BOSTON -- Breastfeeding and immunization protect babies against sudden infant death syndrome (SIDS) but bumper pads don't, according to updated guidelines from the American Academy of Pediatrics.
The recommendations -- last revised in 2005 -- go beyond SIDS and focus on providing a safe sleeping environment for infants to reduce the risk of all sleep-related deaths, such as suffocation.
Supine sleeping position, first recommended by the AAP in 1992, remains the cornerstone of SIDS prevention, along with a firm sleeping surface, and no bed sharing.
"Overall, we are making good progress in understanding SIDS and the importance of the infant's environment in preventing suffocation deaths," Rachel Moon, MD, who chaired the guideline writing committee, said during an AAP press briefing. "However, we still see evidence of unsafe sleeping practices, and we hoped to address those in these new guidelines."
The recommendation against bumper pads is part of the focus on providing infants with safe sleeping environments. Moon and co-authors said no evidence exists to support the view that bumper pads reduce SIDS risk.
The AAP also recommends avoidance of any commercial devices purported to prevent SIDS, as "there is no evidence that these devices reduce the risk of SIDS or suffocation or that they are safe."
The guidelines and a related technical report are published in the November issue of
Pediatrics.
Since AAP launched its "Back to Sleep" campaign in 1992, SIDS deaths have declined by 50%. However, 4,600 sudden unexpected infant deaths (SUID) still occur each year, half of which are ultimately classified as SIDS.
A study reported at the AAP meeting showed that half of SIDS deaths involved infants placed in nonsupine sleeping positions, and 71% of the deaths involved unsafe sleeping surfaces. In more than half the deaths involving unsafe sleeping areas, a crib (recommended by the AAP) was available in the household but was not used or was being used for other purposes.
A breastfeeding recommendation is based on multiple studies showing a lower rate of SIDS among breastfed babies. The AAP encourages exclusive breastfeeding or feeding with expressed milk.
Similarly, recent studies have provided evidence that immunization affords protection against SIDS. The AAP previously joined with the CDC in concluding that "there is no evidence that there is a causal relationships between immunizations and SIDS."
In addition to its traditional support for supine sleeping position and firm sleeping surface, the AAP recommends:
- Room-sharing with an infant -- but not bed-sharing
- Keeping cribs free of soft objects and loose bedding
- Offering a pacifier at naptime and bedtime
- Avoidance of overheating
- No use of home cardiorespiratory monitors
- Expansion of the national SIDS campaign to include the focus on a safe sleeping environment
- Supervised awake "tummy time" for infants to facilitate development
The guidelines also offer recommendations for pregnant women: regular prenatal care, no smoking, and avoidance of alcohol and elicit drugs. The caution against smoking, alcohol, and drugs carries over after birth.
The AAP guidelines urge support for the SIDS/safe sleeping environment campaign from healthcare professionals, media support for the campaign in messages and announcements, and continued research to learn more about the causes, risk factors, and pathophysiology of SIDS and other sleep-related deaths in infants.
Moon and co-authors had no relevant disclosures.
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