Infants should be placed on a firm sleep surface in their parents' room (but separate from their bed), to reduce the risk of sudden infant death syndrome (SIDS), the American Academy of Pediatrics said in a new policy statement.
Ideally, infants should sleep in their parents' room for the first six months to a year of life, in a crib, bassinet, portable crib or "play yard" approved by the Consumer Safety Product Commission, according to the AAP Task Force on Sudden Infant Death Syndrome.
This safe infant sleep surface should include only a fitted sheet, with no soft or loose bedding, which can increase the risk of sudden infant death, task force members wrote in Pediatrics.
Other "A-level" recommendations for safe infant sleep included always placing the infant to sleep or nap on their backs through 1 year of age and offering a pacifier at naptime and bedtime.
An independent clinician contacted by MedPage Today welcomed the new guideline.
"This updated policy fills in the gaps in previous policy guidance and provides clinicians and other stakeholders with evidence-based information and tools to educate, guide and support families and communities in promoting safe sleep practices for young infants," said Deborah Campbell, MD, of Montefiore Medical Center in New York City in an email. "I think these recommendations are more expansive, detailed and helpful to all the stakeholders involved in caring for or supporting the care of the young infant and fostering safe sleep and infant death prevention from SUID/SIDS."
The National Institutes of Health also issued a statement of support for these new recommendations, and urged everyone from healthcare providers to parents to "learn about the updated recommendations for safe infant sleep."
As in previous guidance, the updated AAP guidance warned against bed-sharing. It cited more evidence from case-control studies and case series where certain risk factors have increased the risk of SIDS and other unintentional infant injury or death while bed-sharing, including:
Infant younger than 4 months old
Born preterm or with low birth weight
If parent is current smoker or mother smoked during pregnancy
However, the authors took no position on infant sleep surfaces that attach to the side of a parent's bed, citing "insufficient evidence."
"The task force cannot make a recommendation for or against the use of either bedside sleepers or in-bed sleepers, because there have been no studies examining the association between these products and SIDS or unintentional injury and death, including suffocation," they wrote.
The authors acknowledged the "extraordinarily high risk" of infant death from suffocation if a parent falls asleep with an infant on a sofa or armchair, and that bringing an infant into bed may be "less dangerous." But because of the still-significant risks associated with bringing an infant into a parent's bed for any reason, the guideline stressed that once infants are fed or comforted, they should be returned to their own safe sleep surface.
"It is important to note that a large percentage of infants who die from SIDS are found with their head covered by bedding," they wrote. "Therefore, no pillows, sheets, blankets or any other items that could obstruct infant breathing or cause overheating should be in the bed."
Campbell said she was pleased that that the policy specifically addressed a recent study about infant sleep locations and how parents do not follow safe sleep guidelines, and that it clarifies some of that sleep guidance with supporting evidence.
"This is a part of anticipatory guidance that is critical for all pediatric primary care providers to be aware of and proactively discuss with parents: acknowledging the reality of the exhausted new parent and 'needy' (appropriately so) young infant and nighttime sleep practices -- and what parents can do to make this as safe a time as possible," she said.