The American Academy of Pediatrics (AAP) has updated its guidelines on infant sleeping for the first time in six years, providing up-to-date safety advice to new parents and carers.
Around 3,500 infants die each year in the USA of sudden infant death syndrome (SIDS) or other sleep-related causes of death. AAP provides advice on how to reduce the risk of death during sleep, as well as evidence for it. In the new guidelines, published on Wednesday, the organization stresses the need for infants to sleep on their back on flat, non-inclined surfaces for sleep, and "strongly discourages" bedsharing.
“We’ve made great strides in learning what keeps infants safe during sleep but much work still needs to be done,” lead author of the statement and technical report Rachel Moon said in a statement.
“A baby’s death is tragic, heartbreaking and often preventable. If we’ve learned anything, it’s that simple is best: babies should always sleep in a crib or bassinet, on their back, without soft toys, pillows, blankets or other bedding."
The report highlights the difference in sudden unexpected infant deaths (SUIDs) between different societal groups. Compared to white infants, the rate of SUIDs in Black American infants is more than doubled, and nearly tripled in Indigenous American infants.
“It’s essential for families and pediatricians to partner with each other, to build trust and have thoughtful conversations about how to keep children safe by lowering risks,” Rebecca Carlin, MD, who co-authored the statement and technical report said.
“We know that many parents choose to share a bed with a child, for instance, perhaps to help with breastfeeding or because of a cultural preference or a belief that it is safe."
"The evidence is clear that this significantly raises the risk of a baby’s injury or death, however, and for that reason AAP cannot support bed-sharing under any circumstances.”
The report notes that a number of factors can make co-sleeping even more dangerous to the infant, including when an infant is under 4 months old.
"The risks of sleep-related infant deaths are up to 67 times higher when sleeping with someone on a couch or soft armchair or cushion," the team writes, "and 10 times higher when sleeping with someone who is impaired because of fatigue or use of sedating medications or substances such as alcohol or illicit drugs; or is a smoker."
The risk of death has been shown to rise for infants that sleep next to a person who smokes, even if they do not smoke in bed. Breastfeeding has been shown to reduce the risk of SUIDs, but AAP highlights that parents should take extra care not to fall asleep while breastfeeding in bed.
The updated guidelines make a number of other recommendations for reducing the risk of SIDS, including that infants should sleep in their parents/carer's bedroom for the first six months, or ideally one year, and that swaddling (itself not a method of preventing SIDS) be stopped as soon as the baby shows signs of attempting to roll.