American Academy of Pediatrics Revised Policy Statement
Recommendations to Reduce the Risk of Sudden Infant Death Syndrome (SIDS)

On October 10, 2005, the American Academy of Pediatrics (AAP) released revised guidelines for reducing the incidence of SIDS. These guidelines were presented at the Academy's national conference and featured in the journal "Pediatrics" (Vol. 116, No. 5, November 2005).

SIDS remains the leading cause of infant death beyond the neonatal period.
The recommendations include advice to:

• Place all infants, both term and preterm, on their backs for sleep.
• Use a firm surface for sleep with no soft objects under the infant.
• Not smoke in pregnancy. Smoking is an identified risk factor for SIDS.
• Avoid overheated sleep environments.
• Avoid positional plagiocephaly.
• Target secondary caregivers in the continuing "Back to Sleep" campaign.
• Place infants in their own cribs or bassinets for sleep but near the caregiver.
• Offer pacifiers at nap time and bedtime (after the first month in the breastfed infant).

The policy statement acknowledges the conflicting research on how pacifier use affects breastfeeding, the possible protection provided by pacifiers and/or breastfeeding against SIDS, and the risks and benefits of sharing a bed with an infant. The AAP also says that pacifier use in early infancy may predispose an infant to continue using it after 6 months of age with an increased risk for otitis media and GI and oral yeast infections. However, evidence in support of the recommendations was found to be the more compelling.

The AAP policy statement highlights the importance of neonatal intensive care and newborn nursery practices in positioning infants. The concerns are based on evidence that parents, especially parents of preterm infants, model how they position their infants at home after discharge on the practices they saw in the hospital. The APP recommends that NICU staff members place infants in supine positions well before discharge and, infants in newborn nurseries should be placed on their backs as soon as possible.

Several organizations issued statements addressing the AAP recommendations:

• The US Breastfeeding Committee is concerned about how the recommendations will affect breastfeeding success and said the scientific evidence does not clearly support the use of pacifiers to protect against SIDS, or removing infants from their parents' beds for sleep.
• The Academy of Breastfeeding Medicine cites evidence supporting bed-sharing as a way to protect against SIDS and promote breastfeeding. It cites pacifier use as advantageous in preventing SIDS only in those infants who are not breastfed.
• La Leche League International is concerned that pacifier use and avoidance of bed sharing will impede breast-milk supply and the duration of lactation. It fears that the recommendations will confuse parents.
• National Institute of Child Health and Human Development says it will incorporate the AAP recommendations into all of its "Back to Sleep" campaign materials. The campaign's focus is to educate parents and caregivers about the importance of infants sleeping on their backs.
• First Candle/SIDS Alliance provides an updated checklist for parents and caregivers about infant sleeping practices.

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