Dr. Todd Harris

From the AAP: Updated Safe Sleep Guidance

Written by Dr. Todd Harris

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.)

  1. Back to sleep for every sleep
  2. Use a firm sleep surface
  3. Breastfeeding is recommended
  4. Room-sharing with the infant on a separate sleep surface is recommended
  5. Keep soft objects and loose bedding away from the infant’s sleep area
  6. Consider offering a pacifier at naptime and bedtime
  7. Avoid smoke exposure during pregnancy and after birth
  8. Avoid alcohol and illicit drug use during pregnancy and after birth
  9. Avoid overheating
  10. Pregnant women should seek and obtain regular prenatal care
  11. Infants should be immunized in accordance with AAP and CDC recommendations
  12. Do not use home cardiorespiratory monitors as a strategy to reduce the risk of SIDS
  13. Health care providers, staff in newborn nurseries and NICUs, and child care providers should endorse and model the SIDS risk-reduction recommendations from birth
  14. Media and manufacturers should follow safe sleep guidelines in their messaging and advertising
  15. 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.)

  1. Avoid the use of commercial devices that are inconsistent with safe sleep recommendations
  2. 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.)

  1. 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
  2. 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.


Dr. Todd Harris

November 7, 2016 – Here is a brief and effective video about something that comes up in our office frequently.

A common reason for difficulty with an ear exam is too much wax in the ear canal. Some people try to combat this problem by ‘cleaning’ the ear canal with Q-tips or cotton swabs.

You know when you have good intentions but your efforts just end up making things worse?

This is one of those situations.

This video shows why Q-Tips are not a good idea for your ear canal.


Dr. Todd Harris

Banner Change: Summer Edition

Written by Dr. Todd Harris

2016 Summer Web

June 21, 2016 – At Raleigh Childrens, we love the change of season.

In the spring and summer, it is always good to say “goodbye” to flu season and “hello” to a time that is generally healthier and when we are more physically active. It has become our tradition here to change the banner at the top of our webpage with each season, and – with that change yesterday – we officially welcomed summer.

At Raleigh Childrens, we also love children being active – particularly if they are enjoying themselves because that means they are likely to do it again and take some steps toward developing a good habit. With that in mind, it seemed appropriate to highlight this delightful young lady with her multi-colored fingernails who is pictured here and clearly having fun at the pool.

A few things to keep in mind for the summer:

Have a healthy and fun summer.


Dr. Todd Harris

January 9, 2016 – Be honest. You hear the phrase “new medical recommendations” and you roll your eyes.

If you don’t literally roll your eyes, some eye-rolling thoughts pop into your head (and sometimes out of your mouth):

  • “If it was good enough for me then, it is good enough now.” [a popular choice among grandparents]
  • “How about I wait and hear what next year’s recommendations will be and then do them?” [the procrastinator’s choice]
  • [My personal favorite:] “So let me get this straight, doc – last year – when you told me last year’s recommendations – you were wrong?”

… Continue reading


Dr. Todd Harris

FitbitJanuary 1, 2016I got a Fitbit for Christmas this year.

Perhaps that isn’t a great gift if you didn’t ask for it but I did ask for it (I even texted the link to my wife specifically asked Santa for it so she wouldn’t be tempted to get the expensive one designed for elite marathon runners his elves would put the right one in his sack).

It is a little embarrassing for a physician to admit this but (among other things) I need to be more active and I need to eat better.

I feel okay to write that because I bet some of you reading this have heard a similar voice in your head – maybe 2016 can be the year for you too.

Pediatricians readily admit that a most difficult feat to accomplish – which probably not coincidentally can have the biggest effect on our patients’ overall health – is to aid / motivate a patient or a family to stop being sedentary and to start / continue to be more active.

The New Year is a holiday where we more often resolve to make a change – I think some people call it a New Year’s Resolution.

I came across a Canadian physician – Dr. Mike Evans – who has researched New Year’s Resolutions. He does a great job presenting this information in an organized and practical way.

His article about New Year’s Resolutions can be found here. He has made some interesting videos on the topic. Some of that information is summarized in the following info-graphic (he’s Canadian, so be ready to see “-iour” and “-re” when you are used to seeing “-ior” and “-er”):

New Years Resolution

Good luck with your changes! Don’t get too discouraged. Your health and your family’s health is important.