On June 21, 2022, The American Academy of Pediatrics (AAP) released updated recommendations for infant sleep with the goal of providing safe sleep recommendations to lower the risk of sudden infant death syndrome (SIDS) for kids up to age one. SIDS is the cause of death of approximately 3,500 infants in the U.S. every year. This new policy is the first since 2016 and examined evidence from nearly 160 scientific studies since 2015.
You may recall, in recent weeks, some researchers claimed to have found a biomarker enzyme that could predict which infants were more at risk of SIDS. They claimed "to have found out the "cause" of SIDS." However, the study is extremely preliminary and has no scientific data to back this up yet and unfortunately, it only gives false hope and excuses or justifies unsafe behavior. AAP's timely release of their new policy helps clarify and set the record straight. Parents should continue to follow the AAP's safe sleep guidelines.
AAP's Safe Sleep report is a bit detailed and overwhelming to read through so as a Certified Pediatric Sleep Consultant and Certified Safe Sleep Ambassador, I want to make sure the data is understandable and easy to follow. I've broken it down for you below.
THE AAP's RECOMMENDATIONS:
The AAP still follows ABCs of Safe Sleep meaning baby should sleep Alone, on their Back, in the Crib. The policy Sleep-Related Infant Deaths: Updated 2022 Recommendations for Reducing Infant Deaths in the Sleep Environment is available to the public here.
Here are some highlights from the report broken down for you.
Here's what you need to know:
Room Location/Sharing
AAP Says: Parent(s) and infant sleeping in the same room on separate surfaces designed for infants, ideally for at least the first six months.
What you need to know: Room sharing for the first 6 months as it greatly reduces the risk of SIDS. This recommendation was previously 12 months, but was shortened as 90% of SIDS happens in the 1st 6 months. SIDS risk peaks between 1 and 4 months of age and is uncommon after 8 months of age.
Sleep Surfaces
AAP says: Baby should sleep in a crib, bassinet, portable crib or play yard on a flat, non-inclined sleep surface with a firm, tightly fitting mattress. The mattress should be covered by a fitted sheet with no other bedding or soft objects.
What you need to know: AAP still recommends ABCs of Safe Sleep. No real big change here except AAP took a stronger stance against inclined sleep surfaces. Baby should sleep on a flat, firm surface. Sleep surfaces that have more than 10 degree incline are unsafe for infant sleep as it may encourage the infant to roll. Look for sleeping surfaces that are Consumer Product Safety Commission (CPSC)-approved. If you push on the surface and it leaves an indentation or has give to your hand, it is too soft and not safe. The Safe Sleep for Babies Act of 2021, signed into law May 16, bans the manufacture and sale of crib bumpers or inclined sleepers.
Bed-sharing/Co-sleeping
AAP says: Defined as: Parent(s) and infant sleeping together on any surface (bed, couch, chair). Although the AAP cannot recommend bed-sharing based on the evidence, it also respects that many parents choose to bed-share routinely for a variety of reasons. The AAP strongly recommends that infants never be placed for sleep, with or without another person, on a couch, sofa, armchair and similar cushioned surfaces because of the great (up to 67 times greater) risk of SIDS.
What you need to know: While AAP understands some families have personal reasons to bed-share, they do not recommend it as a safe sleep practice. As the term is often incorrectly used interchangeably with cosleeping or room-sharing, the AAP now prefers the term “surface sharing” instead of "bed-sharing." While bed-sharing and co-sleeping may increase the risk of SIDS, if bed-sharing is important to you, talk to your pediatrician to ensure it is done as safely as possible. If babies were born pre-term or with a low birth weight, co-sleeping may increase their risk of SIDS. While skin to skin is important, it is critical that the caregiver is fully awake and alert and exhibiting absolutely no sign of drowsiness.
Infant Sleep Position
AAP says: Caregivers should follow ABCs of Safe Sleep or the previous campaign of "Back to Sleep." Babies should be placed on their back for every sleep until they reach 1 year of age. Babies should not be placed on their side or tummy for sleep, even for short naps.
What you need to know: Infants should be placed on their back for every sleep until age 1. Infants who can roll from supine (back) to prone (belly) and from prone to supine can be allowed to remain on their belly to sleep.
Bedding
AAP Says: Do not place any soft objects, including pillows, blankets or bumper pads, in the infant’s sleep environment.
What you need to know: Baby should sleep Alone, on their Back, in the Crib. This includes mobiles or wedges. Nothing should be in the crib with baby except a flat, firm mattress and fitted sheet. Parents and caregivers concerned their child will get stuck in the crib rail should not use bumpers, but a swaddle or sleep sack is recommended. Remember, safety over aesthetics. As FTMs we often look to Pinterest for Instagramable nurseries and don't know or even see images of safety. A good colleague and fellow certified sleep consultant, Lucia recently wrote an informative piece about safe sleep environments.
Weighted Sleepers
AAP Says: It is recommended that weighted blankets, weighted sleepers, weighted swaddles, or other weighted objects not be placed on or near the sleeping infant.
What you need to know: Nested Bean has a weighted sleep sack and is not considered safe. Merlin Suit is not a weighted sleep sack and contains no weighted material (despite it looking like the Stay-Puft Marshmallow Man) and is safe to continue to use. Wearable blankets or sleep sacks also can be used.
Swaddle & Swaddle Usage
AAP Says: Weighted swaddle clothing or weighted objects within swaddles are not safe and therefore not recommended. When an infant exhibits signs of attempting to roll (which usually occurs at 3–4 months, but may occur earlier), swaddling is no longer appropriate because it could increase the risk of suffocation if the swaddled infant rolls to the prone position.
What you need to know: While swaddling is a useful and safe tool to help newborns sleep and decrease the Moro Reflex, there is no evidence that swaddling reduces the risk of SIDS. There is a high risk of death if an infant rolls onto their stomach while swaddled. Therefore, swaddled infants should always be placed on their back, but when an infant starts exhibit signs of attempting to roll, swaddling should no longer be used. Many used to follow the old guidance of Dr. Rachel Moon, an internationally recognized expert on infant sleep and SIDS as well as a member of the AAP, who recommended swaddling stop at 8 weeks. AAP's official stance is now to stop swaddling when baby shows signs of attempting to roll, typically by 3-4 months.
Overheating and Hats
AAP Says: Given the questionable benefit of hat use for the prevention of hypothermia and the risk of overheating, it is advised not to place hats on infants when indoors except in the first hours of life or in the NICU.
What you need to know: Don't use a hat on your baby once you come home from the hospital. A warmer room temperature and too many layers with excessive clothing may be tied to SIDS. Best to keep the room 68-72 degrees Fahrenheit and it is best to dress baby in only one more layer than what an adult is wearing. Another risk is that the hat may slide down and cover the mouth or nose blocking the airway. Families concerned that their infant will be cold should add layers of clothing to the body, not head, as this reduces the risk of head covering or entrapment.
Pacifiers
AAP Says: Pacifier use is associated with a reduced risk of SIDS.
What you need to know: Pacifier usage at bedtime and naptime may reduce SIDS by 50%-90%. If the pacifier falls out, there is no need to reinsert it for the child. In fact, this only creates sleep dependencies (or sleep associations). For infants who are not directly breastfed, pacifiers can be introduced at any time. For breastfed infants, the pacifier can be started once breastfeeding is firmly established and the milk supply is sufficient.
Monitoring Devices like Owlet
AAP Says: Home cardiorespiratory monitors should not be used to reduce the risk of SIDS.
What you need to know: Wearable heart rate and pulse oximetry monitoring devices such as the Owlet sold to consumers are not Food and Drug Administration (FDA) approved "medical devices" but rather labeled as "wellness devices." Such devices should not be used at home as a way to prevent SIDS. They are defined as devices intended “for maintaining or encouraging a healthy lifestyle and … unrelated to the diagnosis, cure, mitigation, prevention, or treatment of a disease or condition.” Although use of these monitors may give parents peace, they may get a false sense of security or a get a false alarm. There is no contraindication to using these monitors and data supporting their use to prevent sudden and unexpected death are lacking. There is also concern that use of these monitors will lead to parent complacency and decreased adherence to safe sleep guidelines. Parents who use these monitors at home still should follow safe sleep recommendations.
Tummy Time
AAP Says: Supervised tummy time should start soon after hospital discharge and increase slowly to at least 15-30 minutes total daily by 7 weeks of age.
What you need to know: Tummy time helps strengthen head, neck, shoulder, and back muscles. Supervised, awake tummy time is recommended to help reduce a "flat head" or torticollis.
Other Recommendations:
Babies with Reflux -The supine (laying on the back, face up) sleep position on a flat, non-inclined surface does not increase the risk of choking and aspiration in infants and is recommended for every sleep, even for infants with gastroesophageal reflux (GER).
What you need to know: Reflux is a very common scapegoat and often "improves" after sleep training. If baby has reflux, burp baby when you switch breasts and 3/4 of the way into the second breast, or 3/4 of the way through a bottle and again at the end. Best to keep baby upright for 15-20 minutes after a feed to aid in digestion as well. Reflux should not be used as an excuse for baby to sleep on an incline.
Media and Entertainment
AAP Says: It is advised that media and manufacturers follow safe sleep guidelines in their messaging, advertising, production, and sales to promote safe sleep practices as the social norm.
What you need to know: Don't believe everything you see on TV or on social media. Media often sacrifices and depicts unsafe sleep for the sake of a cute photo. Can you spot all four unsafe sleep practices in this clip from NBC's THIS IS US?
Smoke/Nicotine/Alcohol Exposure
AAP says: Avoid smoke and nicotine exposure during pregnancy and after birth. Avoid alcohol, marijuana, opioids, and illicit drug use during pregnancy and after birth.
What you need to know: If you are breastfeeding, talk to a lactation specialist or your doctor about drinking alcohol. If you're not breastfeeding, you can resume drinking small amounts of alcohol. If it inhibits your ability to care for your child, it is too much.
As a certified safe sleep ambassador, certified through Safe Sleep Academy and having received my sleep training certification through The Center for Pediatric Sleep Management, I am passionate about practicing safe sleep and a critical part of achieving healthy sleep habits begins with safe sleep environments. If you have any questions or concerns about what is considered safe sleep, please email us.
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