SAVANNAH, Ga. (WSAV) — Each year in the United States, 3400 infants die of sleep-related infant deaths, including sudden infant death syndrome (SIDS), and accidental suffocation and strangulation in bed.

In 2020, the state of Georgia was ranked 15th by the Centers For Disease Control with a death rate of 6.1 infant deaths per 1,000 live births. In order to reduce the number of infant sleep deaths, the American Academy of Pediatrics (AAP) has updated its safe infant sleep recommendations from what was last recommended in 2016.

“We’ve made great strides in learning what keeps infants safe during sleep but much work still needs to be done,” said Rachel Y. Moon, MD, FAAP, lead author of the statement and technical report, generated by the AAP Task Force on Sudden Infant Death Syndrome and the AAP Committee on Fetus and Newborn.

In order for infants to have a safe sleeping environment, AAP recommends that parents sleep in the same room but not in the same bed as the infants, preferably for at least the first six months.  

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According to the National Library of Medicine, bed-sharing may lead to suffocation by the larger person accidentally over the infant or pushing the infant into a dangerous location, such as between the mattress and bed frame or wall.

The AAP also suggests that for every sleep, infants should sleep on their backs (supine positioning) on a firm noninclined sleep surface without any soft bedding.

The academy says that this type of sleeping does not increase the risk of choking and aspiration in infants, even those with gastroesophageal reflux.

“Parents and caregivers continue to be concerned that an infant will choke or aspirate while supine. Parents often misconstrue coughing or gagging, which is evidence of a normal protective gag reflex, for choking or aspiration. Multiple studies in different countries have not demonstrated an increased incidence of aspiration since the change to supine sleeping,” the AAP stated.

The AAP says side sleeping is not safe and is not advised because it can increase the risk of rebreathing expired gases which result in labored breathing and low oxygen levels in the blood. It also increases the risk of overheating, alters the autonomic control of the infant’s cardiovascular system, particularly at 2 to 3 months of age, and increases the risk for Sudden Infant Death Syndrome (SIDS).

The infant’s sleep surface should adhere to the June 2021 Consumer Product Safety Commission’s rule that any infant sleep product must meet existing federal safety standards for cribs, bassinets, play yards, and bedside sleepers. Parents should not use products for sleep that aren’t specifically marketed for sleep.

Sitting devices, such as high chairs, car seats, strollers, swings, infant carriers, and infant slings, are not recommended for routine sleep in the hospital or at home, particularly for infants younger than 4 months.

Dressing the infant with layers of clothing is preferable to blankets and other coverings to keep the infant warm while reducing the possibility of head covering or entrapment that could result from blanket use. However, care must be taken to select appropriately sized sleep clothing and to avoid overheating. Wearable blankets can also be used. Nursing and hospital staff should model safe sleep arrangements to new parents after delivery.

Concerning swaddling, AAP says there is no evidence to recommend swaddling as a strategy to reduce the risk of SIDS. However, babies should be on their backs when swaddled and it should not be too tight. Weighted swaddles, weighted clothing or weighted objects on or near the baby are not safe and not recommended. When an infant exhibits signs of attempting to roll (which usually occurs at 3 to 4 months but may occur earlier), swaddling is no longer appropriate, as it could increase the risk of suffocation if the swaddled infant rolls to the prone position.

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AAP also suggests offering a pacifier at nap time and bedtime to reduce the risk of SIDS. Multiple case-control studies and 2 meta-analyses have reported a protective effect of pacifiers on the incidence of SIDS, with decreased risk of SIDS ranging from 50% to 90%.

The academy says that the mechanism for the apparent protective effect is still unclear, but favorable modification of autonomic control during sleep in term and preterm infants and maintaining airway patency during sleep have been proposed. 

The pacifier can be offered when the infant is placed for naps or nighttime sleep. It does not need to be reinserted once the infant falls asleep. Infants who refuse the pacifier should not be forced to take it. In those cases, parents can try to offer the pacifier again when the infant is a little older.

A policy statement from the American Academy of Pediatric Dentistry on oral habits states that nonnutritive sucking behaviors, like fingers or pacifiers, are considered normal in infants and young children and that, in general, sucking habits in children to the age of 3 years are unlikely to cause any long-term problems. They do suggest that pacifier use be discouraged after 4 years of age.