AAP Revises SIDS Prevention Recommendations

from Caring For Our Future, Fall 2005

By Carole Kline, MS, CPNP

Although SIDS deaths continue to decline since the “Back to Sleep” campaign was first introduced in 1994, the American Academy of Pediatrics has revised its policy statement with some relevant research findings. The revised policy statement was presented Oct.10 at the 2005 National Conference and Exhibition of the American Academy of Pediatrics.

Some important new recommendations were added since the last policy statement revision in 2000:

• The AAP no longer recognizes side-lying as a reasonable alternative to the supine position for sleep. This position was found to be unstable and can lead to the infant rolling onto his or her stomach.
• Bed-sharing is not recommended during sleep. Infants may be brought into the parent’s bed for breastfeeding or comforting, but should be returned to their own cribs or bassinets for sleep.
• Research now shows that the use of a pacifier is associated with a reduced risk of SIDS. The revised statement now includes a recommendation for the use of a pacifier for naps and at bedtime for the first year of life. For breastfed infants, the recommendation is to delay introduction of the pacifier until the infant is 1 month old to facilitate the establishment of breastfeeding.

The complete list of recommendations from the policy statement is as follows:

• Infants should be placed on their backs for sleep for every sleep period.
• A firm crib mattress, covered by a sheet, is the recommended sleeping surface.
• Keep soft objects and loose bedding out of the crib; pillows, quilts, comforters, sheepskins, stuffed toys and other soft objects should be kept out of an infant’s sleeping environment.
• Do not smoke during pregnancy. Avoiding infant exposure to secondhand smoke is advisable for numerous reasons in addition to SIDS risk.
• A separate but proximate sleeping environment is recommended such as a separate crib in the parent’s bedroom. Bed-sharing during sleep is not recommended.
• Consider offering a pacifier at naptime and bedtime. The pacifier should be used when placing an infant to sleep and should not be reinserted once the infant falls asleep.
• Avoid overheating. The infant should be lightly clothed for sleep, and the bedroom temperature should be kept comfortable for a lightly clothed adult.
• Avoid commercial devices marketed to reduce the risk of SIDS. Although various devices have been developed to maintain sleep position or reduce the risk of rebreathing, none have been tested sufficiently to show efficacy or safety.
• Do not use home monitors to reduce the risk of SIDS. There is no evidence that use of such home monitors decreases the risk of SIDS.
• Avoid development of positional plagiocehpaly (flat back of head). Encourage “tummy time.” Avoid having the infant spend excessive time in car-seat carriers and “bouncers.” Place the infant to sleep with the head to one side for a week and then change to the other.
• Assure that others caring for the infant are aware of these recommendations.

References

American Academy of Pediatrics Policy Statement , Task Force on Sudd en Infant Death Syndrome (2005). The Changing Concept of Sudden Infant Death Syndrome: Diagnostic Coding Shifts, Controversies Regarding the Sleeping Environment, and New Variables to Consider in Reducing Risk. Pediatrics. Vol. 116 No. 5 November 2005, 1245-1255.