Sudden Infant Death Syndrome
- Back to sleep: Infants should be placed on their backs for every sleep. Side sleeping is not as safe and is not advised.
- Use a firm sleep surface: Soft materials or objects such as pillows, quilts, comforters, or sheepskins should not be placed under a sleeping infant.
- Keep soft objects and loose bedding out of the crib: Soft objects such as pillows, quilts, comforters, sheepskins, and stuffed toys should be kept out. If bumper pads are used in cribs, they should be thin, firm, well secured, and not “pillow like.”
- Do not smoke during pregnancy: Maternal smoking during pregnancy has emerged as a major risk factor for SIDS in numerous studies.
- A separate but proximate sleeping environment is recommended: The risk of SIDS has been shown to be reduced when the infant sleeps in the same room as the mother for the first six months of life. A crib, bassinet, or cradle that conforms to the safety standards of the Consumer Product Safety Commission and ASTM is recommended. The evidence is growing that bed sharing with parents or other children is more hazardous than the infant sleeping on a separate sleep surface.
- Consider offering a pacifier at nap time and bedtime: Although the reason is not known, the most recent evidence is compelling that the use of a pacifier during the first year of life reduces SIDS. The pacifier should be used when placing the infant down for sleep and not be reinserted once the infant falls asleep. Pacifiers should not be sugar coated and should be replaced frequently.
- Avoid overheating: The infant should be lightly clothed for sleep, and the bedroom temperature should be kept comfortable for a lightly clothed adult. Over-bundling should be avoided, and the infant should not feel hot to the touch.
- Avoid commercial devices marketed to reduce the risk of SIDS: Although various devices have been developed to maintain sleep position or to reduce the risk of re-breathing, none have been tested sufficiently to show efficacy or safety.
- Do not use home monitors as a strategy to reduce the risk of SIDS: Electronic breathing and heart monitors may be of value for monitoring selected infants who are deemed to have extreme cardiorespiratory instability. However, there is no evidence that use of such home monitors decreases the risk of SIDS.
- Avoid the development of malformed heads from back sleeping: Spend “tummy time” when the infant is awake and observed. Avoid having the infant spend excessive time in car-seat carriers and “bouncers.” Upright “cuddle time” should be encouraged. The position of the head should be altered from night to night to avoid the development of a flat spot on one side.
- Educate all caregivers about the importance of the above recommendations.
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