Safe Sleep: How to reduce the risk of Sudden Infant Death Syndrome

The American Academy of Pediatrics (AAP) provides recommendations regarding safe sleeping practices for infants from birth to one year of age and can be viewed here.

Dr. Kristen Bettin explains the guidelines and breaks down what parents need to know about safe sleep practices. 

The AAP guidelines are primarily aimed at reducing the risk of Sudden Infant Death Syndrome (SIDS) and other Sudden Unexplained Infant Deaths (SUID), which includes suffocation, asphyxiation, and entrapment in addition to other causes. The AAP continues to recommend that infants sleep on their backs for every sleep.

This is especially important for premature infants and infants with low birth weight. The AAP also strongly recommends that infants are placed on a firm sleeping surface, such as a firm mattress in a crib, covered only with a snug-fitting fitted sheet. Firm sleeping surfaces are surfaces that keep their shape when the infant is placed on them, and do not create a pocket or indentation when the infant is placed on the surface. Loose bedding, mattress toppers, blankets, stuffed animals, bumpers, positioners, or any other soft object should be removed from the infant’s sleeping area. Cribs, bassinets, portable cribs, and play yards that meet safety standards are all acceptable sleep spaces for infants.

Some bedside sleepers that attach to the side of the parents bed do have published safety standards and may be acceptable if these safety standards are followed. However, in-bed sleepers have no published safety standards and are not recommended. There is also evidence that breastfeeding, regularly scheduled immunizations, and pacifier use during sleep may have a protective effect against SIDS and are recommended. Parents should also avoid using tobacco, alcohol, and illicit drugs, which increase th risk of SIDS. Overbundling, overheating, and covering the head of the infant should also be avoided. Swaddling does not prevent SIDS and can be dangerous if the infant is placed on her stomach or rolls to her stomach during sleep.

So what’s different from past recommendations?

The AAP now recommends that infants should sleep in the same room as their parents on their own infant sleep surface for at least 6 months and up to 1 year. This practice is called room-sharing because the child is in the same room as the parents, but should not be confused with bed-sharing which is when the child is sleeping in the parents’ bed. There is new evidence in the AAP guidelines that room-sharing, but not bed-sharing, may reduce the risk of SIDS by up to 50 percent.

Are there any safe ways to co-sleep?

Bed-sharing, also called co-sleeping, is the practice of bringing the child into the parents’ bed for sleep. The short answer is no; we have no evidence to support a safe way to co-sleep. However, in the AAP realizes that many parents may fall asleep overnight while feeding their young infants. The AAP has found that certain instances of co-sleeping are far more dangerous, such as falling asleep with your infant on a couch or armchair compared to in a bed. For this reason, it is important that parents are wakeful when feeding their babies overnight. If parents choose to feed their baby in the bed, then bed must be free of loose sheets, blankets, pillows, pillowtop mattresses or covers, and anything else that could cover the infant’s face and head. The mattress should be firm and the bed should be pulled away from the wall to prevent the child from getting stuck. Infants should then be placed in their own sleep area immediately following the feeding to reduce the risk of SIDS.  Bed-sharing with infants less than 4 months of age is particularly dangerous and is not recommended.

If you have more questions about safe sleep, you should have an open discussion with your pediatrician about your child’s sleeping arrangements.