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Health and Wellness: Safe sleep guidelines — what parents need to know

By Stephen Lee - Special to the Daily Herald | Aug 3, 2022

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From 2016 to 2020, the rate of sudden unexpected infant deaths in Utah was 55.3 per 100,000 live births, according to data from the CDC. Over the years, pediatricians have learned ways to reduce that number, and the American Academy of Pediatrics (AAP) recently updated its guidelines to help. And one of the most important factors in these guidelines is safe sleep.

From birth to old age, sleep never stops impacting our health. Keep reading to learn what safe sleep really means, what the AAP’s guidelines advise and the new 2022 updates to be aware of. By following these guidelines, you can feel confident you are doing everything you can to keep your infant safe.

What is safe sleep?

“Every year, around 3,500 babies in the United States die suddenly and unexpectedly while they’re sleeping,” said Rachel Y. Moon, M.D., FAAP at http://healthychildren.org. “Most of these tragic deaths are due to sudden infant death syndrome (SIDS) or accidental deaths from suffocation or strangulation.”

There is no certain way to prevent SIDS, since we don’t know what causes it. However, creating a safe sleep environment can help reduce your baby’s risk of SIDS.

Although we don’t have all the answers about SIDS, creating a safe sleep environment means applying what we do know to prevent unintentional suffocation and strangulation in bed. Fortunately, following the guidelines set forth by the AAP has been shown to reduce the risk of all sleep-related infant deaths.

What are the 10 guidelines?

The AAP’s 2022 safe sleep guidelines include 10 specific recommendations. Below, they are grouped into three categories to help you remember them. 

Sleep surface and environment.

Parents should sleep in the same room, but not in the same bed, as the baby. Sharing a room is recommended for at least the first six months, if possible.

Lay your baby to sleep on a firm, flat, noninclined surface. Do not use products for sleep that aren’t specifically marketed for sleep. If your baby falls asleep in a sitting device, such as a car seat, stroller, swings or slings, move them to a safe sleep surface as soon as possible. These devices are not recommended for routine sleep.

Although swaddling is not recommended as a strategy to reduce the risk of SIDS, it is not an unsafe practice when done properly. Be sure to place your swaddled baby on their back to sleep. Swaddling should stop as soon as your child shows signs of rolling. Weighted blankets and weighted swaddles should not be used.

Milk and pacifiers.

Evidence indicates that breastfeeding reduces the risk of sleep-related infant deaths, with even two months of at least partial human milk feeding shown to significantly lower the risk of sleep-related deaths. Pacifier use also is associated with a reduced risk of sleep-related infant deaths. 

Healthy habits.

Make sure your baby receives routine immunizations as recommended by your pediatrician, and avoid exposure to nicotine, alcohol, marijuana, opioids and illicit drugs (this applies to both parents and child).

Commercial devices that claim to reduce the risk of sleep-related deaths should be avoided, as there is no evidence that any of these devices reduce the risk of these deaths. Additionally, these devices may provide a false sense of security, causing caregivers to be complacent.

Tummy time activities are recommended to aid infant development and minimize the chances of developing plagiocephaly (flat spot on baby’s head). Supervise your baby in tummy time while they’re awake, starting with short periods of time soon after hospital discharge. Increase the amount of time incrementally for a total of 15 to 30 minutes each day by the time your child is seven weeks old.

What is different about these guidelines?

The last time the AAP issued safe sleep guidelines was in 2016. The 2022 guidelines are very similar, with the addition of the following:

  • Recommending that infants should sleep on a level surface. When your baby suffers from reflux, parents may reason that the baby should sleep on their stomach so as to avoid choking on their spit-up. However, as Anthony Porto, M.D., MPH, FAAP at healthychildren.org explained, “There is no evidence that healthy babies placed on their backs are more likely to have serious or fatal choking episodes than those placed on their stomachs. But there is strong evidence that babies placed on their stomachs are at higher risk for sudden infant death syndrome (SIDS).”
  • Indicating that baby health devices such as home cardiorespiratory monitors are not protective and are not recommended as a SIDS prevention strategy. There are no real benefits to using these devices on healthy infants. Additionally, false alarms may increase anxiety in parents. 

Safe sleep means putting into practice the information experts have learned over the years to create the best chances of healthy outcomes for your infant. The AAP has 10 safe sleep guidelines, which range from avoiding unhealthy drug exposures to placing your baby on a non-inclined surface to sleep. 

While the new guidelines don’t represent a dramatic change in these guidelines, it is a great opportunity for parents to review their habits and ensure they are following the latest and best medical advice for their baby. If you have any questions about your child’s specific situation, be sure to speak with your pediatrician. They can help you feel more confident as you make choices regarding your little one’s care.

Stephen Lee is a pediatrician at Utah Valley Pediatrics, which serves Utah families in nine locations throughout Utah Valley.

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