Tuesday, January 17, 2012
AAP Recommendations to Reduce the Risk of SIDS: An Overview Part I
The American Academy of Pediatrics (AAP) has released an updated report of recommendations to reduce the risk of SIDS and sleep-related suffocation, asphyxia, and entrapment among infants in the first year of life. This is the first report published since the “Back to Sleep” campaign was originally launched in 2005. Though guidelines encouraging caregivers to place babies on their backs to sleep have been around since 1992 and proved successful at decreasing the incidence of SIDS, deaths related to SIDS have recently plateaued. In the mean-time, other sleep-related deaths have increased.
The updated and expanded recommendations provide more evidence-based information about safe infant sleep. In the next 2 posts we will present an overview (without comment) of each of the new recommendations and share important notes about each. It’s also important to note that the recommendations we will focus on in these blog posts are “Level A recommendations” meaning that they are based on “good and consistent scientific evidence.” Please see the link at the bottom of this post to view the full AAP report.
1. Back to sleep for every sleep
“To reduce the risk of SIDS, infants should be placed for sleep in a supine position (wholly on the back) for every sleep by every caregiver until 1 year of life. Side sleeping is not safe and is not advised.”
• Once your infant can roll from back to front and front to back you can leave your baby in whatever sleep position he gets into during the night.
• Side sleeping is discouraged and there is no evidence that side sleeping has any medical benefits, even during 1st few days of life in the hospital.
• While it has been known that choking risk is not greater in babies that sleep on their backs, this has also been shown true in infants with reflux.
• Elevating the head of the bed may be dangerous (for babies with reflux or others elevating the head of the bed does not reduce reflux and the baby may slide to the foot of the crib and get into a position that compromises breathing).
2. Use a firm sleep surface
“A firm crib mattress, covered by a fitted sheet, is the recommended sleeping surface to reduce the risk of SIDS and suffocation.”
• All sleep surfaces should conform to safety standards of the Consumer Product Safety Commission. You can check this out online at http://www.cpsc.gov/info/cribs/index.html. You can also check for recalls regularly at this site too.
• Broken cribs should never be used (risk of death has been associated with broken cribs or those with missing parts).
• Any device that puts your infant in a sitting position, such as a car seat or swing, should not be used for routine sleep, especially in infants under 4 months of age.
• When slings or other soft carriers are used, make sure that your infant’s head and face are above the fabric and that the nose and mouth are not obstructed at any time.
3. Room-sharing without bed-sharing is recommended
“There is evidence that this arrangement decreases the risk of SIDS by as much as 50%. In addition, this arrangement is most likely to prevent suffocation, strangulation, and entrapment that might occur when the infant is sleeping in an adult bed.”
• It’s recommended that babies sleep in the same room as their parents but on a separate sleep surface.
• Babies may be brought into the parents’ bed to feed or be comforted but the baby should be returned to his own sleep surface when the parent is ready to go back to sleep.
• Bed-sharing devices that propose to promote safe bed-sharing are not recommended.
• The AAP does not endorse any particular bed-sharing situation as being safe. However, there are specific circumstances surrounding bed-sharing that have been found to substantially increase the risk of SIDS or other sleep-related deaths. For a list of these, please see the full AAP report below.
4. Keep soft objects and loose bedding out of the crib
“Keep soft objects and loose bedding out of the crib to reduce the risk of SIDS, suffocation, entrapment, and strangulation.”
• Soft objects include: pillows, stuffed animals or soft toys, quilts and comforters, just to name a few.
• Loose bedding includes blankets or sheets.
• Bumper pads used to line a crib may pose suffocation risk and do not prevent injury.
5. Pregnant women should receive regular prenatal care
“There is substantial epidemiologic evidence linking a lower risk of SIDS for infants whose mothers obtain regular prenatal care.”
On Friday, we'll continue with an overview of the rest of the recommendations.