Since the American Academy of Pediatrics (AAP) recommended all babies should be placed on their backs to sleep in 1992, deaths from Sudden Infant Death Syndrome (SIDS) have declined dramatically. But sleep-related deaths from other causes, including suffocation, entrapment, and asphyxia, have increased.

In an updated policy statement and technical report, the AAP is expanding its guidelines on safe sleep for babies, with additional information for parents on creating a safe environment for their babies to sleep.

"We have tried to make it easier for parents and providers to understand the recommendations by providing specific answers to common questions," said Rachel Moon, MD, FAAP, chair of the AAP SIDS task force and lead author of the new guidelines. "As a health care community, we need to do a better job translating what the research identifies as ‘best practices’ into the day-to-day practice of caring for infants in both the hospital and home environment."

The policy statement, "SIDS and Other Sleep-Related Infant Deaths: Expansion of Recommendations for a Safe Infant Sleeping Environment," and an accompanying technical report, was released Tuesday, October 18, at the AAP National Conference & Exhibition in Boston and published in the November issue of Pediatrics.

The policy statement and technical report provide global recommendations for education and safety related to SIDS risk reduction. In addition, the AAP is providing recommendations on a safe sleeping environment that can reduce the risk of all sleep-related infant deaths, including SIDS. Three important additions to the recommendations include:
• Breastfeeding is recommended and is associated with a reduced risk of SIDS.
• Infants should be immunized. Evidence suggests that immunization reduces the risk of SIDS by 50%.
• Bumper pads should not be used in cribs. There is no evidence that bumper pads prevent injuries, and there is a potential risk of suffocation, strangulation, or entrapment.

“It is important for health care professionals, staff in newborn nurseries and neonatal intensive care units, and child care providers to endorse the recommended ways to reduce the risk of SIDS and other sleep-related deaths, starting at birth," Moon said. "There needs to be more education for health care providers and trainees on how to prevent suffocation deaths and to reduce SIDS and other sleep-related infant deaths—our goal is to ultimately eliminate these deaths completely."

The report also includes the following recommendations:
• Always place your baby on his or her back for every sleep time.
• Always use a firm sleep surface. Car seats and other sitting devices are not recommended for routine sleep.
• The baby should sleep in the same room as the parents, but not in the same bed (room-sharing without bed-sharing).
• Keep soft objects or loose bedding out of the crib. This includes pillows, blankets, and bumper pads.
• Wedges and positioners should not be used.
• Pregnant woman should receive regular prenatal care.
• Don’t smoke during pregnancy or after birth.
• Breastfeeding is recommended.
• Offer a pacifier at nap time and bedtime.
• Avoid covering the infant’s head or overheating.
• Do not use home monitors or commercial devices marketed to reduce the risk of SIDS.
• Infants should receive all recommended vaccinations.
• Supervised, awake tummy time is recommended daily to facilitate development and minimize the occurrence of positional plagiocephaly.