Reducing the risk of SIDS: Overview of the updated AAP policy statement

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The incidence of sudden infant death syndrome (SIDS) has decreased dramatically since 1992, when the American Academy of Pediatrics (AAP) released its recommendation that infants be placed in a non–prone position to sleep. In 2001, the SIDS rate was 0.56 deaths per 1,000 live births, compared to 1.20 deaths per 1,000 live births in 1991. Despite this 53% decrease, SIDS remains the major cause of death for infants between one month and one year of age. In an updated policy statement published in November 2005, the AAP released recommendations aimed at further reducing the incidence of SIDS. The updated statement reiterates previous statements that infants should be placed on their "back to sleep" for every sleep, including naps. The recommendations state that side sleeping is not as safe as supine sleeping and is not advised. Important elements of sleep environment such as using a firm crib mattress covered by a tight fitting sheet and keeping soft objects and loose bedding out of the cribs are emphasized. The recommendations also highlight the importance of not smoking during pregnancy and protecting infants from secondhand smoke after birth.

The AAP added three new recommendations to the current policy statement:

  1. provide a close but separate sleeping environment for infants
  2. consider offering a pacifier at naptime and bedtime
  3. avoid using commercial devices that claim to reduce the risk of SIDS

Citing evidence from recent case–control studies, the AAP states that bed sharing is more hazardous than an infant sleeping on a separate surface, and the safest place for an infant is in a crib or bassinet in the same room with the parents. Regarding pacifier use, the AAP concludes that the evidence supporting pacifier use to reduce SIDS rates is compelling. In consideration of study results indicating a possible correlation between pacifiers and reduced breastfeeding duration, the AAP suggests delaying pacifier introduction until one month of age, when breastfeeding is firmly established and risk of SIDS greatly increases. The final new recommendation takes into account the lack of safety and testing requirements for many devices marketed to prevent SIDS. As there is no evidence for the safety or efficacy of these devices, their use is discouraged.

With the release of this policy statement, the AAP recommends that readers consider all the recommendations together and not focus on a single risk factor. Healthcare providers should be diligent in raising awareness of the recommendations while keeping in mind other factors that may affect a family’s ability to follow them. Education efforts should especially focus on African American and American Indian/Alaskan Native families, because this population has a higher prevalence rate of SIDS.

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