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Pediatrics – MA Center for Sudden Infant Death Syndrome (SIDS)

Patient Information – Learning About SIDS: FAQs

Recommendations for a Safe Infant Sleep Environment

The American Academy of Pediatrics (AAP) recently published a new policy statement and technical report expanding the recommendations on how to create a safe environment for infant sleep. The report is titled SIDS and Other Sleep-Related Infant Deaths: Expansion of Recommendations for a Safe Infant Sleep Environment.

There has been a major decrease in the incidence of SIDS since the AAP recommended in 1992 that caregivers put infants to sleep on their backs.  This decline has leveled off in recent years, while other causes of sudden unexpected infant death that occur during sleep have increased, particularly since 2005.  Other causes of death that occur during sleep include suffocation, asphyxia and entrapment and ill-defined causes of death.  The AAP is expanding its recommendations from focusing on SIDS to focusing on a safe sleep environment that can reduce the risk of all sleep-related infant deaths, including SIDS.

The first set of recommendations (Level A) are based on good and consistent scientific evidence.  These recommendations come from consistent findings from at least two well-designed, well-conducted case-control studies, a systematic review or a meta-analysis. Experts are highly certain that the net benefits of these recommendations are substantial and that future studies will probably not change these

Level A Recommendations (based on scientific evidence):

  1. Back to sleep for every sleep.
  2. Use a firm sleep surface. A firm crib mattress covered by a tight fitting sheet is the recommended sleeping surface.
  3. Room-sharing without bed-sharing is recommended.  Baby’s crib should in parents’ bedroom close to parents’ bed.
  4. Keep soft objects and loose bedding out of the crib.  This includes pillows, quilts, comforters, sheepskins, stuffed toys, bumper pads and other soft objects.
  5. Pregnant women should receive regular prenatal care.
  6. Avoid smoke exposure during pregnancy and after birth
  7. Avoid alcohol and illicit drug use during pregnancy and after birth
  8. Breastfeed your baby.
  9. Consider offering a pacifier at nap time and bedtime.
  10. Avoid overheating your baby.
  11. Do not use home cardio-respiratory monitors as a strategy for reducing the risk of SIDS.
  12. Expand the national campaign to reduce the risks of SIDS to include a major focus on the safe sleep environment and ways to reduce the risks of all sleep-related infant deaths, including SIDS, suffocation and other accidental deaths; pediatricians, family physicians and other primary care providers should actively participate in this campaign.

Level B Recommendations

Level B Recommendations are based on limited or inconsistent scientific evidence.  The available evidence is sufficient to determine the effects of the recommendations on health outcomes, but confidence in the estimate is constrained by such factors as the number, size or quality of individual studies or inconsistent findings across individual studies.  As more information becomes available, the magnitude or directions of the observed effect could change and this change may be large enough to alter the conclusion.

  1. Infants should be immunized in accordance with recommendations of the AAP and Centers for Disease Control and Prevention.
  2. Do not use bumper pads in cribs. There is no evidence that bumper pads prevent injuries, and there is a potential risk of suffocation, strangulation or entrapment.
  3. Avoid commercial devices marketed to reduce the risk of SIDS.
  4. Supervise awake tummy time to facilitate development and to minimize development of positional plagiocephaly  (flat heads).

Level C Recommendations

Level C recommendations are based primarily on consensus and expert opinion.

  1. Health care professionals, staff in newborn nurseries and NICU’s and child care providers should endorse the SIDS risk-reduction recommendations from birth.
  2. Media and manufacturers should follow safe-sleep guidelines in their messaging and advertising.
  3. Continue research and surveillance on the risk factors, causes and patho-physiological mechanisms of SIDS and other sleep-related deaths with the ultimate goal of eliminating these deaths entirely.

Pediatrics Volume 128, Number 5, November 2011.   Go to http://www.aap.org/ for additional information.

Contact Us

Call: 617.414.7437 or 800.641.7437
Fax: 617.414.5555

Boston Medical Center
Department of Pediatrics
MA Center for Sudden Infant Death Syndrome
Dowling Building
4th floor, Room 4204
771 Albany Street
Boston, MA 02118

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