Many Crib Deaths are Preventable–Here’s How (Pedcast)

Introduction

Doc Smo here with another edition of Portable Practical Pediatrics. I don’t know how I let this one slip by me but apparently I missed the fact that experts at the AAP put out new updated Safe Sleep Guidelines in 2016 based on the latest studies. These guidelines provide parents and pediatricians with practical dos and don’ts with regards to preventing the most common cause of death in children under a year of age, SIDS and SUIDS, previously known as Crib Death. In my mind, nothing could be more important when it comes to child health than doing everything we possibly can to prevent an infant death and the devastation that those events impose on their families. I’ve done posts on this topic before and… it looks its time for an update.  So if you are a parent, a grandparent, a daycare worker, a babysitter, a healthcare worker, or anyone who is involved in caring for babies under a year of age, listen carefully while I highlight what is new in the evolving science of “Safe Sleep for Babies”.

Musical Introduction

Recommendations that Have Not Changed

First let’s start with what has not changed in these latest guidelines. Infants, when left unattended, are still recommended to be put to sleep exclusively flat on their backs, every time, on a firm to hard surface, dressed to avoid overheating, without any loose bedding or toys around them. That means no bumper pads, pillows, loose blankets, toys, or lovies… anything that could possibly get near their faces.  If they are in a crib, the slats should be no more than 2 3/8″ apart with a government-approved mattress. Babies should sleep in their parent’s room, but not in their beds, until they are at least 6 months of age. There should not be near anyone who is smoking, drinking alcohol, or using illegal drugs.  The temperature of the room should be comfortable but specifics temperatures in these guidelines have been avoided. Previous guidelines recommended 68-72 degrees. The child should have no more than 1 extra layer of clothing than their parents are wearing to avoid overheating the baby.   If the child will fall asleep with a paci, this is encouraged. Breastfeeding and routine immunizations should be given. Infants should be left solely on their backs when unattended, on a level firm surface, not on their sides or in devices like car seats, bouncers, wedges, Boppie pillows, swings, or any other kind of device.

Now for What’s New in the 2016 Guidelines

Now let’s examine some issues that the 2016 guidelines clarified and expanded on from their previous statements based on the latest information.

–Bedside sleepers, attached to the side of the parent’s bed can be considered if they conform to the Consumer Product Safety Commission standards. A link to this site is provided in the show notes.

–In the bed sleep devices are not currently recommended since no standards have been developed for them yet.

–Infants are encouraged to sleep in a parent’s room until 1 year, up from 6 months that was previously recommended.

–The use of cardiorespiratory devices that measure oxygen saturation, breathing, and heart rate are not encouraged since they have not been found to be useful in preventing SIDS or sudden unexpected infant deaths.

–Swaddling a baby tightly in a blanket is neither encouraged nor discouraged but the report does emphasize and warn that when an infant begins to show signs of rolling, swaddling should cease because if an infant rolls over in the swaddled position, they can suffocate. The great debate about whether to swaddle with the arms in or out that got so much attention a few years ago…they now say there is no evidence that one way or the other is safer.

Absolute No No’s

These most recent guidelines that I am summarizing reiterates and emphasizes some extremely important rules for parents to adhere to:

–Infants should never sleep on a surface with a sleeping adult. That means falling asleep with an infant sleeping on or near a parent on a couch, chair, bed, etc. This is extremely dangerous. Smothering can easily happen in this situation.

–Infants should never fall asleep and be left unattended on an adult bed, couch, waterbed, old mattress, or armchair. None of these are safe sleep surfaces because of many of the reasons we have already discussed.

–While all bed sharing is to be avoided, bed sharing with infants less than 4 months of age, with a current smoker, with an impaired adult, with an adult who is not related to the child, or with other children has been found to be particularly dangerous.

Conclusion and Outro

Let me conclude this pedcast by noting that, while following the latest guidelines is not a guarantee that something terrible couldn’t happen, it is the best way we have in 2019 of preventing either SIDS or SIUD.  If you are charged with caring for an infant, please, go over these guidelines until you are very familiar with them and try and live them to the best you can. Every child is a gift to be cherished. Let’s get them all off to a healthy start.

Thanks

Many thanks to Dr. Monica Miller and Dr. Charlotte Rouchouze for their editorial comments in the production of this pedcast. Thanks to Ella Davis for her voice introduction.

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