Updated recommendations for safe infant sleeping to reduce SIDS risk

1. The American Academy of Pediatrics (AAP) has released an updated policy statement on creating safe infant sleeping environments aimed at disrupting the plateau in deaths due to sudden infant death syndrome (SIDS).

2. The policy statement includes previously recommended “back to sleep” supine positioning and use of a firm mattress, while also presenting new evidence for skin-to-skin care, use of bedside and in-bed sleepers, and other adjuncts and interventions.

Policy Rundown: SIDS is a subtype of sudden unexplained infant death (SUID), characterized as an infant death whose cause cannot be explained after thorough review, including scene investigation and autopsy. All AAP recommendations are based on evidence involving studies of infants up to 1 year of age and thus apply only to this group. The AAP continues to recommend “back to sleep” for every sleep, including naps. Meaning, infants should be placed supine every time they go to sleep. Furthermore, infants should be placed on a firm sleep surface covered by a fitted sheet, without extra bedding or soft objects nearby. A firm surface is important to avoid dents that may increase rebreathing risk. Soft objects and loose bedding should be kept away from the infant’s sleep area to reduce risk of entrapment and suffocation. Appropriate sleep surfaces include those certified by the Consumer Product Safety Commission (CPSC) and may include cribs, bassinets, and some bedside sleepers. Regardless, the AAP recommends that infants sleep in the parents’ room within parental line of sight, but on a separate surface for at least the first 6 months of life. Bedside sleepers that attach to the side of the parental bed do not further decrease the risk of SIDS, but there are CPSC approved models that may be used. There are currently no CPSC safety standards for in-bed sleepers, therefore their use is not recommended. The AAP continues to recommend breastfeeding through at least 6 months of life, as it is associated with a reduced risk of SIDS. Studies also show a protective effect of pacifiers, therefore they may be offered at naps and bed time. Cigarette smoke exposure is associated with increased risk of SIDS, therefore pregnant women should not smoke and they, and their infants, should avoid exposure to smoke. Women should avoid alcohol and illicit drug use during pregnancy and after birth, and they should obtain regular prenatal care as these can both decrease risk of SIDS. Appropriate infant vaccination has also been associated with decreased risk for SIDS. There is no evidence that swaddling reduces the risk of SIDS, nor is home cardiorespiratory monitoring recommended as a strategy to reduce SIDS. Finally, the AAP charges pediatricians and other providers to continue the Safe to Sleep campaign, and encourages more research into the causes, risk factors, and pathophysiology of SIDS with a goal of eliminating this syndrome.

Click to read the policy statement, published today in Pediatrics

Relevant Reading: Interaction between bedding and sleeping position in the sudden infant death syndrome: a population based case-control study

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