One set of rules everyone follows, and how I wanted my baby comforted
Sleep was the hardest part of my baby’s first year, and so was making sure every caregiver kept my baby safe. These are the rules everyone gets, and how I learned to say them as requirements.
Key points
- The American Academy of Pediatrics (AAP) and the National Institutes of Health (NIH) say to put babies on their backs for every sleep until age 1, on a firm, flat surface with only a fitted sheet. Give every caregiver the same one-page rules.
- This applies to babies with reflux too; the AAP says back sleeping is still safest, and inclined sleepers aren’t safe. Take reflux or breathing concerns to the pediatrician, not into the crib.
- Stop swaddling at the first signs of rolling; some babies start as early as two months. Put your swaddling rule in writing, as a requirement.
Sleep was the hardest part of my first child’s first year. Not my sleep, though that was hard too. The baby’s, and whether the people caring for my baby at night were keeping them safe.
Our nights
The reflux. My baby gurgled and sounded congested after feeds, woke every time I put them down, and I worried about their breathing. Later, when laryngomalacia came up (a condition in which soft tissue in a baby’s airway is floppy), I asked directly whether it was connected to sudden infant death syndrome (SIDS).
My rules. I had four rules for anyone caring for my baby at night. Two came from safe sleep guidance: on the back, in an empty crib. Two were my own preferences: a prompt response to crying, and no swaddle.
At first, I didn’t state my preference about swaddling clearly. I later wrote it as a requirement for anyone caring for my baby: “I need a Night Nanny who can watch over my baby without swaddling them at night. We won’t be using a swaddle.”
What happened anyway. Caregivers I had hired didn’t always follow the sleep arrangement we’d agreed on. I had to correct unsafe handling and sleep arrangements more than once, with more than one person. Every time, I found out because I was checking.
The long months. In the newborn months, I didn’t want my baby left to cry, and I told every night nanny so. Over time, my approach changed. Later in the first year, after months of trying the Ferber method (checking on a crying baby at gradually longer intervals) and bedside comfort, I asked other parents for help: “After about 5 days of sleep training we get 1-2 night of good results then we regress. The cries are so intense and it’s been so long of this.” Our baby seemed satisfied only in our arms. “Unfortunately I’m not physically able to hold them up for long periods of time anymore and am severely sleep deprived.”
Later, when one sleep training plan told me to stay in the room until my baby slept, my first question was the honest one: “When do I get to sleep?”
The sleep study. As a toddler, my child had a sleep study because of snoring and frequent waking. It found no sleep apnea, but frequent spontaneous awakenings, and recommended following up with dermatology and the allergist, because itchy skin can wake a child up. My child had eczema.
The rules everyone follows
The safe sleep guidance from the AAP and the NIH’s Safe to Sleep campaign is short, and it applies to everyone who puts your baby down:
- On the back for every sleep, naps and nights, until age 1. This includes babies with reflux.
- A firm, flat, level surface that meets safety standards. Not inclined.
- Only a fitted sheet. No pillows, bumpers, blankets, loveys, positioners or weighted products.
- Room-share, don’t bed-share, ideally for at least the first six months.
- Car seats, swings and carriers are not routine sleep spaces. If your baby falls asleep in one, move them to an approved firm, flat sleep surface on their back as soon as it is safe and practical.
- Stop swaddling as soon as your baby shows any signs of trying to roll over. The AAP notes that some babies start working on rolling as early as two months (HealthyChildren.org).
- Never on a couch or armchair, especially with a tired adult.
Inclined sleepers and wedges marketed for reflux have been linked to injuries and deaths. If your baby has reflux or breathing concerns, the soothing plan has to work within these rules.
How I hold the line
- I give every caregiver the same written sleep rules.
- I state non-negotiables as requirements in the interview, in the contract and at home.
- I check, especially in the first weeks with someone new.
- I take breathing and reflux concerns to the pediatrician, not into the crib.
Before someone new starts
- Demonstrate the setup, then watch the caregiver do it during a paid trial.
- Talk through the hard moments in the interview: what happens after a feed, when the baby won’t settle, and what the caregiver will do if they get sleepy. A tired caregiver should put the baby down in the crib and get help.
Take this back
To discuss with your pediatrician:
- My baby has reflux or noisy breathing. What should be checked?
- What soothing approaches are safe for a baby who wakes every time they’re put down?
To discuss with the people in your life: Will you follow the sleep rules exactly, even when you did it differently with your own children? If you disagree, will you tell me instead of changing it?
Next in the series: “Preparing Your Village”
