AAP Guidelines for Infant Sleep Safety


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Infants should sleep in the same bedroom as their parents – but on a separate surface, such as a crib or bassinet, and never on a couch, armchair or soft surface — to decrease the risks of sleep-related deaths, according to a new policy statement released by the American Academy of Pediatrics.

SIDS and Other Sleep-Related Infant Deaths: Updated 2016 Recommendations for a Safe Infant Sleeping Environment,” draws on new research and serves as the first update to Academy policy since 2011.

Recommendations call for infants to share their parents’ bedroom for at least the first six months and, optimally, for the first year of life, based on the latest evidence.

Approximately 3,500 infants die annually in the United States from sleep-related deaths, including sudden infant death syndrome (SIDS); ill-defined deaths; and accidental suffocation and strangulation. The number of infant deaths initially decreased in the 1990s after a national safe sleep campaign, but has plateaued in recent years.

AAP recommendations on creating a safe sleep environment include:

  • Place the baby on his or her back on a firm sleep surface such as a crib or bassinet with a tight-fitting sheet.
  • Avoid use of soft bedding, including crib bumpers, blankets, pillows and soft toys. The crib should be bare.
  • Share a bedroom with parents, but not the same sleeping surface, preferably until the baby turns 1 but at least for the first six months. Room-sharing decreases the risk of SIDS by as much as 50 percent.
  • Avoid baby’s exposure to smoke, alcohol and illicit drugs.

Skin-to-skin care is recommended, regardless of feeding or delivery method, immediately following birth for at least an hour as soon as the mother is medically stable and awake, according to the report.

Breastfeeding is also recommended. After feeding, the AAP encourages parents to move the baby to his or her separate sleeping space, preferably a crib or bassinet in the parents’ bedroom.

“There should be no pillows, sheets, blankets [stuffed animals, wedges bumper pads] or other items that could obstruct the infant’s breathing or cause overheating.”

While infants are at heightened risk for SIDS between the ages 1 and 4 months, new evidence shows that soft bedding continues to pose hazards to babies who are 4 months and older.

Other recommendations include:

  • Offer a pacifier at nap time and bedtime.
  • Do not use home monitors or commercial devices, including wedges or positioners, marketed to reduce the risk of SIDS.
  • Infants should receive all recommended vaccinations.
  • Breastfeeding is recommended and is associated with a reduced risk of SIDS.
  • Infants should be immunized. Evidence suggests that immunization reduces the risk of SIDS by 50 percent.
  • Bumper pads should not be used in cribs. There is no evidence that bumper pads prevent injuries, and there is a potential risk of suffocation, strangulation or entrapment

The AAP recommends that doctors have open and nonjudgmental conversations with families about their sleep practices. Media outlets and advertisers may also play a role in educating parents by following safe sleep recommendations when presenting images and messages to the public.

“We want to share this information in a way that doesn’t scare parents but helps to explain the real risks posed by an unsafe sleep environment,” Dr. Moon said. “We know that we can keep a baby safer without spending a lot of money on home monitoring gadgets but through simple precautionary measures.”

The American Academy of Pediatrics is an organization of 66,000 primary care pediatricians, pediatric medical sub-specialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit www.aap.org; Follow us on Twitter

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Since the American Academy of Pediatrics (AAP) recommended all babies should be placed on their backs to sleep in 1992, deaths from Sudden Infant Death Syndrome have declined dramatically. But sleep-related deaths from other causes, including suffocation, entrapment and asphyxia, have increased.

In an updated policy statement and technical report, the AAP is expanding its guidelines on safe sleep for babies, with additional information for parents on creating a safe environment for their babies to sleep.

“We have tried to make it easier for parents and providers to understand the recommendations by providing specific answers to common questions,” said Rachel Moon, MD, FAAP, chair of the AAP SIDS task force and lead author of the new guidelines. “As a health care community, we need to do a better job translating what the research identifies as ‘best practices’ into the day-to-day practice of caring for infants in both the hospital and home environment.”

The policy statement, “SIDS and Other Sleep-Related Infant Deaths: Expansion of Recommendations for a Safe Infant Sleeping Environment,” and an accompanying technical report, will be released Tuesday, Oct. 18, at the AAP National Conference & Exhibition in Boston and published in the November 2011 issue of Pediatrics (published online Oct. 18).

The policy statement and technical report provide global recommendations for education and safety related to SIDS risk reduction. In addition, the AAP is providing recommendations on a safe sleeping environment that can reduce the risk of all sleep-related infant deaths, including SIDS. Three important additions to the recommendations include:.

“It is important for health care professionals, staff in newborn nurseries and neonatal intensive care units, and child care providers to endorse the recommended ways to reduce the risk of SIDS and other sleep-related deaths, starting at birth,” Dr. Moon said. “There needs to be more education for health care providers and trainees on how to prevent suffocation deaths and to reduce SIDS and other sleep-related infant deaths – our goal is to ultimately eliminate these deaths completely.”

The report also includes the following recommendations:

    • Always place your baby on his or her back for every sleep time.
    • Always use a firm sleep surface. Car seats and other sitting devices are not recommended for routine sleep.
    • The baby should sleep in the same room as the parents, but not in the same bed (room-sharing without bed-sharing).
    • Keep soft objects or loose bedding out of the crib. This includes pillows, blankets, and bumper pads.
    • Wedges and positioners should not be used.
    • Pregnant woman should receive regular prenatal care.
    • Don’t smoke during pregnancy or after birth.
    • Breastfeeding is recommended.
    • Offer a pacifier at nap time and bedtime.
    • Avoid covering the infant’s head or overheating.
    • Do not use home monitors or commercial devices marketed to reduce the risk of SIDS.
    • Infants should receive all recommended vaccinations.
    • Supervised, awake tummy time is recommended daily to facilitate development and minimize the occurrence of positional plagiocephaly (flat heads).

Parent information is available at www.healthychildren.org/safesleep

The American Academy of Pediatrics is an organization of 62,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well being of infants, children, adolescents and young adults. For more information, visit www.aap.org.

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