Pediatricians Sharpen SIDS recommendations

Putting babies down to sleep on their backs has drastically reduced the occurrence of sudden infant death syndrome (SIDS). Yet, SIDS still strikes at a rate that makes it the leading cause of infant death. In order to provide a safe sleeping environment for infants, follow these updated safe-sleeping guidelines provided by the American Academy of Pediatrics:

1. Infants should be placed for sleep in a supine (face up) position (wholly on the back) for every sleep. Side sleeping is not as safe as supine sleeping and is not advised.

2. Use a firm sleep surface: Soft materials or objects such as pillows, quilts, comforters, or sheepskins should not be placed under a sleeping infant. A firm crib mattress, covered by a sheet, is the recommended sleeping surface.

3. Keep soft objects and loose bedding out of the crib.

4. Do not smoke during pregnancy: Maternal smoking during pregnancy has emerged as a major risk factor in almost every epidemiologic study of SIDS

5. A separate but proximate sleeping environment is recommended: The risk of SIDS has been shown to be reduced when the infant sleeps in the same room as the mother. A crib, bassinet, or cradle that conforms to the safety standards of the Consumer Product Safety Commission and ASTM (formerly the American Society for Testing and Materials) is recommended. Although bed-sharing rates are increasing in the United States for a number of reasons, including facilitation of breastfeeding, the task force concludes that the evidence is growing that bed sharing, as practiced in the United States and other Western countries, is more hazardous than the infant sleeping on a separate sleep surface and, therefore, recommends that infants not bed share during sleep. Infants may be brought into bed for nursing or comforting but should be returned to their own crib or bassinet when the parent is ready to return to sleep

6. Consider offering a pacifier at nap time and bedtime:

Although the mechanism is not known, the reduced risk of SIDS associated with pacifier use during sleep is compelling, and the evidence that pacifier use inhibits breastfeeding or causes later dental complications is not. Until evidence dictates otherwise, the task force recommends use of a pacifier throughout the first year of life according to the following procedures:

• The pacifier should be used when placing the infant down for sleep and not be reinserted once the infant falls asleep. If the infant refuses the pacifier, he or she should not be forced to take it.

• Pacifiers should not be coated in any sweet solution.

• Pacifiers should be cleaned often and replaced regularly.

• For breastfed infants, delay pacifier introduction until 1 month of age to ensure that breastfeeding is firmly established.

7. Avoid overheating: The infant should be lightly clothed for sleep, and the bedroom temperature should be kept comfortable for a lightly clothed adult. Over bundling should be avoided, and the infant should not feel hot to the touch.

8. Avoid commercial devices marketed to reduce the risk of SIDS: Although various devices have been developed to maintain sleep position or to reduce the risk of rebreathing, none have been tested sufficiently to show efficacy or safety.

9. Do not use home monitors as a strategy to reduce the risk of SIDS: Electronic respiratory and cardiac monitors are available to detect cardio respiratory arrest and may be of value for home monitoring of selected infants who are deemed to have extreme cardio respiratory instability. However, there is no evidence that use of such home monitors decreases the incidence of SIDS. Furthermore, there is no evidence that infants at increased risk of SIDS can be identified by in-hospital respiratory or cardiac monitoring.

10. Avoid development of positional plagiocephaly: Encourage “tummy time” when the infant is awake and observed. This will also enhance motor development.

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