November 8, 2011 – The American Academy of Pediatrics (AAP) published in October an update on infant sleep environments. It was back in 1992 that the AAP originally published the recommendations that babies be placed on their backs to sleep to reduce the risks of Sudden Infant Death Syndrome (SIDS). This is still true, but there are several new recommendations that reinforce a safe sleeping environment for infants.
- Back to sleep for every sleep – nighttime and naps is the recommended. Side sleeping is no longer recommended. Babies with gastroesophageal reflux disease (GERD) should also be back sleeping unless they have life threatening risks from complications of GERD as in infants with impaired nervous systems who can not protect their airways normally. Normal healthy babies with GERD should continue to back sleep. Babies should also be placed on the back position until a year, but once they are rolling over (usually around 4-6 months) they can be allowed to remain in the sleep position that he or she assumes.
- Use a firm sleep surface using a sleep environment (crib, bassinet or crib/play yard) that conforms to safety standards and make sure that these items are not on recall lists or have broken or missing parts.
- Pillows, cushions, quilts, comforters or sheepskins, even if covered by a sheet should not be placed with the sleeping infant. Bumper pads for cribs should also not be used. There is no evidence that bumper pads prevent injuries and these are also a risk for suffocation, entrapment and strangulation.
- Sitting devices such as car seats, strollers, swings and carriers are not recommended for routine sleep in the home environment.
- Room sharing IS recommended but bed sharing is NOT recommended. There is evidence that room sharing can decrease the risk of SIDS by as much as 50%. However, bed sharing with the infant in the parent’s bed is NOT recommended due to risks of suffocation, strangulation and entrapment with the infant in the adult bed. Co-sleepers are NOT recommended and do not make bed sharing safe. Infants can be brought into the parental bed for feeding but should be returned to their crib or bassinet when the parent is ready to return to sleep.
- Avoid smoke exposure as this increases risks of SIDS.
- Consider pacifier use at nap or bedtime. Although the reasons are unclear, studies seem to show a protective effect of pacifiers on the incidence of SIDS, even if it falls out of the infant’s mouth. However, there is no need to force a baby to take one if they do not like it and generally with breastfed babies, we recommend waiting until after 3-4 weeks of age to introduce a pacifier. Pacifiers should not be attached to the baby with a cord or hung around the neck when babies are sleeping.
- Avoid overheating of babies. Generally about 1 layer more than an adult would wear to be comfortable is a good rule of thumb.
- And remember to avoid positional flattening of the skull (positional plagiocephaly), give babies opportunities to have tummy time when awake. See ideas for doing this on our website under the General Links with Tummy Time Tools handout.