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The American Academy of Pediatrics has updated its safe-sleep guidelines for infants for the first time in more than five years, emphasizing that babies should sleep on their backs on flat, level surfaces to reduce their risk of Sudden Unexpected Infant Death Syndrome (SIDS).

It’s estimated that there are 3,500 sleep-related infant deaths in the United States each year. Many of those deaths are preventable, and the authors of the new guidelines are urging parents to take simple steps to help keep their children safe. 

“The best way to protect your baby while they are asleep is to follow these guidelines,” said UVA Children’s Rachel Moon, MD, the lead author of the new guidelines, which come from the AAP’s Task Force on Sudden Infant Death Syndrome and the AAP’s Committee on Fetus and Newborn. “When you place your baby for sleep, they should be on their back in a crib, portable crib or bassinet that meets Consumer Product Safety Commission standards, and there should be nothing but the baby in the crib.”

Keeping Babies Safe

The United States made great progress in preventing infant deaths during the 1990s, after a public-education campaign urged parents to put their babies to sleep on their backs. But the decline in deaths has been stalled for more than 20 years. Safe-sleep experts say more can be done, and hope the new guidelines spur fresh action.

The recommendations, published online today in the scientific journal Pediatrics, include: 

• Babies should sleep on their back on a firm, flat, non-inclined surface free of soft goods, such as blankets and toys. These items, while appealing to many parents, can pose suffocation hazards.
• The sleep surface should, at minimum, comply with all federal safety standards. 
• Any inclined surfaces, including car seats, strollers, infant carriers and infant slings, should be avoided for routine sleeping, especially for infants younger than 4 months. 
• Swaddling has not been shown to reduce the risk of SIDS. If babies are swaddled, they should always be placed on their back. Weighted swaddles or weighted objects within swaddles are unsafe. Swaddling should be stopped when a baby starts trying to roll over, usually at 3 or 4 months or earlier, as the swaddle can pose a suffocation hazard.
• Parents should avoid devices marketed to reduce the risk of SIDS or other sleep-related deaths. There is no evidence for such claims, and they may lull parents into a false sense of security. 
• While there is no contraindication to using home cardiorespiratory monitors or wearable monitors, there is no evidence that using them will prevent SIDS. Families who decide to use these monitors should still follow the safe sleep guidelines.
• Parents should sleep in the same room as baby, but not in the same bed.

Other recommendations include breastfeeding, when possible; any breast milk, experts say, is better than none. Both breastfeeding and pacifier use are associated with reduced risk of SIDS. Parents should also avoid using drugs and alcohol or exposing babies to drugs and alcohol. 

In addition, parents are advised that awake “tummy time” is important to facilitate infant development. Babies should not be left to sleep on their stomachs, however.

“These recommendations are consistent with prior guidelines, with some updates based on new information. We want to reach new parents, grandparents and other infant caregivers so that everyone is aware about how best to keep their baby safe,” said UVA Health’s Fern Hauck, MD, MS, a member of the AAP’s Task Force on SIDS. “We also want parents to know that it is important to speak to your baby’s doctor about the guidelines and have an open discussion so that you can share your thoughts and make the best choices in caring for your baby.”

About the Safe-Sleep Guidelines

A full list of the AAP’s safe-sleep recommendations is available online. The guidelines are accompanied by a technical report that details the evidence used in developing the recommendations.

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