New Safe-Sleep guidelines aim to reduce infant deaths

New guidelines from the American Academy of Pediatrics offer important guidance for parents on how to keep their babies safe during sleep.

A baby sleeps on his back in a crib that just has a fitted sheet on it and nothing more. To prevent SIDS, always place babies on their backs for naps and at nighttime with no extras in the sleeping space – no toys, bumpers, or blankets.

Joshua Barney, UVA Health June 21, 2022

The American Academy of Pediatrics has updated its safe-sleep guidelines for infants for the first time in more than five years, emphasizing that babies should sleep on their backs on flat, level surfaces to reduce their risk of Sudden Unexpected Infant Death Syndrome (SIDS).

It’s estimated that there are 3,500 sleep-related infant deaths in the United States each year. Many of those deaths are preventable, and the authors of the new guidelines are urging parents to take simple steps to help keep their children safe.

“The best way to protect your baby while they are asleep is to follow these guidelines,” said UVA Children’s Rachel Moon, MD, the lead author of the new guidelines, which come from the AAP’s Task Force on Sudden Infant Death Syndrome and the AAP’s Committee on Fetus and Newborn. “When you place your baby for sleep, they should be on their back in a crib, portable crib or bassinet that meets Consumer Product Safety Commission standards, and there should be nothing but the baby in the crib.”

Safe infant sleep

The United States made great progress in preventing infant deaths during the 1990s, after a public-education campaign urged parents to put their babies to sleep on their backs. But the decline in deaths has been stalled for more than 20 years. Safe-sleep experts say more can be done, and hope the new guidelines spur fresh action.

The recommendations, published online today in the scientific journal Pediatrics, include:

  • Babies should sleep on their back on a firm, flat, non-inclined surface free of soft goods, such as blankets and toys. These items, while appealing to many parents, can pose suffocation hazards.
  • The sleep surface should, at minimum, comply with all federal safety standards.
  • Any inclined surfaces, including car seats, strollers, infant carriers and infant slings, should be avoided for routine sleeping, especially for infants younger than 4 months.
  • Swaddling has not been shown to reduce the risk of SIDS. If babies are swaddled, they should always be placed on their back. Weighted swaddles or weighted objects within swaddles are unsafe. Swaddling should be stopped when a baby starts trying to roll over, usually at 3 or 4 months or earlier, as the swaddle can pose a suffocation hazard.
  • Parents should avoid devices marketed to reduce the risk of SIDS or other sleep-related deaths. There is no evidence for such claims, and they may lull parents into a false sense of security.
  • While there is no contraindication to using home cardiorespiratory monitors or wearable monitors, there is no evidence that using them will prevent SIDS. Families who decide to use these monitors should still follow the safe sleep guidelines.
  • Parents should sleep in the same room as baby, but not in the same bed.

Other recommendations include breastfeeding, when possible; any breast milk, experts say, is better than none. Both breastfeeding and pacifier use are associated with reduced risk of SIDS. Parents should also avoid using drugs and alcohol or exposing babies to drugs and alcohol.

In addition, parents are advised that awake “tummy time” is important to facilitate infant development. Babies should not be left to sleep on their stomachs, however.

“These recommendations are consistent with prior guidelines, with some updates based on new information. We want to reach new parents, grandparents and other infant caregivers so that everyone is aware about how best to keep their baby safe,” said UVA Health’s Fern Hauck, MD, MS, a member of the AAP’s Task Force on SIDS. “We also want parents to know that it is important to speak to your baby’s doctor about the guidelines and have an open discussion so that you can share your thoughts and make the best choices in caring for your baby.”

Guidelines published online

A full list of the AAP’s safe-sleep recommendations is available online. The guidelines are accompanied by a technical report that details the evidence used in developing the recommendations.

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Source University of Virginia Health System


Sleep-Related Infant Deaths: Updated 2022 Recommendations for Reducing Infant Deaths in the Sleep Environment, Moon RY, Carlin RF, Hand I; TASK FORCE ON SUDDEN INFANT DEATH SYNDROME AND THE COMMITTEE ON FETUS AND NEWBORN; Task Force on Sudden Infant Death Syndrome, Abu Jawdeh EG, Colvin J, Goodstein MH, Hauck FR, Hwang SS; Committee on Fetus and Newborn, Cummings J, Aucott S, Guillory C, Hudak M, Kaufman D, Martin C, Pramanik A, Puopolo K; Consultants to Task Force on Sudden Infant Death Syndrome, Bundock E; National Association of Medical Examiners, Kaplan L; Eunice Kennedy Shriver National Institute for Child Health and Human Development, Brown SP; Centers for Disease Control and Prevention, Koso-Thomas M; Eunice Kennedy Shriver National Institute for Child Health and Human Development, Shapiro-Mendoza CK; Centers for Disease Control and Prevention; Consultants to Committee on Fetus and Newborn, Barfield W; Centers for Disease Control and Prevention, Miller R; American College of Obstetricians and Gynecologists, Narvey M; Canadian Pediatric Society, Jancelewicz T; AAP Section on Surgery, Lucke A; AAP Section on Neonatal and Perinatal Medicine, Grisham L; National Association of Neonatal Nurses; Staff, Couto J. Pediatrics. 2022 Jun 21:e2022057990. doi: 10.1542/peds.2022-057990. Epub ahead of print. Full text

Evidence Base for 2022 Updated Recommendations for a Safe Infant Sleeping Environment to Reduce the Risk of Sleep-Related Infant Deaths, Rachel Y Moon, Rebecca F Carlin, Ivan Hand; THE TASK FORCE ON SUDDEN INFANT DEATH SYNDROME and THE COMMITTEE ON FETUS AND NEWBORN. Pediatrics 2022; e2022057991. 10.1542/peds.2022-057991. Full text

  Further reading

Bed-sharing and SIDS: an evidence-based approach, Blair PS, Ball HL, Pease A, Fleming PJ. Arch Dis Child. 2023 Apr;108(4):e6. doi: 10.1136/archdischild-2021-323469. Epub 2022 Mar 7.

Also see
American Academy of Pediatrics Updates Safe Sleep Recommendations: Back is Best American Academy of Pediatrics
Sudden Infant Death Syndrome: How to Keep Babies Safe While Sleeping
Safe Sleep American Academy of Pediatrics

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