What New Grandparents Need to Know

Are you about to become a first-time grandparent? Or are you a parent looking for tips to send the new grandparent in your life? I’m here to help. 

So much has changed in the last 20+ years since I became a mom myself. Because I’m a NICU nurse and baby sleep expert, it’s part of my responsibility to stay up-to-date with all of these changes and to help educate new parents on the latest recommendations. I’ve put together a list of the most important things that have changed with the hope that they might be helpful for you as well.

Before you dive in, let me just say: the way we did things when we were new parents worked for us, and most of the time, our babies turned out fine. But, new grandparents, some babies weren’t fine, and that’s why the recommendations have changed.

What has changed for sleep:#anchor

Babies sleep on firm, flat mattresses only.#anchor

When adults sleep, we often want soft pillows, cushioned mattress pads, or memory foam that adjusts to our specific body. For adults, that is great. But babies need a firm, flat mattress designed specifically for infant sleep.⁽¹⁾ We don’t want to add any pillows, sleep positioners, mattress pads, or extra “cushioning.” A firm, flat mattress with only a fitted crib sheet helps to prevent unintentional suffocation or rebreathing.

Babies sleep in a bare crib. #anchor

The safest place for a baby to sleep is in a bare crib, bassinet, portable crib, or play yard.⁽¹⁾ I know this is a big change from when we used to put bumpers around the crib, place stuffed animals in the corner because they looked cute, or add blankets to keep babies warm. But, over time research has found that those things are not safe. In fact, they can cause unintentional suffocation or entrapment. 

If you’re worried about your sleeping grandbaby staying warm, opt for layers, or using a swaddle or sleep sack (a wearable blanket that stays on them during sleep). While we’re talking about warmth, I want to share one more thing. We want to avoid overheating. I know their hands and feet can feel cool and that might be concerning, but hands and feet aren’t great indicators of a baby’s temperature. Instead, we’ll use the core. If their core feels warm, but not sweaty, and not cold, you’ve nailed it.

Bottom Line: Babies under 12 months need to sleep something labeled crib, bassinet, portable crib, or play yard that has nothing in it except for a fitted crib sheet.⁽¹⁾ Products labeled in any other way (like lounger, sleeper, swing, etc) are simply not safe for baby sleep.

Babies are placed to sleep on their backs.#anchor

Placing babies to sleep on their backs reduces the risk of SIDS (Sudden Infant Death Syndrome). Now, that doesn’t mean that if they roll to their tummy you need to roll them right back! Once a baby can roll both directions on their own, most pediatricians will say sleeping on their stomach is safe, as long as they're unswaddled on a firm infant mattress with no loose bedding. But, even when they’re rolling, continue to lay them down on their back in the crib and let them roll on their own. ⁽¹⁾

Worried about babies choking if they spit up or vomit while on their back? This video shows why back sleep truly is the safest until they can roll to their tummy on their own:

Bottom Line: Any time we place a baby under 12 months of age down for sleep, we’re going to place them on their backs. 

Car seat sleep is only safe in certain circumstances.#anchor

When babies sleep in car seats, we need to keep a few things in mind.

First, infant car seats are designed to work safely when installed in a car. When the infant car seat is installed in the car properly, it reclines the baby in a safe position to keep their airway open. It is safe to let a baby sleep in a car seat installed properly in your car.

However, when the infant car seat is not installed in the car, the position of the car seat may no longer protect the baby’s airway in the same way. When you get home or to your destination, it’s important to remove the baby from the car seat and transfer them to their safe sleeping space.⁽¹⁰⁾ 

You may be wondering if it’s safe to keep an infant in the car seat to walk around a store, go for a walk, or while sitting at a restaurant. In those cases, simply be sure that the baby stays securely buckled and that you have eyes on them at all times. 

Bottom line: If a baby is sleeping in the car seat, not in a car, transfer them to a safe sleeping space or be sure that your eyes are on them at all times.

What has changed for feeding:#anchor

Cereal isn’t safe in a bottle.#anchor

Adding cereal to bottles was a common recommendation for babies who struggled to sleep or experienced reflux. However, research has found that adding cereal to the bottle does not help with sleep, but it does increase a baby’s chance of choking or aspirating the liquid (inhaling it into their lungs). It can also lead to constipation.⁽³⁾ The current recommendation is to offer solids only when a baby is developmentally ready (typically around 6 months) and to never add any cereal, oatmeal, or thickeners to bottles. Cereal can be offered by mixing it in a bowl and offering it with a spoon when a baby is developmentally ready.

Water can be introduced at 6 months of age.#anchor

We used to worry that babies needed water to stay hydrated, but we now know that water before 6 months has the potential to cause serious health concerns.^(4,8) Formula (mixed according to manufacturer’s instructions) and/or breastmilk provides all the nutrition and hydration babies need in the first 6 months. Once babies reach 6 months, water can be introduced. However, the American Academy of Pediatrics recommends offering no more than 8 ounces of water in a day until a baby reaches 12 months. ⁽⁸⁾

No honey before 12 months of age.#anchor

Honey may contain a bacteria that can be harmful to babies when their gut is immature.⁽⁹⁾ In the first 12 months, avoid offering babies honey or products that contain honey (Honey Nut Cheerios or graham crackers containing honey are two examples). Be sure to check the labels before offering babies baked goods or snack products. After a baby turns one, it’s widely considered safe to offer honey because their gut has matured enough to handle the bacteria without causing harm.

What has changed for health and safety:#anchor

No alcohol should be used for umbilical cord care.#anchor

Babies used to be sent home from the hospital with alcohol wipes for umbilical cord care. However, alcohol is no longer recommended. Parents are now instructed to simply keep the umbilical cord dry and clean until their cord falls off. Fold the front of diapers down so that they are below the cord and use only a damp washcloth with mild soap to clean the baby until the cord falls off. ⁽²⁾

Babies should stay rear-facing in car seats as long as possible.#anchor

Rear-facing car seats help distribute the force from a crash more evenly and keep little ones safe. We used to flip babies and toddlers around to forward-facing much earlier, but we now know that rear-facing provides better protection for their head, neck, and spine in the case of an accident. The safest option is to avoid turning the car seat to front-facing until the child exceeds the height and weight limit for rear-facing on their car seat.⁽⁷⁾ 

I know rear-facing may look uncomfortable for toddlers or their legs may look “squished” when rear-facing, but most little ones are very comfortable and happy! Plus, we know that they are safer rear-facing until their little bodies get older and stronger. 

Expert Tip: Car seat manuals provide guidance for how long each car seat can be used for rear-facing. Some families plan ahead by purchasing car seats that have extended height and weight allowances so that their little ones can stay rear-facing as long as possible.

Most coats should not be worn in car seats.#anchor

Coats in car seats are often unsafe.⁽⁶⁾ Let me explain. When a little one wears a fluffy coat in the car, it requires the car seat straps to be lengthened in order to fit over the coat. If there was an accident, the coat would become compressed, and there would actually be more room for their little body to move because of that extra length in the straps, which increases the impact to the child’s body.

Instead, keep little ones warm by using blankets on top of the secured harness, preheating the car, or placing the coat on backward on top of the secured harness.

Expert Tip: There are a few coats that are designed to be used with car seats and would not require the straps to be lengthened, but these are the exception. When in doubt, remove a child’s coat before placing them in the car seat.

One last thing:#anchor

While so much has changed in the last few decades, there is one thing that hasn’t, and that is the love that grandparents offer and the value of having them as a part of their grandchildren’s lives. From one Lola (that’s grandmother in Tagalog) to another grandparent, congratulations on the newest arrival to your family.