AAP offers guidelines to minimize SIDS, sleep-related infant deaths
SAN FRANCISCO — To reduce the risk of sleep-related infant deaths, parents are encouraged to provide a safe sleep environment for infants aged less than 1 year, including supine positioning, the use of a firm sleep surface and avoidance of soft bedding, per a policy statement from the AAP’s Task Force on Sudden Infant Death Syndrome.
The statement was released in conjunction with the 2016 AAP National Conference and Exhibition.
“The policy statement consists of 19 recommendations to help reduce the risk of sudden infant death syndrome (SIDS) and other sleep-related infant deaths, including accidental asphyxia and suffocation in bed,” policy co-author Fern R. Hauck, MD, MS, FAAP, professor of public health science at the University of Virginia, said during a press conference at the meeting. “Nine of these recommendations relate directly to the sleep environment of the infant, and all recommendations should be followed until the baby’s first birthday.”
Based on epidemiologic studies of infants up to 1 year of age, the policy statement offers guidelines to pediatricians to encourage open conversations with parents and other infant caregivers regarding their sleep practices in the hopes of minimizing sleep-related infant deaths. Recommendations for safer sleep practices include:
- Infants should be placed in a supine position for every sleep by every caregiver; side sleeping is not safe and is not advised.
- Infants should be placed on a firm sleep surface, such as a mattress in a safety-approved crib, covered by a fitted sheet with no other bedding or soft objects.
- The infant’s crib, portable crib, play yard, or bassinet should be placed in the parents’ bedroom until the child’s first birthday, based on evidence that sleeping in the parents’ room – but on a separate surface – decreases the risk of SIDS by as much as 50%.
- Soft objects and loose bedding should be kept away from the infant’s sleep area; pillows and pillow-like toys, quilts, comforters, sheepskins, and loose bedding pose a risk of suffocation, entrapment or SIDS.
- A pacifier should be used when putting an infant to sleep as prior studies have noted a protective effect of pacifiers on the incidence of SIDS, even if the pacifier falls out while the infant is sleeping.
- Parents should avoid overheating and head covering in infants, as overheating has been correlated with an increased risk of SIDS; infants should be dressed with no more than 1 additional layer than what an adult would wear in the same environment.
- Parents should refrain from using commercial devices that are inconsistent with safe sleep recommendations or claim to reduce SIDS risk, including wedges and positioners.
- Parents should conduct supervised, awake ‘tummy time’ to promote infant development and curtail positional plagiocephaly, in agreement with an AAP Committee on Practice and Ambulatory Medicine and Section on Neurologic Surgery task force position.
- If infants are swaddled, they should be positioned in the supine position, with the swaddling snug against the chest and sufficient room around the hips and knees; when an infant shows signs of attempting to roll, parents should stop swaddling.
“It is recommended that infants sleep in the parents’ room, close to the parents’ bed but on a separate surface; ideally for the first year of life, but at least for the first 6 months,” Hauck said. “Additionally, babies should not sleep in an adult bed, on a couch, or on a chair alone, with parents or anyone else, including siblings or pets.”
Hauck noted that parents and other caregivers must be especially vigilant as to their wakefulness when feeding or lying with infants. “Couches and armchairs can be very dangerous for babies, especially if adults fall asleep as they feed. Parents and other caregivers should be mindful of how tired they are when feeding, comforting, or bonding with a baby while on these surfaces.”
The AAP’s Task Force on Sudden Infant Death Syndrome also recommends that health care providers continue to support the “Safe to Sleep” campaign, which highlights methods to reduce the risk of all sleep-related infant deaths, including SIDS, suffocation and other unintentional deaths. Additionally, the task force recommends that public education regarding safe sleep environments should be extended to all infant caregivers, including grandparents, foster parents, and babysitters, and foster new strategies for overcoming barriers to behavior change.
“I encourage all physicians, pediatricians, nurses, and other health care and child care providers to lend their authoritative voices to the ‘Safe to Sleep’ effort,” Catherine Y. Spong, MD, acting director of the NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development, said during the press conference. “Join us all in safe infant sleep recommendations and in supporting parents and caregivers to make informed decisions that will help keep their babies safe during sleep.” – by Bob Stott
Disclosure: The researchers report no relevant financial disclosures.