Safety and Injuries
> SIDS prevention
A summary from the AAP's October 2016 Recommendations for Safer Sleep
All recommendations are for babies from birth through 1 year of age.
- Infants should be placed on their back for every sleep by every caregiver. Back to sleep has been the catchy phrase for years. Side sleeping is not safe and is not advised. Stomach sleeping is especially dangerous. Once a baby can roll, there is no way to keep him or her on the back, but there should be no soft or loose bedding.
- Infants should be placed on a firm sleep surface, such as a mattress in a safety-approved crib, covered by a fitted sheet with no other bedding or soft objects. Safe cribs have no more than 2 3/8 inches between slats, a firm mattress that fits snugly, and no drop side.
- The infant’s crib, portable crib, play yard, or bassinet should be placed in the parents’ bedroom until the child’s first birthday, based on evidence that sleeping in the parents’ room – but on a separate surface – decreases the risk of SIDS by as much as 50%. (Note: This point is being debated among pediatricians, many of whom think the data is misrepresented and others who simply think that if kids sleep in a parent's room for a year, they will never leave.)
- Bedside sleepers attach to the parent's bed and can be safely used if the safety standards are followed.
- There is no evidence that special crib mattresses and sleep surfaces that claim to reduce the chance of rebreathing carbon dioxide when the infant is in the prone position reduce the risk of SIDS. Do not use standard matresses or beds with portable bed rails - these are dangerous for infants.
- Keep the sleep area free of hazards, such as dangling cords, window coverings, and electric cords.
- Sitting devices are not safe for sleep. This includes car seats, strollers, infant carriers, and infant slings. If a baby is in any of these devices, he or she should always be strapped in and monitored.
- Couches and armchairs are dangerous places for infant sleep. They can become trapped or wedged between the seat cushions or fall to the floor.
- Soft objects and loose bedding should be kept away from all infants during sleep. Pillows and soft toys, stuffed animals, quilts, comforters, sheepskins, and loose bedding can suffocate a baby and increase the risk of SIDS. No pillows, stuffed animals, or blankets are safe until after the first birthday. Do not use bumper pads. Wearable blankets ("potato sack" sleepers) are preferable to loose blankets. Avoid head coverings because they can come down over baby's face.
- A pacifier should be used when putting an infant to sleep. Studies have shown pacifiers decrease the risk of SIDS, even if the pacifier falls out while the infant is sleeping. Do not use pacifiers that attach to clothing while putting baby to sleep due to risk of strangulation. Of course if your baby will not take a pacifier, it cannot be enforced, but you can offer it intermittently. Some newborns who refuse them will take them eagerly as they get older.
- Avoid overheating and head coverings in infants. If baby wakes sweaty, remove layers of clothing or decrease the temperature in the room. Overheating may increase the risk of SIDS. A general guide is that infants should be dressed with no more than 1 additional layer than what an adult would wear in the same environment.
- Do not use devices that claim to reduce SIDS risk, including wedges and positioners.
- Supervise baby on his or her stomach several times each day and play together. Tummy time helps with baby's development and can help prevent the development of a flat head (plagiocephaly). You can begin this during the first days after birth and increase the amount of tummy time as baby gets stronger and tolerates more.
- If infants are swaddled, they should be positioned on their back, with the swaddling snug against the chest but sufficient room around the hips and knees to allow leg movement. When baby starts trying to roll, stop swaddling.
- Breastfeeding is associated with a decreased risk of SIDS. If possible, breastfeeding or providing expressed breast milk is encouraged.
- Smoke exposure increases the risk of SIDS. This includes maternal smoking during pregnancy and smoke in baby's environment after birth. Have a smoke-free home and car, since even if not currently smoking, the smoke particles remain in an area. Change clothing when holding baby after smoking.
- Immunizations have been shown to decrease the risk of SIDS. Vaccinate on time.
- Home cardiorespiratory monitors have not been shown to decrease the risk of SIDS. This includes state-of-the-art hospital-grade monitors, so the ones marketed to parents are not recommended.
- It is recognized that many parents fall asleep with their babies, whether intentionally or due to sleep deprivation while feeding. If you bedshare, precautions must be followed. Ongoing studies are being done to evaluate safest means, but to date there is limited data so specific guidelines are lacking. It is known that the longer an infant is in the same sleep area, the more risk, so the infant should be placed back on a separate sleep surface on his/her back as soon as the parent wakes. Bedsharing is especially dangerous under the following circumstances and should be avoided at all times:
- Infant under 4 months
- Preterm infants
- Smoker in the bed (even when not smoking in bed) or if the mother smoked during pregnancy
- Someone in the bed with altered level of awareness, such as under the influence of drugs or alcohol or one who is excessively tired
- Sleeping in a bed with someone who is not the parent, including siblings and non-parental caregivers
- Bedsharing on a soft surface, such as a waterbed, old mattress, sofa, couch, or armchair
- Bedsharing with soft accessories, such as pillows or blankets
Note: no product marketed for in-bed sleeping has been shown to be safe. Bedside sleepers that attach to the side of the bed can be safe if guidelines are followed. (See link in #4 above.)
For more on the science behind the recommendations, see Alice Callahan's blog at The Science of Mom