Safe Sleep Guidelines for Babies

AAP Makes Safe Sleep Guidelines to Reduce the Number of Sleep-Related Deaths

Mom putting baby to sleep in crib
Lumina/Stocksy United

The American Academy of Pediatrics (AAP) published new safe sleep guidelines for infants in an effort to help prevent sudden infant death syndrome (SIDS) and other sleep-related deaths like strangulation and suffocations. In doing so, they have given a total of 19 recommendations to help protect your baby. What may be a surprise is that some of them occur before your baby is even born.

The basics are that you should follow all health and safety guidelines, including prenatal care and well care, for you and your baby.

This includes infant vaccines using the Centers for Disease Control and Prevention (CDC) guidelines. You should be wary of and avoid using most infant sleep devices that make claims to protect against SIDS and other risks during sleep for baby as there is no research. Breastfeeding is protective and helps reduce the risk of death and if you breastfeed your baby at night, a safely prepared adult bed is safer than a couch or chair should you accidentally fall asleep. You can read more details below, including other helpful tips for both you and those who care for your baby.

Pregnancy

  • Pregnant women should seek and obtain regular prenatal care. 

    Prenatal care is something that can really be beneficial well beyond the 40 weeks of pregnancy. Not only does the process of prenatal care help to provide a pregnant person and their baby or babies the best chance at a healthy pregnancy and problem-free birth, but it also helps to set the tone of the baby's health status for life. A baby born after a problem-filled pregnancy may experience more risk from complications, including SIDS. By preventing some pregnancy complications like preterm birth when possible and increasing a healthy lifestyle, the benefits go on well past pregnancy and infancy.
  • Avoid smoke expos​ure during pregnancy and after birth. Avoid alcohol and illicit drug use during pregnancy and after birth. 

    Smoking and the use of drugs and alcohol in pregnancy have long been known to cause potential problems with the pregnancy, including preterm labor, small for gestational age (SGA) babies, placental complications, etc. There is now evidence that beyond the risks that they can cause in pregnancy, there are potential problem later in life as well, including the risk of SIDS. Please note that this recommendation continues throughout the life of the infant, particularly in terms of smoking and includes not only the mother but those around the baby.

    Infancy

    • Back to sleep for e​very sleep.

      Having your baby sleep on their back has been shown to reduce the numbers of deaths from SIDS drastically since the implementation of the Back to Sleep Campaign (now the Safe to Sleep campaign) from the AAP and partners. This recommendation is for all sleeps with all care providers. It is imperative that you do this and be sure that anyone that cares for your baby does the same, including grandparents and day care providers.
    • Use a firm sleep surface.

      While you might initially think that this is only about the firmness of a crib mattress, which it is, it is also about avoiding some surfaces for infant sleep like couches, water beds, etc. These surfaces have been shown to increase the risk of suffocation and death in infants.
    • Breastfeeding is recommended.

      Breastfeeding is protective and helps prevent SIDS, in addition to many other benefits. This protection increases the longer you breastfeed and is higher when you are giving your baby only breast milk. But it is important to note that any breast milk is protective and your baby will get these benefits when getting breast milk via a bottle or cup as well. One of the most interesting changes in this set of recommendations is that if a mother is going to breastfeed in the night, they recommend that if you are sleepy, bring the baby back to your bed (which should be made safer according to these guidelines) in case you fall asleep with the baby. There have been numerous cases of infant deaths where parents, thinking they are safer, fall asleep while feeding a baby in the middle of the night on a couch or chair, only to have the baby suffocate in the couch.
    • Room-sharing with the infant on a separate sleep surface is recommended.

      Keeping your baby in your room for the first six months can help protect your baby too. The AAP recommends that this should be in a separate bed when not following some of the above guidelines for bed-sharing with your baby. This can be in a crib, a bassinet, or a side sleeper.
    • Keep soft objects and loose bedding away from the infant’s sleep area.

      All sleep surfaces, including a parental bed, should be free of soft items, including extra bedding. This means you should ditch the toys, infant pillows, and potentially some of the bumpers and other crib blankets. It's much better to keep your baby covered with tight clothing than with blankets that can tangle and strangle the baby.
    • Consider offering a pacifier at nap time and bedtime.

      There are some studies that show a baby with a pacifier may have less of a risk of SIDS. However, it is noted that you should note force a child to take a pacifier. You may also want to offer the pacifier only once breastfeeding is well established to protect your milk supply.
    • Avoid overheating.

      Babies are often seen decked out in a ton of extra clothes, even in the summer time. While newborns do have issues with temperature regulation, they rarely need more than a light layer extra than what we would wear. Though it's better to use a sleeper for the baby than a blanket, just make sure it's weather appropriate.
    • Infants should be immunized in accordance with AAP and CDC recommendations.

      A healthy infant is less likely to die of SIDS in addition to the diseases that the vaccines are protecting against.
    • Supervised, awake tummy time is recommended to facilitate development and to minimize the development of positional plagiocephaly.

      One of the concerns of back sleeping has been positional plagiocephaly, where the back of the baby's head becomes flat from sleeping on it. To help prevent this from happening, tummy time is recommended for your baby during waking hours while you are able to pay attention and protect your baby from danger.

    Products

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

      There are a lot of products that are sold to new parents. Many of these products make claims that are not actually verifiable with scientific research. This can lead to accidents that cause harm or death to your baby. There have been several recalls in the past years of these types of products. The AAP wants to go one step further and prevent parents from buying products based on these false claims. So if you see something and think about buying it, reconsider if the claims seem counterintuitive to these guidelines.
    • There is no evidence to recommend swaddling as a strategy to reduce the risk of SIDS.

      Swaddling has been held up as a way to prevent SIDS. This has not been found in the research. So if your baby hates swaddling, don't stress about it. If you do swaddle your baby, be sure to watch for overheating and protect their hips among other safe swaddle strategies.
    • Do not use home cardiorespiratory monitors as a strategy to reduce the risk of SIDS.

      Some parents have thought that monitors to watch the baby would be helpful, but this has not been found to be the case. Save your money and talk to your practitioner before using home medical-type equipment.

    Policy

    • 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 entirely.

      The research in the last 20 years has done so much for preventing infant death as it relates to sleep. We need to be vigilant and continue looking for ways to prevent these deaths.
    • Media and manufacturers should follow safe sleep guidelines in their messaging and advertising.

      The AAP is stepping up its call to the product manufacturers to not prey on families who are scared and wonder what they can do to help save their babies. The AAP wants them to do heir fair share in protecting families.
    • Continue "Safe to Sleep" campaign, focusing on ways to reduce the risk of all sleep-related infant deaths, including SIDS, suffocation, and other unintentional deaths.

      The campaign is important to ensure that all parents know the ways to keep their babies safe. By continuing it, we can help to ensure that all parents get this message. 
    • Health care providers, staff in newborn nurseries and NICUs, and child care providers should endorse and model the SIDS risk-reduction recommendations from birth.

      Part of the educational efforts of the campaign is to reach people other than parents who may care for your children. This includes the doctors and nurses who care for your baby from the hospital and in the pediatric offices. It also includes day care workers where your baby may be napping during the day.
    • Pediatricians and other primary care providers should actively participate in this campaign.

      The goal of this educational campaign is to reach every adult. While that seems broad, remember that many people may have contact with your child and not fall into one of the professional categories. Think about the people who might work in your church nursery, these may be volunteers who may not have had children or their children are older, meaning they have not heard about the new guidelines.  

    Sources:

    Blair PS, Sidebotham P, Pease A, Fleming PJ. Bed-sharing in the absence of hazardous circumstances: is there a risk of sudden infant death syndrome? An analysis from two case-control studies conducted in the UK. PLoS One. 2014;9(9):e107799.

    Moon RY; AAP Task Force on Sudden Infant Death Syndrome. SIDS and other sleep-related infant deaths: Evidence base for 2016 updated recommendations for a safe infant
    sleeping environment. Pediatrics. 2016;138(5):e20162940.

    Rechtman LR, Colvin JD, Blair PS, Moon RY. Sofas and infant mortality. Pediatrics. 2014;134(5). 

    Scheers NJ, Woodard DW, Thach BT. Crib bumpers continue to cause infant deaths: a need for a new preventive approach. J Pediatr. 2016;169:93–97, e91.

    SIDS and Other Sleep-Related Infant Deaths: Updated 2016 Recommendations for a Safe Infant Sleeping Environment. TASK FORCE ON SUDDEN INFANT DEATH SYNDROME. Pediatrics; originally published online October 24, 2016; DOI: 10.1542/peds.2016-2938.

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