Among the biggest changes: Pacifiers are now recommended at nap time and bedtime throughout the first year of life; bed sharing is not recommended during sleep, but close sleeping arrangements are; and side sleeping is no longer recognized as a reasonable alternative to the back sleep position.
SIDS is defined as the sudden death of an infant under 1 year of age, which remains unexplained after an autopsy and death scene investigation. Despite major decreases in the occurrence of SIDS over the past 10 years, it's still the leading cause of infant deaths in the United States.
The AAP recommendations, which are an update to their 2000 statement, come amid new research, including several studies that have shown a protective effect of pacifiers on the incidence of SIDS. Although the reason is unclear, several theories, such as they help to keep babies from sleeping too deeply, have emerged. The AAP encourages pacifier use at nap time and bedtime, but says if an infant refuses the pacifier, it should not be forced. Also, if the pacifier falls out of the baby's mouth, parents should not try to reinsert it.
Among the other research: There is growing evidence that room sharing (infant sleeping in a crib in parents' bedroom) is associated with a reduced risk of SIDS. So the AAP now says that infants can be brought into bed for nursing or comforting, but should be returned to their own crib or bassinet when it's time to sleep-preferably near where the parents sleep.
Also, studies have found that the side sleep position is unstable and increases the chance of the infant rolling onto his or her stomach. So every caregiver should put a baby down on his back during every sleep period, the AAP says.
The occurrence of SIDS is rare during the first month of life, increases to a peak between 2 and 3 months of age, and then decreases, according to the AAP. Risk factors for SIDS include lying on stomach sleep position, sleeping on a soft surface, maternal smoking during pregnancy, overheating, late or no prenatal care, young maternal age, preterm birth and/or low birth weight, and male gender.
Other key recommendations of the AAP's new policy:
- Use a firm sleep surface: A firm crib mattress, covered by a sheet, is the recommended sleeping surface.
- Keep soft objects and loose bedding out of the crib. Pillows, quilts, comforters, sheepskins, stuffed toys, and other soft objects should be kept out of the crib.
- Do not smoke during pregnancy. Also avoid an infant's exposure to second-hand smoke.
- Avoid overheating. The infant should be lightly clothed for sleep, and the bedroom temperature should be kept comfortable for a lightly clothed adult.
- Avoid commercial devices marketed to reduce the risk of SIDS. None have been tested sufficiently to show efficacy or safety.
- Do not use home monitors as a strategy to reduce the risk of SIDS. There is no evidence that use of such monitors decreases the incidence of SIDS.
- Avoid development of positional plagiocephaly (flat back of head) by encouraging "tummy time" and placing the infant to sleep with the head to one side for a week and then changing to the other.
- Assure that others caring for the infant (child care provider, relative, friend, babysitter) are aware of these recommendations.
The AAP promotes a policy of breastfeeding until at least their baby's first birthday, so in order to further support this goal, the AAP recommends that pacifier introduction for breastfed infants be delayed until one month of age.
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