Safe Sleep

by Brandy Gheesling, CLC, IBCLC, MD, FAAP

As I prepare for the arrival of my third child, I have been busy getting everything together for the nursery.  There are so many different gadgets and sleeping devices available, so I thought it would be a good time to review what the American Academy of Pediatrics (AAP) currently recommends for safe sleep.  

Sudden Infant Death Syndrome (SIDS) is the unexplained death of a seemingly healthy baby less than 1 year of age that usually occurs while they are sleeping.  Sadly, per the AAP Policy Statement on SIDS published in 2016, “Approximately 3,500 infants die annually in the US from sleep-related deaths, including SIDS and accidental suffocation and strangulation in bed.”   

The AAP recommends always putting your baby on its back in its own bed.  Their bed should be in the parent’s room ideally for the first year of life but at least for the first 6 months.  Room sharing decreases the risk of SIDS by 50%.  Many of my patient’s parents ask me why they can’t just use a video monitor and put their baby in their own room.  And the reason is when a baby shares a room with its parents, it prevents the baby from going into the deep sleep that is associated with SIDS.  In their bed, there should only be a firm crib mattress with a fitted crib sheet.  No pillows, blankets or stuffed animals should be in the bed with them.  The AAP recommends avoiding the use of commercial sleep devices that are not consistent with safe sleep environments such as couches, recliners, swings and car seats.  It is actually better for your infant to be cold rather than hot to avoid overheating and covering their heads.  And avoid the use of wedges or positioners.   

The parent’s behaviors and health can also affect their baby’s SIDS risk.  Parents should avoid smoke exposure, alcohol, and illicit drug use during pregnancy and after birth.  Pregnant women should obtain regular and early prenatal care.  Breastfeeding is recommended and has been shown to reduce the risk of SIDS by 50% if the baby is exclusively breastfed for the first month of life.   

Pacifiers have been shown to reduce the risk of SIDS if a baby falls asleep with it in their mouth.  If the pacifier falls out of their mouth after they are asleep, it is not necessary to replace it.  Pacifiers should only be introduced to breastfed babies once breastfeeding is well established which is usually at 3-4 weeks of life. Ultimately, it is safe to sleep with a pacifier.

Vaccinating is so important as well. It is recommended that your child should be immunized in accordance with the recommendations set forth by the AAP & Centers for Disease Control (CDC).  According to a meta-analysis in the journal Vaccine, “Immunizations are associated with a halving of the risk of SIDS.”

The AAP does not recommend the use of home CPR monitors, such as the owlet, as a strategy to reduce the risk of SIDS.  Unfortunately, they have a lot of false alarms which deconditions the parents to responding when they go off.  

Supervised awake tummy time is recommended to facilitate development and has been shown to reduce the risk of SIDS.  So, make sure to put your baby on its tummy several times per day for 10-15 minutes at a time.  And yes, most babies hate it and will scream and cry, but the importance of tummy time far outweighs their discomfort.

There is no longer evidence to recommend swaddling as a strategy to reduce the risk of SIDS.   There is a risk of death if your swaddled baby rolls over to its belly, so once your baby rolls over once, please do not swaddle anymore. 

SIDS is the leading cause of death for children during their first year of life, so please follow these guidelines to reduce the risk of SIDS for your child.  Having a baby can be exhausting and can make following these guidelines hard to do.  Make a pact with your partner to follow these guidelines no matter how tired you may be in order to provide your baby with the best and safest sleep environment.

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