AAP updates recommendations for SIDS and safe infant sleeping environment

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A safe sleep environment can prevent suffocation and strangulation, two major causes of sudden infant death.
A safe sleep environment can prevent suffocation and strangulation, two major causes of sudden infant death.

The American Academy of Pediatrics (AAP) has released updated recommendations for a safe infant sleeping environment, which are published in the October issue of Pediatrics.

The AAP encourages a safe sleep environment that can reduce the risk of all sleep-related infant deaths.

The recommendations from the Task Force on Sudden Infant Death Syndrome (SIDS) are as follows:

  • Back to sleep for every sleep. To reduce the risk of SIDS, infants should be placed for sleep completely on their back until the child reaches 1 year old.

  • Use a firm sleep surface. Infants should be placed on a mattress in a safety-approved crib with a fitted sheet with no other bedding or soft objects, to reduce suffocation.

  • Breastfeeding is recommended.

  • Infants should 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. Infants sleeping in the parent's room but on a separate surface decrease the risk of SIDS by as much as 50%.

  • Keep soft objects and loose bedding away from the infant's sleep area. Pillow-like toys, quilts, comforters, sheepskins, and loose bedding can obstruct an infant's nose and mouth.

  • Consider offering a pacifier at nap time and bedtime. Studies have reported a protective effect of pacifiers on the incidence of SIDS.

  • Avoid smoke exposure during pregnancy and after birth.

  • Avoid alcohol and illicit drug use during pregnancy and birth

  • Avoid overheating and head covering in infants. Infants should be dressed appropriately for the environment in which they are sleeping.

  • Pregnant women should obtain regular prenatal care.

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

  • Avoid the use of commercial devices that are inconsistent with safe sleep recommendations. Examples of these include wedges, positioners, and other devices placed in the adult bed for the purpose of positioning or separating the infant from others in the bed.

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

  • Supervised, awake tummy time is recommended to facilitate development and to minimize development of positional plagiocephaly. This helps prevent the development of flattening of the occiput and facilitates development of the upper shoulder girdle strength necessary for timely attainment of certain motor milestones.

  • There is no evidence to recommend swaddling as a strategy to reduce the risk of SIDS. If infants are swaddled, they should always be placed on the back, as there is a high risk of death if a swaddled infant rolls into the prone position.

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

  • Media and manufacturers should follow safe sleep guidelines in their messaging and advertising. Media and advertising messages contrary to safe sleep recommendations may create misinformation about safe sleep practices.

  • 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.

  • 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.  

Reference

  1. Moon RY, Darnall RA, Feldman-Winter L, et al. SIDS and other sleep-related infant deaths: updated 2016 recommendations for a safe infant sleeping environment. Pediatrics. October 2016. DOI: 10.1542/peds.2016-2938
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