by Anne Eglash MD, IBCLC, FABM
Breastfeeding prevents Sudden Infant Death Syndrome (SIDS), according to the latest American Academy of Pediatric Policy Statement entitled SIDS and Other Sleep-Related Infant Deaths: Updated 2016 Recommendations for a Safe Infant Sleeping Environment.
SIDS is an unexpected infant death which, after thorough evaluation, does not have a known cause. Sudden Unexpected Infant Death (SUID) is an infant death that is sudden and unexpected, but might or might not have an identifiable underlying cause. Breastfeeding is known to prevent SIDS, but does not necessarily prevent SUIDs.
This AAP policy statement provides 19 recommendations to prevent SUIDS. Which one of the following statements is not consistent with the AAP policy statement?
- Exclusive breastfeeding for the first 6 months is more protective of SIDs than partial breastfeeding.
- Side sleeping on a firm surface next to mother is safe if the baby is breastfeeding, but not if the baby is fully formula feeding.
- Any breastfeeding is more protective of SIDS than no breastfeeding.
- Babies who are nursing in slings should be repositioned in the sling after nursing so the head is up and out of the sling.
- Late at night, it is safest to nurse a baby in the parent’s bed on a firm surface, rather than on a couch or recliner, in case the parent falls asleep while nursing.
See the Answer
Abstract:
Approximately 3500 infants die annually in the United States from sleep- abstract related infant deaths, including sudden infant death syndrome (SIDS; International Classification of Diseases, 10th Revision [ICD-10], R95), ill defined deaths (ICD-10 R99), and accidental suffocation and strangulation in bed (ICD-10 W75). After an initial decrease in the 1990s, the overall death rate attributable to sleep-related infant deaths has not declined in more recent years. Many of the modifiable and non-modifiable risk factors for SIDS and other sleep-related infant deaths are strikingly similar. The American Academy of Pediatrics recommends a safe sleep environment that can reduce the risk of all sleep-related infant deaths. Recommendations for a safe sleep environment include supine positioning, the use of a firm sleep surface, room-sharing without bed-sharing, and the avoidance of soft bedding and overheating. Additional recommendations for SIDS reduction include the avoidance of exposure to smoke, alcohol, and illicit drugs; breastfeeding; routine immunization; and use of a pacifier. New evidence is presented for skin-to-skin care for newborn infants, use of bedside and in-bed sleepers, sleeping on couches/armchairs and in sitting devices, and use of soft bedding after 4 months of age. The recommendations and strength of evidence for each recommendation are included in this policy statement. The rationale for these recommendations is discussed in detail in the accompanying technical report (www. pediatrics. org/ cgi/ doi/ 10. 1542/ peds. 2015- 3147).
Milk Mob Comment
By Anne Eglash MD, IBCLC, FABM
One of the most important features of the new AAP statement on safe sleep is acknowledging that parents have a natural tendency to bring their babies into bed to feed in the middle of the night. Previous warnings about never having the baby in bed led many breastfeeding (and non-breastfeeding) mothers to move to the couch or recliner to feed their babies in the middle of the night. We now know that falling asleep with the baby on a couch or recliner is much less safe than falling asleep with the baby on a bed’s firm mattress. The AAP statement has several specific recommendations to keep infants safe at night from accidents occurring from unsafe sleep environments. And, of course, the statement emphasizes the importance of breastfeeding to protect from SIDS. These recommendations do not completely embrace the Safe Sleep Seven recommendations from La Leche League (see Clinical Question #5, August 15, 2016). However, I am pleased to see how the AAP’s updated statement has become more reasonable regarding he realities of life for breastfeeding families in the USA.