From the WebMD Archives

Aug. 8, 2019 -- New mom Theresa Alvarez-Salazar, 44, stood in the aisle of a Los Angeles area baby store and studied the many baby monitors and trackers on display. Her daughter, Lucila, was now 6 months old, and it was decision day.

Lucila had been sleeping in a bassinet in the same room as Theresa and her husband, Mark. But now they wanted to move her into her own room.

Why did she want a monitor? "Peace of mind," Theresa says.

Long gone are the days when parents depended on their innate ability to hear a baby's cry to jolt them out of peaceful sleep at 2 a.m. Today, smart monitors and trackers can alert parents not only to a baby's cries, but also to a baby's heart rate, oxygen level, and sleep patterns. Other monitors measure the humidity level in the nursery, and one coming on the market soon will tell parents when their baby’s diaper is soggy.

While parents like Alvarez-Salazar cite peace of mind as the primary reason for buying the devices, some experts caution that the monitors and trackers can lead to a false sense of security, add to parental anxiety, or even not work. The American Academy of Pediatrics warns parents not to rely on the monitors to lower the risk of sudden infant death syndrome, or SIDS.

Even so, the smart baby monitor market is booming. Global sales reached about $897 million in 2016, according to Statista, an online portal for statistics that collects data from market research institutes. The baby monitor market is estimated to reach past $1 billion dollars in 2019.

In the last decade, the market has changed dramatically, says Kurt Workman, CEO of Owlet Baby Care Inc. The company makes the Owlet Smart Sock, which wraps around a baby's foot to track heart rate, oxygen levels, and sleep. "Six to 10 years ago, audio, [with] no cameras, was the trend," he says. Then video monitors were added to the audio.

Now, he says, "We're seeing this shift from video to more proactive." He cites as an example his company’s Owlet as ''the sock that senses information."

So Many Choices

Simple audio monitors, such as the VTech Digital Audio Monitor with 1,000 feet of range and a ceiling night light, are relatively inexpensive (about $39.99 at Target), with a two-way talk-back intercom so parents can try to soothe a baby without heading to the nursery.

Among the many step-up options from a simple audio monitor are products such as the Arlo baby monitor and baby camera (about $127 on Amazon), which includes a monitoring camera, lullaby player, air sensors, and rechargeable battery. Parents can listen in and talk to the baby from their smartphone, plus check the nursery's temperature and humidity and get motion and sound alerts.

Angelcare's model AC527 (about $199.99 on Amazon), is a breathing monitor with video, says Marc Hardenberg, a spokesperson for Angelcare Monitors Inc. A battery-operated wireless sensor pad slips under the crib mattress and doesn't touch the baby. An alarm sounds after 20 seconds if the baby doesn’t make any breathing movements.

Owlet's Smart Sock plus Cam (about $399 directly from Owlet) uses light, sounds, and smartphone app notifications if the baby’s heart rate or oxygen levels go too high or too low.

Nanit Plus, a monitor and camera ($289 on Amazon) has video, audio, sleep tracking, night vision and temperature and humidity tracking. The Breathing Wear ($49.99 on Amazon), a band that can be wrapped around the baby, can be added for breathing motion detection.

The devices are considered consumer products, not medical devices, and are not FDA-approved. Companies say that any data collected is secure and their conversations private.

AAP's Policy on Monitors

Sudden infant death syndrome, or SIDS, is every parent's fear. But the monitors are not the way to address that fear, the American Academy of Pediatrics says. In its policy on safe infant sleep, it says: "The use of cardiorespiratory monitors has not been documented to decrease the incidence of SIDS.

"Do not use home cardiorespiratory monitors as a strategy to reduce the risk of SIDS."

In a report published last year, researchers from the Children's Hospital of Philadelphia tested two home baby monitors -- the Owlet Smart Sock 2 and Baby Vida. They found that the Owlet detected low oxygen levels but performed inconsistently -- for example, it missed low levels sometimes. The Baby Vida never detected low oxygen during their testing and also displayed falsely low pulse rates.

Both devices use pulse oximetry, which uses light to measure oxygen in the blood. The researchers compared the devices' functioning with an FDA-cleared device as a reference.

Workman, Owlet’s CEO, took exception to the study, saying that a better comparison would have been to use arterial blood gas measurements instead of pulse oximetry. The writers of the study acknowledged this limitation as well.

The Baby Vida device, although still listed on Amazon, is currently not available.

In the report, published in JAMA, the researchers say parents and doctors should ''exercise caution incorporating data from these monitors into medical decisions."

Workman agrees with the AAP policy for now because of the lack of evidence. But, he adds, "we believe that monitoring can one day help us reduce the risk of SIDS, and we are studying that right now."

Pediatricians Weigh In

Questions about baby monitors come up all the time, says Elizabeth Murray, DO, an assistant professor of pediatrics at the University of Rochester.

"We know parents are wanting to do what is best," she says. "The trick with these advanced monitors is that they can frequently have a false alarm. You wake up and think something is wrong, and it's false data."

Monitors at the hospital "are checked on a regular basis to be sure they are calibrated correctly," she says. There is no way the home monitors can be as accurate as the hospital monitors, she tells parents.

Some of the monitoring devices ''play on fear," says Murray, who’s also a pediatric emergency room doctor and a spokesperson for the American Academy of Pediatrics. She worries that in some cases, the monitors may ''induce more worry and insecurity."

Michael Grosso, MD, chief medical officer and chair of pediatrics at Northwell Health's Huntington Hospital, in Huntington, NY, doesn’t recommend monitors for parents.

"Studies have found no benefit, and as physicians, we have a responsibility to avoid recommending interventions we know to be useless. Beyond that, these devices are far from harmless,” he says. “Parents risk losing sleep needlessly over the inevitable false alarms. And that's not good for parents or infants."

Grosso cites yet another pitfall -- that a potential problem identified by the monitor will lead to a medical evaluation that will trigger tests that won’t be needed.

Others are raising questions as well. The National Advertising Division of the Council of the Better Business Bureaus says advertising for the Owlet “Smart Sock” gives an accurate description of the monitor’s tools, but other important information was hard to find and full of dense language. The NAD says it is concerned parents could be under the mistaken impression the Owlet device could prevent SIDS.

Two California mothers have also raised concerns about Owlet’s products in a federal lawsuit filed this year in Utah. The pair want the lawsuit opened as a class action. In it, the plaintiffs say the monitors gave multiple false alarms a night, created anxiety, and failed to accurately monitor heart rate or oxygen levels.

Owlet filed a motion to dismiss the suit in June.

“The Smart Sock is not a medical device and Owlet has never marketed the product as such,” the company says. “Plaintiffs are merely disappointed customers who filed this putative class action rather than availing themselves of Owlet’s ‘return for any reason’ 100% money-back guarantee.”

New Parents, Veteran Parents Speak

Emily Pappas, 32, of Phoenix, AZ, and her husband, Andrew Pappas, 37, use two monitors to keep tabs on 6-month-old Sophie. One is audio only, and the other is an audio-video model that alerts them to motion and noise and tells the temperature, humidity, and air quality in Sophie's room.

They decided on both because the more sophisticated monitor is based on having an internet connection, ''and every once in a while, it does not connect." So they see the audio monitor as a backup, she says.

"It's reassuring for the most part," Pappas says. For instance, she will sometimes hear the baby through the monitor, but when she looks on the video monitor, she can tell that Sophie is just happily chatting to herself.

Billie Ortiz, 38, and her husband, Aaron Slotnick, 39, of Westchester, CA, used baby monitors for their children, now 5 and 2, when they were infants. Ortiz says the options for monitoring seemed to explode between their first and second child. She soon learned to adopt the philosophy of her pediatrician and can still recall his words: "Look, Billie," he told her, "don't obsess over the monitors." She took that to heart. She soon realized that if the monitors were turned up too loud, ''I would wake up with every little sound. I realized I was waking myself up for no reason."

She says the monitors can help keep peace of mind, "but I think they can drive up the anxiety."

Alvarez-Salazar, the baby store shopper, bought an audio-only monitor and a Nanit monitor and camera. She likes the peace of mind but knows the monitors are only a part of what's needed to keep little Lucila safe. "From the moment my daughter was born," she says, "the doctors and nurses kept telling me to always lay her on her back," she says.

Safe Sleep: What Else to Do

About 3,500 infants die annually in the U.S. from sleep-related deaths such as SIDS and strangulation, the American Academy of Pediatrics says. Placing infants on their back to sleep is among many ''low-tech'' recommended ways to cut the risk of SIDS, says Grosso. Parents should also:

  • Use firm bedding.
  • Keep soft objects and loose bedding away from infants.
  • Keep an infant in their room, but on a separate sleep surface meant for babies, for at least 6 months and up to a year.
  • Avoid tobacco smoke exposure before and after a child's birth and while breastfeeding.

Monitors and Trackers: What's Next?

Workman says his company plans to look at other sleep services, including a sleep training program for infants.

The company is also exploring a way to use data to alert parents to symptoms of an oncoming illness, he says. A predictor, which would need FDA approval, would enable parents to seek medical care sooner and hopefully reduce midnight runs to the emergency room.

This fall, Procter & Gamble plans to launch the Lumi by Pampers System. This ''smart diaper" system includes a video monitor and an activity sensor that tracks wet diapers and sleep patterns and sends the information to a smartphone app.

The Long View

Whether parents use a monitor or not, Murray urges new parents to keep perspective. It's very easy for people to hear horror stories of infants having sleep problems or breathing issues. Those problems can go viral quickly because of social media, she says.

"Very rarely do parents post, 'Everyone slept. We had a great night. Everything is fine.' " Yet that is the much more common scenario, Murray says.