The American Academy of Paediatrics (APP) this week warned against parents co-sleeping with their babies in its first update to its safe sleep guidelines for babies since 2016.
Some 3,500 infants, many of whom are in socially disadvantaged communities, die from sleep-related infant deaths in the United States each year, it said, according to a CNN report.
“Many parents choose to share a bed with a child, perhaps to help with breastfeeding or because of a cultural preference or a belief that it is safe,” said Dr Rebecca Carlin, who co-authored the guidelines and technical report from the AAP Task Force on Sudden Infant Death Syndrome and the AAP Committee on Foetus and Newborn.
However, she added, the evidence is clear that co-sleeping “significantly raises the risk of a baby's injury or death”. Carlin, an assistant professor of paediatrics at Columbia University Irving Medical Centre said for that reason, “the AAP cannot support bed-sharing under any circumstances”.
This was just one of a number of recommendations the AAP has provided to paediatricians to help stem the tide of infant sleep deaths.
“The rate of sudden unexpected infant deaths (SUIDs) among black and American Indian/Alaska Native infants was more than double and almost triple, respectively, that of white infants (85 per 100 000 live births) in 2010-2013,” the AAP noted.
Sleep in same room, separate bed
While the AAP strongly advises against co-sleeping, its updated guidelines say babies should sleep in the same room with their parents for at least six months on a separate sleep surface with a firm, flat surface.
Based on new Consumer Product Safety Commission regulations that will go into effect this week, the only products which can be marketed for infant sleep include cribs, bassinets, play yards and bedside sleepers. Bedside sleepers are separate small cribs or bassinets that attach to the parent's bed but allow babies to sleep alone without any bedding.
Parents should not use products for sleep that aren't specifically marketed for sleep, the AAP said.
Other sleep environments can also put infants at risk. Resting with a baby on a couch, armchair or cushion and falling asleep raises the risk of infant death by 67%, the AAP noted.
If the baby is pre-term, born with a low birth weight or is under four-months-old, the risk of death while co-sleeping on a bed, couch or other spot increases five to 10 times, the academy said.
Bare is best
Parents should always put babies to sleep alone on their backs on a flat, firm mattress covered in a snug, fitted sheet. Avoid all extras in the crib, including soft toys, blankets, pillows, soft bedding, sleep positioners or crib bumpers, as babies can become trapped by such items and suffocate.
Crib bumpers have been linked to more than 100 infant deaths during the past 30 years, the association said.
These products are generally used by well-meaning parents, who only want the best for their child and believe they are doing the right thing. But babies do not need any of those cushioned products to be warm and comfortable. Instead of a sheet or blanket, place baby in a swaddle sack or wearable blanket.
In fact, putting excessive clothing or blankets on an infant, especially in a warm room, can be associated with an increased risk for SIDS.
Hats and any other head covering should be removed before placing your baby down to sleep.
Since cribs slats are now regulated to be close together, bumpers are no longer needed, the AAP said. “Stores now sell mesh bumpers and vertical crib liners. But even these can get loose and become a strangulation risk. Babies can also get trapped between them and the crib mattress.”
Less than a 10% incline allowed
The new CPSC regulations will ban all products marketed for infant sleep with more than a 10% incline. Those include inclined sleepers and sleep positioners, also called baby nests, docks, pods, loungers, rockers, and nappers, the AAP said. Many of the products may not be sold as sleep aids, but babies often fall asleep in them.
The US guidelines comes after at least 13 deaths were linked to Fisher-Price baby rockers, The Independent reports.
Fisher-Price on last week also issued an alert for the company’s Infant-to-Toddler Rockers and Newborn-to-Toddler Rockers after “at least 13 reported deaths” occurred between 2009 and 2021.
According to the CPSC, the deaths happened when the babies fell asleep in the rockers. The company advised parents and caregivers that rockers “should never be used for sleep and should never be unsupervised or unrestrained in the Rockers.”
Now, the CPSC has finalised a rule that requires infant sleep products to have a sleep surface angle of 10 degrees or less, which goes into effect on 23 June 2022.
“Parents and caregivers should never use inclined products, such as rockers, gliders, soothers, and swings, for infant sleep and should not leave infants in these products unsupervised, unrestrained, or with bedding material, due to the risk of suffocation,” the CPSC warned.
“Infants who fall asleep in an inclined or upright position should be moved to a safe sleep environment with a firm, flat surface such as a crib, bassinet or play yard,” the agency said.
Many such products have up to a 30% incline, which can be dangerous because babies' heads fall forward during sleep. This chin-to-chest position can restrict their airway, causing suffocation. Infants can also roll out of the devices and become trapped under them.
The Safe Sleep for Babies Act, signed into law last year, outlaws the manufacture and sale of inclined sleepers and crib bumpers.
Car seats, strollers, swings, infant carriers and infant slings can also obstruct a baby's airways, the AAP said. So when baby falls asleep in them – which is inevitable – parents should move the child to lie on their back on a flat, firm surface.
Avoid commercial devices sold for SIDS
The AAP also warns against commercial devices that claim to reduce the risk of SIDS or other sleep-related issues, including wearable monitors.
In addition, do not use home cardiorespiratory monitors – devices that monitor baby’s heart rate and oxygen levels – as a way to reduce the risk of SIDS, because there is no evidence that they work.
Updated recommendations for safe infant sleeping
Independent report – Fisher-Price issues warning after 13 infant deaths from rockers
See more from MedicalBrief archives:
Baby sleep products linked to 200 deaths now banned in the US
Some retailers stop selling baby sleep positioners after US report
Siblings of SIDS infants at 10-fold risk of same death
Message on SIDS not getting through