Parenting

Infant Safety

Since 1992, the American Academy of Pediatrics has recommended that infants be placed to sleep on their backs to reduce the risk of sudden infant death syndrome (SIDS), also called crib death. SIDS is the sudden and unexplained death of a baby under 1 year of age. Even though there is no way to know which babies might die of SIDS, there are some things that you can do to make your baby safer:

• Always place your baby on his or her back to sleep, even for naps. This is the safest sleep position for a healthy baby to reduce the risk of SIDS.
• Place your baby on a firm mattress, such as in a safety-approved crib. Research has shown that placing a baby to sleep on soft mattresses, sofas, sofa cushions, waterbeds, sheepskins, or other soft surfaces raises the risk of SIDS.
• Remove soft, fluffy, and loose bedding and stuffed toys from your baby’s sleep area. Make sure you keep all pillows, quilts, stuffed toys, and other soft items away from your baby’s sleep area.
• Make sure everyone who cares for your baby knows to place your baby on his or her back to sleep and about the dangers of soft bedding. Talk to child care providers, grandparents, babysitters, and all caregivers about SIDS risk. Remember, every sleep time counts.
• Make sure your baby’s face and head stay uncovered during sleep. Keep blankets and other coverings away from your baby’s mouth and nose. The best way to do this is to dress the baby in sleep clothing so you will not have to use any other covering over the baby. If you do use a blanket or another covering, make sure that the baby’s feet are at the bottom of the crib, the blanket is no higher than the baby’s chest, and the blanket is tucked in around the bottom of the crib mattress.
• Do not allow smoking around your baby. Don’t smoke before or after the birth of your baby and make sure no one smokes around your baby.
• Don’t let your baby get too warm during sleep. Keep your baby warm during sleep, but not too warm. Your baby’s room should be at a temperature that is comfortable for an adult. Too many layers of clothing or blankets can overheat your baby.

Some mothers worry if the baby rolls over during the night. However, when your baby is able to roll over by herself, the risk for SIDS is reduced. During the time of greatest risk, 2 to 4 months of age, most babies are not able to turn over from their backs to their stomachs.

What to Avoid While Breastfeeding

How Lifestyle Affects Breast Milk

Your lifestyle can have an effect on your breast milk, and therefore on your baby. It’s important to take care of yourself so you can provide the best care to your baby. This includes getting enough rest and proper nutrition so you have enough energy to take care of your baby and avoid illness. Some women think that when they are sick, they should not breastfeed. But, most common illnesses, such as colds, flu, or diarrhea, can’t be passed through breast milk. In fact, if you are sick, your breast milk will have antibodies in it. These antibodies will help protect your baby from getting the same sickness. Here are some other lifestyle issues that affect breast milk:

• Diet
• Smoking, Drugs, and Alcohol
• Medications
• Sleeping Close to Baby

Diet & Breastfeeding

Nutrition

If you generally have a good diet, you will produce healthy breast milk for your baby, even if you don’t eat well at times. Women often try to improve their diets while they are pregnant. Continuing with an improved diet after your baby is born will help you stay healthy, which will help your mood and energy level. But, chronically undernourished women who have had diets very low in vitamins and minerals, and low stores in their bodies may produce milk that is lower than normal in some vitamins, especially vitamins A, D, B6, or B12. These breastfeeding mothers can help the vitamin levels in their milk return to normal by improving their diets or by taking vitamin supplements. It is recommended that nursing mothers take in about 2700 calories every day (about 500 calories more than a non-pregnant, non-nursing woman).

Fluids

Many women think they have to drink a lot of fluids to have a good milk supply. This is actually untrue. But, you do need to drink enough fluids to stay well hydrated for your own health and strength to give your baby the best care you can. Always drink when you are thirsty, which is your body’s signal that you need fluid. You can make it easy to remember to get enough fluid if you drink a glass of water or a nutritious beverage, like milk or juice, every time you feed your baby.

Caffeine

Many breastfeeding women wonder about how caffeine will affect their baby. Results from studies show that, while excessive caffeine intake (more than five 5 ounce cups of coffee per day) can cause the baby to be fussy and not able to sleep well, moderate caffeine intake (fewer than five 5 ounce cups) usually doesn’t cause a problem for most breastfeeding babies.

Allergies

Research shows that a mother’s milk is affected only slightly by the food in her diet. But sometimes a baby may have a reaction to something you eat (like spicy foods, foods that can cause gas, or dairy products). Symptoms in your baby of an allergy to something in your diet include diarrhea, rash, fussiness, gas, dry skin, green stools with mucus, or the baby pulling up his/her knees and screaming. This doesn’t mean the baby is allergic to your milk. If you stop eating whatever is bothering your baby, the problem usually goes away on its own.

Here’s how to tell if something you are eating is upsetting your baby:

It takes about two to six hours for your body to digest and absorb the food you eat and pass it into your breast milk.

• If you eat dinner at 5:00 P.M., and your baby shows the symptoms listed above around 9:00 P.M., think about what you ate for dinner. To be sure if those foods are causing the problem, you will have to eat them again and see if your baby has the same reaction.
• If your baby seems very fussy, try keeping a record of what you eat and drink.
• Bring the record to your baby’s doctor to talk about a possible link between certain foods and your baby’s symptoms.
• If you think a particular food is causing a problem, stop eating it for a while and see if your baby reacts better. You can always try later to introduce that food again into your diet in small amounts. If your baby doesn’t seem to react to it anymore, you could add more the next time.

Sometimes a baby can be born with a condition called primary lactase deficiency or with galactosemia, in which he or she can’t tolerate breast milk. This happens when the body can’t break down lactose, a sugar found in the milk of humans and animals. Symptoms include diarrhea and vomiting. Babies with severe galactosemia may have liver problems, malnutrition, or mental retardation. Babies with these conditions must be fed formula that comes from plants, such as soy milk or a special galactose-free formula.

Smoking, Drugs and Alcohol While Breastfeeding

Smoking

If you smoke tobacco, it is best for you and your baby if you try to quit as soon as possible. Talk to your doctor for help. Tobacco from cigarettes contains a drug called nicotine, which transfers to breast milk and may even affect the amount of milk you produce. The risk for sudden infant death syndrome (SIDS) becomes greater when a mother smokes or when the baby is around second-hand (or passive) smoke. Smoking and passive smoke may also increase respiratory and ear infections in babies. If you can’t quit, it is still better to breastfeed because the benefits of breast milk still outweigh the risks from nicotine.

Illegal Drugs & Breastfeeding

If you are breastfeeding, you should not take illegal drugs. Some drugs, such as cocaine and PCP, can make the baby high. Other drugs, such as heroin and marijuana can cause irritability, poor sleeping patterns, tremors, and vomiting. Babies can become addicted to these drugs. If you are having a hard time quitting, ask your doctor or a trusted friend for help.

Alcohol & Breastfeeding

If you breastfeed, you should avoid drinking alcohol. Alcohol does get to your baby through breast milk, and has been found to peak in its concentration about 30 to 60 minutes after drinking, or 60 to 90 minutes if it is taken with food. The effects of alcohol on the breastfeeding baby are directly related to the amount of alcohol a mother consumes. Moderate to heavy drinking (2 or more alcoholic drinks per day) can interfere with the let-down reflex and the milk-ejection reflex. It also can harm the baby’s motor development and cause slow weight gain. For this reason, and for your general health, if alcohol is used, intake should be limited. Light drinking or an occasional drink is okay, but avoid breastfeeding for two hours after the drink.

Medications While Breastfeeding

Always talk with your doctor before taking any medications. Most medications pass into your milk in small amounts. If you take medication for a chronic condition such as high blood pressure, diabetes or asthma, your medication may already have been studied in breastfeeding women, so you should be able to find information to help you make an informed decision with the help of your doctor. Newer medications and medications for rare disorders may have less information available.

In general, when breastfeeding it is safe to take:

• acetaminophen (like Tylenol)
• antibiotics
• epilepsy medications (although one, Primidone, should be taken with caution – talk with your doctor about this drug)
• most antihistamines
• moderate amounts of caffeine (remember there is caffeine in soda and in chocolate)
• decongestants
• ibuprofen (like Advil)
• insulin
• quinine
• thyroid medicines
• progestin-only birth control pills (the “mini-pill”)

Medications that are not safe to take when breastfeeding:

Some drugs can be taken by a nursing mother if she stops breastfeeding for a few days or weeks. She can pump her milk and discard it during this time to keep up her supply. During this time, the baby can drink her previously frozen breast milk or formula. These drugs include radioactive drugs used for some diagnostic tests like Gallium-67, Copper 64, Indium 111, Iodine 123, Iodine125, Iodine-131, radioactive sodium, or Technetium-99m, antimetabolites, and a few cancer chemotherapy agents.

There are drugs that if new mothers have to take them, they need to choose between taking them or breastfeeding.

Some of these drugs that should never be taken while breastfeeding include:

• Bromocriptine (Parlodel) – a drug for Parkinson’s disease, it also decreases a woman’s milk supply.
• Cyclophosphamide, Doxorubicin, and most chemotherapy drugs for cancer – these drugs kill cells in the mother’s body and may harm the baby.
• Ergotamine (for migraine headaches); Methotrexate (for arthritis); and Cyclosporine (for severe arthritis and psoriasis, aplastic anemia, Crohn’s disease, kidney disease, and for after organ transplant surgery).

Drugs whose effects on nursing infants is not known but may be cause for concern include:

• Anti-anxiety drugs – Alprazolam, Diazepam, Lorazepam, Midazolam, Perphenazine, Prazepam, Quazepam, Temazepam.
• Antidepressant drugs – Amitriptyline, Amoxapine, Bupropion, Clomipramine, Desipramine, Dothiepin, Doxepin, Fluoxetine, Fluvoxamine, Imipramine, Nortriptyline, Paroxetine, Sertraline, Trazodone.
• Antipsychotic drugs – Chlorpromazine Galactorrhea, Chlorprothixene, Clozapine, Haloperidol, Mesoridazine, Trifluoperazine.
• Other drugs – Amiodarone, Chloramphenicol, Clofazimine, Lamotrigine, Metoclopramide, Metronidazole, Tinidazole.

Sleeping Close to Baby

In February 2005 in their policy statement on Breastfeeding and the Use of Human Milk, the American Academy of Pediatrics (AAP) recommended that for breastfed healthy term infants, mothers and infants should sleep close to each other to help with breastfeeding.

AAP cites this recent study which found these answers about infant safety and sleeping close to or with parents:

• Co-sleeping with an infant on a sofa was associated with a particularly high risk of sudden infant death syndrome.
• Sharing a room with the parents was associated with a lower risk.
• There was no increased risk associated with bed sharing when the infant was placed back in his or her cot.
• Among parents who do not smoke or infants older than 14 weeks there was no association between infants being found in the parental bed and an increased risk of sudden infant death syndrome.
• The risk linked with bed sharing among younger infants seems to be associated with recent parental consumption of alcohol, overcrowded housing conditions, extreme parental tiredness, and the infant being under a duvet.

When to Call the Baby’s Doctor

Knowing when to call your baby’s doctor can be worrisome. More likely than not, whatever you observe happening with your baby is normal, but what happens if it isn’t? There is no need to agonize over the decision to call the doctor. If you are worried about something, make the call.

Here are some common reasons to make the call to your baby’s doctor.

• If your baby has not urinated in the first 24 hours
• If there is fewer than 6 wet diapers within a 24 hour period
• If your baby has not had a bowel movement in the first 48 hours
• Diarrhea (This is hard to detect especially with breastfed newborns). Diarrhea usually has a foul odor and can be streaked with mucus and/or blood. If baby’s bowels are watery or looser than normal, or are far more frequent than normal.
• Temperature above 100.4 degrees F or below 97.8F, taken rectally
• If there is trouble breathing or very rapid breathing (more than 60 breaths per minute)
• If there is pulling in of the ribs while breathing
• Wheezing, whistling, or grunting sounds when breathing
• If baby’s lips or fingernails appear blue
• Persistent cough
• Refusing several feedings, or is eating poorly
• Vomiting (not necessarily spit-up)
• Nosebleeds
• Sunken soft spot the your baby’s head
• Unusually sleepy, or is very hard to waken (this can be a hard call since most newborns and infants normally require a lot of sleep)
• Lethargic, unusual limpness or floppy
• If baby seems anxious, jittery
• Lengthy crying and very difficult to console
• Greenish or yellowish discharge from the eyes
• Red skin or pus around the umbilical cord
• Yellow color in whites of the eyes
• Yellowish skin (jaundice)
• Circumcision problems. Bleeding from circumcision area, more than expected. Blood stains on baby’s diaper that are larger than nickel.

If your concern is not on the list, do not let that stop you from contacting your baby’s doctor if you notice something irregular happening.

What is Sudden Infant Death Syndrome?

(Also known as ‘crib death’)

SIDS is the sudden, unexplained death of an infant less than one year old. Most SIDS occur between the ages of 2 to 4 months, and is the leading cause of death in children from 1 month to the age of one year. Most SIDS occur at less than 6 months old. There are about 2,500 SIDS deaths a year in the United States.

Reducing the Risk of SIDS

There has yet to be a confirmed cause for SIDS. However, there are a few things you can do to reduce the risk:

• Always put your baby on his/her back to sleep. This is the number one risk reducer.
• Always put you baby on his/her back to sleep, during the night and for naps. This warrants repeating. Baby’s who are put on their stomachs to nap on at VERY high risk for SIDS.
• Use only firm surfaces for your baby to sleep on. Do not use a pillow, sheepskin, quilt, or soft surface. Use a safety approved crib mattress and a fitted sheet.
• Keep all items away from your baby’s face. This includes blankets, pillows, stuffed toys, fluffy bumper pads. Dress your baby in clothing to keep him/her comfortable without using a blanket. If you must use a blanket, make sure it is tucked into the bottom of the crib and pulled up no higher than baby’s chest.
• Avoid letting your baby overheat during sleep. Keep the room at a temperature that you, as an adult, are comfortable with. You do not need to overheat a room for a baby.
• NO smoking around your baby. If there is a smoker, have them go outside to smoke.
• If you use a pacifier, make it a clean, dry one and do not force your baby to take it. If you are breast feeding, wait at least 1 month before offering a pacifier.
• Make sure you inform anyone caring for your baby about these precautions.

Babies At Risk for SIDS

• African-American babies are more than 2 times more likely to die of SIDS than white babies.
• American Indian/Alaska Native babies are 3 times more likely to die of SIDS than white babies.
• Babies who are placed on their stomachs or sides are more likely to die of SIDS.

Flat Spots on Baby’s Head

Once your baby learns to sit up, any flat spots created by back sleeping will go away. Here are some ways to reduce the chance of flat spots:

• Tummy Time – When someone is watching, put your baby on his/her tummy to play. This will also strengthen baby’s neck, head, and shoulder muscles. Make sure there is someone watching.
• Switch the direction that your baby faces in the crib from week to week, so he/she is not always laying on the same part of the head.
• Avoid too much time in car seats, bounce chairs, and carriers. Hold your baby upright often during the day.

Content Created/Medically Reviewed by our Expert Doctors