DOCTORS ’ LOUNGE
SAFE INFANT SLEEP : 2016 UPDATE
Elizabeth A . Amin , MD
DOCTORS ’ LOUNGE
As a grandmother of three with a fourth grandchild expected in February , I try to be alert to new recommendations regarding infant and child safety . A few days ago , my attention was drawn to a brief announcement indicating that the American Academy of Pediatrics had updated its safe sleep recommendations for newborns and infants through the first year of life . ( 1 ) For those of us whose visits to the pediatrician ’ s office are a distant – and in my case a rather blurry – memory , there are numerous sites where this information can be accessed . The American Academy of Pediatrics website ( aap . org ) is the ground source , heavy on detail and the fine distinctions between Sudden Infant Death Syndrome ( SIDS ) and other causes of Sudden Unexpected Infant Death ( SUID ) during sleep . There are some charming , informative and non-threatening public announcement videos on the National Institutes of Health website ( nichd . nih . gov ) ( 2 ) where the new mother-to-be is explaining to her mom , the new grandmother-to-be , how and why things have changed . These , I am sure , will be available in different forms in the many magazines and online blogs that parents have access to nowadays .
The abstract to the 2016 recommendations indicates that , “ Approximately 3,500 infants die annually in the U . S . from sleep-related infant deaths . This includes SIDS and accidental suffocation and strangulation in bed .” Reading through the list of 19 recommendations , I noted that the last four (# 16 , # 17 , # 18 , # 19 ) are directed to health care providers , researchers and other professional groups . However , 15 recommendations are directed to parents / caregivers . Many of these are common
-sense risk avoidance measures related to daily issues of modern life . Some of them are more complex , and I was struck by a certain rigidity in some of the latter . The objective of the new guidelines is to eliminate accidental causes of infant death during sleep ; such things as avoidable entrapment , suffocation and asphyxiation . Also , they aim to reduce and eventually eliminate SIDS . SIDS is defined as , " the sudden death of an infant that is unexpected by history and unexplained by a post-mortem examination that includes a case investigation , complete autopsy and examination of the death scene ." SIDS is therefore considered a subset of SUID . The fear of SIDS is omnipresent whenever a new baby joins a household . Rules that are clear and reasonably easy to implement go a long way towards alleviating the anxiety of new parents . Recommendations that may be confusing or harder to implement may add to parental anxiety , especially if two parents / caregivers don ’ t see eye to eye . SIDS is devastating to all involved . In my opinion , parental guilt should never be implied .
The first clear guidelines on infant sleep safety were published in the early 1990s . There followed a measurable and significant reduction in SIDS . Apparently , the incidence of SIDS has leveled out during the last decade and updating the recommendations a ) brings them back into focus and b ) adds some new information - although this comes with caveats that are important . First and foremost is the now well-accepted Back To Sleep rule . Soon after this was first instituted in 1994 I remember learning from friends that one of the problems associated with always putting babies to sleep on their backs was the development of positional plagiocephaly ; flattening of the occipital bone at the back of the skull . The remedy at that time was for the infant to wear a custom designed little helmet . I believe it was worn for 23 out of 24 hours a day . I am not sure what the average duration of that treatment was . I had given it no thought until 2009 when our first granddaughter was born . When I received my instructions the day I was going to babysit for the first time I mentioned this to our daughter-in-law . She had heard about the condition but per her pediatrician , providing the baby with enough tummy time during waking hours , and when a caregiver was present , was adequate to prevent it . The updated guidelines are very clear on this . Nevertheless , when it was time for me to put this tiny little creature down for the night , on her back , hopefully with her swaddling not too loose and not too tight but just right , I had a knot in my stomach .
Our first son was born in 1977 . He slept face down . I am not sure if it was just my paranoia at the time , that he would regurgitate , aspirate and die before morning . Part of my brain says that that was a “ safe ” recommendation at the time but I don ‘ t pretend to remember . In reviewing these new recommendations , I am relieved to know that “ face down ” sleep was not a risk factor for suffocation but the evidence is in that it is one of the factors associated with SIDS .
A lot of other things have changed since 1977 . I know how dangerous our drop-sided crib was . Shopping for our granddaughter ’ s crib in 2009 , I walked around the showroom several times trying to figure out how I would be able to lay a baby gently on the CPSC ( Consumer Product
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