How to prevent sleep-associated infant deaths

Sudden infant death syndrome (SIDS) is the sudden and unexpected death of infants under 1 year of age.

SIDS rates have dropped dramatically around the world since professionals began sharing tips on how to put your baby to sleep and how to care for them in that environment. The American Academy of Pediatrics (AAP) recently updated that list of recommendations in a report published in Pediatrics.

Experts say that SIDS has a higher risk of occurring between two and four months of age, affects more boys than girls, and usually occurs during the winter.
Many causes are responsible for neonatal deaths, including premature births, birth-related complications (including perinatal asphyxia), infections, and birth defects.

From the end of the neonatal period and during the first 5 years of life, the leading causes of death are pneumonia, diarrhea, birth defects, and malaria. “Malnutrition is the underlying concomitant factor that heightens children’s vulnerability to serious illness,” reports the World Health Organization (WHO).

In recent decades, a significant decrease in the number of newborn deaths has been observed (from 5 million in 1990 to 2.4 million in 2019). Many experts agree that this is because health authorities began to share advice on how to put babies to sleep, primarily by recommending that they sleep in a supine (back) position.

Although taking this position to reduce the risk of SIDS seems like a no-brainer, for a long time it was not only not recommended, but also not practiced in hospitals.

A study published in 2003 in Anales Españoles de Pediatría conducted surveys in 213 hospitals in Latin America and the Caribbean to find out how newborns were put to bed.

The authors found the following results: in 18 (8.5%) healthy children were placed on their stomachs, 104 (48.8%) on their sides, 53 (25.2%) on their backs, and 37 (17.5%) did not. took a definite position or the answers were inconsistent.

Regarding the recommendations to parents, in 54 hospitals (25.7%) the position on their back was recommended, in 16 (7.6%) face down, in 124 (59%) on their side, and in 16 (7.6%) they did not. directly recommendations.

Approximately 3,500 sleep-related infant deaths occur each year in the US, according to the AAP. The risk of infant death is up to 67 times higher when sleeping with another person on a sofa or couch, and 10 times higher when sleeping with another person who is tired or who uses sleeping pills, illegal drugs, or smokes.

“We’ve made great strides in learning what keeps babies safe during sleep, but there’s still a lot of work to be done,” said Dr. Rachel Moon, a professor of pediatrics at the University of Virginia School of Medicine and an author of the new AAP report.

“The death of a baby is tragic, heartbreaking, and often preventable. If we’ve learned anything, it’s that simplicity is best: Babies should always sleep alone in a crib or bassinet, on their backs, without toys, pillows, blankets, or other soft bedding,” Moon added in a news release.

How to reduce the risk of SIDS

To reduce the risk of sleep-related infant death, the AAP recommends:

• Place babies in a supine position every time they sleep until they are 1 year old. Sleeping on your side or stomach is not considered safe.
• Sleeping surfaces should be firm, flat, and not sloped to reduce the risk of suffocation.
• Feeding should be breastmilk, as it is associated with a lower risk of sleep-related infant death.
• Babies can sleep in their parents’ room, close to their beds, but in a separate area designed exclusively for them (preferably for at least the first 6 months).
• Keep soft objects such as pillows, similar toys, comforters, mattress pads, loose sheets, or loose clothing away from the baby’s sleep area, as they may increase the risk of suffocation or strangulation.
• Use a pacifier when breastfeeding is firmly established. Babies who are not being directly breastfed can start using the pacifier as soon as they want.
• Avoid exposure to smoke and nicotine, as well as the consumption of alcohol, marijuana, opioids, and illicit drugs during pregnancy and after childbirth.
• Avoid overheating and cover babies’ heads.
• Pregnant people should get regular prenatal care, this provides an opportunity for doctors and non-physician clinicians to advise expectant parents on safe sleep practices and help them manage high-risk behaviors.
• Vaccinate infants following AAP and Centers for Disease Control and Prevention (CDC) guidelines. There is no evidence that there is a causal relationship between vaccines and the risk of sleep-related infant death.
• Avoid using commercial devices that do not align with safe sleep recommendations, especially those that claim to reduce the risk of sleep-related deaths.
• Do not use home cardiorespiratory monitors as a strategy to reduce the risk of sleep-associated infant death. There is concern that the use of these monitors will lead to parental complacency and decrease adherence to safe sleep guidelines.
• Babies should spend time awake on their tummy to promote infant development and minimize flat head syndrome, always under parental supervision.
• Do not resort to swaddling (use of a diaper or wrapping the baby in light blankets to calm him down and encourage the supine position).
• Physicians, non-physician clinicians, hospital staff, and child care providers should support and exemplify guidelines for safe infant sleep from early in pregnancy.

The AAP also stresses that it is important for the media and manufacturers to follow these safe sleep guidelines in their messages, advertisements, production, and sales to promote safe sleep practices as a social norm.

Sources consulted: American Academy of Pediatrics (AAP), Spanish Annals of Pediatrics, US National Library of Medicine, Centers for Disease Control and Prevention, Mayo Clinic, World Health Organization (WHO).