New SIDS Guidelines Say Breastfeeding Lowers Risk

Sleeping in the Same Room but Not in the Same Bed Also Recommended

Reviewed by Laura J. Martin, MD on October 18, 2011
From the WebMD Archives

Oct. 18, 2011 -- Breastfeeding and up-to-date immunizations can lower infants’ risk of sudden, unexpected death during sleep, according to updated guidelines issued today by the American Academy of Pediatrics.

Since 1992, the pediatricians group has been advising parents to place young infants on their backs to sleep to minimize the risk of sudden infant death syndrome, or SIDS.

Between 1992 and 2001, the SIDS rate declined from 120 deaths per 100,000 live births to 56 deaths per 100,000 live births, according to the academy. But from 2001 to 2006, the latest year for which information is available, the rate plateaued, and SIDS remains the leading cause of death in infants 28 days to 1 year of age.

Other causes of sudden, unexpected death of infants during sleep, such as suffocation and entrapment, have become more common. Previously, some of those deaths would have been classified as SIDS.

“The AAP, therefore, is expanding its recommendations from focusing only on SIDS to focusing on a safe sleep environment that can reduce the risk of all sleep-related infant deaths,” the policy statement notes. “Many of the modifiable and nonmodifiable risk factors for SIDS and suffocation are strikingly similar.”

Breastfeeding Recommended to Protect Against SIDS

This is the first time that the academy has recommended breastfeeding to protect against SIDS, says pediatrician Rachel Moon, MD, chair of the academy’s SIDS task force and author of the new guidelines.

When the group last issued SIDS guidelines, in 2005, evidence showed only that breastfeeding protected infants from dying but not specifically from dying of SIDS, says Moon, a SIDS researcher at the Children’s National Medical Center in Washington, D.C.

In addition, she says, evidence shows babies who’ve been immunized in accordance with recommendations from the American Academy of Pediatrics and the CDC have half the risk of SIDS as babies who aren’t fully immunized. Previous studies have suggested that certain infections may be associated with some cases of SIDS. Whooping cough in infants has been shown to cause significant breathing problems, such as coughing and apnea, a pause in the breathing pattern. Other recommendations include using a firm sleep surface, avoiding crib bumper pads, keeping the crib free of soft objects and loose bedding, and avoiding devices marketed to reduce the risk of SIDS.

Such devices, none of which have been approved to protect babies against SIDS, include infant positioners, mattresses, crib bedding, pillows, crib tents, and baby monitors, according to the FDA. The FDA on Monday said it is asking manufacturers of these devices to drop their claims concerning preventing SIDS unless they get agency approval.

Share a Bedroom, Not a Bed

To make breastfeeding easier and minimize the risk of sudden, unexpected infant death during sleep, the pediatricians recommend mothers and babies sleep in the same room but not in the same bed.

“I think you can breastfeed successfully without bed-sharing,” Moon says. “We do want the crib right next to the parents’ bed.”

In a study reported at the American Academy of Pediatrics’ meeting in Boston on Monday, researchers reported that half of 91 cases of sudden unexpected deaths in infants in New Mexico occurred on a shared sleep surface. Some of the babies who died while sharing a bed with their parents lived in homes with cribs that weren’t being used for sleeping.

“Unfortunately, families get mixed messages,” says researcher Jessica Black, a third-year student at the University of New Mexico School of Medicine in Albuquerque. While their pediatrician might recommend sleeping separately in the same room, the La Leche League, which promotes breastfeeding, encourages bed-sharing as an option.

Moon says her task force has asked the American Academy of Pediatrics to launch a new national campaign to promote safe sleeping environments for all babies.

The new policy statement appears in the November issue of the journal Pediatrics.

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Rachel Moon, MD, Children’s National Medical Center, Washington, D.C.

Jessica Black, medical student, University of New Mexico School of Medicine.

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