Recommendations from the American Academy of Pediatrics (AAP) for Reducing the Risk of Sudden Infant Death Syndrome (SIDS)
Sudden infant death syndrome (SIDS) is the leading cause of death in infants from ages one month to one year. October is SIDS Awareness Month, a time to raise awareness about this tragic cause of death.
“It is critical for new parents to have open communication and trust with their pediatrician,” says Elizabeth Berk Carlin, MD, chief, Department of Pediatrics and Newborn Medicine. “Pediatricians play a critical role in discussing and stressing ‘safe sleep’ in a supportive and nonjudgmental environment.”
Here are 15 recommendations from the American Academy of Pediatrics on reducing the risk of SIDS.
1. Back to sleep for every sleep.
Whether it’s a short nap during the day, or putting your baby down for the night, infants should always be placed to sleep on their backs.
2. Use a firm mattress in a safety-approved crib.
Cover the mattress with a fitted sheet and nothing else! No soft, fluffy bedding, toys, or pillows in the baby’s sleep area.
3. Breastfeeding is recommended.
Unless medically contraindicated, mothers should breastfeed exclusively or feed with expressed milk (i.e., not offer any formula or other non-human milk-based supplements) for at least six months.
4. Room-in with your infant at home.
It is recommended that infants sleep in the parents’ room, but in his/her own crib or basinet, ideally for the first year of life, but at least for the first six months. Evidence exists that infants who sleep in their parents’ room, in their own cribs, have a decreased risk of SIDS of as much as 50%.
5. Keep soft objects and loose bedding away from the infant’s sleep area to reduce the risk of SIDS, suffocation, entrapment, and strangulation.
Soft objects, such as pillows and pillow-like toys, quilts, comforters, sheepskins, and loose bedding, such as blankets and non-fitted sheets, can obstruct an infant’s nose and mouth. An obstructed airway can pose a risk of suffocation, entrapment, or SIDS.
6. Consider offering a pacifier at nap time and bedtime.
Although the mechanism is yet unclear, a protective effect of pacifiers on the incidence of SIDS has been reported. The protective effect of the pacifier is observed even if the pacifier falls out of the infant’s mouth. It does not need to be reinserted once the infant falls asleep.
7. Do not allow any smoking near or around your baby!
Both maternal smoking during pregnancy and smoke in the infant’s environment after birth are major risk factors for SIDS. Mothers should not smoke during pregnancy or after the infant’s birth. The risk of SIDS is particularly high when the infant shares a bed with an adult smoker, even when the adult does not smoke in bed.
8. Avoid alcohol and illicit drug use during pregnancy and after birth.
There is an increased risk of SIDS with prenatal and postnatal exposure to alcohol or illicit drug use. Parental alcohol and/or illicit drug use in combination with bed-sharing places the infant at particularly high risk of SIDS.
9. Avoid overheating and head covering in infants.
In general, infants should be dressed appropriately for the environment, with no greater than one layer more than an adult would wear to be comfortable in that environment. Parents and caregivers should evaluate the infant for signs of overheating, such as sweating or the infant’s chest feeling hot to the touch. Overbundling and covering of the face and head should be avoided.
10. Pregnant women should obtain regular prenatal care.
There is a substantial linking of a lower risk of SIDS for infants whose mothers obtain regular prenatal care. Pregnant women should follow guidelines for frequency of prenatal visits.
11. Infants should be immunized in accordance with recommendations of the AAP and Centers for Disease Control and Prevention.
Evidence suggests that vaccination may have a protective effect against SIDS.
12. Avoid the use of commercial devices that are inconsistent with safe sleep recommendations.
Be particularly wary of devices that claim to reduce the risk of SIDS. Examples include, but are not limited to, wedges and positioners and other devices placed in the adult bed for the purpose of positioning or separating the infant from others in the bed.
13. Do not use home cardiorespiratory monitors as a strategy to reduce the risk of SIDS.
The use of cardiorespiratory monitors has not been documented to decrease the incidence of SIDS.
14. Supervised, awake tummy time is recommended to facilitate development.
The SIDS taskforce and the AAP Committee on Practice and Ambulatory Medicine and Section on Neurologic Surgery agree that “a certain amount of prone positioning, or ‘tummy time,’ while the infant is awake and being observed is recommended to help facilitate the infant’s development and strength necessary for timely attainment of certain motor milestones.”
15. Swaddling is not recommended as a strategy to reduce the risk of SIDS.
Swaddling, or wrapping the infant in a light blanket, is often used as a strategy to calm the infant while he/she is lying on their back. There is a high risk of death if a swaddled infant is placed in the crib/basinet lying on their stomach, or if a swaddled infant rolls to that position. If infants are swaddled, they should always be placed on the back. Swaddling should be snug around the chest but allow for ample room at the hips and knees. When an infant exhibits signs of attempting to roll, swaddling should no longer be used.
All parents of babies born at Englewood Hospital and Medical Center are provided information and education on ‘safe sleep’ and reducing the risk of SIDS. “Expectant and new parents are educated during the Mom 101 seminars held by the Childbirth Education Department,” says Leilani Feliciano, MSN, MA, RNC-OB, APN-C, WHNP-BC, an advanced practice nurse in Englewood Hospital’s Family Birth Place. “After delivery, education on safe sleep and SIDS prevention continues during the parent’s hospital stay, before they are discharged home with their newborn.”
For additional information, please see “SIDS and Other Sleep-Related Infant Deaths: Updated 2016 Recommendations for a Safe Infant Sleeping Environment” from the AAP.
Posted on October 28, 2016