sleeping baby with stuffed animal bunnyUS Federal agencies and the  American Academy of Pediatrics (AAP) just updated recommendations on safe sleep for  infants younger than 1 year of age.  Parents, grandparents, family members, child care providers, health care providers, and others — are encouraged to learn about the updated recommendations for safe infant sleep.

The guidelines  are designed to help reduce the risk of SIDS and other sleep-related causes of infant death. The main ways recommended for reducing the risk of SIDS remains the same: place babies completely on their backs to sleep for all sleep times, naps and at night. Other recommendations include: breastfeeding for at least 6 months, using a pacifier, having the baby sleep in or near the parents bedroom ( but bed sharing shows and increases SIDS deaths), and swaddling  is shown to have no impact on SIDS and can be dangerous if done when the infant begins to turn over.

Nine of the recommendations relate directly to the infant’s sleep environment. For example, one recommendation is to place baby to sleep on a firm sleep surface, such as a mattress in a crib that meets the safety standards of the U.S. Consumer Product Safety Commission. Another advises the removal of blankets, soft objects, toys, crib bumpers, and loose bedding from the sleep area.

The updated recommendations also emphasize that couches and armchairs can be very dangerous places for babies.

Research described in the recommendations suggests that this is especially true if adults fall asleep as they feed, comfort, or bond with baby while on these surfaces. The AAP guidelines emphasize that parents and other caregivers should be aware of how tired they are when feeding, comforting, or bonding with baby while on these surfaces to avoid falling asleep in such situations.

Here are all 19 recommendations to reduce SIDS and other sleep related infant deaths from the American Pediatric Association:

1. Back to sleep for every sleep.

  1. a.  Preterm infants should be placed supine as soon as possible.

    b. “Skin-to-skin care is recommended for all mothers and newborns, regardless of feeding or delivery method, immediately following birth (as soon as the mother is medically stable, awake, and able to respond to her newborn), and to continue for at least an hour.”

2. Use a firm sleep surface.

Infants should be placed on a firm sleep surface (eg, mattress in a safety-approved crib) covered by a fitted sheet with no other bedding or soft objects to reduce the risk of SIDS and suffocation.

3. Breastfeeding is recommended.

  1. Breastfeeding is associated with a reduced risk of SIDS. Unless contraindicated, mothers should breastfeed exclusively or feed with expressed milk (ie, not offer any formula or other nonhuman milk-based supplements) for 6 months,

  2. The protective effect of breastfeeding increases with exclusivity. However, any breastfeeding has been shown to be more protective against SIDS than no breastfeeding.

4. It is recommended that infants sleep in the parents’ room, close to the parents’ bed, but on a separate surface designed for infants, ideally for the first year of life, but at least for the first 6 months.

There are specific circumstances that, in case-control studies and case series, have been shown to substantially increase the risk of SIDS or unintentional injury or death while bed-sharing, and these should be avoided at all times:

    1. Bed-sharing  has an increased risk of SIDS.  If parents choose to feed their infants younger than 4 months in bed, they should be especially vigilant to not fall asleep.

5.. Keep soft objects and loose bedding away from the infant’s sleep area to reduce the risk of SIDS, suffocation, entrapment, and strangulation.

6. Consider offering a pacifier at nap time and bedtime.

Although the mechanism is yet unclear, studies have reported a protective effect of pacifiers on the incidence of SIDS. The protective effect of the pacifier is observed even if the pacifier falls out of the infant’s mouth.

7. Avoid smoke exposure during pregnancy and after birth.

8. Avoid alcohol and illicit drug use during pregnancy and after birth.

9. Avoid overheating and head covering in infants.

Although studies have shown an increased risk of SIDS with overheating, The definition of overheating in these studies varies. Therefore, it is difficult to provide specific room temperature guidelines to avoid overheating.

  1. In general, infants should be dressed appropriately for the environment, with no greater than 1 layer more than an adult would wear to be comfortable in that environment.

  2. Parents and caregivers should evaluate the infant for signs of overheating, such as sweating or the infant’s chest feeling hot to the touch.

10. Pregnant women should obtain regular prenatal care.

There is substantial epidemiologic evidence linking a lower risk of SIDS for infants whose mothers obtain regular prenatal care. Pregnant women should follow guidelines for frequency of prenatal visits.

11. Infants should be immunized in accordance with recommendations of the AAP and Centers for Disease Control and Prevention.

There is no evidence that there is a causal relationship between immunizations and SIDS. Indeed, recent evidence suggests that vaccination may have a protective effect against SIDS.

12. Avoid the use of commercial devices that are inconsistent with safe sleep recommendations.

Be particularly wary of devices that claim to reduce the risk of SIDS. Examples include, but are not limited to, wedges and positioners and other devices placed in the adult bed for the purpose of positioning or separating the infant from others in the bed.

13. Do not use home cardiorespiratory monitors as a strategy to reduce the risk of SIDS.

The use of cardiorespiratory monitors has not been documented to decrease the incidence of SIDS.

14. Supervised, awake tummy time is recommended to facilitate development and to minimize development of positional plagiocephaly.

15. There is no evidence to recommend swaddling as a strategy to reduce the risk of SIDS.

Swaddling, or wrapping the infant in a light blanket, is often used as a strategy to calm the infant and encourage the use of the supine position. There is a high risk of death if a swaddled infant is placed in or rolls to the prone positionIf infants are swaddled, they should always be placed on the back. Swaddling should be snug around the chest but allow for ample room at the hips and knees to avoid exacerbation of hip dysplasia. When an infant exhibits signs of attempting to roll, swaddling should no longer be used. There is no evidence with regard to SIDS risk related to the arms swaddled in or out. These decisions about swaddling should be made on an individual basis, depending on the physiologic needs of the infant.

16. Health care professionals, staff in newborn nurseries and NICUs, and child care providers should endorse and model the SIDS risk-reduction recommendations from birth.

17. Media and manufacturers should follow safe sleep guidelines in their messaging and advertising.

18. Continue the “Safe to Sleep” campaign, focusing on ways to reduce the risk of all sleep-related infant deaths, including SIDS, suffocation, and other unintentional deaths. Pediatricians and other primary care providers should actively participate in this campaign.

19. Continue research and surveillance on the risk factors, causes, and pathophysiologic mechanisms of SIDS and other sleep-related infant deaths, with the ultimate goal of eliminating these deaths altogether.

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Marilyn Clinton

Mary is a single parent and writer. She likes to share her family adventures, and tips for managing a busy family and a full-time job.

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