11 of the Most Common Worries About Baby Safety, Answered

Editor’s Note: This article was written by Dr. Seran Kim, a board-certified emergency physician specializing in pediatric emergency care, answering real questions submitted by real Babylist parents.

Keeping your baby safe is your number one priority as a parent, and there’s a lot to remember when it comes to little ones. So it’s understandable that you have questions. Like, can you give a baby cough medicine? And when can you give baby a blanket to sleep with? I’m here to answer these questions and more, and hopefully give you a little more clarity and peace of mind.

How to Keep Baby Safe While Sleeping

When can you put items in baby’s crib?

Remove all pillows, blankets, stuffed animals and toys from the crib—including crib bumpers—until baby is at least 12 months old. All of these items pose a potential risk for suffocation, strangulation and entrapment.

The American Academy of Pediatrics (AAP) warns against the use of any of these items in the crib, as they can increase the risk of SIDS during the first year of life. Contrary to popular belief, crib bumpers don’t actually prevent injury of any kind. Crib bumpers were originally designed to prevent infants from getting their heads caught between the crib slats and decrease the risk of injury as babies roll around. However, cribs are now highly regulated by the Consumer Product Safety Commission (CPSC), and therefore the slats are much closer together, preventing babies’ heads from getting stuck.

Pillows are also popular registry items, but babies should always lay flat on their back on a firm surface.

Remember, inclined sleepers and bedsharing are also not recommended—ever. And if you’re concerned that your baby will get cold, use a swaddle or sleep sack rather than a loose blanket, which could suffocate and strangle a newborn.

To decrease the risk of SIDS, practice safe sleep habits, which have been proven to be more effective than any monitor. These include:

• Placing your baby to sleep on their back. Placing your baby on their side or stomach may compromise breathing.

• Avoid placing your baby on a soft surface, such as a couch, fluffy comforter or soft mattress.

• Avoid placing any pillows, blankets, stuffed toys or crib bumpers in the baby’s sleep area.

• Don’t co-sleep with your baby. While the risk of SIDS is lowered if a baby sleeps in the same room as their parents, the risk increases if baby sleeps in the same bed with parents, siblings or pets.

• Dress your baby in thin layers and avoid over-bundling. Overheating can increase a baby’s risk of SIDS.

How can I tell if a crib mattress is firm enough?

Always place your baby on a firm, flat sleep surface, which means that it should not indent when you place your baby on it. Be sure the crib mattress is designed for your specific crib, and that it fits tightly. Always check that your mattress (and crib) meet the safety standards of the Consumer Product Safety Commission (CPSC), which is constantly evaluating and updating its safety recommendations. 

Be sure to double-check for recalls of baby items through the CPSC website, because even if products were approved for your older child, they may have been recalled since. Hand-me-downs are amazing (and encouraged), but verify that these are still safe. And even if certain items are banned, they may still turn up at garage sales or second-hand stores. You can also sign up to receive free safety alerts and resources directly from the CPSC to help you stay up-to-date.

Can you tilt the crib to help baby with reflux?

The AAP generally doesn’t recommend elevating one side of the crib or mattress. They also don’t recommend any devices (including sleep positioners or nests) marketed for treating reflux. Studies show that placing your baby in a semi-inclined position doesn’t actually make reflux any better. In fact, there’s some evidence that a semi-inclined position can actually make baby’s reflux worse. 

Not only is it ineffective in reducing reflux, but elevating your baby’s head during sleep can also increase the risk of them rolling to the foot of the bed or into a position that might cause serious (and fatal) breathing problems.

So with sleep positioners and gadgets out, what’s a desperate parent of a reflux baby to do? The only thing you can really do is wait. Reflux will naturally end for most babies when they outgrow the symptoms. By four months of age, most babies will be able to burp on their own, and by six months, they’re usually able to sit up on their own. If you have any concerns about your baby’s reflux, be sure to discuss these with your pediatrician.

Can baby sleep in a swing?

The simple answer is no. Infant swings can be a valuable asset when parents need help soothing a fussy baby or a safe respite for their infant—and they should always be supervised when in these devices. But the AAP advises parents against using infant swings for sleeping babies. 

These recommendations came after many injuries and even deaths were reported when infants in swings suffered what’s known as head slump (more on that below). In general, these tips can help keep babies safe when in infant swings:

• Newborns and infants under four months old should be seated in the most reclined swing position to avoid head slump and suffocation.

• The swing should not tip over or fold up easily.

• If the seat can be adjusted to more than a 50-degree angle, it should have shoulder straps to keep the infant from falling out.

• Toys on mobiles attached to the swings should not be pulled off easily.

• The baby should not be heavier than weight limits specified on the swing label or instructions.

• The swing’s cradle surface should stay fairly flat while in motion and while stopped so the infant will not tip or fall out.

• If baby falls asleep in the swing, the AAP advises moving them to a firm sleep surface as soon as possible.

How to Keep Baby Safe In the Car

Can baby sleep in a car seat?

Despite going against every ounce of parental intuition to not move a sleeping baby, if your baby falls asleep in a car seat, it is recommended that you move them to a firm sleep surface on their back as soon as possible.

Every year, several hundred infants fall victim to sleep-related deaths in sitting devices—mostly car seats—for routine sleep. Although sitting devices are designed for activities such as transportation, parents may inappropriately rely on them as an alternative to a crib or bassinet. 

When these devices aren’t used as directed, infants can fall from an elevated surface on which the device was placed or flip onto a soft surface and suffocate. They also can be injured or killed with improper buckling of car seat straps. That’s why the AAP recommends that babies be placed on their back for every sleep until they reach one year old.

How do I keep baby’s head upright in the car seat?

“Head slump” is used to describe the position of the head when it moves down far enough that the chin touches the chest. This position most commonly occurs when children fall asleep, especially while restrained in a car seat. For older babies and children with head control, it’s nothing to worry about. For newborns, however, it gets a little more complicated.

Newborns have airways the size of drinking straws, which are subsequently easier to block or collapse. They also don’t have a mature neurological drive to signal that the airway is being compromised, nor the neck muscles to lift their proportionally large heads against gravity. So to prevent head slump in newborns, you’ll need to make sure that:

• The car seat is in the maximum rear-facing recline angle, as defined by the car seat manufacturer.

• The harness is snug and the chest clip is appropriately placed. When in doubt, set up an appointment with your local Child Passenger Safety technician, or CPSt (you can use their database to find a car seat expert near you).

• Do NOT use any after-market devices, such as head straps or slings. These devices can cause a secondary “rebound” motion that the rear-facing child experiences in the late phases of a frontal crash, causing significant spinal injury. Even without a crash, these slings can slide out of place and pose a strangulation or smothering risk for your baby.

For a child with special needs or considerations, discuss car seat safety with your doctor. And for older babies with head control, head slump is no longer a concern!

Are car seat protectors safe?

As tempting as they are, car seat protectors are generally not recommended for use under infant car seats. This is because a thick seat protector or mat between a child restraint and the vehicle seat introduces space between the two. If the seat protector shifts over time, that can loosen the car seat’s installation and compromise your car seat’s safety and effectiveness.

That being said, you should refer to your car seat’s instruction manual. Some manufacturers may allow a thin towel, blanket or their specific brand of seat protector underneath the seat. Or the manual may specify that nothing should be used under the car seat at all. If your car seat manufacturer produces car seat protectors, they’ll generally advocate for their own product. However, be aware that even if they assert that they comply with Federal Motor Vehicle Safety Standards, that doesn’t necessarily mean they’ve been crash-tested with their car seats. There are no standards, regulations or benchmarks for testing these accessory products.

How to Keep Baby Safe When They’re Sick

Can babies have cough medicine?

No. It’s important to know that the FDA does not recommend any over-the-counter medicines for cough or cold symptoms containing dextromethorphan, guaifenesin (such as Robitussin, NyQuil, Triaminic, Theraflu) in children under two years old. These include: expectorants (for loosening mucus so that it can be coughed up) and antitussives (cough suppressants).

The label may also include nasal decongestants and antihistamines, which should also be avoided in children under two years. Keep in mind that manufacturers are now voluntarily relabeling packaging to warn for use in children under four years old. Ingestion of these medications can lead to convulsions, rapid heart rates, decreased levels of consciousness and even death. Safer alternatives for cold symptoms include a cool mist humidifier and/or nasal suctioning with saline.

Is my baby sweating because they’re sick?

It’s completely normal for babies to sweat, as their temperature regulation systems are still maturing. Sweating is the body’s natural response to becoming too hot. Babies who get too hot may be overheating, which causes them to sweat (they can’t tell you that they’re hot or peel off layers themselves). They may sweat all over the body or only in certain areas, like on their back. Other common causes of sweating include crying or mounting (or breaking) a fever.

But in rare cases, sweating can indicate a medical issue. These include sleep apnea, congenital heart disease, idiopathic hyperhidrosis or other endocrine or glucose disorders. In a few studies, it’s been shown that sleep apnea (when a baby stops breathing for 20 seconds or more during sleep) occurs more frequently when babies are hot. Sleep apnea doesn’t cause overheating, but overheating may cause sleep apnea.

Babies who have congenital heart disease sweat nearly all the time because their bodies are compensating for the cardiac defect and working harder to pump blood through the body. These babies also have a hard time feeding, which is often associated with fast, shallow breathing.

Idiopathic hyperhidrosis is excessive sweating without a clear cause. Most babies with this condition have the same number and size of sweat glands as those who don’t sweat excessively. However, the sweat glands are more active—possibly due to increased activity in part of the nervous system—and is most common in the hands, armpits and feet.

Sweating can also be the earliest indicator of an endocrine problem, such as a thyroid disorder or diabetes. It’s important to discuss any sweating symptoms with your doctor if you have any concerns.

If you’ve ruled out illness, your baby is likely sweating because they’re just too hot. Keeping a comfortable home and bedroom temperature helps your baby thermoregulate, especially at night. Some studies have found that a room temperature between 68 and 72 degrees Fahrenheit may be comfortable for babies, while others range between 61 and 68 degrees Fahrenheit. However, the AAP refrains from providing a specific temperature range for baby’s bedroom, as the optimal room temperature for a sleeping baby might depend on the typical climate in your region (especially since you should dress your baby in clothing that’s appropriate for your local ambient temperatures).

It’s very important to note that dressing your baby in too many layers, using thick blankets or having the sleeping environment too hot are all associated with overheating—and an increased risk of SIDS.

How to Keep Baby Safe Around the House

What’s the best way to baby-proof the house?

Congratulations, your little one is up and walking! This is a big milestone, but be sure to prep your entire home well in advance to prevent household-related injuries. Infants and children under five years old account for over 40% of pediatric Emergency Department visits. Most of these common injuries occur in and around the home, so don’t forget to check all of these precautions off your list:

• Cover all unused electrical outlets with plugs, to prevent electrical shock.

• Keep all cords out of reach, including electrical cords (which can cause oral electrical burns if baby chews on the wire) as well as cords for blinds (which can be a strangling risk).

• Secure TVs, bookshelves and furniture, which are significant topple risks.

• Use protective padding on corners of coffee tables or any furniture with sharp edges.

• Cover your fireplace with an appropriate gate to prevent flame injuries.

• Use safety gates on the top and bottom of stairs.

• Use safety latches on lower cabinets and doors.

• Lock medicine cabinets or boxes.

• Lock cleaning supplies. Don’t forget to keep bleach and laundry pods (which may look like candy) out of reach as well!

• Keep house plants out of reach. Some plants (which thankfully don’t taste good) may be extremely poisonous if ingested in larger quantities.

• Use window guards or move furniture away from windows (which could provide climbing access to toddlers). Windows should be able to open no more than four inches.

• Lock away any guns separately from ammunition, or better yet, remove any firearms from the house.

• Check for chipping paint, especially in older homes, which can be a lead poisoning risk.

• Use stove knob covers. 

• Be sure to also turn pot handles backwards when in use and use rear burners.

• Cover radiators and heating vents to prevent burn injuries.

• Apply door pinch guards to all doors to prevent finger crush injuries.

• Use toilet locks, since even one inch of water can pose a drowning risk.

• Lock your liquor cabinet.

• Lock away batteries, especially button batteries, which can lead to serious injury or death if placed in the nose or ears or if ingested.

• Avoid games with marbles, small balls, beads or any small part smaller than 1¾ inches, which are common choking hazards.

Remember, prevention is the best safeguard. Thoroughly baby-proofing your home helps prevent accidental injuries and help avoid visits to the ER.

What if my baby falls and bumps their head?

Trust your instincts. If you’re worried, then I’m worried. For any traumatic injury in a baby, consult your doctor immediately or go to the nearest emergency department. These injuries should be evaluated by a medical professional. Red flags for serious head injury include:

• Loss of consciousness, even for a second

• Weakness or limpness

• Inability to wake

• Seizure

• Incessant crying or difficulty to console

• Refusing to eat or nurse

• Vomiting

No matter what injury your baby might have or whether you think it's minor or serious, if you have any safety concerns, reach out to your doctor for advice.