Infant Pillow and Blanket Use
I have a 7 month old son. When can I start using blankets and pillows in my son’s crib?
Dear “Curious Mom”
A baby should sleep on a firm mattress without pillows. Their head should be placed directly on a firm mattress with nothing obstructing the face. Soft mattresses, feather beds, stuffed animals or any fluffy item that could potentially cover the baby’s mouth or nose are not recommended. (1)
It is okay to swaddle a baby by wrapping him in a light receiving blanket up to the level of his chest. Researchers found that 25% of babies are fussy when they are forced to sleep on their backs and swaddling improves the behavior and sleep of most babies who previously did not tolerate the supine sleeping position. (2) Swaddling also promotes restful sleep, is easily accepted by most babies, reduces the amount of times that a baby wakes and diminishes the frequency and intensity of crying.(3) The other benefit of Swaddling is that it does not promote Sudden Infant Death Syndrome (SIDS) as long as the swaddled baby sleeps on his back and the blanket does not cover the baby’s face during sleep. (3) When swaddling, it is not recommended to use layers of blankets or have the heat in the home set at high temperatures. These measures promote overheating which is a risk factor for SIDS. (1) There was a report of twins swaddled with several layers of flannelette, with a room temperature set at 80 degrees Fahrenheit who suffered from the devastating effects of heat injury. (3)
From my experience, by the time a baby is 3 months old they typically break out of the swaddling blanket. At this point a light blanket covering the baby up to the point of his chest is sufficient, using caution not to over bundle the child or use too many blankets. In most cases a blanket is not needed at all as long as the baby wears a one piece pajama outfit to keep him warm. Generally SIDS is a risk of early infancy with most deaths occurring before 4 months old, and a small percentage occurring up until the age of one.(1) Because of this it is not recommended to put fluffy comforters, stuffed animals or pillows in a child’s crib under the age of one. A child can use a pillow at 2 years old or when they are old enough to sleep in a bed.
When putting a baby to sleep it is essential that the baby be placed on his back. The American Academy of Pediatrics recommends that babies go “back to sleep” or sleep on their backs in order to reduce the risk of SIDS. SIDS is defined as the sudden death of an infant which is unexplained after review of the clinical history, examination of the circumstances of death and post-mortem examination. (1) In other words a parent places an apparently healthy baby down to sleep only to find him a few minutes or a few hours later, dead with not adequate explanation for the death. There has been a reduction in the amount of SIDS babies as a result of the “back to sleep” positioning campaign.
Other risk factors for SIDS besides prone sleeping position and overheating include parental smoking, soft sleeping surface and bed sharing. (1) The interesting thing is that sleeping in the same room as mother, but not in the same bed, decreases the SIDS risk. (1). Measures that parents can take to reduce the risk of SIDS include putting baby in a safe supine sleeping position, avoid over bundling, sleep in the mother’s room, but not in her bed, use a firm mattress, free from pillows, stuffed animals or comforters and avoid all smoking in the home.
(1)Carbone, T. Sudden Infant Death Syndrome: The Most Devastating Pediatric Sleep Disorder. Presented at: Pediatric Sleep Disorders Conference;May 31, 2002:Edison.
(2)Gerard CM, Harris KA, Thach BT. Physiologic studies on swaddling: an ancient child care practice, which may promote the supine position for infant sleep. Pediatrics. 2002; 141:398-403.
(3)Schwartz R, Guthrie K. Musings on infant swaddling. Infectious Diseases in Children. 2006. June:14.
Lisa-ann Kelly R.N., P.N.P.,C.
Certified Pediatric Nurse Practitioner
Pediatric Advice About Keeping Babies Healthy