Creating a Safe Sleep Environment                                             Bookmark and Share


In 2005, the American Academy of Pediatrics released a new version of the SIDS recommendations. Some things have changed and others have been revised.  The intent is to prevent sudden infant death as best we can with using the best available research.  Despite the changes to the sleep environment that we have made in the past, SIDS is still the number one cause of neonatal deaths.  SIDS is rare in the first month of life and peaks at 2 to 3 months of age, but the definition includes children up to 1 year of age.

First things first.  SIDS is defined as "The sudden death of an infant under 1 year of age, which remains unexplained after a thorough case investigation, including a performance of a complete autopsy, examination of the death scene, and review of the clinical history."   In this definition of SIDS is the crux of the problem: we don't know what causes it.  When we don't know what causes something in medicine, we make lists.  So here's the list (some of these have their own separate pages):

The official recommendations for SIDS prevention: and everyone who cares for your baby should know these!

Back to sleep

Children should sleep on their backs. "Back to Sleep" has been the mantra since 1994.  The original policy statement also said side sleeping was OK.  That is no longer the case.  It is not OK for children to sleep on their side.

Also important is this:  infants who usually sleep on their back and then have a caregiver place them on their side or stomach to sleep are at VERY high risk for SIDS (somewhere around 6-8 times more at risk).  If the child is used to sleep on their back, make sure everybody who cares for the baby knows that.  By the way...that recommendation should sound familiar as it is the same recommendation for pacifiers.

Use a firm surface/ Keep soft objects and loose bedding out of the crib.

No waterbeds.  No soft pillows.  No soft mattresses including babies sleeping for whatever reason on adult beds.

This also includes bumper pads, stuffed animals, and blankets.  If you think the baby is cold, add more layers.  Never too early to teach a Wisconsin kid how to layer-up!

Do not smoke

In case you haven't heard, smoking is bad for you.  It's bad for everybody around you. The increased risk of sudden infant death is another good reason to quit.  The Wisconsin Tobacco quit line will help. SIDS risk is increased because of maternal smoking during pregnancy, so being pregnant is a great reason to quit smoking.  And if you choose to co-sleep, you need to QUIT SMOKING!!!!  You should quit anyway.

Separate but proximate sleeping environment

This means the baby should be in your room.  Not in a nursery with a monitor.  In your room, nearby.

This, of all the recommendations made in this policy, is the closest I've seen to the AAP saying what I think is the underlying idea to all these recommendations:  kids should be arousable.  They shouldn't sleep through the night.

Kids on firm surfaces, sleeping on their backs, around other people, sucking a pacifier without blankets and getting too warm will wake up.  They will be arousable.  They will be able to respond to changing environmental conditions and then keep breathing and stay alive. Frequent arousals at night are NORMAL and probably protective.  Don't complain too loudly about your child not sleeping through the night.

Of course, I have an opinion on this "separate" thing, and maybe it belongs on the "soapbox" page, but it's my website and I'm putting it here.  This part of the policy statement was published over the loud protests of other members of the AAP, including me.  When a child dies in a crib (and we called it "crib death" before we called it SIDS) we look and see what about the crib was unsafe and modify the practice.  Most SIDS deaths still take place in cribs.  When a child dies in bed with their parents, we ban the whole practice instead of looking to see what was unsafe.

So, safe co-sleeping:  Co-sleeping needs to be defined.  It means being close to your baby as they sleep.  And there are safe ways to do this, and ways that we shouldn't do it.

Safely co-sleeping: