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Pediatricians Revise SIDS Prevention Recommendations

October 11, 2005
To reduce the risk of Sudden Infant Death Syndrome (SIDS), Pediatricians are warning parents against letting infants sleep on their sides or backs and cautioning parents not to share a bed with their infant. In a recommendation that surprised some, the academy also endorsed the use of pacifiers.

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Despite major decreases in the incidence of SIDS over the past decade, the syndrome is still responsible for more infant deaths beyond the newborn period in the United States than any other cause of death during infancy.

In an updated policy statement, the AAP said it no longer recognizes side sleeping as a reasonable alternative to sleeping while fully supine (lying on back).

Studies have found that the side sleep position is unstable and increases the chances of the infant rolling onto his or her stomach. Every caregiver should use the back sleep position during every sleep period, the academy said.

Bed Sharing

Bed sharing is not recommended during sleep. Infants may be brought into bed for nursing or comforting, but should be returned to their own crib or bassinet when the parent is ready to return to sleep.

However, there is growing evidence that room sharing (with the infant sleeping in a crib in the parent's bedroom) is associated with a reduced risk of SIDS. The AAP therefore recommends a separate but proximate sleeping environment.

Research now indicates an association between pacifier use and a reduced risk of SIDS, which is why the revised statement recommends the use of pacifiers at nap time and bedtime throughout the first year of life.

The evidence that pacifier use inhibits breastfeeding or causes later dental complications is not compelling enough to discredit the recommendation.

However, it is recommended that pacifier introduction for breastfed infants be delayed until one month of age to ensure that breastfeeding is firmly established. In addition, if the infant refuses the pacifier, it should not be forced.

There is a slight increased risk of ear infections associated with pacifier use, but the incidence of ear infection is generally lower in the first year of life, especially the first six months, when the risk of SIDS is the highest.

The following have been consistently identified as risk factors for SIDS:
• prone (lying on stomach) sleep position,
• sleeping on a soft surface,
• maternal smoking during pregnancy,
• overheating,
• late or no prenatal care,
• young maternal age,
• preterm birth and/or low birth weight and
• male gender.

Consistently higher rates of SIDS are found in black and American Indian/Alaska Native children -- two to three times the national average.

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