Laird Harrison

October 24, 2016

SAN FRANCISCO — Infants should sleep in the same room, but not in the same bed, with their caregivers to reduce the risk for sudden infant death syndrome (SIDS), the American Academy of Pediatrics (AAP) is recommending in new guidelines released today.

And for the first time, the academy is recommending that mothers spend some time in skin-to-skin contact with newborns.

"It is recommended that infants sleep in the parents' room," said Fern R. Hauck, MD, MS, a coauthor of the first update to the AAP SIDS guidelines since 2011. "And if you bring your baby into bed for feeding or comforting, remove all soft objects."

Dr Hauck and colleagues presented the new guidelines here at the AAP 2016 National Convention and Exhibition, and they were published in the journal Pediatrics.

Approximately 3500 infants die every year from SIDS. The number dropped sharply when the "back to sleep" campaign raised public awareness of risk factors in the 1990s, but has leveled off since, according to the guideline.

The new SIDS guidelines do not contradict anything in the previous version. They still recommend putting infants to sleep on their backs. But the new guidelines provide some key nuances, said Dr Hauck, from the University of Virginia School of Medicine in Charlottesville.

One question that prompted the update was, "What can we recommend for parents who feed in the middle of the night?" coauthor Lori Feldman-Winter, MD, MPH, told Medscape Medical News.

Many mothers worry that they and their babies will fall asleep while breast-feeding, before the mother can put the baby on its back on its own sleep surface, she said.

For this reason, the guideline recommends that caregivers who think they might fall asleep feed the babies in a bed without blankets, pillows, or other soft objects in it. Upon waking, the caregiver should put the baby on its own sleep surface such as a crib, bassinet, or play yard.

The baby's sleeping surface should be free of soft objects including crib bumpers, according to the guidelines. This is because some babies have asphyxiated on bumpers while trying to climb from their cribs. And the slats of cribs are now designed to prevent babies from trapping their heads.

While previous guidelines suggested soft objects could be used after 4 months, the new guidelines extend the restriction to a year, said Dr Feldman-Winter, because about 10% of SIDS cases occur after the fourth month.

Armchairs and couches are particularly dangerous places to feed babies if caregivers are feeling sleepy, the guideline says.

At the press conference, Samuel Hanke, MD, from the Cincinnati Children's Hospital Medical Center in Ohio, recounted how he fell asleep with his infant son, Charlie, in 2010, while sitting on a couch watching television. "When I woke up, Charlie was gone," he said. He has devoted himself to spreading awareness of SIDS prevention ever since that day.

The recommendation to spend time in skin-to-skin contact with infants stems from research showing that it can enhance children's neurological development, said Dr Feldman-Winter.

While it is particularly important in the first hour after the infant's birth, it may have benefits after that, she said. Skin contact with someone other than the mother can also be beneficial, she added. And skin contact may affect mothers' nerves as well as the infants', making mothers calmer and more patient, she said.

The committee noted that many new products are being promoted for the purpose of SIDS reduction. Such products remain unproven, they said. And the guidelines specifically recommend against home monitors, wedges, or positioners.

The committee did not make any recommendation with respect to sleeping surfaces that attach to the caregiver's bed.

Among the other recommendations:

  • Offer a pacifier at nap time and bedtime. Studies show these can reduce the risk for SIDS, although it's not clear why.

  • Give infants all recommended vaccinations.

  • Provide supervised, awake tummy time daily to facilitate development.

  • Remove infants from car seats, strollers, swings, infant carriers, and infant slings, if they fall asleep in them, to reduce the risk for gastroesophageal reflux and positional plagiocephaly.

The guidelines come with specific estimates of the increased risk for SIDS for the practices they recommend against. And they review the literature on the causes of SIDS. While the ultimate cause of the syndrome remains unknown, multiple factors appear to be involved.

National surveys have shown that many parents do not get messages from pediatricians about SIDS; only 54.5% had received a recommendation to place their infant supine for sleep, and 19.9% had received information about appropriate sleep location.

This sort of evidence-based review will provide a solid foundation for pediatricians to provide recommendations to the families of their patients, said Vincent J. Palusci, MD, MS, from the NYU Langone Medical Center in New York.

"If they were breast-feeding and they fell asleep, moms were feeling terrible," he said.

He said pediatricians can also play an important role in providing medical history information when an apparent SIDS death occurs. A small portion of these deaths turn out to involve abuse by caregivers, said Dr Palusci, who specializes in preventing abuse.

But he added that pediatricians' first goal in these cases should be to comfort parents and help them understand how to prevent such deaths in the future.

Dr Hauck, Dr Felman-Winter, Dr Hanke, and Dr Palusci have disclosed no relevant financial relationships.

American Academy of Pediatrics (AAP) 2016 National Conference and Exhibition. Presented October 24, 2016.

Pediatrics. Published online October 2016. Full text

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