AAP urges parents to make sure the baby sleeps on a flat – not inclined - surface during sleep and strongly discourages bedsharing
The American Academy of Pediatrics emphasizes the need for infants to sleep on their backs on flat noninclined surfaces without soft bedding and details the risks of bed-sharing under various scenarios within its first update to safe infant sleep recommendations since 2016.
The policy statement promotes human milk feeding and tummy time, and also addresses questions about popular products such as home cardiorespiratory monitors, which are not recommended as a strategy to prevent sudden infant death syndrome.
The policy statement, “Sleep-Related Infant Deaths: Updated 2022 Recommendations for Reducing Infant Deaths in the Sleep Environment,” will be published in the July 2022 Pediatrics. The statement is accompanied by a technical report that provides the evidence base for updated recommendations, which apply to children up to 1 year old. The policy statement and technical report will be published online June 21.
“We’ve made great strides in learning what keeps infants safe during sleep but much work still needs to be done,” said Rachel Moon, MD, FAAP, lead author of the statement and technical report, generated by the AAP Task Force on Sudden Infant Death Syndrome and the AAP Committee on Fetus and Newborn.
“A baby’s death is tragic, heartbreaking and often preventable. If we’ve learned anything, it’s that simple is best: babies should always sleep in a crib or bassinet, on their back, without soft toys, pillows, blankets or other bedding,” said Dr. Moon, professor of pediatrics at the University of Virginia School of Medicine.
Approximately 3,500 infants die from sleep-related infant deaths annually in the United States. Research indicates that sleep-related death can occur when an infant with an intrinsic vulnerability to SIDS is placed in an unsafe sleep environment. The annual number of deaths has remained about the same since 2000 following a substantial decline in deaths in the 1990s as the result of a national educational campaign to put babies on their backs to sleep.
While overall numbers of deaths have declined, persistent racial and ethnic disparities exist that reflect broader societal inequities, according to research. The rate of sudden unexpected infant deaths (SUIDs) among Black and American Indian/Alaska Native infants was more than double and almost triple, respectively, that of white infants (85 per 100 000 live births) in 2010-2013.
“It’s essential for families and pediatricians to partner with each other, to build trust and have thoughtful conversations about how to keep children safe by lowering risks,” said Rebecca Carlin, MD, FAAP, who co-authored the statement and technical report. “We know that many parents choose to share a bed with a child, for instance, perhaps to help with breastfeeding or because of a cultural preference or a belief that it is safe.
The evidence is clear that this significantly raises the risk of a baby’s injury or death, however, and for that reason AAP cannot support bed-sharing under any circumstances.”
The risks of sleep-related infant deaths are up to 67 times higher when sleeping with someone on a couch or soft armchair or cushion; and 10 times higher when sleeping with someone who is impaired because of fatigue or use of sedating medications or substances such as alcohol or illicit drugs; or is a smoker. Risks of sleeping on the same surface with someone else also increase 5-10 times when an infant is under four months of age; is sharing the surface with someone other than a parent; or is a pre-term or low-birthweight, regardless of other factors.
To reduce the risk of sleep-related infant death, the AAP recommends:
The new federal Safe Sleep for Babies Act will help get rid of potentially dangerous baby sleep products such as inclined sleepers, in-bed sleepers, loungers, and travel/compact sleepers by mid-2022.
“Parents might think that their infant is waking up too much during the night and fear that something is wrong,” Dr. Moon said. “But babies by their nature wake up frequently during the night. Although this can be understandably frustrating for parents who are exhausted and losing out on their own sleep, babies have to wake to feed every 2-3 hours, so this is normal and healthy, and should be expected. When parents have questions about their infant’s sleep, they should always ask their pediatrician for guidance.”
HealthyChildren.org offers additional resources for parents that can be shared by media outlets with a link or excerpt that includes attribution to AAP:
The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults.