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Elise Herman , MD

COVID-19 and Children- Infection and Vaccines

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Contributor: Dr. Elise Herman, KVH Pediatrics

Parents know too well what “pandemic fatigue” is. They are tired of it all- the masking, the distancing, the quarantining, the disruption of life, and the loss of a “normal childhood” for their kids. But this is a critical time in the COVID-19 pandemic as the Omicron variant surges; Omicron is certainly targeting the unvaccinated, and many of those are children.

The number of daily cases of COVID-19 in the US is over 900,000 as of January 7, 2022. 17% of these are children and most concerning is the huge jump in pediatric hospitalizations. There recently has been a 50% increase in COVID hospitalizations for kids under age 5, the biggest increase since the pandemic started. Over 82,000 kids have been hospitalized with COVID thus far, and there is now a new record for hospitalizations of kids under age 18 years- almost 800 daily. Some of these are as young as 2 months old.

Pediatric hospitals are feeling the strain, including Seattle Children’s Hospital, according to staff pediatric infectious disease specialist Dr. Danielle Zerr. Dr. Zerr noted in a recent New York Times article that the number of young children in Seattle Children’s Hospital with COVID is much higher than with previous Delta surges. Some of these very sick children have risk factors such as asthma or obesity, but many were previously healthy children without underlying problems.

Omicron seems to cause milder disease overall but can cause severe illness and is much more transmissible than the Delta variant. With so many more people getting infected, even if a smaller percentage get very sick, the total number of those who get severely ill will be very large. The unvaccinated are most at risk, and of course this includes kids under 5 years since they are not eligible for the vaccine yet. A parent’s best strategy to protect their child is straightforward: vaccinate if eligible, avoid crowded spaces (especially inside), continue masking and social distancing. Additionally, make sure all the older kids and adults in their family are vaccinated.

Those who are vaccinated can still get COVID, especially with the Omicron variant, but they are less likely to get a severe illness, and less likely to be hospitalized. If kids are fully vaccinated and exposed at school, they do not need to quarantine. Those who are vaccinated are less likely to transmit the virus, helping to keep their family healthy and their school open.

As of December 5, 2021, almost 4.8 million US kids ages 5-11 had received at least one COVID vaccine dose. There have been no cases of heart inflammation (myocarditis) in this age group which was noted to be a very rare side effect of the vaccine in young adult and adolescent males previously. It is important to remember that COVID infection itself is much more likely to cause heart problems in this age group than would the vaccine. We have had enough experience now to know the vaccine is safe and effective.

Can we imagine a time when there is ‘background’ COVID, like influenza, but not huge surges that overwhelm our healthcare systems, shutter schools and businesses, and disrupt our lives? That is the “learning to live with the virus” scenario that may be our future. To get there we need to have many more people vaccinated (including our children) to minimize the rise of new variants. Increased access to testing and better therapies to fight COVID infection will also be important. We all really do have the opportunity to help move us along towards that goal, and towards a better future for our children.

more about the contributor

Dr. Elise Herman

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Dr. Herman is passionate about community health outreach, school programs, and child/family health and wellness. She has more than 31 years of experience as a pediatrician in Ellensburg, Washington, the last 3 with KVH Pediatrics. In 2022 Dr. Herman retired from practice and continues to contribute blog posts and remain a visible advocate for kids in the community.

Tick bites in children

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Contributor: Dr. Elise Herman, MD, KVH Pediatrics

Ahhh, summer! As that much anticipated warmer weather comes, it brings with it the risk of tick bites and the diseases they can cause. Knowing how to prevent tick bites, what to watch for if your child is bitten and how to remove ticks can make us feel more ready for outdoor adventures with our kids.

Ticks have 8 legs, flat oval bodies, and vary in size from the tiny deer tick (size of a poppy seed) to the wood/dog tick (size of an apple seed). They can swell to two or three times their usual size when they have had a blood meal. After sucking blood for 3-6 days, ticks fall off on their own, often leaving a small red bump. As it feeds on the blood, some of the tick’s spit gets transmitted to the host’s body and can cause infection. Ticks must be attached for at least 36 hours to spread infection.

Washington has fewer tick-borne diseases compared to other parts of the country, but we do have cases of Lyme Disease, babesiosis, tick paralysis, and tularemia. Lyme Disease is the most common tick-borne disease in our state and the US. It is most prevalent in the Northeast, mid-Atlantic, upper Midwest, and to a lesser extent on the West Coast. It is spread by the very small deer tick. 80% of Lyme Disease starts as a circular or oval red bull’s eye rash called erythema migrans at the tick bite location within 3-30 days of a bite. It can expand to up to 12 inches and lasts 2-3 weeks. Other signs of early Lyme Disease are fever, body aches, headache, chills, and neck stiffness. If Lyme disease is diagnosed early and treated with antibiotics, progressing to later stages of the disease is very unlikely. The later stages can involve bull’s eye rashes elsewhere on the body, joint pain, temporary facial paralysis, and limb weakness.

There are steps you can take to help prevent tick bites. Avoid dense, grassy or wooded areas, and stay to the center of the trail. Ideally, everyone should wear hats, light colored clothing, long sleeves, and long pants tucked into socks. You can spray permethrin on clothing (not the skin) to decrease tick attachment. Insect repellent containing 20-30% DEET is safe for children but you should minimize its use on very young children and infants. Do not use products that combine DEET and sunscreen since sunscreen needs to be applied more frequently than DEET. Do not apply DEET to the hands of young kids or near their eyes or mouth.

Do a tick check of your child right after being outdoors where there might have been tick exposure. Look at the clothing first, then the skin and scalp. Don’t forget behind the ears, in the armpits and groin area. Showering may help prevent attachment. If you do find a tick, use tweezers to grasp it close to the skin; pull gently and slowly to remove. Try not to crush it when doing this and wash the area well afterwards.

It is important to remember that the chance of a tick bite causing any disease is extremely low. Only 2% of deer tick bites will cause Lyme Disease even in high-risk areas and here in Washington state we are at low risk of any tick disease. So, wherever your outdoor adventures take you and your kids this summer, a bit of planning to prevent tick bites and knowing how to handle them if they happen will help you to all enjoy those long summer days!

Talking about racism to children

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Contributor: Dr. Elise Herman, KVH Pediatrics

Racism is front and center now, and parents may wonder how to have important conversations with their child about diversity, equality, and discrimination. It helps to keep your discussion age-appropriate, share your feelings and listen to your child.

Under age 5 years – Studies have revealed that even infants notice different skin tones and preschool kids have been shown to view those who look like themselves more positively, so addressing racism early is important. Kids relate easily to the concept of fairness so it can simply be explained as treating someone unfairly based on how they look. Young kids may ask about why people’s skin colors are different. Explain simply that darker skin has more of the pigment melanin in it and that no skin color is ‘better’ than another. Celebrate human diversity by noting that “we are all human but can have lots of differences, too, making everyone special!”. Encourage your young child’s appreciation for diversity by reading books and playing with toys featuring people of different races.

6-11 years old – At this age, children are more aware of current events based on what they have heard and seen from adults, other kids and on the news or in social media. Ask your child about what they know and what questions they have. Kids this age understand empathy so discussing how it would feel to be judged unfairly can be helpful. Children of all ethnicities can be assured that people world-wide are upset about racism and are working to make things better.

12 and older – Kids this age are often very informed and have developed their own opinions about issues such as racism and protests. Discussing the news and current events and how it affects them opens the door to a deeper conversation. The same concepts of fairness and empathy apply, but now taking action may be a logical next step. It may be sharing something on social media, reading more about the history of oppressed peoples or attending an event.

All kids benefit from social experiences with a variety of people. Cooking food and listening to music of different cultures broadens our horizons. It is alright to let your child know that you are upset or sad about what is happening, but you also need to assure your child that they are safe in what can be a frightening time. This conversation will look different for families of color where the issue hits a lot closer to home than for whites.

As always, what we do and say speaks volumes to our children. It is vital that as parents we confront our own prejudices and biases and work to be more open and understanding. Let your kids see you speaking out against racism, embracing diversity and calling for justice for all people.

Traditional vs. Electronic Books and Your Child

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Contributor: Dr. Elise Herman, KVH Pediatrics

Simply put, reading to your child daily is one of the best things you can do as a parent. But does it need to be a traditional (paper) book or is an electronic book pretty much the same experience for your child? There have been studies that suggest reading a traditional book does have some advantages.

The Journal of the American Medical Association published a study in September 2019 that showed fewer ‘back and forth’ interactions between parents and toddlers when using an electronic tablet. This type of interplay is important as it builds connections in the brain and helps develop communication and social skills in children.

A recent study from the University of Michigan found that parents and kids interact more when reading a paper book and that communicating this way helped encourage healthy child development. Parents often asked how the story related to the child’s experiences or about the story and its characters. They also posed more open-ended questions, such as asking what the child liked about the story, which created more opportunities for a conversation between the two.

When parents and children are reading from a device, be it a table, computer or smart phone, interactions tend to be more focused on the technology itself. Comments about the device, instructions to not push buttons, how to set the volume if applicable, etc., can dominate the conversation. There has been research showing that “enhanced” digital books that have sound and animation can be distracting and therefore children do not remember the content as well.

So how best to read with your child? Although there seem to be real advantages to traditional books, reading from electronic books is still fine in addition to paper books. Here are some tips to make reading to your child the best experience:

– Read daily including at bedtime – and try not to rush
– Let your child choose the book at least some of the time (going to the library together also builds excitement for reading)
– Let your child hold the book and turn the pages
– Avoid electronic books that are “enhanced” with sound and animation
– During reading, ask questions about the story (“What do you think will happen next?”) and relate the story to your child’s life (“Remember when we went to the park and played like that?”)
– Encourage your child to point to things in the book (“Where is the rainbow?”)
– Read books with simple rhymes and repetition; your child will be more likely to ‘read’ along with you
– Make it fun! Silly voices and acting out the story makes reading very engaging to kids of all ages
– It is also good to encourage your child to look at books independently regardless of whether they can actually read yet

Be a good role model to your child, and read a lot at home. Since we don’t want our kids to see us always looking at electronic devices or a computer, make it a habit to read from traditional books, magazines and newspapers. And remember that whether it is a traditional book or at times an electronic book, it is wonderful that you are sharing reading with your child. Well done, Mom and Dad!

Managed by Kittitas Valley Healthcare, HealthNews does not provide medical advice. For medical advice, please see your healthcare provider.

Positional Plagiocephaly Prevention and Treatment

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“‘Tummy time’ while awake should start right away…”

Contributor: Dr. Elise Herman, KVH Pediatrics

When your infant is seen for a Well Child Exam, checking growth and development are the top concerns. Additionally, careful attention should be paid to your young child’s head shape. We are now in the middle of an ‘epidemic’ of head flattening, medically known as positional plagiocephaly, meaning a change in head shape due to positioning of the baby. Typically this is flattening of either side of the back of the head or symmetric flattening of the entire back of the head. This is not just a cosmetic concern as significant health issues can result from the altered head shape.

The flattening that can develop is related to a baby’s skull being relatively soft until about age 5-6 months. Babies spend a lot of time on their backs between sleeping (the recommended sleep position is on their back to decrease the risk of SIDS) and while awake until they are old enough to be rolling, sitting up,etc. If the head is turned to one side when sleeping (for example if the baby is turning to look towards a parent), this can result in localized flattening of one side of the back of the head. With this flattening on one side, it is then harder for the baby to turn their head to the opposite side. Over time the neck muscle on the flatter side can become tighter and shorter, causing the neck to stay in a twisted position (this is called torticollis). This may affect the shape of the face with jaw asymmetry and other changes. In some cases it can be related to problems with development if left untreated.

It is important to be pro-active to minimize the risk of infant head flattening. Your baby should absolutely sleep on their back, but otherwise should be up and off the back of their head a lot. ‘Tummy time’ while awake should start right away and not only helps head shape but increases the strength in your baby’s neck, chest and arms. Options for tummy time include having baby lay with their face/ chest on your chest or baby laying down over your lap. You can also have baby lay on the floor with a rolled small blanket to prop up their chest only until they are strong enough to push up on their arms. Begin with 5-10 minutes 3 times a day with a goal of about 60-90 minutes total a day by age 4 months. Babies often don’t like tummy time at first (it’s a lot of work for your little one!) but it gets easier as they get stronger.

If a baby has flattening on one side of the head, the baby can be laid down to sleep alternating their head in opposite ends of their crib or bassinet each night. This means they will have to turn their head the opposite way to continue to look at their parent and can improve head shape. Parents should alternate which arm they hold the baby in for feeding as well. Upright chairs like the Bumbo for babies not sitting yet are recommended at age 3-4 months. Front packs also help your baby be upright during the day.

If a baby has significant head turning with neck twisting (torticollis), physical therapy is usually started and can be very helpful to restore normal movement of the neck. If by 4-5 months there is significant flattening despite increasing tummy time, etc., a referral may be made for helmet therapy. Wearing a custom soft helmet with a foam liner that is adjusted over time, the head shape becomes more rounded. Helmet therapy is most effective between 4 and 12 months of age, and babies usually accept the wearing of the helmet very well. Most babies are treated with helmet therapy for 1-4 months.

Having some degree of head flattening even with lots of tummy time and upright positioning is fairly common and is not a problem if it is mild. Talk with your health care provider if you have concerns about your baby’s head shape; they can help determine if any specific treatment is needed.

Managed by Kittitas Valley Healthcare, HealthNews does not provide medical advice. For medical advice, please see your healthcare provider.

Play time for children

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KVH Contributor*
Elise Herman
Dr. Elise Herman
KVH Pediatrics

Play time for children

As a pediatrician, I often tell parents that with the exception of books (which are free from the library), they have everything they need within them to raise a happy and healthy child. Reading to your child, getting outside, and playing cost nothing, are technology – free, fun and easy.

Play in particular is generating a lot of interest right now; it has been shown to promote brain development as well as social and emotional well-being. ‘Unstructured’ play (no adult control or directing) allows kids to explore their world, try on different roles and work through their fears. Kids learn how to interact in groups, lead and share, and resolve conflicts, thereby developing vital positive behavioral skills. This type of play encourages creativity and experimentation. It also helps kids work on their “executive function” which is important with decision making and controlling impulsivity. There is evidence that neural pathways in kids’ brains are enhanced through the skills that develop with unstructured play.

Of course the physical benefits of playing including running, jumping, throwing, climbing, etc., are obvious. Playing outside offers even more benefits. Kids tend to burn more calories playing outside than inside, important in our current fight against childhood obesity. Fresh air and contact with nature are helpful in reducing stress levels. Research has shown that kids who play outdoors regularly tend to stick with tasks longer, be more curious and self-directed.

Quite simply, then, play is crucial to child development and learning. Unfortunately, play is threatened on a variety of fronts. There is increasing pressure on children (even kindergartners) to perform academically, and school days can be packed with ‘orderly activities’ with less time for unstructured and especially outdoor play. Many school districts have decreased the amount of recess time as well as PE. The draw of passive entertainment (TV, computer, you tube, video games) is such that the American kids age 5 to 16 spend an average of 6 ½ hours a day in front of a screen, much of it on personal devices such as tablets and smart phones. These personal devices mean kids are usually by themselves without parental involvement—not ideal. Unstructured play is getting squeezed out by this, and our children are the worse for it.

In general, children seem to have a lot more scheduled activities in their increasingly busy days, leaving less time for unstructured play. Between sports, music, etc. parents often feel they hardly have enough time to meet for dinner with their children (but please make time for those family meals!). So how to make time for this important activity? Something may have to give for your child to have the recommended minimum 60 minutes a day of unstructured play, but keep in mind that the benefits of this type of play are many and long lasting. And although unstructured play means you won’t be directing the play, you can still be involved – just let your child lead. Good for everyone!

*Opinions expressed by KVH Contributors are their own. Managed by Kittitas Valley Healthcare, HealthNews does not provide medical advice. For medical advice, please see your healthcare provider.

Pediatric food allergies

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KVH Contributor*
Elise Herman
Dr. Elise Herman
KVH Pediatrics

Pediatric Food Allergies

We seem to hear a lot more about food allergy lately – and for good reason. Food allergy is more common in kids than adults, the prevalence of it is increasing, and 8% of all kids under the age of 6 have food allergies. Understanding food allergy and the newest recommendations about peanut allergy is important for parents and anyone interacting with children.

A food allergy is an abnormal immune response of the body to a particular food. You must be exposed to a certain food at least once (either by eating directly or via breast milk) in order to have an allergic reaction. An allergic reaction occurs when the immune system’s IgE antibodies react with the food, which releases histamines. These histamines cause the signs and symptoms of food allergy that range from mild to life threatening.

90% of all food allergies are caused by the following foods: milk, eggs, wheat, soy, tree nuts (walnuts, almonds, etc.), peanuts, fish, and shellfish. In children, eggs, milk and peanuts are the most common causes of food allergy. Severe reactions are usually caused by peanuts, tree nuts and seafood. Children often outgrow their allergies; 80-90% of milk, egg, wheat and soy allergies resolve by age 5 years. Allergies to peanuts, tree nuts and seafood are more likely to persist. Approximately only 1 in 5 children will outgrow their peanut allergy.

An allergic reaction to a food usually occurs within minutes to hours of eating it. In addition to hives and wheezing, a child may also have itching, swelling of lips/ tongue, shortness of breath, stomach pain, lowered blood pressure, vomiting, diarrhea and/or anaphylaxis (a severe shock-like reaction). Testing for food allergy is only done if there is a strong suspicion of allergy; an abnormal test does not always mean the child is truly allergic. Testing may include blood tests or a skin prick test.

Treatment for food allergies most importantly means avoiding that food (and similar foods) – not easy in today’s world of processed foods that may contain many ingredients. Even a tiny amount of the offending food can trigger a reaction. Epinephrine is the only treatment for severe allergic reactions and comes in the form of an auto-injector called Epi-Pen. Allergy specialists typically do allergy testing and decide if a child should have an Epi-Pen. It is crucial that anyone who will have contact with a child who has a severe food allergy is aware of this and has access to (and knows how to use) an Epi-Pen.

There has recently been exciting news about peanut allergy, which affects 2% of all children. Previously the recommendation was to wait until at least age 1 year for peanut products but it has been shown that earlier introduction actually decreases a child’s risk of peanut allergy. New guidelines from the National Institute of Allergy and Infectious Diseases state that for those children at highest risk – those with severe eczema and/or egg allergy – blood testing should be done by age 4-6 months, and if abnormal the child should see an allergist.

For children who have mild to moderate eczema, peanut products may be introduced and given regularly starting at age 6 months. If the infant has no eczema or food allergy, peanut products may be introduced “freely” into the diet and given regularly with other foods at age 4-6 months (ideally solids are begun at 6 months for breast-fed infants). It is important to remember that peanut products may be a choking hazard. A small amount of smooth peanut butter blended into other foods such as applesauce or oatmeal is ideal. If a rash or any sign of allergy occurs, a doctor should be contacted.

*Opinions expressed by KVH Contributors are their own. Managed by Kittitas Valley Healthcare, HealthNews does not provide medical advice. For medical advice, please see your healthcare provider.

Chores and Children

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KVH Contributor*
Elise Herman
Dr. Elise Herman
KVH Pediatrics

Chores for Children
Little girl washing dishes in the kitchen

As parents, one of our goals is to raise our kids to become responsible, independent adults. Part of this process is having kids do chores, although it is safe to say most kids do not see the value in this activity. Besides becoming proficient at basic household duties, chores also teach kids responsibility and the importance of making a contribution. Doing chores makes kids feel needed and valued – even if they complain about it!

Chores seems to be a waning part of family life, squeezed out by pressure for kids to compete academically and be involved in lots of extracurricular activities.  It has been shown, however, that giving kids chores early (starting at age 2-3) leads to good relationships with family and friends, as well as academic and early career success. Besides creating a sense of self-sufficiency, doing chores teaches empathy and consideration for others, according to psychologist Richard Weissboud of the Harvard Graduate School of Education.

So how to make those kids do chores? Ideas abound, including household chore apps and chore charts. Just the way we adults phrase the concept can make a difference. Saying, “Thanks for being a helper” was much more persuasive to kids than “Thanks for helping,” according to a recent study in the journal Child Development. Emphasizing the child’s identity as a ‘helper’ was very motivating. Telling kids that they “get to help” as opposed to “have to help” feeds into a child’s desire to be ‘grown up’.

We all like to have a choice in life – and the same holds true for kids and chores. Listing all jobs to be done and letting kids choose from the list each week increases the odds they will feel positively about their tasks. Rotating jobs is a fair way to divvy up responsibilities. Tying chores to allowance has actually been shown to be counterproductive; when paid to do housework, kids actually are less motivated to work hard and help out the family. When creating a chore chart, remember to be specific, stating the steps to a job. “Cleaning the bathroom” is vague; “scrub the toilet, clean the sink and tub” is more precise and easy to follow.

Being consistent with a time for the family to do chores together makes it more of a group activity – everyone pulling together for the greater good. Phrasing it as a time to do “our” chores as opposed to “your” chores emphasizes that doing chores is a way we take care of each other. Listing time for chores on the calendar makes the expectation very clear. Kids are also more likely to have a good attitude if we remember not to complain about our own household duties – those little ears are listening!

Start kids out early in terms of household responsibilities. Toddlers can help by putting away toys, clearing unbreakable dishes from the table and putting clothes in the hamper. Preschoolers can sweep, wash plastic dishes and empty wastebaskets. By age 8 or 9 kids can load a dishwasher, vacuum, pull weeds, etc. The child “gets to do” more and more as they get older, and you get the satisfaction of raising a self sufficient and responsible child! There might be some grumbling along the way, but doing chores is an important part of childhood and ultimately kids feel good about contributing and becoming more self-reliant.

*Opinions expressed by KVH Contributors are their own. Managed by Kittitas Valley Healthcare, HealthNews does not provide medical advice. For medical advice, please see your healthcare provider.

Childhood Obesity

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KVH Contributor*
Elise Herman
Dr. Elise Herman
KVH Pediatrics

Childhood Obesity

Childhood obesity is truly an epidemic. In the past 30 years, the percentage of American kids who are overweight has tripled to 17%, or about 1 in 5 children. Additionally, the very heaviest children are even bigger than previously. Adults also have an increasing rate of obesity, but it is especially sad to see kids now dealing with what used to be adult-only health issues due to obesity: Type 2 diabetes, high blood pressure, high cholesterol and lipid levels, fatty liver, sleep apnea and joint problems. Obese children are more likely to grow up to be obese adults, with increased risk of stroke, heart disease, high blood pressure and diabetes.

The emotional and psychological side of obesity is significant as well. These children have greater occurrence of depression, low self-esteem, poor body image and eating disorders. Overweight kids are also more likely to be bullied, compounding their distress.

There is no single cause of childhood obesity, but there are know factors that contribute, including the child’s diet. Diets higher in fats and simple sugars and lower in fruits and vegetables are linked to obesity. Drinking sweetened liquids such as soda and juice can count for lots of extra calories with minimal nutrition. Even diluted juice can give a child extra calories and sugar they do not need and is not recommended on a regular basis. Milk, although a good source of calcium and protein, should be limited to 16 ounces per day.

Snacking can be a major source of calories for American kids, as snacks are increasingly processed and high calorie. Some kids snack almost continuously and can take in more than a quarter of their daily calories in this way; this is especially true in 2-6 year olds. Having regular family meals with minimal snacking decreases the risk of childhood obesity.

Genetics may play a role as well, although the bigger issue may be the environment—high calorie snacks, inadequate exercise and lack of regular family meals probably contribute more than actual genetics.

Exercise helps kids maintain a healthy weight by not only burning calories but also by keeping them busy and elevating their mood. Like adults, kids may eat out of boredom or for emotional reasons; exercise works against this. Due to computer, TV, personal electronic devices and video games, however, kids are more sedentary than ever. Limiting the usage of electronics and encouraging kids to get at least 1 hour of exercise a day (with most of this being aerobic exercise) is important.

A surprising contributor to childhood and adult obesity is lack of sleep. This may be due to hormonal alterations, less regular meals and poorer food choices when sleep-deprived. It is recommended that kindergartners get 10-12 hours of sleep a night, with the amount decreasing as kids get older, with the goal for the teen to be 9-10 hours per night.

So what’s a parent to do? Like many issues, setting a good example is important. Regular family meals, minimal snacking of healthy foods such as fruits and vegetables, routine exercise (ideally outside to elevate the mood and keep us away from the kitchen!) and regulated use of technology all help. The goal should also be a healthy lifestyle and healthy habits, not a number on the scale or the desire to be thin, as this could backfire and predispose to an eating disorder. Have fun with your family as you enjoy regular meals together as well as getting out and being active, and preventing childhood obesity will be a natural healthy side effect!

*Opinions expressed by KVH Contributors are their own. Managed by Kittitas Valley Healthcare, HealthNews does not provide medical advice. For medical advice, please see your healthcare provider.

Safe Sleep for Baby

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KVH Contributor*
Elise Herman
Dr. Elise Herman
KVH Pediatrics

Safe sleep for baby

Many parents are familiar with the recommendation that newborns should sleep on their backs, but ‘safe sleep’ is more than just the positioning of the baby. The American Academy of Pediatrics (AAP) has addressed sleep safety both in the 2016 original safe sleep policy (for newborns and infants up to age 1) and in a recent update April 2019.  The Family Birthing Place at Kittitas Valley Healthcare is making safe newborn and infant sleep a focus with materials given to parents in prenatal classes, those delivering at KVH and those whose young child is seen in the KVH Emergency Department.

The fact that annually more than 2,500 babies in the US die unexpectedly while sleeping is tragic. These deaths are often due to SIDS (Sudden Infant Death Syndrome) or accidental suffocation or strangulation.  The “Back to Sleep” campaign in 1994 recommended babies sleep on their backs and as a result the SIDS rate decreased by half. This continues to be the recommendation both for nighttime sleeping and naps. The crib should be free of blankets, pillows, bumper pads, stuffed animals, etc. – some call this “the naked crib”. 

If desired, babies can sleep in a wearable blanket or sleep sack to keep them warm enough at night  –  but not too warm. It is better for babies to ‘sleep cool’ than get overheated while sleeping. Swaddling with a thin breathable cotton blanket is fine until 1-2 months of age. The swaddle should be snug around the chest but looser around the legs so the baby can move her hips freely. It is important that the swaddling blanket cannot get up around her face. 

The sleeping surface should be flat and firm- it should not indent when baby is lying on it. Devices that aim to position the baby a certain way for sleep (like the “Rock N Play”) have been found to be dangerous and are not recommended. Babies should sleep close to the parents’ bed but in their own space (i.e. crib, bassinet, portable crib).  The AAP recommends room sharing ideally for the first year of life but at least for the first 6 months.

Although room-sharing is recommended, bed-sharing is not. Baby may come into the parents’ bed only for feeding and comforting and then be returned to his own ‘sleep space’ when the parent is ready for sleep.  Babies should never sleep on a couch, armchair, or other soft surface as these pose a significant suffocation risk.

Smoke exposure is associated with an increased risk of SIDS; if a parent is a smoker they should smoke outside of the home and change clothes before being near the baby.  Ideally, they should quit smoking for their own health as well as that of the baby’s.

All parents are tired, all parents want their newborns and infants to sleep well, but sleep safety is vital. Having babies sleep in their own space, on their backs, not over-bundled, on a firm, flat surface, and without anything else in the bassinet or crib is essential for sleep safety.

For more information here is the link to the AAP’s policy:  
SIDS and Other Sleep-Related Infant Deaths:  Updated 2016 Recommendations for a Safe Infant Sleeping Environment https://pediatrics.aappublications.org/content/138/5/e20162938

*Opinions expressed by KVH Contributors are their own. Managed by Kittitas Valley Healthcare, HealthNews does not provide medical advice. For medical advice, please see your healthcare provider.