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AAP Statement on Infant Safe Sleep

October 2016

In the United States, there has been a controversy over the past decade about locations of infant sleep, pitting the research and promoters of safe co-sleeping with a breastfeeding dyad and the research and promoters of never allowing the breastfeeding baby into the parental bed. There are guilt-inducing media campaigns with a tombstone for a headboard or a knife in the parental bed. The American Academy of Pediatrics has been a major backer of the "never sleep together" camp. The research done primarily by James McKenna promotes SAFE co-sleeping. At least 3500 annual infant deaths in the US have been attributed to Sudden Infant Death Syndrome (ICD-10 R95), ill-defined deaths (ICD-10 R99), and accidental suffocation and strangulation in bed (ICD-10 W75).

There are pros and cons to everything, and part of the cons of telling exhausted breastfeeding mothers to never co-bed is the number of deaths that have increased due to sleeping together on the couch, in a recliner, or other soft surfaces, all of which are not safe sleep environments.

Breastfeeding bed 

The lumping together of various categories of sleep-related deaths is cause for further research, as it includes such examples as infants who have rolled off their sleeping surfaces into a pile of clothing or plastic; parents who have ingested alcohol or medications that impair sleep cycles; pets or siblings in the same bed as the infant; or grandparents who fall asleep with a newborn in their arms.

Enter lobbyists who impact safe sleep campaigns, such as the crib industry. That can and does impact local, state and national legislation regarding sleep environments. Or hospital regulations that forbid any discussion of safe co-sleeping. Or personal opinion (yes, nurses do share how they did things and feel about it!!).

Below is a summary of the 2016 American Academy of Pediatrics Recommendations for a Safe Infant Sleep Environment and the accompanying technical report (links provided at the end of this post). This position addresses the stance against any co-sleeping arrangements at any age, and is a must-have piece of documentation from the AAP Task Force on Sudden Infant Death Syndrome. It states, "After an initial decrease in the 1990s, the overall death rate attributable to sleep-related infant deaths has not declined in more recent years", (AAP, 2016, p 1). Current recommendations include:

  • Place on back to sleep for every sleep
  • Use a firm sleep surface
  • Breastfeeding
  • Room-sharing with the infant on a separate sleep surface for the first year
  • No soft objects or loose bedding in infant's sleep area
  • Use of a pacifier at naptime and bedtime after breastfeeding has been well established
  • Avoid smoke exposure during pregnancy and after birth
  • Avoid alcohol and illicit drug use during pregnancy and after birth
  • Avoid overheating and head covering
  • Regular prenatal care
  • Recommended infant immunization
  • Avoid commercial devices that claim to reduce SIDS
  • Avoid home use of cardiorespiratory monitors that claim to reduce SIDS
  • Supervised tummy time during awake periods
  • Avoid swaddling
  • Endorsement and modeling of recommendations by hospital staff
  • Media and manufacturers should follow safe sleep guidelines in messaging and advertising
  • Continue "Safe to Sleep" campaign
  • Continue research and surveillance on risk factors, causes and pathophysiologic mechanisms of SIDS

Download these two documents here:

Technical Report--www.pediatrics.org/cgi/doi/10.1542/peds.2015-3147

James McKenna Sleep Lab at University of Notre Dame--http://cosleeping.nd.edu/

I would enjoy hearing how this topic is addressed in facilities, both within and outside of the US. Do you talk about safe sleep? Do you use blankets and bedding in your bassinets/cribs? Do you swaddle? How long do you recommend safe skin-to-skin care continue after discharge?


Kathy Parkes, MSN-Ed, BSPsy, RN, IBCLC, RLC, FILCA

Professional Development Educator, Step 2 Education International




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