Is a comforter or quilt safe for a 21-month-old child to use?

From the Guidelines

A comforter or quilt is not recommended for a 21-month-old child due to ongoing safety concerns, and instead, a lightweight blanket, sleep sack, or wearable blanket should be used. For toddlers at this age, the risk of suffocation and entrapment is still present, although lower than in the first 12 months 1. The American Academy of Pediatrics (AAP) recommends keeping the sleep environment free of soft objects and loose bedding to reduce the risk of SIDS, suffocation, entrapment, and strangulation 1.

Some key considerations for a safe sleep environment include:

• Using a firm mattress and fitted sheet
• Keeping the room at a comfortable temperature (68-72°F/20-22°C) to minimize the need for heavy bedding
• Avoiding pillows, heavy quilts, or comforters until the child is older and has better motor control to move bedding away from their face if needed
• Introducing small, lightweight blankets gradually, ensuring they stay at waist level or lower and cannot cover the child's face

It's essential to prioritize the child's safety and follow the AAP's guidelines for a safe infant sleeping environment, even as they approach age 2 1. By taking these precautions, parents and caregivers can reduce the risk of sleep-related hazards and create a safe sleep environment for their child.

From the Research

Safety of Comforters or Quilts for 21-Month-Old Children

• At 21 months, a child is still considered a toddler, and their safety while sleeping is of utmost importance.
• According to the American Academy of Pediatrics, as mentioned in the study 2, the use of potentially hazardous bedding, such as comforters or quilts, is a modifiable risk factor for sudden infant death syndrome (SIDS) and unintentional sleep-related suffocation.
• The study 3 emphasizes the importance of a safe sleep environment, which includes the avoidance of soft bedding and overheating, to reduce the risk of all sleep-related deaths.

Recommendations for Safe Sleep Environment

• The American Academy of Pediatrics recommends a firm, noninclined sleep surface and avoidance of soft bedding, as stated in the study 3.
• The study 4 suggests that normal infants are unlikely to succumb to rebreathing suffocation, but infants with blunted ventilatory responsiveness and delayed arousal due to prior hypoxia may be at increased risk.
• It is essential to follow the "Back to Sleep" guideline, as mentioned in the study 4, which recommends placing the infant on their back or side to reduce the risk of SIDS.

Precautions for Using Comforters or Quilts

• While there is no specific age mentioned in the studies for the safe use of comforters or quilts, it is crucial to exercise caution and follow the guidelines for a safe sleep environment.
• The study 5 highlights the importance of ensuring that the sleep environment is free from potential hazards, such as wedging and suffocation associated with sleeping on or near a mattress on the floor.
• As stated in the study 6, mothers have higher self-efficacy regarding prevention of accidental suffocation, and healthcare professionals should discuss both SIDS risk reduction and prevention of accidental suffocation when advising parents about safe sleep practices.