It is time to set your infant’s cot back in your bedroom, at least until he is one-year-old, to provide a safe sleeping environment to them, according to a new report. American Academy of Pediatrics (AAP) has announced its new safe sleep recommendations today, 24th October, to protect infants against sudden infant death syndrome (SIDS).
The details of the policy statement and its technical report will be released at the AAP National Conference & Exhibition which is scheduled to be held in San Francisco today.
These updated 2016 recommendations for a safe infant sleeping environment, also published in the journal Pediatrics, are released after a 5-year gap, following the recommendations released in 2011.
While the recommendations say that ideally the infant should sleep in the parents’ room during the first year, it was added that the time spent in the same room as parents should not be less than the first six months of child’s age while the child should not share the sleeping surface with the parents. Parents should arrange for a separate sleeping surface for their infant, which should be a hard-surface bassinet or a crib, but never a sofa, armchair or other soft surface.
Furthermore, the researchers observed that sharing a room with parents cut off the SIDS risk by 50% as the infant was under consistent surveillance. The report emphasized greatly on the importance of firm sleeping surface with tight fitting sheeting, giving support to their back to avoid unforeseen consequences.
What Leads To SIDS?
As horrifying as it sounds, SIDS is a term used for sudden infant deaths which cannot be associated to an evident cause. These deaths remain unexplained after autopsy, scene investigations or review of clinical history.
It is one of the three causes of sudden unexpected infant death (SUID), while the other two causes of SUID are stratified by Centers of Disease Control and Prevention (CDC) as unknown cause and accidental suffocation and strangulation in bed. However, due to little evidence, it is often hard to separate SIDS from deaths caused by accidental suffocation by soft bedding; thereby, they are generally discussed as one larger term, SIDS.
Collectively leading to about 3,500 sudden and unexpected deaths in children during the first year of age, 44% of the deaths are attributed to SIDS. 1,500 infant died in the US in 2014 due to SIDS.
According to AAP, 90% cases of SIDS take place during the first 6 months, peaking during the time between 1-4 months.
Majorly contributed by wrong sleeping position of the infant, the prone (sleeping on stomach) and side sleep position are linked with an elevated risk of the infant rebreathing expired gases leading to conditions like hypercapnia, marked by dangerously increased levels of carbon dioxide in the blood and hypoxia, which deprives tissues to get sufficient oxygen supply.
This can lead to damage to the liver, brain and other organs followed by the symptom onset which commonly include shortness of breath, increased heart rate, rapid breathing, wheezing or sweating.
In addition to this, evidence showed that sleeping in a prone position leads the child, who is particularly between the age of 2 to 3 months, to experience altered automatic control of cardiovascular system which can subsequently result in reduced cerebral oxygenation. While researchers previously linked prone position to increased risk of SIDS, it was later found that the risk of prone and SIDS is similar to the risk of side position and SIDS.
What Do Recommendations Say Further?
It is recommended that the child sleep at a supine position (sleeping on the back, horizontally with the body facing up). While it helps in providing the infant with optimal oxygen supply, it also reduces the risk of overheating that results from reduced heat dissipation and increased body temperature, attributed to prone sleeping.
General trend in the parents however is marked with a misconception that associates supine position with increased risk of aspiration or choking.
It was found that the sleeping position is not the sole culprit in this situation, but the soft bedding of the infants also plays an essential role in increasing the risk of SIDS. The report cautioned that soft beddings like blankets, crib bumpers, soft toys and pillows should not be put in the crib and that the crib better remain bare. This can be an obstruction to the child’s breathing and also a cause of overheating.
The lead author, Rachel Moon, MD, FAAP, said, “We know that parents may be overwhelmed with a new baby in the home, and we want to provide them with clear and simple guidance on how and where to put their infant to sleep.”
She added that if you have slept on a couch or a sofa with your infant, make sure that you shift your infant to the bed, as soon as you wake from your sleep. Similarly, if you are feeding your child on a sofa and it is highly likely that you will fall asleep, then shift to the bed and feed your child there.
The report also included some more integral parenting guidelines so that parents can provide better nurturing to their children. Amongst these guidelines, it was suggested that a skin-to-skin care should be provided to the child by the mothers for at least an hour, after birth, as soon as the mother is in a stable health. It was added that the process should not be influenced by the feeding or birth giving method and be offered by every mother. AAP also recommends that infants aged 4 to 12 months sleep for 12 to 16 hours per day, including naps.
Similarly, breast feeding was said to reduce the risk of SIDS. The recommendation further suggested the use of pacifier during bedtime and timely vaccinations. Awake tummy time (prone position while the child is awake and under surveillance) was also emphasized upon for proper development. On the contrary, the use of commercial devices like positioners, wedges and home monitors should be discouraged.
Unsurprisingly, the recommendations state that SIDS risk can also increase by baby’s exposure to smoke and other drugs. Concluding the report, these easy-to-follow steps should reduce the SIDS incidence rate which has plateaued over the years.