As our understanding of safe sleep practices have been evolving over the past 30 years, I have joked that when we finally figure out what the “safest” sleep environment is for infants, it will probably turn out to be laying on a rock (hard bedding), facing the stars (on their back), with only their fingers as comfort (no toys, pillow, bumpers), with fresh air (no cigarette smoke), and a little cool breeze in their face (making overheating almost impossible), in eyesight of their mother (at the campsite). Sounds a lot like what our ancestors must have experienced who lived in relatively warm climates. Most of us are living a life very different from our tribal ancestors, but the recent guidelines set out by the AAP sound like they would like to get us as close to our roots as possible. Let me summarize the AAP’s dos and don’ts with regards to a safe sleeping environment for your infant:
-Infants should be laid on their backs (not any other position) for every sleep that is not supervised by their parents until they are 1 year old.
-Only firm bedding that conforms to safety standards should be used as a sleep surface.
-Room-sharing (without bed-sharing) is recommended for the first 6 months.
-Babies should be in a crib without bumpers, pillows, sheepskins, blanketing, or loose toys.
-Breastfeed your infant.
-Immunize your infant.
-Consider offering a pacifier to your infant.
-Avoid alcohol and illicit drugs around your baby.
-Do not expose your baby to cigarette smoke during pregnancy or after birth.
-Make sure your infant does not get overheated while sleeping
-Do not use sleep positioners, co-sleepers, or respiratory monitors in healthy babies
-Do not use crib mattresses that leave a gap between the crib and the mattress.
-Do not sleep while holding your baby, such as in your bed, a chair, or on a couch.
Well, that’s it in a nutshell. The best that science has to offer to protect your infant in the first year with regards to sleep safety. Longtime listeners of my podcast will recognize that the new recommendation for infants to sleep in their parents’ room is at odds with the advice I gave in my podcast, “Straight Talk about Sleep in Infancy.” In light of these new guidelines, I will begin recommending that sleep training for infants routinely begin at 6 months rather that the 4 months that I recommended previously. Additionally, I have recommended what I considered safe toys be placed in the cribs of older infants. I assume that an activity center tied to the crib side would be a safe toy, but I am not sure the AAP would agree. Does all sleep for the first 6 months need to be witnessed by a parent, even when it occurs during the day? To me, this is unclear from the guidelines. How about swaddling: is the risk of overheating too high to be tolerated? Every time we answer some questions, we pose more. Hopefully these new guidelines will help make SIDS (Sudden Infant Death) and SUIDS (Sudden Unexpected Infant Death) a thing of the past. We can hope.
1. SIDS and Other Sleep-Related Infant Deaths: Expansion of Recommendations for a Safe Infant Sleeping Environment
2. The Changing Concept of Sudden Infant Death Syndrome: Diagnostic Coding Shifts, Controversies Regarding the Sleeping Environment, and New Variables to Consider in Reducing Risk — Task Force on Sudden Infant Death Syndrome 116 (5): 1245 — AAP Policy