Important news for parents everywhere! The American Academy of Pediatrics (AAP) recently announced an expansion of the “Back to Sleep” Campaign to reduce infant deaths from SIDS (Sudden Infant Death Syndrome), now making it a “Safe Sleep” Campaign. As a result of extensive research over the years, new recommendations about safe sleep practices are now available to further lower the rate of infant deaths.
The sudden, unexplained death of an infant is a horrific and tragic experience that can turn families’ dreams of a “happy-ever-after” with their baby into a nightmare. SIDS is the label given to a baby’s death if it can’t be explained after a thorough investigation and autopsy have been completed. Although still not completely understood, SIDS likely results when a vulnerable baby encounters an environmental stressor during a critical period of development. Ninety percent of these deaths occur before the baby reaches 6 months of age, most between 1 and 4 months.
In 1992, the AAP first recommended that babies no longer sleep in the prone position (on their tummies). By 2001, SIDS deaths had been cut in half, a fantastic result of this educational campaign. However, SIDS deaths have not dropped any further since 2001, while infant deaths from accidental suffocation and strangulation in bed have gone up. We now know many of the specific risk factors for both SIDS and for accidental suffocation and strangulation, and by following the AAP’s advice, more lives can be saved.
The AAP’s updated recommendations include the following:
1. Always place your baby on her back (supine) to sleep. Side sleeping is not a safe alternative to sleeping in the supine position, and is not advised. The risk of SIDS doubles when an infant sleeps on her tummy compared with either her back or side, and is even higher when a baby is placed on her side and then rolls into the prone position. You should place your baby on her back for every sleep period, even naps, and make sure all of her other caregivers know to do this as well. Once your baby can roll from her back to her stomach, she can be allowed to remain in the sleep position she assumes.
Right now only 75% of white infants and 52% of black infants are placed on their backs to sleep. Many parents fear their babies will choke and aspirate when sleeping on their backs, but this is not proven to be true.
2. Make sure your baby sleeps in a safety-approved crib, portable crib, play yard, or bassinet; do not routinely let baby sleep in a car seat, stroller, swing, infant carrier or infant sling. One study found the average baby spends more than 5 hours a day in a car seat or similar sitting device. This is potentially dangerous for several reasons. Your baby’s head may flex forward and block her airway, leading to SIDS. And, if her car seat is set on a bed, mattress, or couch, it can overturn and lead to the baby’s suffocation. Do you love snuggling your baby in an infant sling? Just be sure your baby’s head stays up above the fabric of the sling so the baby’s face remains visible, and that the baby’s nose and mouth remains clear of secretions.
3. Have baby sleep in your room but not in your bed. “Room-sharing” and not “bed-sharing” decreases the risk of SIDS by 50%. While bringing baby into bed with you may seem like the natural thing to do as a way to facilitate breastfeeding and bonding, if baby sleeps with you, this doubles to triples the risk of SIDS. When infants sleep in the same bed with others (whether with parents, other infants or children), they may become overheated, obstruct their airways, suffocate in soft bedding (especially if sleeping on a couch or armchair), become entrapped, fall or strangulate. If your baby is less than three months old, was born prematurely or with a low birth weight, or if you and/or your partner are a smoker, the risk to baby of sharing your bed is even higher. The same is true if you or your partner consume alcohol before going to bed.
Even twins, triplets and other multiples should sleep in their own beds to minimize their risk of SIDS and accidental suffocation.
Having baby sleep in your room allows you to stay close to her and makes feeding, comforting and monitoring her easier. Baby can be brought into your bed for feeding and then returned to her crib or bassinet afterwards.
4. Avoid soft bedding at all times; this can increase the risk of SIDS by a factor of five, no matter what position baby sleeps in. You may think you are making your baby more comfortable by using pillows, quilts, comforters, and sheepskins, but these items should never be placed directly under the infant or left loose in the infant’s sleep area, or be used to create a barrier to keep the infant from falling off an adult bed or couch.
Infants should sleep on a firm surface without any soft or loose bedding. Blankets can be used only if they are thin and are tucked under the mattress to avoid covering the baby’s head or face.
5. Do not use wedges, positioning devices, and bumper pads in your baby’s crib. These products have all been associated with infant deaths from suffocation, entrapment and strangulation.
5. Breastfeed your baby; it protects against SIDS. Breastfeeding also protects against infectious diseases (diarrhea, respiratory infections) that may make a baby more vulnerable to SIDS. Once again, remember to return your baby to her own bed after breastfeeding.
6. Consider offering your baby a pacifier at both naptime and bedtime, because this practice decreases the risk of SIDS by 50-60%. Exactly how pacifier use works to decrease the risk of SIDS is not well understood. It may be that using a pacifier enables a baby to be aroused during sleep more easily, helps maintain the airway in an open position, and makes it easier for baby to more effectively regulate her breathing. Even if the pacifier falls out of baby’s mouth shortly after the baby falls asleep, pacifier use has been found to be protective.
You may be concerned that pacifier use will interfere with breastfeeding, but recent studies do not support the notion that using a pacifier interferes with either duration or exclusivity of breastfeeding. You can wait to introduce a pacifier until you are confident breastfeeding is going well.
7. Avoid overheating and head covering. Bedrooms should not be too warm, and good ventilation is important. Avoid use of blankets or anything else that could potentially cover baby’s head during sleep.
8. There is not enough evidence to recommend swaddling as a way to reduce the risk of SIDS, although it may encourage supine sleeping. Swaddling may calm infants and help them sleep longer, but there is no definite benefit to swaddling as a way to avoid the chance of SIDS.
9. Vaccinate your infants according to current guidelines of both the AAP and CDC. The risk of SIDS is cut in half by immunization, which suggests that vaccination may be protective against SIDS.
10. Do not rely on infant home monitors as a strategy to prevent SIDS, although home monitors can be used in infants who have already had an apparent life-threatening event.