Babies should sleep in their parents' rooms for the first six months of life and ideally up to a year, a leading group of pediatricians said. This may not be great for the marriage or the parents' sleep, but it's important to help keep babies safe, according to the American Academy of Pediatrics, which released its updated "safe sleeping" guidelines Oct. 24.
The guidelines, last issued in 2011, are part of an effort to combat Sudden Infant Death Syndrome, which, along with accidental suffocation or strangulation, kills about 3,500 infants each year. They're also the latest in evolving advice that seems to change every few years but has made babies much more likely to survive their first year of life.
In 1900, about 1 in 10 babies died before their first birthday, according to the Centers for Disease Control and Prevention. In some cities, first-year mortality was as high as 30 percent. But by 1997, the rate was less than 1 percent: 7.7 deaths for every 100,000 births.
While some experts believe the United States may be at or near an "irreducible minimum" of infant mortality — the point at which no further improvement is possible — the battle wages on against SIDS. Doctors don't know exactly why some babies stop breathing in the night with no apparent cause, but they know babies are at greatest risk when they are between 1 and 4 months old and if they fall asleep on a sofa or cushioned chair.
When babies share a room with their parents, however, the risk of SIDS is cut in half, the AAP said, which should motivate parents to welcome their infant into their room, even if their own sleep suffers. But that's not all new parents should know.
Beware the bumper
Babies should sleep in their parents' room, but not their parents' bed, the AAP said. Instead, they should be put to sleep on their backs in a crib or bassinet outfitted with only a firm mattress covered by a tight-fitting sheet.
"Avoid use of soft bedding, including crib bumpers, blankets, pillows and soft toys. The crib should be bare," the guidelines say.
This is bad news for manufacturers of crib bedding, as well as parents who like the look of a crib made up cozily with plush blankets and matching bumpers.
Bumpers are padded panels of fabric that line the inside of the crib, ostensibly to protect the baby from injury. But babies have suffocated after getting caught in their folds or rolling facedown on the fabric, and they have strangled when the bumper ties became wrapped around their necks, leading some doctors to call for a ban on the products. They are still widely sold on the internet, although some manufacturers have switched to thin, breathable panels.
Most infant deaths occur when babies are put to sleep on their stomach or in a crib with soft bedding, or when they are sleeping with another person, the AAP said.
While the report is based on the latest data on sleeping infants and mortality, it demonstrates how recommendations for new parents change as new information becomes available — and why parents should welcome advice that is constantly changing.
In 1992, the AAP announced parents should put babies to sleep on their backs or sides, instead of their stomachs. Four years later, it changed course, saying babies should sleep only on their backs.
And the policy worked: Between 1992 and 1999, SIDS deaths declined by half, from 4,073 to 2,643, the CDC said, and the annual number of deaths seems to have plateaued.
Here's a look at some other ways in which once-common practices in infant care have changed over the centuries.
In the early days of the American colonies, infants were put to sleep in narrow cradles so they could stretch their legs but not curl up. Infants were swaddled until around the age of 6 months, when they were dressed in skirts and petticoats that prevented the child from crawling. People at this time believed crawling was for animals and that children should go straight to walking.
Because some children were being pushed to walk before they were ready, toddlers wore padded hats called "pudding caps" to prevent them from injuries that would turn their brains to "pudding," according to The Pilgrim John Howland Society.
Although science and psychology have proved the importance of early attachment between mother and child (one reason the AAP stresses skin-to-skin contact), during the Renaissance, it was common for infants to be taken from their mothers and handed over to other women who would breast-feed them.
"Wet nursing was commonplace in pre-modern urban societies," wrote Margaret L. King in "The Renaissance in Europe." The practice fit in with a general detachment from babies since so many died in the first year of life, which is why babies were baptized within hours after birth.
Art from the time shows babies were swaddled so tightly with strips of fabric that it looked as if they were bound from the arms down. Parents then believed swaddling ensured that children's legs wouldn't grow crookedly.
Wet nursing continued as a common practice in Europe until well into the 1800s. In his book "Baby Meets World," Nicholas Day wrote that Paris in 1780 was a "city without babies" because of 21,000 babies born that year, only 700 were nursed by their own mothers; the rest were cared for by women in the country.
The Middle Ages
In the Middle Ages, babies slept in rocking cradles next to their mothers' beds, according to Lynne Elliott, author of "Children and Games in the Middle Ages."
While this is similar to what the AAP suggests for American families today, this runs counter to what new parents have done throughout most of history.
Co-sleeping (the child sleeping in the parents' bed) is the "customary sleeping arrangement for children in many countries and cultures," according to a 2011 study in the journal Pediatrics.
In 2005, however, the AAP said parents should not sleep with their infants. The group's new guidelines suggest that parents bring infants into their beds to feed, but to return babies to their cribs afterward. They also suggest that parents have no pillows, loose sheets or blankets in their bed while feeding babies, which Elissa Strauss noted in Slate will make the parent less comfortable, and therefore less likely to fall back asleep with the child in the bed.
Ancient Rome and other cultures
Historian Nancy Padgett has said Roman women were "perpetually pregnant" trying to create a family in a society with mortality rates that approached 75 percent. But infanticide was legal — the father decided whether to keep the child or let it die from exposure. Infants were not considered fully human until they had developed teeth and could eat solid food, British biologist and researcher Simon Mays told LiveScience.
On the other side of the world, however, new parents treasured their infants a thousand years before Christ, archeologists have inferred from seal-skin baby pants they found during an excavation in Alaska. The fancy pants did not serve as a diaper. Eskimos at that time made something resembling a diaper by using a wad of reindeer moss, hair and wood shavings, anthropologist Meghan Mulkerin wrote.
As for food, although women have nursed their infants since Eden, archaeological digs have turned up ancient versions of baby bottles, such as pots with spouts and cow horns with leather nipples, the BBC reported.
"Infants in ancient Greece were fed wine and honey, while Indian children in the second century A.D. were given diluted wine, soups and eggs at 6 months of age," Kate Dailey wrote for the BBC News Magazine.
In ancient Egypt, mothers would tie amulets around their baby's limbs with a plea for a deity to protect it, according to "Growing Up in Ancient Egypt" by Rosalind and Jac Janssen. They would also put a protection spell in a pendant that would be placed around the child's neck.
Today, keeping an infant healthy and safe is much simpler: If possible, breast-feed your infant exclusively for the first six months. And keep your baby close at night, just not in your bed.