SIDS prevention/ New AAP guidelines |
The American Academy of Pediatrics just came out with their newest guidelines updating the best safe sleeping practices for babies. It is hard to believe that it has been 30 years since the ‘back to sleep’ recommendations were first instituted. That change made a measurable difference and cut the SIDS incidence by roughly 50%. The annual number of sleep-related deaths has remained steady since then. Unfortunately that case count is still too high. There are still approximately 3,500 infant deaths every year here in the US. These incidents usually occur when an infant with an intrinsic vulnerability to SIDS is placed in an unsafe sleep environment. The most common risk factors include:
Obviously, aside from the smoking, most of these are not in your control. So, what is in our power? That is what the guidelines are all about. Here are some considerations for creating the safest sleep situations. Back to sleep is basic. Generations ago, kids were put to sleep on their tummies. Grandmas knew that they slept more soundly that way. Here’s the thing. It is actually better for infants to be having lighter sleep for the first couple of months. Because the sleep isn’t quite as deep, babies can rouse more easily if they have unmet needs. Believe it or not, the goal at this age is not to get your baby to sleep through the night. They need to wake up to feed. Ideally a baby wakes up periodically and then can settle themselves back to sleep without too much assistance. The safest position is on their back, not on their tummy or their side. Some parents worry about choking being more of an issue in that position. In fact, healthy babies naturally swallow or cough up fluids. It is an evolutionary reflex. Babies may actually clear such fluids better when sleeping on their backs. Infants don’t have very good head control, so another benefit of them being on their back is that they are less likely to smoosh their little faces into the mattress. Make sure they are getting some regular tummy time. That head control will improve more quickly with your help. You can start this within the first couple of days. Even having them lay on top of you, for several seconds bobbing their little heads up, counts. The amount of time per session can increase gradually. This supervised time is so important for strength and development. It also can help you avoid a flat head (positional plagiocephaly). Here is one of my blog posts on that topic. Once they can roll, it is common for parents to stress because all of a sudden babies have the ability to flop onto their tummy. Please note, it is not reasonable for you to stay awake and keep flipping them onto their back. Your job is to place them on their backs and make sure the crib is safe. Keep doing plenty of tummy time and floor exercise. This will help them work on the skills so that soon they have more control. The AAp recommendation is for babies to sleep in the room with the parents, preferably for at least the first six months. They want you in the room but not the same bed. The guidelines are clear about co-sleeping. The AAP gives that a big no. I understand that this is a tough one, I know that in many cultures folks sleep in a family bed. Unfortunately the statistics are jarring. The risk of SIDS is 10 times higher when sleeping with someone who is impaired because of their use of sedating medications, drugs, alcohol or simply exhaustion. Show me a new parent who isn’t exhausted… It isn’t just a risk at night time. The risk of SIDS is up to 67 times higher when sleeping with someone on a couch or soft armchair or cushion. By all means snuggle them to pieces when you are awake, but when you are at risk of dozing off, they are safer in their own little bed. The guidelines also advise parents to take steps to ensure that the baby doesn’t get overheated. They are not hothouse flowers. A cooler room is better than a hot one. It is interesting that the risk for SIDS is higher during colder months. This is likely because in the colder weather, caregivers might be tempted to use extra blankets or clothes. Over bundling may cause overheating, which elevates an infant’s risk for SIDs. The ideal temperature for babies is between 68 to 72 degrees fahrenheit or 20 to 22 degrees celsius. It is common for infants to start off in the smaller infant bassinets before moving into a full sized crib. The safety consideration for bassinets and cribs are the same. Some of the infant beds, like the snoo, have movement and sound to help soothe them. There are no safety issues with those, just make sure that any infant sleep product is JPMA certified (Juvenile Products Manufacturers Association). When it is time to move into a full sized crib, you want to look for that same JPMA certification. Older models might not meet the current safety standards. It is essential to get one with stationary sides. The older cribs used to have rails that you could lower. This was easier on your back, but no longer considered safe. If you do have an older model, double check with the cpsc.gov to make sure there are no recalls associated with it: By law, the production date of a crib must be displayed on it and on its shipping carton. Take a photo of that so you have it for your records. Check for any obvious safety hazards. Slats should be no wider than 2 & 3/8 inches wide. If you buy a crib online, get your ruler out and measure any openings immediately when it arrives at your home. Check for sharp edges and protruding screws, nuts, corner posts, decorative knobs, and other pieces that could catch your baby's clothing. The mattress should fit tightly in the crib with no gaps. If you can place more than two fingers between the mattress and the crib frame, the fit isn't snug enough. Use a tightly fitted sheet. There is nothing wrong with a quality hand-me-down sheet as long as the elastic at the corners is still strong. Test the sheet, whether new or used, by pulling up on each corner to make sure it doesn't pop off the mattress corner. There should be nothing else in the bed. No stuffed animals, pillows, blankets or crib bumpers. I confess that my kids had a crib full. Lauren used to have long conversations with her Winnie the Pooh bumpers. Those days are gone. Infants can be kept cozy in a swaddle until they start to roll. At that point I would switch to a sleep sack. One good brand is the Woolino, it isn’t too hot or too cold. The weighted swaddles are not on the AAP list for safe sleep products. I am trying to get more info about some of the specific products and will update this post when I am able to get more information. The mattress should be a firm, flat surface. If they are at an incline they can slide down and there is a risk of suffocation. The new guidelines specifically state that devices such as car seats, strollers, swings, infant carriers and infant slings are not recommended for routine sleep, especially for infants younger than 4 months. These infant seats and carriers are fine if you need to have the baby hanging out in the room with you during a wake window. I am going to permit a loophole and say that for a closely supervised nap these are still okay, just not at night. Supervised means that you are keeping an eye on the baby as they sleep, not completely engrossed in another activity or taking a nap yourself. Flat is best, but if you have been reading my blogs these past years you know that if your little one has a cold or congestion, I have always suggested putting them on a little bit of a slant. You can still do that by putting a little towel under the mattress but now it needs to be more subtle. The angle should be no more than 10%. The new guidelines also suggest avoiding the use of home cardiorespiratory monitors as a strategy to reduce the risk of SIDS. The concern is that they might provide a false sense of security. Breastfeeding is ideal. Being a good parent is NOT about how you feed your baby. Not everyone is able to nurse. But, data shows that breastfeeding reduces the risk of sleep related infant deaths. During the first 2 months, feeding at least partial human milk has been found to significantly lower the SIDs risk. If your baby got any at all during those early attempts, that might make a difference. If you do produce enough milk and can manage to nurse at least for the first 6 months, that is consistent with the AAP recommendation. Of course, if you can make it through the first year with some breastmilk as part of their diet. that is even better. Pacifier use is associated with reducing risk. I have no issue with a baby falling asleep with a pacifier in their mouths. I would not force it, if they don’t seem to want one. I would also try hard NOT to get into the habit of replacing it every time they fall out. As kids get older, there are fresh safety issues to consider. Make sure the mattress is at the lowest level so that your little one can’t climb out. Make sure the crib isn’t near any wires, lamps, window shades or cords that they can reach. The good news is that once they are a year old, I am fine letting them have a little comfort object in the crib with them. You might feel like you are in the dark tunnel of sleep deprivation right now, but babies grow fast. I know it can feel overwhelming and a bit terrifying when they are little and at their most vulnerable, but there are actions listed above that can help keep them safe. Blink and they will be asking for the car keys, Then you will have a whole new set of things to worry about! |
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