The American Academy of Pediatrics has issued new safe sleep guidelines for infants.
In its first update to safe infant sleep recommendations since 2016, the AAP reemphasizes the need for infants to sleep on their backs on flat, non-inclined surfaces without soft bedding. The new guidelines also stress against co-sleeping under any circumstances.
The guidelines were released Tuesday along with a technical report that provides the evidence base for updated recommendations, which apply to children up to 1 year-old.
"A baby's death is tragic, heartbreaking and often preventable. If we've learned anything, it's that simple is best: babies should always sleep in a crib or bassinet, on their back, without soft toys, pillows, blankets or other bedding," Dr. Rachel Moon, professor of pediatrics at the University of Virginia School of Medicine and lead author at the AAP report, said in a statement.
Approximately 3,500 infants die from sleep-related infant deaths annually in the United States, according to the AAP. The risks of sleep-related infant deaths are up to 67 times higher when sleeping with someone on a couch or soft armchair or cushion. Risks of sleeping on the same surface with someone else also increase 5-10 times when an infant is under four months of age; is sharing the surface with someone other than a parent; or is a pre-term or low-birthweight, regardless of other factors, the AAP said.
"We know that many parents choose to share a bed with a child, for instance, perhaps to help with breastfeeding or because of a cultural preference or a belief that it is safe. The evidence is clear that this significantly raises the risk of a baby's injury or death, however, and for that reason AAP cannot support bed-sharing under any circumstances," said Rebecca Carlin, who co-authored the report.
To reduce the risk of sleep-related infant death, the AAP recommends:
• The baby should sleep on a firm, flat non-inclined surface that, at a minimum, adheres to the June 2021 Consumer Product Safety Commission's rule that any infant sleep product must meet existing federal safety standards for cribs, bassinets, play yards, and bedside sleepers. Parents should not use products for sleep that aren’t specifically marketed for sleep.
• Sitting devices, such as car seats, strollers, swings, infant carriers, and infant slings, are not recommended for routine sleep in the hospital or at home, particularly for infants younger than 4 months.
• Breastfeeding reduces the risk of sleep-related infant deaths, and while any human milk feeding is more protective than none, 2 months of feeding at least partial human milk feeding has been demonstrated to significantly lower the risk of sleep-related deaths. The AAP recommends exclusive human milk feeding to 6 months, with continuation of human milk feeding for 1 year or longer as mutually desired by parent and infant.
• AAP recommends that parents sleep in the same room – but not in the same bed as a baby, preferably for at least the first six months.
• Avoid parent and infant exposure to nicotine, alcohol, marijuana, opioids, and illicit drugs.
• Make sure the baby receives routine immunizations.
• Pacifier use is associated with reducing risk.
• Avoid the use of commercial devices that claim to reduce the risk of SIDS or other sleep-related deaths. There is no evidence that any of these devices reduce the risk of these deaths. Importantly, the use of products claiming to increase sleep safety may provide a false sense of security and complacency for caregivers. Do not use home cardiorespiratory monitors as a strategy to reduce the risk of SIDS.
• Supervised, awake tummy time is recommended to facilitate infant development and to minimize development of positional plagiocephaly. Parents are encouraged to place the infant in tummy time while awake and supervised for short periods of time beginning soon after hospital discharge, increasing incrementally to at least 15 to 30 minutes total daily by 7 weeks of age.
• There is no evidence to recommend swaddling as a strategy to reduce the risk of SIDS. If infants are swaddled, always place them on the back. Weighted swaddles, weighted clothing or weighted objects on or near the baby are not safe and not recommended. When an infant exhibits signs of attempting to roll (which usually occurs at 3 to 4 months but may occur earlier), swaddling is no longer appropriate, as it could increase the risk of suffocation if the swaddled infant rolls to the prone position.