The term “sudden unexpected infant death (SUID)” is defined by the Centers for Disease Control and Prevention (CDC) as “the death of an infant less than 1 year of age that occurs suddenly and unexpectedly, and whose cause of death is not immediately obvious before investigation.” There were approximately 3,500 sudden unexpected infant deaths in the United States in 2014. SUID is divided into three categories:
- Sudden Infant Death Syndrome (SIDS) — A thorough investigation including examination of the death scene, autopsy, and review of the baby’s medical history fails to uncover a cause. SIDS is the leading cause of infant deaths under 12 months old. (1,500 of those sudden unexplained deaths in 2014 ultimately remained unexplained and were therefore declared SIDS.)
- Unknown Cause — A thorough investigation cannot be completed.
- Accidental Suffocation and Strangulation in Bed — There are four primary causes of this:
- Suffocation by soft bedding, including soft mattresses (waterbeds), pillows, sheets, and blankets.
- Overlay. When another person (usually a parent) rolls on top of or against a sleeping infant.
- Wedging or entrapment between two objects like a mattress and a wall, or a sofa back and seat cushion.
Last week, the American Academy of Pediatrics updated their policy statement on recommendations for a safe infant sleep environment. Most of the guidelines are not new and reflect what we listed on “Preventing SIDS” on The PediaBlog last December:
- Place a baby to sleep on his/her back.
- Babies should sleep on a firm surface, such as a crib, and NEVER on a soft surface, like a sofa.
- Babies should not sleep in the same bed as their parents or other children. (Babies may sleep in a crib in the same room as their parents.)
- Soft bedding materials — pillows, comforters or quilts — don’t belong in a baby’s crib. Soft toys should also be kept out of the baby’s sleeping area. The safest sleep environment consists solely of a firm crib mattress covered by a fitted sheet, with no bumper pads on the crib.
- Avoid products marketed as a way to reduce SIDS risk, such as wedges and positioners. These are marketing gimmicks that have never been tested or proven to be safe or effective.
- Allow babies to sleep with a pacifier (unattached to clothing with a clip and string or ribbon).
- Don’t smoke during and after pregnancy; prohibit exposure to secondhand tobacco smoke and avoid other forms of air pollution during and after pregnancy.
- Don’t drink alcohol at all during pregnancy.
- Breastfeed babies, exclusively if possible, for their first six months.
- Immunize babies completely and on-time.
The new update includes several additional recommendations:
- Avoid overheating and head covering in infants.
- Pregnant women should obtain regular prenatal care.
- Don’t use home cardiorespiratory monitors as a strategy to reduce SIDS risk.
- Supervised tummy time while the infant is awake can help development and minimize positional plagiocephaly.
- There is no evidence to recommend swaddling to reduce the risk of SIDS.
- Health care professionals and staff in newborn nurseries and neonatal intensive care units as well as child care providers should endorse and model recommendations to reduce SIDS risk.
- Media and manufacturers should follow safe sleep guidelines in messaging and advertising.
- Continue the Safe to Sleep campaign, focusing on ways to further reduce sleep-related deaths.
- Research and surveillance should continue on all risk factors.
But it’s this recommendation that sent shockwaves through the pediatric community last week:
It is recommended that infants sleep in the parents’ room, close to the parents’ bed, but on a separate surface designed for infants, ideally for the first year of life, but at least for the first 6 months.
For some parents, this is a no-brainer. For others (and for this pediatrician), the recommendation that babies sleep in the same room as their parents for 6-12 months is a head-scratcher. We’ll discuss this latest recommendation on safe sleep environments from the AAP’s updated policy statement on The PediaBlog tomorrow.