SIDS: New sleep guidelines to keep your baby safe
For the first time in more than five years, the American Academy of Pediatrics has updated its safe-sleep guidelines for infants in the hope of preventing deaths from Sudden Infant Death Syndrome (SIDS). The new guidance recommends putting babies on their backs to sleep on a flat, level surface.
“Previous guidelines did not comment on the angle of the sleeping surface,” says Dr. Michael Faust, a general pediatrician with Washington Health System and Washington Pediatrics. “After evaluating cases of SIDS, the experts have found an association with sleep surfaces that are not level.” Specifically, research found the risk of SIDS increases if the head of the bed is elevated 10 degrees or more. “This increased angle makes it easier for the infant to accidentally roll to their side or stomach by raising their head off the sleeping surface.”
Previous guidelines recommended tummy sleeping for infants for a number of reasons.
“The most commonly held belief is that many cases of SIDS involve the infant repeatedly breathing in the air they just exhaled,” Dr. Faust says. “By repeating this cycle, the air becomes less oxygen-dense, eventually leading to cardiorespiratory arrest and the infant succumbing to SIDS.” Other SIDS cases may be due to the bedding causing a physical obstruction to the airway, making it too difficult for the infant to breathe. Also, there may be cases where the infant refluxes into their mouth or airway.
“It is important to note that the trachea or ‘windpipe’ sits in front of the esophagus,” Faust says. “When an infant is on their stomach, gravity will tend to position that refluxed liquid near the entrance to the windpipe. Whether any of these theories are accurate is less important than the fact that by putting a baby to sleep on their back instead of their stomach decreases the risk of SIDS by tenfold.”
What Is SIDS?
Estimates put the number of sleep-related infant deaths in the United States each year at nearly 3,500. These new guidelines are meant to urge parents to take simple steps to help keep their children safe.
“SIDS likely has more than one cause,” explains Faust. “The most accepted theory currently is the ‘triple risk model.’ This postulates that SIDS occurs when an infant with a predisposing vulnerability (decreased ability to arouse or respond to a stress) is exposed to a risky situation (such as an unsafe sleep environment) during a critical period of their life.” He points out that the incidence of SIDS peaks at three months of life but can occur at any time during the first year.
The new guidelines come from the AAP’s Task Force on Sudden Infant Death Syndrome and Committee on Fetus and Newborn. They recommend placing your baby in the crib flat on their back with nothing else in the bed – no blankets or toys. “This has been a recommendation for a while now,” says Faust. “If a blanket covers an infant’s face, they can get into the negative breathing cycle I mentioned earlier. There are also cases involving entanglement where the baby dies from physical restriction of their chest or strangulation of their airway.” If you’re worried about baby getting cold, the American Academy of Pediatrics recommends “wearable blankets,” such as sleep sacks, which it says are just as effective but won’t interfere with sleep.
The recommendations include sleeping in the same room with your infant – same room but not the same bed – until age 6 months. They also warn against using car seats, strollers, swings, or carriers for sleep. Also, the guidance warns against using commercial devices that claim to reduce the risk of SIDS and cardiorespiratory monitors, as they are not reliable and can give parents a false sense of security.
Faust said home cardiorespiratory monitors cause some angst among pediatricians. “These are the devices that attach to your baby, then feed information to a smartphone app such as your baby’s heart rate, respiratory rate and even their estimated oxygen saturation,” he says. “These devices provide a beautiful interface and irresistible data to the concerned parent.”
Unfortunately, Faust said these devices are not required to meet the same standard as real medical devices. “Using one of these on your baby while following the safe-sleep guidelines is fine,” he adds. “The concern is that parents will trust these devices and ignore some or all of the proven risk-reduction measures.”
Faust advises that while there is no reason to not use home cardiorespiratory monitors or wearable monitors, there is no evidence that using them will prevent SIDS. Families who decide to use these monitors should still follow the safe sleep guidelines.