News | American Academy of Pediatrics, RI Chapter

New AAP Safe Sleep Guidelines

The American Academy of Pediatrics (AAP) has released its first update to its safe infant sleep policy statement and technical report since 2016. Use of the evidence-based recommendations presented in the policy help reduce the risk of sleep-related infant deaths, including those classified as Sudden Infant Death Syndrome (SIDS) and Ill-defined deaths, as well as those due to accidental suffocation and strangulation in bed.

The guidelines are for use with infants from birth to 12 months of age. They offer further support for well-known recommendations and elaborate on these with additional information. In addition to continuing to recommend supine placement for all sleep times and avoidance of soft and loose objects in the crib, such as bumpers, pillows and blankets, the AAP news release of June 21st states:

The baby should sleep on a firm, flat non inclined surface that, at a minimum, adheres to the June 2021 Consumer Product Safety Commission’s rule that any infant sleep product must meet existing federal safety standards for cribs, bassinets, play yards, and bedside sleepers. Parents should not use products for sleep that aren’t specifically marketed for sleep.
Sitting devices, such as car seats, strollers, swings, infant carriers, and infant slings, are not recommended for routine sleep in the hospital or at home, particularly for infants younger than 4 months.
Breastfeeding reduces the risk of sleep-related infant deaths, and while any human milk feeding is more protective than none, 2 months of at least partial human milk feeding has been demonstrated to significantly lower the risk of sleep-related deaths. The AAP recommends exclusive human milk feeding to 6 months, with continuation of human milk feeding for 1 year or longer as mutually desired by parent and infant.
AAP recommends that parents sleep in the same room – but not in the same bed as a baby, preferably for at least the first six months. (As quoted in the news release, Rebecca Carlin, MD, FAAP, a co-author of the guidelines, stated, “The evidence is clear that (bed sharing) significantly raises the risk of a baby’s injury or death,…and for that reason AAP cannot support bed-sharing under any circumstances.”)
Avoid parent and infant exposure to nicotine, alcohol, marijuana, opioids, and illicit drugs.
Make sure the baby receives routine immunizations.
Pacifier use is associated with reducing risk. (Wait until breastfeeding is well established and do not attach them with a string or other device to the baby’s clothing.)
Avoid the use of commercial devices that claim to reduce the risk of SIDS or other sleep-related deaths. There is no evidence that any of these devices reduce the risk of these deaths. Importantly, the use of products claiming to increase sleep safety may provide a false sense of security and complacency for caregivers. Do not use home cardiorespiratory monitors as a strategy to reduce the risk of SIDS.
Supervised, awake tummy time is recommended to facilitate infant development and to minimize development of positional plagiocephaly. Parents are encouraged to place the infant in tummy time while awake and supervised for short periods of time beginning soon after hospital discharge, increasing incrementally to at least 15 to 30 minutes total daily by 7 weeks of age.
There is no evidence to recommend swaddling as a strategy to reduce the risk of SIDS. If infants are swaddled, always place them on the back. Weighted swaddles, weighted clothing, or weighted objects on or near the baby are not safe and not recommended. When an infant exhibits signs of attempting to roll (which usually occurs at 3 to 4 months but may occur earlier), swaddling is no longer appropriate, as it could increase the risk of suffocation if the swaddled infant rolls to the prone position.

Additional details are provided in the policy guidelines.