Updated recommendations aimed at keeping infants safe from SIDS
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* Sabrina Halberg

Sleep-related deaths kill thousands of babies annually without a clear cause, but there are new ways to reduce infants’ risk by providing a safe sleep environment, according to new recommendations.

“SIDS and Other Sleep-Related Infant Deaths: Updated 2016 Recommendations for a Safe Infant Sleeping Environment,” a new policy statement released Oct. 24 by the American Academy of Pediatrics, covers new research and preventive measures that can help reduce sleep-related risks to infants.

Sleep-related deaths, including sudden infant death syndrome, account for about 3,500 child deaths annually, according to the Centers for Disease Control and Prevention. SIDS is the sudden death of an infant less than 1 year old for reasons that remain undetermined. Rates of SIDS deaths have decreased substantially since the 1990s, thanks to the national Back to Sleep campaign, but in recent years they have remained generally stagnant.

The new AAP policy statement and accompanying technical report provide protective measures parents can take without too much difficulty.

“There’s a lot of people feeling like, ‘This will never happen to me…this only happens to parents who don’t pay attention to their babies,’” said Rachel Moon, MD, lead author of the report and professor at the University of Virginia. “And there are a lot of influences that tell parents they don’t have to (follow recommendations).”

Most important, the report noted, is the recommendation to always place babies on their backs on a firm surface, such as a crib or bassinet with a tight-fitting sheet. New evidence also supports parents restricting infants from sleeping on soft surfaces, breastfeeding when possible and sleeping in the same room, but not the same bed, as the infant to reduce SIDS risks, Moon told The Nation’s Health.

A common problem is that parents fall asleep on soft surfaces, such as couches and armchairs, with their baby, which can increase an infant’s risk of SIDS. About 25 percent of mothers said that they had fallen asleep while breastfeeding their baby at night while on a soft surface, the report showed.

A baby that falls asleep on a soft surface is at a high risk of suffocation, entrapment or having parents lie on top of them, if they are sharing the surface. Planning ahead and being careful about not falling asleep on couches or other soft surfaces, as well as clearing the bed if there is any risk of falling asleep while feeding or snuggling the baby, can significantly reduce an infant’s risk, the report noted.

“We have parents who come home from work and want to snuggle with the baby on the couch and they all fall asleep and that is extremely dangerous,” Moon said.

Breastfeeding is a protective measure against SIDS as it can help the infant respond and awaken, according to the report. The benefits are increased when an infant is exclusively breastfed, but any breastfeeding is better than none. The German Sudden Infant Death Syndrome Study Group, cited in the report, found that exclusively breastfeeding a baby for the first month of life can cut the risk of SIDS in half. Breastfed infants were found to be better able to arouse from sleep than infants fed formula, making them less vulnerable to possible SIDS causes, including body systems’ failure to respond.

Parents are also advised to roomshare, but not bed-share, with their infants, ideally for the infants’ first year. A baby’s risk of SIDS can be decreased by as much as 50 percent if the infant and the caretaker share a room. Sharing a room lowers a baby’s risk of suffocating on something in the bed and allows parents’ to monitor and care for the baby, which in turn lowers their risk of dying from SIDS. Doing so for the first six months is most essential, because sleep-related death risks are highest during that time.

About 46 percent of parents reported sharing a bed with their baby of eight months or younger less in the last two weeks, according to a JAMA Pediatrics 2001-2010 national survey. But up until a child is 12 months old, bed-sharing can increase the risk of a parent rolling onto the child and suffocating her or him. Bed-sharing has also been connected to other risk factors of SIDS, including soft bedding, head-covering and exposure to tobacco smoke, according to the report.

To continue reducing the rates of SIDS and other sleep-related deaths, a shift in behavioral norms is necessary.

“The reason why parents do what they do is because they’re desperate,” Moon said. “You don’t have parents in other developed countries that go back to work when the babies six weeks old or eight weeks old.”

The academy recommends educating health care providers and staff in intensive care units and nurseries on how to screen for and inform parents on safe sleep practices in an open, judgment free-way. Health professionals, media and advertising need to spread the same message and social support for families is needed in order to start a sea change in sleep practices.

For a copy of the report and policy statement, visit [www.aap.org](http://www.aap.org).

*   Copyright The Nation’s Health, American Public Health Association