Sleeping like a baby is now more regimented than ever, in light of updated guidelines by the American Academy of Pediatrics (AAP) about how best to put baby to bed to reduce the risk of SIDS, or sudden infant death syndrome.
Much has changed in the six years since the AAP’s previously released policy. In March, AAP president O. Marion Burton advised parents to stop using crib bumpers, even before the U.S. Consumer Products Safety Commission completed a review of 52 infant deaths in 20 years, potentially related to bumpers. Bumpers originated years ago as a means of making sure baby’s head didn’t get stuck between crib slats. But since that space has shrunk to the current 2 3/8 inches, the reason for tying on bumpers — aside from cushioning baby’s head — no longer exists. “The risk of death by suffocating far outweighs baby getting a bruise,” says Michael Goodstein, a neonatologist in York, Pa., and a member of the AAP SIDS task force that updated the guidelines.
The AAP’s long-standing emphasis on putting babies to sleep on their backs on a firm surface hasn’t changed. Infant deaths due to SIDS have decreased as a result. But pediatricians have simultaneously noted an increase in deaths due to accidental strangulation or suffocation; the numbers increased from 103 in 1984 to 669 in 2007. It’s not clear what’s caused the spike.
But health officials hope to reduce those numbers by making cribs — which were already supposed to be a pretty spartan landing pad for baby, without pillows, fluffy bedding or stuffed animals — even safer. “Cribs are thought of as something to be beautified, but they’re really a safety device,” says Goodstein. “If you want to decorate something, decorate the room.”
In July, the sale of cribs with drop-side rails was also banned over concern that babies could become entrapped.
MORE: Bye-Bye, Baby: Why Selling Your Crib Hurts
Breast-feeding is another addition to the guidelines. Long advised by the AAP as the healthiest way to nourish newborns, it is now being recommended as a way to decrease the risk of SIDS. A study published in June in the journal Pediatrics found that exclusive breast-feeding cut the risk of SIDS by more than 50%, perhaps because the antibodies in breast milk help breast-fed babies experience less infection. Breast-fed babies are also more easily awakened, which is significant because SIDS can occur in babies who are difficult to rouse.
The AAP also emphasizes adherence to recommended vaccination schedules to reduce the risk of SIDS. In 2007, research published in the journal Vaccine found that getting immunized in accordance with the AAP-advised timeline reduced the risk of SIDS by up to half.
But guidelines, in the end, are merely advice. Goodstein acknowledges that not all parents embrace the continuous changes in official policy. The numbers of parents putting their infants to sleep on their backs, for example, has dropped over the years; it now hovers around 75%. “There are some barriers to changing behavior, and we know not everyone is doing everything,” says Goodstein.
“All we can do is help people understand why we make these recommendations and encourage their use,” he says. “We don’t have sleep police out there.”
MORE: Babies With Flat Heads on the Rise: Is ‘Back to Sleep’ to Blame?
Here are some of the AAP’s other recommendations:
- Sharing a room with baby is O.K.; sharing a bed is not.
- Don’t use foam wedges or sleep positioners in the crib.
- Offer a pacifier at nap time and bedtime; pacifier use is associated with a decreased risk of SIDS.
- Do not use home monitors or commercial devices marketed to reduce the risk of SIDS.
- Offer supervised, awake “tummy time” to encourage development and minimize the occurrence of positional plagiocephaly, or flattened head.
Bonnie Rochman is a reporter at TIME. Find her on Twitter at @brochman. You can also continue the discussion on TIME‘s Facebook page and on Twitter at @TIME.
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