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2022 American Academy of Pediatrics Safe Sleep Guidelines

The American Academy of Pediatrics (AAP) has released updated guidelines aimed at reducing the risk of sudden infant death syndrome (SIDS) and improving safe sleep practices for infants. These recommendations were issued by the Task Force on Sudden Infant Death Syndrome and the Committee on Fetus and Newborn. Below, we break down the key points of the updated policy and what they mean for parents and caregivers.

1. Safe Sleep Position and Surfaces

One of the most important aspects of safe sleep for infants is their positioning. The AAP strongly reiterates the importance of placing infants on their backs (supine position) on a firm, flat, non-inclined surface. This recommendation aligns with recent federal legislation banning the sale and manufacture of inclined sleepers with an angle greater than 10 degrees. All sleep products should meet federal safety standards for cribs, bassinets, play yards, and bedside sleepers to ensure a safe environment for infants.

2. Benefits of Human Milk Feeding

Feeding human milk to both term and preterm infants has been highlighted as a significant SIDS risk-reduction strategy. The AAP recommends breastfeeding for at least the first 6 months of life to support infant health and reduce the likelihood of SIDS.

3. Guidelines on Bedsharing and Room Sharing

The AAP continues to advise against bedsharing in any form. However, room sharing—keeping the infant’s crib or bassinet close to the parent’s bedside—is strongly recommended for at least the first 6 months. Bedsharing poses even higher risks if:

  • The infant is younger than 4 months old.
  • The caregiver is impaired by substances such as alcohol or certain medications.
  • The caregiver is a smoker.
  • The sleep environment includes soft bedding or pillows.

4. Safe Use of Pacifiers

The AAP provides clearer recommendations on the use of pacifiers as a SIDS risk-reduction tool. Parents are encouraged to introduce pacifiers at the appropriate time and manner, which can be a helpful practice when used correctly.

5. Avoiding Harmful Substances

Pregnant and postpartum mothers are advised to avoid exposure to nicotine, marijuana, opioids, and other drugs, as these substances can increase the risk of SIDS. This extends the longstanding advice to steer clear of smoking, alcohol, and illicit drugs.

6. Avoiding Hats to Prevent Overheating

To prevent overheating, the use of hats on infants should be avoided, except during the initial hours after birth and in neonatal intensive care unit (NICU) settings. Overheating can contribute to unsafe sleep conditions.

7. Monitoring Devices and Safety

The AAP clarifies that consumer heart rate and pulse oximetry monitoring devices, while sometimes marketed as safety tools, are designated as consumer wellness devices by the FDA. These devices are not recommended as reliable means to prevent SIDS, as they may give parents a false sense of security.

8. Tummy Time Recommendations

Tummy time is essential for an infant’s development, but it should be done during supervised, awake periods. The AAP provides specific timing and duration guidelines to support healthy growth and development.

9. Swaddling Practices

The updated guidelines warn against using weighted swaddles or placing weighted objects inside swaddlers, as these can be unsafe. Swaddling should be discontinued once an infant starts showing signs of attempting to roll over, which typically occurs around 3-4 months of age.

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Conclusion

he AAP’s updated guidelines provide critical advice to promote safer sleep for infants and reduce the risk of SIDS. Parents and caregivers should familiarize themselves with these practices and ensure that their baby’s sleep environment meets current safety standards. For more detailed information, consult the full AAP policy statement or speak with a pediatrician.

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