Safe Sleep Recommendations

This blog has discussed safe sleep many times. Sleep-related infant deaths exact an enormous toll. All pediatric physicians should take the opportunity to counsel parents to reduce this risk.

Recently, the AAP updated their recommendations, open access: RY Moon et al. Pediatrics (2022) 150 (1): e2022057990. Sleep-Related Infant Deaths: Updated 2022 Recommendations for Reducing Infant Deaths in the Sleep Environment

Some of the recommendations:

  • Sleep surfaces: Use a flat, noninclined sleep surface. A crib, bassinet, portable crib or play yard should conform to the safety standards of the Consumer Product Safety Commission (CPSC). Recent biomechanical analyses have demonstrated that sleep surfaces that are inclined more than 10 degrees from horizontal are unsafe for infant sleep.
  • Sleep location Infants should sleep in the parents’ room, close to the parents’ bed but on a separate surface designed for infants, ideally for at least the first six months.
  • Bedding Do not place any soft objects, including pillows, blankets or bumper pads, in the infant’s sleep environment.
  • Pacifiers Pacifier use is associated with a reduced risk of SIDS. For infants who are not directly breastfed, pacifiers can be introduced at any time. For breastfed infants, the pacifier can be started once breastfeeding is firmly established 

Bed-sharingAlthough the AAP cannot recommend bed-sharing based on the evidence, it also respects that many parents choose to bed-share routinely for a variety of reasons. It is important for clinicians and parents to have frank and nonjudgmental discussions about the family’s bed-sharing circumstances. The policy provides a risk-stratification analysis to guide these discussions…The safest place for a baby to sleep is on a separate sleep surface designed for infants close to the parents’ bed.

These situations “increase the risk of SIDS or unintentional injury or death while bed sharing, and these should be avoided at all times:

  • Bed sharing with a term normal weight infant aged <4 mo and infants born preterm and/or with low birth weight…even for breastfed infants…
  • Bed sharing with a current smoker (even if he or she does not smoke in bed) or if the mother smoked during pregnancy
  • Bed sharing with someone who is impaired in his or her alertness or ability to arouse because of fatigue or use of sedating medication
  • Bed sharing on a soft surface, such as a waterbed, old mattress, sofa, couch, or armchair
  • Bed sharing with soft bedding accessories, such as pillows or blankets

Summary of new guidelines from AAP News: New safe sleep recommendations can help pediatricians guide families

My take: It is a good idea to incorporate safe sleep messages when infants are seen for a variety of disorders including reflux and colic.

Related blog posts:

  • Safe Sleep A terrific website that focuses on this crucial issue:; it has videos, do’s and don’ts as well as a link to Cribs for Kids (discounted safe crib website). In addition,this website has a book called “Sleep Baby Safe and Snug” which incorporates updated recommendations on safe sleep practices.
  • The High Toll of Sudden Infant Death From 2013-2015, there was an average of 3523 US infants each year who died from SUID (sudden unexpected infant death), peaking at 1-2 months of life.  More black infants died of SUID in the first year than black children who died from firearm homicides in all of childhood through age 19 years. SUID deaths from 2013-2015 (10,568) was similar to the total number of motor vehicle-traffic deaths in all of childhood (10,714) and greater than the total number of any of the other causes.
  • Are We Making Progress on Infant Sleep-Related Deaths? (not anymore) 
  • Safe Sleep (AAP 2017) 
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