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Sleeping on back safest for babies

The most important news to come out of the AAP's new recommendations is that it highlights what we already know: babies should be placed on their backs, period. When I discuss sleep position with new parents, someone always brings up the notion that a baby might choke if placed on its back. However, the AAP has found no evidence to support the belief that choking occurs more commonly in the back position.

In the Yale-New Haven Children's Hospital newborn nursery, babies sleep on their backs. Moms who deliver here learn from day one that that is best. The reason we don't like the side position is that babies roll very early on from the side to the stomach. That's not safe. Babies are at increased risk of dying from SIDS when they are placed on their sides.

Pacifier use and decreased risk of SIDS
Research now indicates an association between pacifier use and a reduced risk of SIDS, which is why the revised AAP statement recommends the use of pacifiers at nap time and bedtime throughout the first year of life. For breastfeeding moms, the AAP suggests that they wait until breastfeeding is well established, typically several weeks before introducing the pacifier.

Use a firm sleep surface Studies show a much lower incidence of SIDS when babies sleep on firmer surfaces. The mattress should fit snugly against the sides of the crib. Don't put a pillow or stuffed animal in with a newborn; they don't need it and it's dangerous. It's also probably better not to use bumper pads.

We recommend that you don't sleep with your baby
It's OK to bring your baby into your bed for nursing or comforting - but return your baby to the crib or bassinet when you're ready to sleep. An infant sleeping in an adult bed cannot defend himself if he gets stuck up against the headboard or under a pillow, comforter or person. He can't move his head or his body to get fresh air. This risk is even greater if the adult in the bed has been drinking, using drugs or is a heavy sleeper.

AAP SIDS guidelines recommend that babies sleep in the same room as the parents, though not in the same bed

The AAP reports increasing evidence that having the baby in his or her crib or bassinet in the parent's bedroom is associated with a reduced risk of SIDS.

Dress your baby lightly for sleep
Avoid overheating your baby by dressing him for sleep in lightweight clothing. The bedroom temperature should be kept comfortable for a lightly clothed adult. It's not good for the baby to get too warm.

Avoid products claimed to help prevent SIDS
It is not necessary to use home monitors as a strategy to reduce the risk of SIDS. There's no evidence that home monitors are effective, and positioning devices haven't been fully tested for safety.

Avoid secondhand smoke
A crucial factor that needs to be greatly emphasized in any campaign against SIDS is the risk of parents (and others) smoking around children. We recommend that you quit smoking when pregnant and avoid exposing your baby to secondhand smoke. I encourage women who are smokers to join a smoking cessation program or at the very least don't smoke in the house.

Prevent flat spots on your baby's head
With close supervision, when the baby is awake, place your baby on his or her tummy to play for a period of time each day. When you place your baby on his or her back to sleep, alternate the direction your baby's head faces. Moving the baby's mobile in a different direction is helpful too.

Back to sleep at daycare
There is still a high rate of SIDS in babies and infants in daycare, and it is thought that this is because daycare workers are still putting children to sleep on their stomach. For parents with infants under a year placed in childcare or left with friends or relatives for the day, insist your child be placed on his or her back to sleep. If someone puts the infant down to sleep on his stomach, the risk of SIDS is further increased because that child is not used to sleeping on his stomach.

Families are sometimes confused because it seems that we've changed our recommendations over the past 15 years from stomach to side to back. We can safely say that the current evidence for back sleeping is very strong and that the recommendation to have your infant sleeping on the back is here to stay.

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Pediatrician Eve R. Colson, MD, is a director of the Well Newborn Nursery at Yale-New Haven Children's Hospital and associate professor of pediatrics at Yale University School of Medicine.