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American Academy of Pediatrics (2022) Safe Sleep Guideline Updates: What Parents Need to Know

Have you ever woken up in the middle of the night panicked that your child might have stopped breathing in the five minutes you dozed off after a feeding? Maybe you stayed up all night watching their little chest rise and fall with every breath, because you just didn’t want to take your eyes off them for one second? I get it! Parenting is hard and sleep can be scary! There are so many opinions and guidelines out there about how to be a good parent, but how much of it is based on science? As Mama Coaches and Registered Nurses, we want to inform you with the latest evidence to help you make evidence-informed decisions that are right for your family. Here’s what you need to know about the latest guidance from the American Academy of Pediatrics (AAP) for how to create a safe sleep environment for your little ones, up to one year of age!

Let’s start with a little background. On average, 3500 infants die each year because of sleep related deaths.  Researchers aren’t exactly sure in every case why this happens; however, they have identified ways to prevent things like accidental suffocation and strangulation from happening. While low-birth weight infants, weighing less than 5 pounds, 8 ounces, and premature infants, born before 37 weeks’ gestation, are at increased risk for infant sleep related deaths, all babies are at risk, especially during the first four months of life. Most sleep-related infant deaths occur because of suffocation, including getting their faces buried in soft surfaces, such as pillows, mattresses, couches or covered by blankets; as well as getting trapped between a mattress and a wall or other surface.  This is because their neck, head, arm, and chest muscles are still developing, and often babies are unable to move out of dangerous positions and situations, they accidentally get into. So, what can you do to keep them safe? 

The number one recommendation is to ensure that every time you put your little one down, they are on a safe sleeping surface. This includes always laying them on their back, on a firm, flat surface, without blankets, loose sheets, pillows, snugglies or other soft items. There is no evidence that infants with reflux benefit from sleeping on a slightly inclined surface; therefore, all infants should be lying flat for sleep, at home. The AAP now acknowledges that at times, parents may need to create an alternative or emergency sleep space such as use of a basket, box, or dresser drawer but in any case, the rules of creating a safe sleep space still apply. Infants should be transitioned to a crib, bassinet or other safe sleep surface that meets the federal safety standards, as soon as possible. It is important to note, although cradleboards are considered a culturally appropriate sleep surface, there is no evidence regarding its safety and parents should be cautious not to over bundle infants, as overheating increases the risk of sleep related deaths. AAP recommends dressing infants in temperature appropriate clothing such as footed pajamas, use of a sleep sack, or swaddling infants who are not yet able to roll-over, to avoid the use of loose blankets. Weighted blankets, weighted sleepers or other weighted objects should not be placed on or near the infant, as this could stop their breathing. Head coverings such as hats are now only recommended for use the first few hours of life in the hospital, as they could cause accidental suffocation. 

Besides ensuring the physical environment your baby is sleeping in, is safe, what else can you do? Researchers have found that the amazing protective factors of breastmilk also help reduce the likelihood of infant sleep related deaths. Breastfeeding, including pumping and feeding expressed breastmilk, reduces infants’ risk of sleep related deaths, with the greatest benefit being for those infants who are exclusively breastfed for at least 6 months. The great news is the longer you choose to breastfeed, the longer your baby is protected! The AAP also recommends the use of a pacifier for sleep, once breastfeeding is well established, as this reduces the risk of infant sleep related deaths.  So, does that mean you can now sleep with your infant in your bed if you are breastfeeding? Unfortunately, the risk of infant sleep related death for a baby who is bed sharing, still outweighs the benefits of exclusive breastfeeding; therefore, it is not recommended. If you take your baby to bed to feed them, or accidentally fall asleep with them in bed, return them to their safe sleep surface as soon as possible. The AAP now recommends infants sleep on a separate, safe sleep surface, in the parent’s room, for at least the first 6 months, as this can reduce the risk of infant sleep related deaths up to 50%. 

Be sure that you are alert and able to safely care for your infant and get help from a trusted partner when you are not. Many mamas need pain medication and sleep when they are recovering from birth. It’s okay! Your health is just as important as your baby’s, but when you are under the influence of medications, alcohol, opioids, marijuana, or illicit drugs, that make you sleepy or alter your alertness, you cannot safely monitor your baby. Seek help! Relying on a baby monitor, heart rate, oxygen or breathing monitor to keep your baby safe and alert you if something is wrong, is not failproof. The truth is, similar devices used in hospitals are regulated by high safety standards from the FDA, but those that are available to you at home, don’t have to meet the same safety standards.  It’s always best to have a responsible adult look after your child, if you are unable to do so. 

I know all of this can sound overwhelming, especially to a new parent! Talk to your healthcare professional. Be honest about your situation, concerns and needs. As Mama Coaches and Registered Nurses, we are here to provide non-judgmental support, every step of the way. Don’t suffer in silence! Together, we can create a plan that meets your family’s needs and ensure you have the tools to create a safe sleep environment for your little one!

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