When I first started in pediatric practice, my experience quickly reinforced what I had personally come to realize upon becoming a parent: that sleep (and often the lack thereof) is one of the most common and pressing issues of new parenthood.

Sure, there are a whole host of other important things to master -- clothing, crying, car seats and diapers, just to name a few). But, given all we now know about the all-encompassing role a good night’s sleep plays in everything from our physical health and our mood to our ability to think clearly and function, my initial “revelation” that one of my top priorities as a physician should be to have conversations with parents about how both they and their babies are sleeping now seems like stating the obvious.

Safe Sleep is Good Sleep

Focusing on how everyone in the family is sleeping is important for the simple reason that parental sleep is inevitably tied to how well one’s child sleeps (or, in some cases, doesn’t). For new parents, it’s important to consider one’s own sleep habits and establish conducive conditions for getting a good night’s sleep in addition to considering how to help their children learn to do the same, safely.

This brings us to the absolutely necessary discussion that no parent wants to have, but that every parent (as well as anyone who cares for and about babies) must think about -- safe sleep and preventing Sudden Infant Death Syndrome ( SIDS).

Pediatricians have long been committed to sharing this potentially life-saving information for good reason - both in our offices, and nationally in the form of safe sleep campaigns. Although it should be reassuring to parents and pediatricians alike that U.S. SIDS-related deaths have decreased more than 50% since the launch of the first Safe to Sleep campaign in the 1990s, the fact is that SIDS still remains the leading cause for death for infants between 1 month and 1 year of age. As such, it’s as important as ever that we, as parents and physicians, make knowing the facts about SIDS and promoting safe sleep our top priorities.

New Guidelines for Safe Sleep

The American Academy of Pediatrics’ Task Force on SIDS, after a thorough review of all of the published literature (63 new studies, to be exact), has just released an updated policy statement that offers the most up-to-date, evidence-based recommendations for keeping your baby safe and sound while sleeping. Several of these are new, while some are unchanged and their efficacy was reaffirmed.

Some of the key recommendations include:

• Back to sleep. This means placing infants on their backs to sleep each and every sleep, until their first birthday.
• Firm sleep surface and a well-fitted sheet. These support your baby and eliminate things that could impede breathing.
• No soft objects or bedding. As much as this recommendation may go against your image of cute and cozy, there should be nothing soft in your baby’s sleep space. Soft toys or blankets have the potential to threaten a baby’s ability to breath. Even bumper pads have been found to pose a risk. Along the same lines of avoiding all things big, soft and fluffy, placing a baby on a sofa, couch or cushioned chair is extremely risky and could put the child at a higher risk of dying.
• Share a room. Shown to decrease the risk of SIDS by as much as 50%, room-sharing is recommended as a safer option than either bed-sharing (see below) or sleeping alone in a different room. Be aware that room sharing is not the same thing as bed-sharing. The AAP’s recommendation is to place your baby in a separate, safe sleep space near, but not in, your bed. This arrangement is recommended for at least the first 6 months of your child’s life, but it’s ideal for it to last a full year.
• Say no to bed-sharing. Based on their thorough review, the AAP’s Task Force concludes that “it is not recommended that infants sleep on the same surface with other people.” Although this is an across the board recommendation, the policy statement also identifies a whole list of specific circumstances that have been shown to substantially increase the risk of SIDS, unintentional injury or death: including, but not limited to, infants under the age of 4 months, those born prematurely and/or those with low birth weight, sleeping on soft surfaces, and sleeping with an adult who smokes, is fatigued, or has used alcohol, just to name a few.
• Breastfeed. Breastfeeding continues to be associated with a reduced risk of SIDS, and therefore continues to be recommended for all except when contraindicated. A review of the evidence suggests that exclusive breastfeeding increases the protective effect, although any breastfeeding is thought to still offer some protection.

Other Common Concerns

In the new recommendations, the AAP Task Force on SIDS also addresses several other particularly common parenting questions, concerns and habits regarding getting infants to sleep. They again found pacifiers to be protective, but found insufficient evidence for the effectiveness of several SIDS-related commercial devices, including products that promote to make bed-sharing safe. They found no evidence to support the use of special “re-breathing“ mattresses or cardiorespiratory monitors. They also found no evidence that swaddling reduces the risk of SIDS and noted that it is important to avoid the potential risks of swaddling by limiting its use only to infants on their backs, and only until the age at which they start trying to roll.

There are certainly plenty of things that we can all do to help ourselves get a better night’s sleep, but I’m convinced that nothing stands to come close to offering parents (and other dedicated infant caregivers) the kind of peace of mind guaranteed to help you sleep better than committing to following the most up-to-date Safe to Sleep recommendations.