Pediatric experts give new recommendations to keep sleeping babies safe

In its first update since 2016, the American Academy of Pediatrics (AAP) outlined recommendations to reduce the risk of sleep-related infant deaths. In the new policy statement, AAP is emphasizing the need for infants to sleep on their backs, for parents to keep the sleep environment “bare,” and to avoid bed-sharing under any circumstances, according to a recent press release.  

“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,” said lead author Dr. Rachel Moon, professor of pediatrics at the University of Virginia School of Medicine. 

The recommendations apply to children up to a year old. 

Approximately 3,500 infants die from sleep-related deaths every year in the United States, but the annual number of deaths since 2000 have been similar after a “substantial” reduction in deaths in the 1990s due to national education for infants to sleep on their backs, the press release said. 

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But even though the overall numbers of deaths are down, the rate of sudden unexpected infant deaths (SUIDs) more than doubled among Black infants and tripled among American Indian/Alaska Native infants compared to White infants in 2010 to 2013.

Additionally, infants have a 67 times higher risk of a sleep-related death when sleeping with someone on a couch, soft armchair or cushion, 10 times higher risk when sleeping with someone who is impaired because of tiredness, sedating medications or substance abuse, and 5-10 times higher risk when sleeping on the same surface with someone else when under four months of age.  

“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,” said Dr. Rebecca Carlin, a co-author of the statement and its accompanying technical report. “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.” 

The AAP recommends for babies to sleep on a surface that is flat, firm and not inclined with the sleep product meeting the Consumer Product Safety Commission’s safety standards for cribs, bassinets, play yards and bedside sleepers, which go into effect this week, according to CNN. 

“A great way to test if a surface is too soft is to press your hand down and then lift it up.  If your hand leaves an indentation, it’s too soft,” according to First Candle, a non-profit organization committed to the elimination of SIDS. 

The AAP press release also heralded the passage of the Safe Sleep for Babies Act, which bans the sale of unsafe crib bumpers and inclined sleepers by mid-2022.  

The policy statement reminded parents to avoid items — especially soft objects, such as pillow-like toys, mattress toppers, fur-like materials, loose bedding or crib bumpers because of the potential to suffocate them.   

“Place infants on a firm, flat, [non-inclined] sleep surface (eg, tightly fitting crib mattress in a safety-approved crib) covered by a fitted sheet with no other bedding or soft objects. Sleep surfaces with inclines of more than 10 degrees are unsafe for infant sleep,” the policy statement said.  

Crib bumpers, which are meant to cushion the baby from the crib slats, are linked to more than 100 infant deaths in the past 30 years, according to healthychildren.org, a website recommended by the AAP for additional resources on sleep safety for infants.  

The pediatric association recommended parents should sleep in the same room with their infants, but not the same bed as them, for at least the first six months. 

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The release noted pacifier use is also associated with reducing sleep-related deaths, but advised “supervised, awake tummy time” for infant development and to prevent a flat spot developing on the back or side of their head due to their sleep position, a condition known as positional plagiocephaly, per the statement.  

“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,” the release said. 

And when an infant shows signs of attempting to reach the rolling milestone, which is often around three to four months of age, the statement advises against swaddling because the swaddled infant may roll to the prone position and suffocate.  

Breastfeeding decreases the risk of sleep-related infant deaths with the statement noting, “2 months of feeding at least partial human milk feeding has been demonstrated to significantly lower the risk of sleep-related deaths.” 

“Parents might think that their infant is waking up too much during the night and fear that something is wrong,” Dr. Moon said.  

“But babies by their nature wake up frequently during the night. Although this can be understandably frustrating for parents who are exhausted and losing out on their own sleep, babies have to wake to feed every 2-3 hours, so this is normal and healthy, and should be expected. When parents have questions about their infant’s sleep, they should always ask their pediatrician for guidance.”