Sunday, April 13, 2014

Reducing the Risk of Sudden Infant Death Syndrome - Recommendations

The AAP guidelines to reduce the risk of SIDS in individual infants are appropriate for most infants, but physicians and other health care providers might, on occasion, need to consider alternative approaches. The major components are as follows:

  •     Full-term and premature infants should be placed for sleep in the supine position. There are no adverse health outcomes from supine sleeping. Side sleeping is not recommended.



   •     It is recommended that infants sleep in the same room as their parents but in their own crib or bassinette that conforms to the safety standards of the Consumer Product Safety Commission. Placing the crib or bassinette near the mother's bed facilitates nursing and contact.

   •     Infants should be put to sleep on a firm mattress. Waterbeds, sofas, soft mattresses, or other soft surfaces should not be used.

   •     Soft materials in the infant's sleep environment—over, under, or near the infant—should be avoided. These include pillows, comforters, quilts, sheepskins, cushion-like bumper pads, and stuffed toys. Because loose bedding may be hazardous, blankets, if used, should be tucked in around the crib mattress. Sleeping clothing, such as a sleep sack, can be used in place of blankets.

   •     Avoid overheating and overbundling. The infant should be lightly clothed for sleep and the thermostat set at a comfortable temperature.

   •     Infants should have some time in the prone position (tummy time) while awake and observed. Alternating the placement of the infant's head as well as his or her orientation in the crib can also minimize the risk of head flattening from supine sleeping (positional plagiocephaly).

   •     Devices advertised to maintain sleep position, “protect” a bed-sharing infant, or reduce the risk of rebreathing are not recommended.

   •     Home respiratory, cardiac, and O2 saturation monitoring may be of value for selected infants who have extreme instability, but there is no evidence that monitoring decreases the incidence of SIDS and it is therefore not recommended for this purpose.

   •     Consider offering a pacifier at bedtime and naptime. The pacifier should be used when placing the infant down for sleep and not be reinserted once it falls out. For breast-fed infants, delay introduction of the pacifier until breast-feeding is well established.

   •     Mothers should not smoke during pregnancy and infants should not be exposed to secondhand smoke.

   •     The national Back to Sleep campaign should continue and be expanded to emphasize the multiple characteristics of a safe sleeping environment and to focus on the groups who continue to have higher rates of SIDS. Educational strategies must be tailored to each racial or ethnic group to ensure acceptance within that cultural context. Secondary care providers need to be targeted to receive these educational messages, including daycare providers, grandparents, foster parents, and babysitters. Health care professionals in intensive care and normal newborn nurseries should implement these recommendations well before anticipated discharge.