Recommendations for a Safe Infant Sleeping Environment

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Recommendations for a Safe Infant Sleeping Environment


During 2015 Sudden Unexpected Infant Death (SUID) claimed the lives of 106 infants in the state of Louisiana. This death toll is more than 20 times the number of infants killed in car crashes in Louisiana during 2015. In October 2016, the American Academy of Pediatrics (AAP) published an updated AAP Policy Statement on “Safe Sleep” recommendations for infants younger than one year of age. The article was titled SIDS and Other Sleep-Related Infant Deaths: Updated 2016 Recommendations for a Safe Infant Sleeping Environment. This updated policy statement reflects an exhaustive review of research, literature and new evidence specific to the topics of Sudden Infant Death Syndrome (SIDS) and other causes of sleep-related Sudden Unexpected Infant Deaths (SUID).

Policy statement recommendations are now listed as A, B, and C level recommendations with A level recommendations having the strongest research/support/evidence. We recommend reading the full policy statement and the Technical Report if you have an infant, care for an infant, or are expecting a baby.

The updated policy statement recommended that infants sleep in the parent’s room close to the parent’s bed, but on a separate sleep surface designed for infants, ideally for the first year of life. The policy statement continues to support previous recommendations that infants be placed on their backs for each sleep.

Presented in the update is new evidence that couches and armchairs are extremely dangerous places for sleeping infants and that sleeping in these locations places infants at extraordinarily high risk of infant death. Evidence now suggests that it is less hazardous to fall asleep with an infant in the adult bed than on a sofa or armchair. The publication cautions, however that “A large percentage of infants who die of SIDS are found with their head covered by bedding. Therefore, no pillows, sheets, blankets, or any other items that could obstruct infant breathing or cause overheating should be in the bed”.

Several circumstances that may substantially increase the risk for SIDS or unintentional injury or death while bed-sharing are cited.

Parents should be vigilant and avoid falling asleep when:

• Bed-sharing with a term normal weight infant younger than four months

• Bed-sharing with a pre-term or low birth weight infant

• Bed-sharing with a current smoker

• Bed-sharing with a mother who smoked during pregnancy

• Bed-sharing with someone who is impaired in his or her alertness or ability to arouse because of fatigue or use of sedating medications or substances

• Bed-sharing with anyone who is not the infant’s parent including non-parental caregivers and other children

• Bed sharing on a soft surface, such as a waterbed, old mattress, sofa, couch or armchair

• Bed-sharing with soft bedding accessories, such as pillows or blankets

The safety and benefits of co-bedding for twins and higher order multiples has not been established. It is prudent to provide separate sleep surfaces and avoid co-bedding the infants.

Among the important takeaways from this AAP Infant Safe Sleep policy update is that some infant sleep environments seem to pose significantly more risk than others. This new information is not intended to encourage us to “normalize” risk that can be avoided. Best practice is still to place infants to sleep alone, on their back in a crib, bassinet or portable play yard. Sleeping in the same bed with your infant is risky. The risks involved in sleeping with an infant in an adult bed unfortunately can only be modified, not eliminated.

Please Note: This blog post does not represent a complete review of the current AAP Policy Statement and Recommendations. The 2016 AAP Policy Statement update includes many other recommendations on Safe Sleep Environments for infants.

About Karen Ahmad, RN

Karen Ahmad is the Injury Prevention Coordinator for Our Lady of the Lake Children’s Hospital and Alliance Safety Council.

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