Reviewed by Brunilda Nazario, MD on November 07, 2019
From the WebMD Archives

Nov. 7, 2019 -- The Consumer Product Safety Commission is warning parents not let a baby sleep in rockers, pillows, car seats, or any other product that holds an infant at an incline -- with their head higher than their feet.

The warning comes after the agency studied what happened to babies’ movements and oxygen levels when they were placed in various products and positions.

Infant sleep experts cheered the agency’s statement.

“I do think it should have happened a while ago when we saw there were deaths from them, but I’m glad they did it now,” says Sarah Lazarus, DO, a pediatric emergency medicine physician at Children’s Healthcare of Atlanta. Dr. Lazarus is also an injury prevention researcher at Emory University and reviews infant deaths for the state of Georgia.

The researcher who did the study for the commission concluded that none of the inclined sleepers her team tested were safe for babies to sleep in.

Erin Mannen, PhD, a mechanical engineer at the University of Arkansas for Medical Sciences, designed the study to evaluate how babies move and use their muscles in inclined devices.

Mannen’s team studied 10 babies who were 2 to 6 months old while they sat in seven products. Each child was placed in a product for no longer than 60 seconds at a time for safety.

“The results showed some evidence that it’s easier for babies to roll from their backs to their stomachs in these products,” she says.

Mannen and her team found that lying on an incline activates the baby’s stomach muscles and makes it easier for them to lift their heads -- all of which makes it more likely that they’ll turn over, even if they’ve never done it before.

Once they flip, the angle of the sleeper and the soft material that most are made of can make it tough for them to get out of that position. She found that babies who wind up on their stomachs struggle and may get fatigued quickly, leading to suffocation.

She says her findings back up case reports of infant deaths. The Consumer Product Safety Commission authorized the study after receiving reports of more than 1,100 incidents, including 73 infant deaths between January 2005 and June 2019.

“Several of the parents indicated that they’d never before observed their infant roll on a flat surface until they found their infant dead in one of these products,” Mannen says.

Not all of the infant deaths tied to sleepers involved babies that rolled. In some cases, parents found the babies dead on their backs. Mannen says in many of those instances, some parents reported finding their babies with their faces pressed into the soft, pillow-like material that some sleepers are lined with. When babies burrow their faces into a soft surface like that, they can end up continuously breathing the carbon dioxide they exhale, eventually leading to suffocation.

Because of those reports, the commission has already worked with several companies to recall some infant sleepers, including the popular Fisher-Price Rock ’n Play Sleeper, the Kids II Rocking Sleeper, the Eddie Bauer Slumber and Soothe Rock Bassinet, and the Disney Baby Doze and Dream Rocker.

Now the agency says parents should not use any inclined sleep products with a seat back that rises more than 10 degrees. It also says parents shouldn’t let babies sleep in car seats, bouncers, or any other device, pillow, or seat that holds them at an angle.

Pediatricians say they know that advice can be hard to follow, especially if a child falls asleep in the car.

“Especially if a baby is under four months, it’s very, very important to move them if they’re sleeping in a car seat,” says Lazarus. “We’ve seen deaths where a baby’s airway gets cut off when their head falls forward,” she says.

And what about putting the crib mattress at an incline to help with reflux?

Lazarus says she knows pediatricians used to recommend that, but she says new studies show that it doesn’t really help and may be unsafe.

“We do not recommend any sort of wedging or propping or positioning at this point,” she says.

In addition to avoiding inclined surfaces, the commission is reminding parents that babies can suffocate if they sleep with blankets, pillows, or other items. The safest way for a baby to sleep is flat on their back, in a bare crib, and on a flat, firm surface.

Show Sources

Consumer Product Safety Commission: “CPSC Cautions Consumers Not to Use Inclined Infant Sleep Products,” Oct. 31, 2019.

Erin Mannen, PhD, assistant professor and director of orthopedic research, University of Arkansas for Medical Sciences, Little Rock.

Sarah Lazarus, DO, pediatric emergency physician, Children’s Healthcare of Atlanta, Atlanta, GA

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