New Infant Sleep Guidance: Law Bans Inclined Sleepers, Bumpers

July 18, 2022

Many parents love putting their babies in inclined sleepers, those slanted hammocks made of soft material that hang from a frame. Many of these products can vibrate, blow air or play music, and provide parents the promise of helping a baby fall – and stay – asleep.

But these products can be dangerous. In 2019 Fisher-Price recalled 4.7 million Rock ‘n Play infant sleepers following reports of babies who died while in them. Some of the infants rolled from their back to their stomach while unrestrained. The American Academy of Pediatrics (AAP) says inclined sleepers like the Rock ‘n Play increase the likelihood of airway compression and suffocation.

The outcry from safe sleep advocates has led to the passage of a new federal law. Earlier this spring President Joe Biden signed the Safe Sleep for Babies Act, which prohibits the manufacture or sale of inclined sleep products, along with padded crib bumper pads, which are also considered unsafe and can increase the risk of suffocation or entrapment.

Safe Sleep Guidelines for Babies

Babies should be put to bed on their back – alone, unrestrained and on a firm, flat surface without bumpers and other soft bedding, says the AAP and other organizations such as the National Institutes of Health, the Centers for Disease Control and Prevention and the Federal Maternal and Child Health Bureau. The AAP says parents should never use a product for sleep unless it is specifically marketed for sleep – so items such as strollers, swings and car seats are not recommended for infant sleep on a routine basis.

The AAP also recently updated their sleep guidelines to strongly discourage bed-sharing with infants as well. Although many parents choose to co-sleep to assist with breastfeeding or because of cultural or social preferences, the AAP says sharing a bed with your baby increases the risk of injury or death, and it is not recommended under any circumstances.

Instead, they recommend room-sharing, with baby in a separate crib, bassinet play yard or bedside sleeper, until the child is at least 6 months old.

The AAP also recommends avoiding the use of commercial devices that claim to reduce the risk of sudden infant death syndrome (SIDS) or other sleep-related deaths. This includes at-home cardiorespiratory monitors. There is no evidence that these devices reduce the risk of death and they may provide a false sense of security and complacency, the AAP warns.

Q&A on Dangers of Inclined Sleepers

In this Q and A, we talked with pediatrician Erin Frank, MD, Associate Division Chief, Pediatric Hospital Medicine at UH Rainbow Babies & Children’s Hospital, about reclining sleepers and why they present a danger to infants. Here is what she had to say:

Q. Why are these kinds of sleepers popular?

A. This kind of product keeps a baby inclined, which parents may think helps prevent reflux or spitting up. So people may think their babies sleep a little better in this position, despite medical experts' recommendations.

The reclining sleepers also keep an infant in one spot, so parents believe they can have a little freedom to move around the house or to relax while the child is in the device.

Many of these products come with controls that shine a nightlight, play soft music or rock the baby.

Q. What makes reclining sleepers dangerous?

A. One of the real dangers is that babies have poor head control. They can slouch down while sleeping at an incline and tuck their head into their chest. This closes the airway and causes problems with breathing. If Mom or Dad is watching, they can do something about it. But if no one is around, this could be a serious problem.

Many of these products are made of fabric that might look soft and comfortable, but can be dangerous. If the baby can roll or move around, they can move their face into the side of the sleeper and smother.

The biggest risk comes if an infant rolls over in these devices. Many parents don’t realize the possibility that the first time a baby rolls over is when they are sleeping. You never know when your baby is actually going to roll over for the first time. We tell new moms that when their baby is two months old, they can expect the infant will begin rolling sometime in the next two months.

The majority of deaths occurred when babies managed to change their positions while in the sleeper.

Q. Is a reclining sleeper ever safe to use?

A. Any of the products like the Rock ‘n Play Sleeper are safe to hold a baby under the observation of a parent or caregiver who can respond to their needs. They are not safe for infant sleep, especially when no adult is watching closely.

In general, though, I think it’s one of those devices that’s not necessary. Most people don’t want to move a baby after she’s fallen asleep, so it’s not realistic to expect people to move an infant from a reclined sleeper to a crib.

Parents should not purchase any of these devices that may still be available through the second-hand market, such as resale stores or garage sales.