January 12, 2017 – Recently, the American Academy of Pediatrics (AAP) came out with some updated and expanded safe sleep recommendations.
They list 19 recommendations for a safe infant sleeping environment and it is definitely worth taking a look at the details.
The 19 recommendations for a safer infant sleep environment:
- Small detail: The 19 recommendations are listed with their strength of recommendation at the bottom of this post
- Some detail: A listing that includes brief explanations is found here.
- More detail: The official AAP policy statement is found here.
- Lots of detail: The AAP technical report is found here.
What your pediatricians at RCAM think about these new safe sleep recommendations:
1. New recommendations reflect the best information available now
First of all, we don’t shy away from new recommendations. Not at all. That is one of the strengths of medicine.
We know that we don’t know everything, and there is a vast and constant pursuit of better information. When more complete, up-to-date knowledge about how to keep our children healthy comes available, we want to incorporate it into what we do.
That is why it is okay that we sometimes hear grandmothers say, “That’s not what I was told when you were a baby.“
Medicine strives to recommend based on the best information available now.
2. Old habits are sometimes hard to kick
It has taken us a few months to comment as a practice because these 19 recommendations include some real game changers.
For example, consider #4 below: “Room-sharing with the infant on a separate sleep surface is recommended” (for the first 6-12 months).
As a practice, we have generally agreed that establishing a healthy, through-the-night sleep pattern is greatly aided by the move of your infant into a separate room. But, some studies have shown a 50% reduction in the incidence of Sudden Infant Death Syndrome (SIDS) in infants who room-shared (not bed-shared) for the first 6-12 months. That is what I mean by a game changer.
There are 19 recommendations. No one will be perfect and follow all of them 100% of the time for the first 12 months of life (if your child has ever fallen asleep in their car seat and you didn’t as quickly as possible move them to a firm, flat surface, then you haven’t followed all the recommendations all the time).
However, it is important that we assess what we do and change our habits to be as safe as we can with out most valued members of society – our children.
3. Some old habits do not need to change
Back to sleep for every sleep is still very important for a safe infant sleep environment.
Summary of Recommendations With Strength of Recommendation
The list below comes from the AAP (link). The linked article provides more information along with references with each recommendation. The recommendations are grouped based on the Strength-of-Recommendation Taxonomy (SORT) for the assignment of letter grades to each of its recommendations (A, B, or C).
A-level recommendations (Level A: There is good-quality patient-oriented evidence.)
- Back to sleep for every sleep
- Use a firm sleep surface
- Breastfeeding is recommended
- Room-sharing with the infant on a separate sleep surface is recommended
- Keep soft objects and loose bedding away from the infant’s sleep area
- Consider offering a pacifier at naptime and bedtime
- Avoid smoke exposure during pregnancy and after birth
- Avoid alcohol and illicit drug use during pregnancy and after birth
- Avoid overheating
- Pregnant women should seek and obtain regular prenatal care
- Infants should be immunized in accordance with AAP and CDC recommendations
- Do not use home cardiorespiratory monitors as a strategy to reduce the risk of SIDS
- Health care providers, staff in newborn nurseries and NICUs, and child care providers should endorse and model the SIDS risk-reduction recommendations from birth
- Media and manufacturers should follow safe sleep guidelines in their messaging and advertising
- 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
B-level recommendations (Level B: There is inconsistent or limited-quality patient-oriented evidence.)
- Avoid the use of commercial devices that are inconsistent with safe sleep recommendations
- Supervised, awake tummy time is recommended to facilitate development and to minimize development of positional plagiocephaly
C-level recommendations (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.)
- 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
- There is no evidence to recommend swaddling as a strategy to reduce the risk of SIDS
Note: “patient-oriented evidence” measures outcomes that matter to patients: morbidity, mortality, symptom improvement, cost reduction, and quality of life; “disease-oriented evidence” measures immediate, physiologic, or surrogate end points that may or may not reflect improvements in patient outcomes (eg, blood pressure, blood chemistry, physiologic function, pathologic findings). CDC, Centers for Disease Control and Prevention.