Posted by Audra Baumgartner on October 27, 2016 · Leave a Comment
The American Academy of Pediatrics (AAP) held their annual conference this week in San Francisco, and has used this event as a platform for announcing new or updated policy guidelines in a number of areas. One we reported on earlier this week was about New Guidelines on Children’s Exposure to Digital Media.
We report here on another set of updated guidelines – this time focused on safe sleep environments for infants.
The Problem
More than 3500 infants die each year in the US from sleep-related deaths. This number includes cases of SIDS (Sudden Infant Death Syndrome), plus other sleep-related deaths like accidental strangulation in bed. The rate of infant sleep-related deaths had been dropping up to the 1990s – but little change has been seen in recent years. The issues behind these deaths can all be addressed by similar improvements to enhance the safety of a baby’s sleep environment.
Overview of the Guidelines
Several of the elements outlined in the updated policy are not new, though nonetheless very important. The AAP has long been recommending that babies be put to sleep on their backs (supine position) – and that soft bedding be avoided. They also emphasize the importance of breastfeeding and avoiding smoking and drug use while pregnant – and exposure to smoke/drug use after birth. While most people are likely aware of the risks to babies from exposure to these toxins, not all may know that smoking and drug-use environments are associated with increased infant sleep-death risk, including SIDS. Details of all the guidelines are listed in the box at the end of this article.
What is particularly new and notable in these guidelines is the recommendation for babies to sleep in their parents’ room for up to the first year after birth – especially for the first 6 months when 90% of SIDS cases occur. Research suggests that infant sleep-related deaths could be reduced by 50% through “room-sharing” – as long as the baby is sleeping in their own safety-approved crib or bassinet and not in the parental bed.
“Couches and armchairs are extremely dangerous places for infants.” – AAP Guidelines
The authors of the new guidelines note that “bed-sharing” greatly increases risk for SIDS and other sleep-related infant deaths – and are “especially dangerous” in the following cases:
- When one or both parents are smokers, even if they are not smoking in bed
- When the mother smoked during pregnancy
- When the infant is younger than 4 months of age
- When the infant is born preterm and/or with low birth weight
- When the infant is bed-sharing on excessively soft or small surfaces, such as waterbeds, sofas, and armchairs
- When soft bedding accessories such as pillows or blankets are used
- When there are multiple bed-sharers
- When the parent has consumed alcohol and/or illicit or sedating drugs
- When the infant is bed-sharing with someone who is not a parent
“Skin-to-skin care is recommended for all mothers and newborns immediately following birth” – AAP Guidelines
The updated guidelines FOR PARENTS from the AMERICAN ACADEMY OF PEDIATRICS on safe sleep environments for infants are:
- Back to sleep for every sleep. Babies should be put to sleep on their backs on a surface that meets the Consumer Product Safety Commision (CPSC) should be used. These include cribs, bassinets, portable cribs or play yards. Once babies are able to roll into different positions they can be allowed to sleep in those positions.
- Use a firm sleep surface with NO soft objects or loose bedding. Infant beds should have firm mattresses and tight fitting sheets – and nothing else – including no crib bumpers.
- Breastfeeding is recommended. Breastfeeding reduces the risk of SIDS and the more that a mother exclusively breastfeeds, the greater the reduction in risk. But the authors note that “any breastfeeding is more protective against SIDS than no breastfeeding”.
- Room-sharing with the infant on a separate sleep surface is recommended. Having the baby sleep in its own crib or bassinet is best, but bedside sleepers that are CPSC-approved can be used. No safety guidelines have been developed for in-bed sleepers and there is currently no evidence regarding their ability to reduce SIDS risk – so these are not recommended.
- Avoid overheating and head covering in infants. AAP does not provide specific room temperature guidance, but states that babies should wear only one more layer than an adult would to be comfortable in the room.
- Consider offering a pacifier at nap time and bedtime. Although experts do not yet know why, use of pacifiers has been shown in multiple studies to guard against SIDS. The pacifier should be used when laying the baby down to sleep. It does not need to be put back in the mouth if it falls out while the child is asleep.
- Avoid smoke exposure and alcohol/illicit drug use during pregnancy and after birth. Prenatal and environmental smoking exposure are major risk factors for SIDS.
- Prenatal care and immunization of infants is important. Both prenatal care and infant immunization have been shown to have a protective effect against SIDS.
- Do not use home cardiorespiratory monitors as a strategy to reduce the risk of SIDS. There is no evidence these reduce risk of sleep-related death.
The Academy has also recommended against use of products marketed to reduce risk of SIDS – such as wedges and positioning devices. These are not CPSC-approved and do not have scientific evidence to support their claims, and may actually pose hazards. They also caution against swaddling. However, the authors do support daily tummy time for babies to promote development.
Finally, AAP has also provided guidelines for health care providers (including in NICUs, nurseries, and childcare centers), public health officials, and manufacturers. These can be found on the AAP website.
