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Updated AAP Recommendations for Preventing SIDS and Other Sleep Related Infant Deaths

The American Academy of Pediatrics (AAP) released updated recommendations for creating safe sleep environments for infants.

Updated AAP Recommendations for Preventing SIDS and Other Sleep Related Infant Deaths

The American Academy of Pediatrics (AAP) released updated recommendations for creating safe sleep environments for infants.  Previous recommendations by the AAP saw a dramatic decrease in the incidence of sudden infant death syndrome (SIDS) when they were first released in the mid-1990's, but that decline has tapered off in recent years.  Each year, 3500 infants are lost to SIDS or other sleep related infant deaths.  The AAP is hoping the new recommendations will create a similar decline in the incidence of SIDS as when they released their initial recommendations for safe sleep.

One of the best ways to prevent SIDS or other sleep related infant deaths is to always place the baby to sleep on their back.  Infants should sleep in the supine position  (on their back) until they reach one year of age.  Infants should also sleep on a firm surface like a mattress in a safety approved crib covered with a fitted sheet and nothing else. Nearly one quarter of all SIDS victims are found with their heads covered in bedclothes. Therefore, soft objects and loose bedding should be kept away from the infant's sleep area to reduce risk of SIDS, suffocation, entrapment or strangulation. 

Tummy time, described as a certain amount of prone positioning while the infant is awake, is recommended to help the infant develop the upper shoulder strength  necessary to attain certain motor milestones in a timely manner.

Swaddling does not reduce risk of SIDS and actually increases risk if the infant is placed in the prone position or rolls over into the prone position.  Parents who swaddle their babies should also place infants on their back to sleep.  When the baby starts showing signs of attempting to roll over, swaddling should no longer be used.  Parents should avoid over-bundling of infants to prevent potential SIDS due to overheating.   Parents should be especially careful of using head coverings as this can dramatically increase the risk of SIDS.

Breastfeeding reduces the risk of SIDS.  Exclusive breastfeeding at 1 month cuts risk of SIDS in half.  Studies also show breastfed infants are more easily aroused from sleep which helps prevent SIDS.  Exclusive breastfeeding offers the most protection against SIDS, however any breastfeeding shows protection against SIDS as opposed to no breastfeeding at all.  Infants should share a room, although not occupy the same sleeping space, as their parents for the first six months to a year after they are born.  Sharing a room with parents for the first six months to a year can reduce the risk by 50%. While parents and infants should share a room, they should not share a bed.

While the AAP does not recommend bed-sharing, they recognize that many parents may fall asleep while feeding due to exhaustion.  To reduce the risk of SIDS in these instances, parents should feed in their bed since couches and chairs are extremely dangerous for infants and can dramatically increase risk of SIDS and accidental suffocation.  The adult bed should be cleared of loose bedding and pillows before feeding.  Parents should also avoid smoking and use of alcohol and illicit drugs as this dramatically increases the risk of SIDS. 

Using a pacifier has also been shown to reduce incidents of SIDS by 50-90%.  Soft objects such as stuffed animals and other toys attached to the pacifier may present additional suffocation or choking risks.  Pacifiers should not be hung around the neck as this also poses a risk of choking or accidental strangulation.  Although it is not clear how, pacifier use has been shown to protect against SIDS even if the pacifier falls out of the infants mouth.

Bumper pads should not be used as they increase the risk of unintentional strangulation or suffocation.  Bumper pads were originally recommended to keep babies from getting their heads caught in between the crib slats.  New crib standards require crib slats to be closer together, which makes bumper pads no longer necessary.

The use of cardio-respiratory monitors (used to alert parents if an infant stops breathing or has a slow heart rate) is not recommended as there has not been documented evidence that they decrease the incidence of SIDS.  Some commercial devices are advertised as reducing the risk of SIDS.  The American Academy of Pediatrics also does not recommend the use of these items as there is no scientific evidence which supports these claims.  The AAP also emphasizes that using products that claim to reduce SIDS does not diminish the importance of following the recommended safe sleep practices.  Commercial devices that are inconsistent with safe sleep recommendations should be avoided at all costs.

 While the exact cause of death in many instances of SIDS remains unknown, what is known is avoiding certain risk factors can dramatically reduce the incidence of SIDS.  Health care professionals and staff as well as child care providers can have a great impact by endorsing the safe sleep recommendations and offering education and support to new parents.  Media such as movies and television, and manufacturers should portray safe sleep recommendations in their messaging and advertising.  Arming new parents with knowledge and encouraging them to communicate with healthcare providers and caregivers about safe sleep strategies will go a long way towards reducing the incidence of SIDS and other sleep related infant deaths.  Talk to your child's pediatrician for more information.

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