The American Academy of Pediatrics released a new policy statement, “SIDS and Other Sleep-Related Infant Deaths: Updated 2016 Recommendations for a Safe Infant Sleeping Environment,” at its national convention in October 2016. Policy statements are created when new research changes current practice or confirms traditional advice. This update was written based on the most current research in the area of sleep-related infant deaths and includes some practical SIDS prevention advice for parents of newborns and infants.
The policy reinforces the need for babies to sleep on their backs during naps and at night. Side sleeping or sleeping on their tummies is not recommended. Older infants who are able to roll themselves independently from back to stomach can be left on their tummies if they roll over at night. Babies who sleep on their backs are not at increased risk for choking, and the dangers of side-sleeping in babies with mild reflux outweigh the dangers due to reflux.
Babies who fall asleep in bouncers, car seats, or similar containers should be transferred to their normal sleep space as soon as possible. Sleeping on any surface other than a crib mattress, bassinet mattress, or play yard mattress is not recommended. The chosen sleep surface should meet the safety standards of the Consumer Product Safety Commission. Bedside sleepers that attach to the adult bed on the side are also subject to CPSC standards. There are no standards for in-bed sleepers and there is no safety data for either those or bed-side sleepers, so no specific for/against recommendation was made.
Perhaps the biggest change was the new recommendation that infants share a room with their caregivers, “ideally for the first year of life, but at least for the first six months.” The sleep surface should be separate but close enough so that feeding, soothing, and checking on the infant is easy. Room-sharing instead of bed-sharing decreases the incidence of suffocation, strangulation, and entrapment that can occur when an infant is placed in the adult bed. The benefit in some studies was as high as a 50 percent decrease in risk of SIDS when an infant room-shared for the first six months.
The use of pacifiers was again reconfirmed. The pacifier should be offered at each sleep time, naps, and at night. The pacifier does not need to be reinserted in the mouth once it falls out and should not be forced upon an infant who is not interested. Pacifiers should be offered alone and not attached to any object, clip, necklace, or soft toy. For breastfeeding families, the pacifier does not need to be introduced until breastfeeding is well established if nipple confusion is an issue. Why pacifiers, and not fingers, offer some protection against SIDS is still not clear.
Parents are reminded to avoid the use of devices marketed to decrease the risk of SIDS. These include cardiorespiratory monitors, unless one is prescribed by a doctor. Also included are wedges and other positioning devices that claim to decrease SIDS risk when used in the adult or infant bed. Similarly, there is no evidence that swaddling increases or decreased SIDS risk. Families who swaddle are reminded to avoid swaddlers that can come loose and cover the baby’s face and to stop swaddling once the baby can roll over.
- New AAP guidelines reinforce that babies should be put to sleep on their backs.
- Sleeping on surfaces other than a firm crib mattress, bassinet mattress, or play yard mattress is not recommended.
- Infants should room-share with caregivers for the first year of life when possible.
- Pacifiers are recommended for use at night.