Evidence Base for 2022 Updated Recommendations for a Safe Infant Sleeping Environment to Reduce the Risk of Sleep-Related Infant Deaths

Abstract

Every year in the United States, approimately 3500 infants die of sleep-related infant deaths, including sudden infant death syndrome (SIDS) (International Statistical Classification of Diseases and Related Health Problems 10th Revision [ICD-10] R95), ill-defined deaths (ICD-10 R99), and accidental suffocation and strangulation in bed (ICD-10 W75). After a substantial decline in sleep-related deaths in the 1990s, the overall death rate attributable to sleep-related infant deaths have remained stagnant since 2000, and disparities persist. The triple risk model proposes that SIDS occurs when an infant with intrinsic vulnerability (often manifested by impaired arousal, cardiorespiratory, and/or autonomic responses) undergoes an exogenous trigger event (eg, exposure to an unsafe sleeping environment) during a critical developmental period. The American Academy of Pediatrics recommends a safe sleep environment to reduce the risk of all sleep-related deaths. This includes supine positioning; use of a firm, noninclined sleep surface; room sharing without bed sharing; and avoidance of soft bedding and overheating. Additional recommendations for SIDS risk reduction include human milk feeding; avoidance of exposure to nicotine, alcohol, marijuana, opioids, and illicit drugs; routine immunization; and use of a pacifier. New recommendations are presented regarding noninclined sleep surfaces, short-term emergency sleep locations, use of cardboard boxes as a sleep location, bed sharing, substance use, home cardiorespiratory monitors, and tummy time. In addition, additional information to assist parents, physicians, and nonphysician clinicians in assessing the risk of specific bed-sharing situations is included. The recommendations and strength of evidence for each recommendation are published in the accompanying policy statement, which is included in this issue.

Perceptions and Use of Safe Sleep Baby Boxes at Hospital Discharge by New Mothers

“…Our findings indicated that only 41.7% of participants were using the safe sleep baby box all or most of the time, as compared with occasional use or no use. American Academy of Pediatrics recommends that infants be placed on their back every time they are put to sleep until they are 1 year of age (Moon et al, 2016; Moon et al, 2022a; Moon et al, 2022b), yet only 70% of participants reported putting their babies to sleep on their back every time. Five mothers wanted a thicker mattress or padded sides in the box, is contradictory to the AAP safe sleep guidelines.…”

Survey of Korean daycare personnel on safe sleep practices related to sudden unexplained infant death: a cross-sectional exploratory study

“…This is a remarkable finding, given that 99.2% of personnel said that parents brought bedding materials for their infants from home. Infant vulnerability is known to be a crucial factor responsible for sleep-related SUID [1][2][3]. Therefore, it is very important for daycare personnel to acknowledge the value of data on infants' health information and sleep rituals at home to promote SSP at daycare centers.…”

Subject Matter Expert Nurses in Safe Sleep Program Implementation

“…For this QI safe sleep program, SMEs represented the “structure” with their in-depth knowledge of infant SS environments and practice aligned with evidence and recommendations from the 2016 AAP Guidelines for SS (Moon et al, 2016). The AAP safe sleep guidelines were updated in June 2022 (Moon et al, 2022a; Moon et al, 2022b).…”