The New AAP Guidelines on SIDS and Safe Sleep Recommendations

by Donna Walls, RN, BSN, IBCLC, ICCE, ANLC

On 24 October 2016, the American Academy of Pediatrics released their Policy Statement entitled “SIDS and Other Sleep-Related Infant Deaths: Updated 2016 Recommendations for a Safe Infant Sleeping Environment”. So what does this mean for childbirth educators, doulas and lactation care providers?

Here are the basic recommendations from the AAP:

  1. Breastfeeding is recommended to reduce the risk of SIDS and to enhance the health and well-being of the infant and the mother. The AAP recommends exclusive breastfeeding for 6 months (no formula,  nutritional liquids or solid foods). Newer research demonstrates that exclusive breastfeeding can reduce the risk of SIDS by as much as 70%.
  2. Skin to skin care is recommended for all mothers and newborns, regardless of feeding or delivery method…for at least an hour after birth.
  3. Room-sharing with the infant on a separate sleep surface is recommended. Keep infants in close proximity to parents.
  4. The AAP recognizes that parents may fall asleep in bed after or during feeding their infant, so remove pillows, loose blankets, loose sheets and move the bed away from walls to prevent entrapment, and follow remainder of safe sleep recommendations.
  5. Avoid nighttime feeding on couches and arm chairs which are not considered safe sleep surfaces at any time for infants.
  6. It is important that anyone who cares for the infant puts the baby to sleep on their e back. Prone sleeping (sleeping on the stomach) increases the risk of re-breathing the same air that is under the baby’s face which can increase the levels of carbon dioxide in their blood, not enough oxygen in their blood which can be potentially fatal.
  7. Creating a safe sleep surface. Recommendations from the National Action Partnership to Promote Safe Sleep (in partnership with the AAP) recommends:

“Use a firm sleep surface, such as a mattress in a safety-approved crib covered by a fitted sheet, to reduce the risk of SIDS and other sleep-related causes of infant death. Firm sleep surfaces with no other bedding or soft objects. Nothing soft such as pillows etc. should be placed under the baby. Appropriate surfaces can include safety approved cribs, bassinets, and portable play areas. Safety approved cribs are those that have been manufactured and sold since the requirements went into effect on June 28, 2011. They have been designed to have the spaces between the bars too small for a baby’s head to get through and get stuck. Standards for other safety approved spaces such as bassinets, portable play areas and side cars (attachment to an adult bed that provides a separate, but close safe space) have also been developed by the U.S. Consumer Product Safety Commission, the agency that tracks accidents and deaths with products and helps keep babies safe from products that can be harmful or cause accidents. For information on safety standards for sleep products, contact the Consumer Product Safety Commission at 1-800-638-2772 or

Other considerations for safe sleep surfaces:

  1. Do not use bumper pads in a crib.
  2. Never place baby to sleep on soft surfaces, such as on a couch or sofa, pillows, quilts, sheepskins, or blankets.
  3. When using a sling to carry a baby, make sure the baby’s face is facing up and is above the fabric completely uncovered and open to the air.
  4. Do not use a car seat, carrier, swing, or similar product as baby’s everyday sleep area.
  5. Infants should not be placed to sleep on adult beds. Portable bed railings intended to keep a child from falling off a bed should not be used for infants.
  6. Avoid smoking, alcohol, and drugs during pregnancy and after birth.
  7. Avoid devices marketed to reduce risk of SIDS such as monitors, wedges, devices or specific mattresses.
  8. Swaddling does not reduce the risk of SIDS and in some cases may increase the risk for overheating and SIDS.
  9. Consider offering a pacifier at nap or bed time, after breastfeeding is firmly established (no specified time frame). If not breastfed can introduce as soon as family desires.
  10. Supervised, awake tummy time is recommended to facilitate development and to minimize development of positional plagiocephaly.

Teaching points for expectant or new parents includes the importance of open discussion on infant sleeping concerns and questions. Emphasize information on the benefits of exclusive breastfeeding as a strategy for SIDS risk reduction and how to create a safe sleep surface for infants in the first months of life. Encourage parents to have a frank, open conversation with the infant’s health care provider (Pediatrician or Family Physician) and any other infant care providers including family members, daycare providers or babysitters.

References and Resources Moon RY; Task Force on Sudden Infant Death Syndrome. SIDS and other sleep-related infant deaths: expansion of recommendations for a safe infant sleeping environment. Pediatrics. 2011;128(5). Available at: National Institute of Child Health and Human Development/National Institutes of Health. Safe to Sleep campaign. Available at: Accessed September 21, 2016 National Infant Sleep Position Study Web site. Available at: Accessed January 10, 2016 Highet AR, Berry AM, Bettelheim KA, Goldwater PN.. Gut microbiome in sudden infant death syndrome (SIDS) differs from that in healthy comparison babies and offers an explanation for the risk factor of prone position. Int J Med Microbiol. 2014;304(5–6):735–741pmid:24951305 McKenna J. Sleeping With Your Baby: A Parent’s Guide to Cosleeping. Washington, DC: Platypus Media, LLC; 2007 Kendall-Tackett K, Cong Z, Hale TW.  Mother-infant sleep locations and nighttime feeding behavior: U.S. data from the Survey of Mothers’ Sleep and Fatigue. Clin Lactation. 2010;1(1):27–31

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