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Babies Should Sleep in Parents' Room to Reduce SIDS Risk

RDR Staff

Each year, approximately 3500 infants die in the United States from sleep-related infant deaths including sudden infant death syndrome (SIDS), and accidental suffocation and strangulation in bed.
 
The American Academy of Pediatrics (AAP) has released its new guidelines for reducing the risk of sleep-related deaths. Those recommendations are listed below and include having the baby sleep in the parents’ bedroom and to keep soft objects away from the infant’s sleeping area.
 
Level A: There is good-quality patient-oriented evidence.
Level B: There is inconsistent or limited-quality patient-oriented evidence.
Level C: The recommendation is based on consensus, disease oriented evidence, usual practice, expert opinion, or case series for studies of diagnosis, treatment, prevention, or screening.
 
A-level recommendations (good-quality patient-oriented evidence)  
B-level recommendations (inconsistent or limited-quality patient-oriented evidence)  
C-level recommendations (based on consensus, disease oriented evidence, usual practice, expert opinion, or case series)  

Details of A-Level Recommendations

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 the child reaches 1 year of age. Side sleeping is not safe and is not advised.
 
Use a firm sleep surface.
Infants should be placed on a firm sleep surface (eg, mattress in a safety-approved crib) covered by a fitted sheet with no other bedding or soft objects to reduce the risk of SIDS and suffocation.
 
Breastfeeding is recommended.
Breastfeeding is associated with a reduced risk of SIDS. Unless contraindicated, mothers should breastfeed exclusively or feed with expressed milk (ie, not offer any formula or other nonhuman milk-based supplements) for 6 months, in alignment with recommendations of the AAP.
 
It is recommended that infants 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, but at least for the first 6 months.
There is evidence that sleeping in the parents’ room but on a separate surface decreases the risk of SIDS by as much as 50%. 6, 8, 41, 42 In addition, this arrangement is most likely to prevent suffocation, strangulation, and entrapment that may occur when the infant is sleeping in the adult bed.
 
Keep soft objects and loose bedding away from the infant’s sleep area to reduce the risk of SIDS, suffocation, entrapment, and strangulation.
Soft objects, such as pillows and pillow-like toys, quilts, comforters, sheepskins, and loose bedding, such as blankets and non-fitted sheets, can obstruct an infant’s nose and mouth. An obstructed airway can pose a risk of suffocation, entrapment, or SIDS.
 
Consider offering a pacifier at nap time and bedtime.
Although the mechanism is yet unclear, studies have reported a protective effect of pacifiers on the incidence of SIDS. The protective effect of the pacifier is observed even if the pacifier falls out of the infant’s mouth.
 
Avoid smoke exposure during pregnancy and after birth.
Both maternal smoking during pregnancy and smoke in the infant’s environment after birth are major risk factors for SIDS. Mothers should not smoke during pregnancy or after the infant’s birth.
 
Avoid alcohol and illicit drug use during pregnancy and after birth. There is an increased risk of SIDS with prenatal and postnatal exposure to alcohol or illicit drug use.
 
Avoid overheating and head covering in infants.
Although studies have shown an increased risk of SIDS with overheating, 86–89 the definition of overheating in these studies varies. Therefore, it is difficult to provide specific room temperature guidelines to avoid overheating. In general, infants should be dressed appropriately for the environment.
 
Pregnant women should obtain regular prenatal care.
There is substantial epidemiologic evidence linking a lower risk of SIDS for infants whose mothers obtain regular prenatal care.
 
Infants should be immunized in accordance with recommendations of the AAP and Centers for Disease Control and Prevention.
There is no evidence that there is a causal relationship between immunizations and SIDS.
 
Avoid the use of commercial devices that are inconsistent with safe sleep recommendations.
Be particularly wary of devices that claim to reduce the risk of SIDS. Examples include, but are not limited to, wedges and 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 the risk of SIDS.
The use of cardiorespiratory monitors has not been documented to decrease the incidence of SIDS.
 
Supervised, awake tummy time is recommended to facilitate development and to minimize development of positional plagiocephaly.
Although there are no data to make specific recommendations as to how often and how long it should be undertaken, the task force concurs with the AAP Committee on Practice and Ambulatory Medicine and Section on Neurologic Surgery that “a certain amount of prone positioning, or ‘tummy time, ’ while the infant is awake and being observed is recommended to help prevent the development of flattening of the occiput and to facilitate 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. Swaddling, or wrapping the infant in a light blanket, is often used as a strategy to calm the infant and encourage the use of the supine position. There is a high risk of death if a swaddled infant is
placed in or rolls to the prone position.
 
Media and manufacturers should follow safe sleep guidelines in their messaging and advertising.
Media exposures (including movie, television, magazines, newspapers, and Web sites), manufacturer advertisements, and store displays affect individual behavior by influencing beliefs and attitudes.
 
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. Public education should continue for all who care for infants, including parents, child care providers, grandparents, foster parents, and babysitters, and should include strategies for overcoming barriers to behavior change.
 
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 altogether.
Education campaigns need to be evaluated, and innovative intervention methods need to be encouraged and funded. Continued research and improved surveillance on the etiology and pathophysiologic basis of SIDS should be funded.

Reference

AAP Task Force on Sudden Infant Death Syndrome. SIDS and Other Sleep-Related Infant Deaths: Updated 2016 Recommendations for a Safe Infant Sleeping Environment. Pediatrics 2016. 138(5):e20162938
 
 
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