Hispanic, 30 percent white and 18 percent black. The most common risk factor was an unsafe sleep environment including inappropriate bedding (pillows, quilts or bumpers) in about 80 percent of cases and co-sleeping with an adult in 70 percent of cases. Only a minority of cases (less than 20 percent) involved a parent who was under the influence of drugs or alcohol.

While we don’t know all the factors that make co-sleeping dangerous, we are sure that it’s safer not to do it.

Here at Children’s Hospital of Wisconsin, we follow the recommendations of the American Academy of Pediatrics and encourage you to follow the ABCs of safe sleep:

A: Alone. Babies should not share a sleep surface with anyone or anything. No adults or other children should sleep with a baby. The crib should be empty without toys, bumper pads, wipes or extra blankets. This might look cold and empty to you and a lot different from the plush and filled cribs in the stores or magazines, but it’s safest and your baby will be sleeping and won’t even notice.

B: Back. Deaths due to SIDS have been cut in half since we began recommending all babies be put on their backs to sleep. This position keeps the baby’s face clear, allows him or her to breathe freely, helps regulate breathing and prevents choking if he or she spits up during the night. When you’re on your back, your windpipe is higher than your esophagus, so food and fluid run back into your stomach and not down to your lungs. Remember to let your baby get plenty of “tummy time” when you’re playing with him or her. This will help your baby’s arms and neck grow strong and help his or her head keep a round shape.

C: Crib. Babies don’t need a lot of space, but need their space to be their own. Babies should sleep on a firm, flat surface like an infant crib mattress or Pack ’n Play. Adult mattresses and couches are too soft and are a suffocation risk. If you want to be close to your baby throughout the night, put your crib, bassinet or Pack ’n Play in your bedroom so you can share a room, not a bed.

Finally, remember that one of the best ways to take care of your baby is to take care of yourself. Make sure you get plenty of sleep and exercise and don’t use alcohol or drugs when you’re caring for a child. Spend quality time with your baby, including snuggling and breastfeeding while you’re awake. Then put your child into a protected environment.

Practicing safe sleep is a simple, yet highly effective way to keep your baby safe and healthy. Visit www.chw.org/safesleep to learn more.

~ Jason Jarzembowski, MD, PhD, program director of perinatal pathology, Children’s Hospital of Wisconsin

As a doctor at Children’s Hospital of Wisconsin, I see the good and the bad. I see smiling babies toddling down our hallways and giggling infants squealing with delight. But, I also see families whose lives changed forever because of the death of an infant.

While I am a doctor, my most important title in life is “dad” to a 7-year-old son. I simply cannot imagine life without him. When he was a baby, my wife and I took extra precautions to put him in a safe sleep environment. It wasn’t always easy. We were tired. Sometimes, we were downright exhausted. But, it was our job to protect him.

Taking our cue from the American Academy of Pediatrics, we used three easy-to-remember steps to help maintain a safe sleep environment for my son when he was an infant:

• A: Babies always should sleep alone. Sleeping with your baby in your bed, on a couch or in a chair is not safe.

• B: Babies should sleep on their backs. According to the American Academy of Pediatrics, this is the safest position for babies to sleep in.

• C: Babies should sleep in a crib. Make sure there are no bumper pads, toys or other items in the crib.

Download Children’s Hospital’s safe sleep flier, post it in your child’s nursery and share it with a friend.

~ Jason Jarzembowski, MD, PhD, is the program director of perinatal pathology at Children’s Hospital of Wisconsin and the medical advisor for the Infant Death Center of Wisconsin.

You probably know that adults need 7 to 8 hours of sleep per night. But how much sleep do kids need?

Infants (birth to 12 months old) – 10 ½ to 18 hours (total of nighttime and naps)
Toddlers (1 to 3 years old) – 12 to 14 hours (total of nighttime and naps)
Preschoolers (3 to 5 years old) – 11 to 13 hours
School-age kids (6 to 12 years old) – 10 to 11 hours
Teens (13 to 18 years old) – 9 to 9 ½  hours

Here’s a helpful sleep checklist:

• Set a regular bedtime and wake-up time. Kids with bedtimes before 10 p.m. are much more likely to get enough sleep than kids with later bedtimes. If necessary, the schedule can be adjusted at a gradual pace (about 15 minutes every two days) to ease the transition.

• Be consistent with your children’s sleep schedules, even on the weekends. Emphasize activity and bright light in the morning; these help to train the brain to be wide awake in the morning. Whenever possible, send them outside to play, rather than allowing them to sit watching TV and eating snacks – it’s better for their brain and their body!

• Establish a relaxing evening routine. Avoid exercising or stimulating activities in the last few hours before bedtime.

• Create a sleep environment that is cool, dark, quiet and comfortable.

• Limit caffeine, especially after lunch.

• Avoid having a TV or computer in the bedroom and turn them off at least 30 to 60 minutes before bedtime.

Make sleep a priority for yourself and your family.

~Megan Grekowicz, MSN, APRN, FNP-BC, pediatric nurse practitioner, Sleep Center, Children’s Hospital of Wisconsin Clinics-New Berlin

The American Academy of Pediatrics recommends that parents follow the ABC’s of safe sleep.

Sometimes, babies can’t fall asleep on their own or wake up frequently at night, which can make parents very tired and cranky. Parents can try the following tips to help baby fall and stay asleep.

Keep bedtime and naptime routines the same every day.

• Keep things quiet for 1 hour before bedtime.
• Soft lighting helps baby get sleepy.
• Babies like to hear a quiet story or song before bedtime.
• Cuddle and rock baby gently before bedtime.
• Most babies sleep well after a feeding and/or a bath.
• Gently rub baby’s arms and legs.

Consider using a pacifier when you place baby on his/her back for sleep. If baby is breastfed, wait until she is 1 month old or is used to breastfeeding before using a pacifier. If baby spits out the pacifier after falling asleep, you do not need to put it back in her mouth.

If baby is only fussing wait a minute to make sure baby is actually awake. Some babies fuss a bit during sleep but will quickly settle down.

If baby wakes up and cries, go to him or her as quickly as possible. Calming the baby down quickly should help the baby go back to sleep. Try not to play with baby during the night when s/he wakes up. Keep play time during daytime hours.

Hold and feed baby if s/he is hungry, and comfort him or her before placing on their back to sleep in their own crib or bassinet. In the early weeks and months of life, babies need to be fed often. The time between night feedings should increase as babies grow bigger and begin to sleep for longer periods of time at night.

For more information about safe sleep visit Children’s Health Alliance of Wisconsin.

~Abby Collier, MS,  project manager, Children’s Health Alliance of Wisconsin

Did you know that over half of home fires happen late at night when people are sleeping? A nighttime house fire can be devastating, but knowing a few facts may protect your family if you wake up in the middle of the night and smell smoke.

Kids sleep more deeply than adults, and that may make it more difficult to wake them during an emergency. I recently read a study that said young children often sleep through normal smoke detector alarms or respond so slowly that they can’t escape within the critical three-minute time period. This makes it easier to understand why more than 50 percent of child deaths from fire occur when children are sleeping.

This is national Burn Awareness Week. As you review your family’s fire escape plan, consider these tips:

1. Always have a working smoke alarm on each floor of your home.
2. Hold a late night fire drill to see how your kids would react to the sound of the smoke alarm.
3. Don’t assume a smoke alarm will wake up our kids during a fire. Make sure your escape plan includes a way to help get them up and out safely. This could include shouting their first name and giving simple directions such as, “Get out of bed. There’s a fire. Go outside!”
4. Kids wake up more quickly and respond better if they hear a familiar voice. Smoke alarms that let you record an emergency message are available.
5. Never leave a young child at home unsupervised.

-Megan Grekowicz, MSN, APRN, FNP-BC, pediatric nurse practitioner, Sleep Center, Children’s Hospital of Wisconsin Clinics-New Berlin.

Learn more about Children’s Hospital of Wisconsin at chw.org.

Suggestions to improve your teen’s sleep:
1.    Avoid having a TV or computer in the bedroom and turn them off at least 30-60 minutes before bedtime.
2.    Set limits for when your teen can make or receive phone calls and text messages.
3.    Limit caffeine, especially after lunch time.
4.    Make sleep a priority in your family and set a good example.

If you are concerned about your teen’s sleep habits, learn more about how we can help by visiting Children’s Sleep Center.

Nightmares occur at all ages, but the peak ages are between 3 and 6 years old, when most children’s imaginations blossom. The content of these dreams varies across the age groups. Younger children may dream about separation from parents, shots at the doctor’s office or scary monsters. Older children may have nightmares about stories they’ve seen in the movies or on TV.

Telling the difference between nightmares and sleep terrors can be difficult because they both can happen in early childhood and the child may appear frightened and scream under both conditions. But during sleep terrors, the child doesn’t appear to be awake, and trying to console the child worsens the situation. Children can recall details about a bad dream but have no memory of a sleep terror. Therefore, sleep terrors often are more distressing to the parent or caregiver than the child.

So, what is a parent to do?

Nightmares and sleep terrors increase with sleep deprivation, so a regular sleep schedule, good sleep habits (no TV, computer or video games or caffeine before bedtime) and a quiet sleep environment are helpful. Avoiding frightening movies. Parental reassurance and security objects may help with nightmares. If your child seems to fight or avoid your attempts to comfort, he or she may be having a sleep terror. The best thing to do is to make sure your child is safe but avoid contact. Interfering with the sleep terror may increase your child’s agitation and prolong the episode. Don’t worry, sleep terrors usually disappear by adolescence. But nightmares can persist into adulthood, so choose your movies wisely this Halloween season.

–Louella Amos, MD, fellow, Children’s Hospital of Wisconsin Sleep Center

How can a loving parent provide the safest possible sleep environment for that beautiful little infant? The most important advice has been repeated since 1992: Always place your baby on his or her back to sleep. This has cut the number of infant deaths from sudden infant death syndrome in half.

Unfortunately, 50 percent of babies still are dying. A close look at the deaths has revealed that many of these babies who died were sleeping in unsafe places. We don’t know all of the answers to the question of why these babies die. But we do know the chance of death would have been reduced if those babies were placed to sleep in the way recommended by the American Academy of Pediatrics.

After extensive research, the AAP recommends an infant be placed to sleep on his or her back alone in a safety approved crib. This crib should have a tight fitting mattress with a fitted crib sheet and there must never be loose blankets, pillows, bumper pads or toys in the crib with the baby. The crib should be in the parents’ bedroom close to the parents’ bed. This allows the parent to reach over to soothe the baby during the night and easily place the baby back in his own crib after feeding.

In the first months of a child’s life it is crucially important that a baby and his or her mother form a firm bond. Some proponents of co-sleeping justify the risks with the argument that being in close proximity allows for bonding. Bonding and attachment are vital, but the most significant bonds are formed while the baby is awake and interacting with the mother or father. It is this action and response – give and take – that ensures a baby’s security and self-esteem. Furthermore, quality sleep is an essential component of healthy parenting and infant growth and development. It is questionable whether or not both mother and baby are receiving periods of deep sleep with active REM while sleeping in the same bed.

Adult beds are not appropriate for infants. Heavy quilts or comforters and pillows can cover or smother a baby. Soft bedding also may surround the infant and reduce the flow of oxygen while trapping carbon dioxide so the baby re-breaths air and thereby stresses their system. Also, a parent who is too tired or even unaware that the baby is in the bed may put an arm over the infant or somehow roll onto the baby.

Babies have slept with their parents for ages. Most babies do not die. But the chance of a tragedy is increased by this practice. Historically, in many parts of the world where babies slept with their mother, adult beds were mats, not with soft bedding. Our affluence has increased our comfort and the bed is luxuriously filled for our sleeping comfort. If we would be willing to remove all the blankets and pillows, we could reduce risks.

Many people are advised to take their baby to bed for a variety of reasons. Usually this is recommended by someone who thinks, “I did it and my child was fine.” The probability is that your baby will be fine, too, because the number of babies who die compared to the number of babies that are born is small. But the risk has to be considered. Never sleep with a baby.

Never sleep with an infant in a chair, recliner, couch or waterbed. The baby may fall between the body and the back of the couch or between cushions or in a crevice at the side and suffocate.

Not everyone always does what they know is best for their baby. Sometimes it is just easier to bring the baby to bed with you. But the fact is ­– having a baby is not easy. As a parent, you have a responsibility to care for your child in spite of the fact that a lot is demanded of you as a parent. The safest place for a baby to sleep is on the back, alone in a safety-approved crib near your bed.

– Dora Gorski, Infant Death Center and Children’s Service Society of Wisconsin in Wausau

Kids need more sleep than adults. Children ages 6 to 12 years old need 10 to 11 hours of sleep at night. Teenagers need at least nine hours of sleep.

It’s important to get enough sleep because chronic sleep deprivation has been linked to poor school performance, behavioral, developmental and mood problems, weight gain and obesity. Drowsy teens who get behind the wheel of a car can cause a deadly accident.

Here’s a sleep checklist to start working on now:

• At least two weeks before school starts, set a regular bedtime and wake-up time. Kids with bedtimes before 10 p.m. are much more likely to get enough sleep than kids with later bedtimes. If necessary, the schedule can be adjusted earlier at a gradual pace (about 15 minutes every two days) to ease the transition.

• In the last days of summer, wake your kids at the time they will need to be getting up for school. Emphasize activity and bright light in the morning; these help to train the brain to be wide awake in the morning. For example, send them outside to play, rather than allowing them to sit in front of a TV set – it’s better for their brain and their body!

• Be consistent with your children’s sleep schedules, even on the weekends.

• Establish a relaxing evening routine. Avoid exercising or stimulating activities in the last few hours before bedtime.

• Create a sleep environment that is cool, dark, quiet and comfortable.

• Limit caffeine, especially after lunchtime.

• Avoid having a TV or computer in the bedroom and turn them off at least 30 to 60 minutes before bedtime.

• Make sleep a priority in your family and set a good example.

Good sleep habits set the stage for active learning and better performance in school. We wish you and your kids good luck as they prepare to kick off the year. Many sleep issues are treatable. If you are concerned your child might have a sleep disorder please call us.

–Nan Norins, MD, pediatric sleep specialist, Children’s Sleep Center, Children’s Hospital of Wisconsin.

When I ask new and expecting mothers, ‘Where does or will your baby sleep and why,’ I think I’ve heard just about every response you can imagine. Some believe babies actually die by being placed in the crib, so they want to keep the baby close and safe at night. Others talk about the benefits of breastfeeding and bonding with their bundle of joy. Oh, and yes, that old wives tale of “crib death” is still lurking in the shadows. They all seem to have their own set of rational justifications for co-sleeping. But for every justification by a parent, I can think of at least one case if not more in the medical examiners’ reports that sadly describes the same scenario.

It’s perfectly fine to have your baby sleep in the same room as you – as long as he or she sleeps alone in a crib, bassinet or portable crib. Please share this information with your friends, family and colleagues. These simple steps can save the life of a child.

More information about ensuring a safe sleep environment for babies can be found on our Web site at idcw.org.

–Vivian Jackson, community services coordinator, Infant Death Center of Wisconsin