PITTSBURGH - To further reduce the risk of sleep-related deaths in infants, children's health experts on Monday issued updated safe sleeping guidelines that emphasize the importance of a baby sleeping in the same room - but not the same bed - as the mother.
And in what might be a surprise to many new parents, the American Academy of Pediatrics is urging that babies sleep in their parents' bedrooms for at least the first six months, and, optimally, until the baby is 1 year old.
After reviewing research on sudden infant death syndrome, the AAP is reinforcing previous advice that the safest way to put an infant down to sleep is on the baby's back and be in a separate bed near the mother.
Dannai Harriel, program manager of Allegheny County's Maternal and Child Health Program, said sharing a room is already popular with some families. "I think it will reinforce what families want to believe," she said. "They want to be close to their children."
The county program's continuing challenge, however, is to keep parents from sharing their own bed with their baby, she said.
"We can say to our families: This is a win for you."
A member of the task force that developed the AAP guidelines, Lori Feldman-Winter of Cooper University Hospital in Camden, N.J., said, "Studies were done showing you can decrease (SIDS) risk by 50 percent and they included infants up to 1 year," she said. The highest risk of death by SIDS occurs in infants under 6 months old.
"We know from additional evidence, room-sharing facilitated breastfeeding," Dr. Feldman-Winter said, adding that exclusive breastfeeding has been linked to reducing the risk of SIDS by up to 70 percent.
It's the academy's first update of safe-sleep guidelines in five years. Key recommendations include:
• Baby sleeps on his back, on a firm sleep surface such as a crib or bassinet with a tight-fitting sheet.
• The crib should be empty: no soft bedding, including bumpers, blankets, pillows and soft toys.
• Put baby to sleep on a separate surface in the parents' bedroom.
• Skin-to-skin care should start immediately after delivery, for at least an hour.
• Breastfeeding is recommended. After feeding, the baby should be moved to his or her separate sleeping surface.
A safe sleeping surface that's portable is a core service provided by Pittsburgh-based nonprofit Cribs for Kids, which provides SIDS education and promotes SIDS research.
"Since 2005 they've said babies should sleep in a crib, in the same room with the mother," said Judith Bannon, executive director. Cribs for Kids has 710 partners nationwide that offer Graco Pack 'n Play, a portable play yard with a bassinet feature that can sit next to the mother's bed. In Allegheny County, mothers who can't afford a safe sleeping space can obtain a free Pack 'n Play.
Although her group has recommended room-sharing with the mother for the first six months, Bannon said a play yard can hold a baby up to 30 pounds, so it can be used through the baby's first year. She said her clients are primarily low-income families who have no objections to keeping their baby in their room.
"We had to take them out of the (parents') beds," she said. "They worried about keeping their babies in another room."
Families who have lost a child from SIDS in the county are referred to her agency, which offers them grief support at its Hazelwood location.
"We have seen a decrease in the number of babies who have died in unsafe sleeping environments," Bannon said. "This year we only got four referrals from the coroner's office. In the past, before Cribs for Kids, we were losing 28 babies a year in unsafe environments."
She said the latest guidelines should encourage pediatricians to work with mothers.
Feldman-Winter agreed. "It's important to have these open and nonjudgmental discussions with parents and families - first, sitting back and listening. We don't want to rush to the guidance with what to do. We want to reach parents where they're at."
Everyone involved in infant care has to get on board, she said, including hospital staff. She's seen babies in hospitals put to sleep on the side, which doubles the risk of SIDS. Skin-to-skin care should be routine as well, she said.
Other recommendations from the academy include offering a pacifier at sleep time after breastfeeding is established, keeping a child up to date with vaccinations, regular tummy time while awake to help development and avoiding use of home monitors or other devices that claim to reduce the risk of SIDS.
"Just because these are marketed and being sold," Feldman-Winter said, "doesn't mean it's safe for your baby."
"Portable cribs are fine; playpens are OK as long as they have a tight-fitting mattress and tight-fitting sheet. We don't recommend slings or bouncy sets or (Fisher Price) Rock 'n Play or even car seats. With car seats there can be a problem with airway obstruction; it's an unstable sleep position . the head tends to fall down and obstructs the airway. A flat sleep surface is recommended for that reason."
SIDS-prevention devices aren't helpful, she said. "That's really sending the wrong message. It assumes the baby will be in a separate sleep environment."
For parents concerned that a baby in their bedroom will disturb the adults' sleep, Feldman-Winter said that is normal.
"Babies are supposed to feed through the night. Parenting is difficult. It is exhausting. This is just part of parenting. . We don't know why room-sharing reduces the risk of SIDS. … You're supposed to be with your baby. The baby is not supposed to be alone."
