Saturday, November 5, 2011

New SIDS Prevention Guidelines

As pediatricians we practice a lot of preventative medicine.  Our patients are generally young and healthy... and we want them to stay that way!  One way we do this is to discuss safety at well visits.  We try to share safety tips on our facebook page, website, and here.

A big safety issue is the sleep position of babies.  Most parents by now have heard that it is safer to put babies to sleep on their back, not belly.  Occasionally we hear of young babies sleeping on their stomachs because parents have realized they sleep longer that way, and they do.  But this is dangerous. Babies don't wake up as much when on their stomach, this is true.  Some babies simply don't wake up.  Please put your babies on their back to sleep!

Parents often want to sleep with their babies because it also is associated with longer sleep time for the baby and more convenience for the parent (especially the breastfeeding mother).  Despite ease and convenience, this is not a safe sleeping arrangement for babies. Arguments that this is safe because world wide many families share beds is not often a valid argument. Americans tend to sleep on a bed with a headboard and bedding.  Babies can get their head stuck between the mattress and headboard (or wall).  They can suffocate from the bedding.  Parents can roll over in their sleep and smother the baby.  There are simply safer options for all to sleep better.

Recently the American Academy of Pediatrics (AAP) released new Sudden Infant Death Syndrome (SIDS) prevention guidelines.  AAP SIDS prevention Guidelines that are based on strong evidence:

  • Back to sleep every time.
  • Use a firm sleep surface covered with a fitted sheet.
  • Room share without bed share (put the baby in a crib or bassinet near the parent bed).
  • Keep soft objects and loose bedding out of the crib.
  • Pregnant women should receive routine prenatal care.
  • Avoid smoke exposure during pregnancy and after birth.
  • Breastfeed.
  • Consider a pacifier at nap and bed times, but do not attach it to the infant or infant's clothing or stuffed toys.
  • Avoid overheating.
  • Do not use home cardiorespiratory monitors as a strategy to reduce SIDS.
Other recommendations based on limited evidence:
  • Immunize in accordance with the AAP and CDC guidelines.
  • Avoid commercial devices marketed to reduce the risk of SIDS (postitioners, co-sleepers, wedges).
  • Supervised, awake tummy time is recommended to help development and reduce the risk of  positional plagiocephaly (a misshapen head from laying on one side routinely).
Other issues addressed:
  • Co-sleepers are not recommended.
  • Absolutely no bed sharing the first 3 months.
  • No bed sharing at any age if a person in the bed is a smoker.
  • No bed sharing with anyone who is excessively tired.
  • No bed sharing with someone who is using medications that increases drowsiness or impairs alertness (pain medicications, alcohol, illicit drugs, certain antidepressants).
  • No bed sharing with anyone who isn't a parent. This includes no bed sharing with siblings or other children.
  • No bed sharing with multiple persons.
  • No bed sharing on a soft surface (waterbed, old mattress, sofa, armchair)
  • No bed sharing on a surface with soft bedding, including pillows, heavy blankets, quilts, comforters.
  • Because of the high correlation with SIDS and suffocation on couches and armchairs, infants should not be fed on these when the parent is extremely tired and at risk of falling asleep.
  • When choosing a crib, be sure it has not been recalled and all the parts are put together properly.
  • Use only mattresses designed for infants.  Do not add any comforters, quilts, pillows, or other soft bedding to the sleep area.
  • Bumper pads are not recommended.
  • Infants should wear clothing that will keep them warm (not excessively hot) and that will not cover the head/face.
  • Keep dangling cords or window coverings away from the sleep area.
  • If infant slings are used, it is important to keep the infant's head up and above the fabric so the face is visible (unless currently breastfeeding).  
  • Infants should not routinely sleep in car seats or other sitting devices (strollers, carriers, or backpacks/slings).

NOT safe!!!!!!
Picture actually taken to show the person who gave the comforter and bumper pad set, then it was put away. 
Keep your baby safe by placing her in a safe place at all times.  It only takes one accident to have life-ending consequences.  To say that you've always slept with your babies and they are fine, so it's not a problem for babies to sleep with their parents is like saying you never wear a seatbelt and haven't had any problems.  Just wait until that first crash...

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