Recently the AAP published recommendations for a safe sleep environment that can reduce the risk of all sleep-related infant deaths (such as suffocation, asphyxia, and entrapment), as well as SIDS. The recommendations for infants up to 1 year of age are categorized into 2 levels of strength:
Level A Recommendations (based on good and consistent scientific evidence)
- Always place the infant on the his/her back for every sleep for the first year of life (includes infants with GE reflux)
- No side sleeping.
- Do not elevate the head of the bed (includes infants with GE reflux).
- Once an infant can roll in both directions, the infant may be left in the position he/she assumes.
- Use a firm sleep surface or mattress approved by the US Consumer and Product Safety Commission (US CPSC) covered by a thin, tightly fitted sheet.
- Use a crib, bassinet, or portable-crib that conforms to current US CPSC standards.
- Parents/providers should check that the crib/bassinet has not been recalled by the USCPSC.
- Infants should not be placed on a standard bed for sleep.
- Sitting devices, car seats, strollers, swings are not recommended for routine sleep, especially under 4 months of age.
- Do not use broken cribs or attempt to fix a broken crib.
- Room-sharing without bed-sharing is recommended (i.e. do not use “in-bed co-sleepers”; avoid co-bedding for twins and multiples).
- Keep soft objects, such as pillows or toys out of the crib.
- Bumper pads are not recommended.
- Consider offering a pacifier at nap time and bedtime (if breast-feeding, introduce pacifier after breastfeeding is firmly established, usually by 3-4 weeks of age). Do not reinsert pacifier if it falls out once the infant is sleeping; If infant refuses the pacifier, the infant should not be forced to take it; do not attach to infants’ clothing during sleep; Pacifiers should not be hung around the infant’s neck)
- Avoid overheating (dress accordingly; check if sweating or feels hot). [Sorry, no recommended room temp!]
- Avoid the routine use of home cardio-respiratory monitors as a strategy for reducing the risk of SIDS (ok for selected infants).
Level B Recommendations (based on limited or inconsistent scientific evidence)
- Avoid commercial devices marketed to reduce the risk of SIDS (claims need scientific evidence).
- Supervised, awake tummy time is recommended to facilitate development and to minimize development of positional plagiocephaly.