Transcription:
New Guidelines to Reduce Sudden Infant Death Syndrome

Melanie Cole (Host):  Approximately 3,500 infants die annually in the United States from sleep related deaths, including SIDS, ill-defined deaths, and accidental suffocation and strangulation. The American Academy of Pediatrics recently published new recommendations to reduce these risks. My guest today is Dr. Rachel Moon. She's an internationally recognized expert in SIDS and post-neonatal infant mortality and serves as the Division Head of Pediatrics at the University of Virginia Health System. Welcome to the show, Dr. Moon. Let's start with these recommendations from the American Academy of Pediatrics. Is this new recommendations? What's changed?

Dr. Rachel Moon (Guest):  We have updated the data and the research. The basic recommendations have stayed the same. We still want babies on their backs in a crib which is in their parent’s room. We want the crib to be flat and firm and well-fitting without any extra bedding, just the baby in the crib. Those kinds of things are all the same. We still want babies to be breastfed. We don't want them to be around smoke or families who have been drinking or things like that. There are some nuances that have changed. For instance, we now recognize that couches and sofas and cushioned chairs and things like that are very, very dangerous for babies. We don't want babies to be placed on those services to sleep. We also recognize that parents sometimes may accidentally fall asleep while they're feeding their baby, and if you think that's going to happen, then we want you to rather do that in your bed rather than on a couch or sofa or an armchair, and to remove all the bedding from your bed so that if you do accidentally fall asleep, it won't be quite as dangerous for your baby. There are some things like that which we have with increasing and newer data we have updated.

Melanie:  Parents are always wondering if you put your baby on their back to sleep and for every sleep including naps but some babies start to roll over earlier than others. Do you keep going in and rerolling your baby? What do you do?

Dr. Moon:  Well you know there's rolling over and there's rolling over. If it's a first time that the baby has rolled over and sometimes the babies will do it and you're not sure that they know how to do it again. A baby like that, I would actually roll them back over. If the baby is really pretty comfortable with rolling back and forth by him or herself, it's fine to leave them as they are. I would put them on their back to start with and then, if they roll over onto their stomach, it's fine to leave them as they are but I would make sure that there is nothing else in the crib, no blankets, no soft pillows, no stuffed animals, no bumper pads because we know that if babies roll into soft bedding, then sometimes they get stuck and they can't get out.

Melanie:  You mentioned about if you fall asleep feeding your baby and it's in your bed. What do you think, Dr. Moon, about co-sleeping and sleeping with your baby in the bed as opposed to maybe just in your room in their own separate sleeping arrangement?

Dr. Moon:  We don't recommend that because the data has shown that it is a more dangerous situation than having the baby in a crib next to the parents' bed. So, what we recommend is that a crib or a bassinette or a portable crib be placed right next to the parents' bed and then, that way you can have the baby close to you, and you can hear the baby, and you can monitor the baby, you can bring the baby into the bed to feed them, but that's going to be the safest place for the baby.

Melanie:  The guidelines are indicating that babies should receive as much breast milk as possible for as long as possible. Does this help reduce those sleep related deaths?

Dr. Moon:  Yes, it does. We don't exactly know why. There are a lot of different possibilities but we do know that babies who receive breast milk are at lower risk for SIDS.

Melanie:  What else would you like parents to know? Things that should be avoided, you've mentioned things in the crib. What about the ambient air or noises or any of these kinds of things? Do they play a role in a child safe sleep?

Dr. Moon:  There has been one study that showed that a fan in the room reduces the risk. Nobody else has been able to reproduce those results, so that's not a consistent finding that we've seen in multiple studies. I would take that with a grain of salt. There really aren't any data that I know of in terms of noise level. So, I can't really make any recommendations about that.

Melanie:  What about pacifiers at naptime and bedtime? Are there any studies or research involving the use of pacifiers?

Dr. Moon:  Yes, and actually almost every single study that has looked at pacifiers has shown that the pacifiers reduced the risk of SIDS, and it's interesting because the risk reduction comes if you fall asleep with a pacifier in your mouth, even if the pacifier, which we know always happens, even if it falls out as soon as the baby falls asleep. Just the fact that it was in the baby’s mouth as the baby was falling asleep has a protective effect.

Melanie:  What about products that claim to reduce the risk of SIDS? People look at positioners, wedges, and special mattresses. What do you say about that?

Dr. Moon:  What I would say would be none of them have been shown to reduce the risk of SIDS. If they claim that they do, be wary. That's number one. Number two, if they tell you that you can do something that Safe Sleep recommendations tell you not to do—so, if they say that you can sleep on your stomach, or you can stand upside down, or do something like that, again, be wary. If it's a product that meets the safety standards and you use Safe Sleep recommendations ,then that's fine.

Melanie:  What about tummy time? Does that interfere with Safe Sleep recommendations? Should we still be giving our baby's tummy time?

Dr. Moon:  We should definitely be giving our babies tummy time when they're awake and they're being supervised by an adult, they should get tummy time starting early. Do it early; do it often because we know that helps with upper body motor strength.

Melanie:  Then, wrap it up a bit for us, Dr. Moon, and what you want parents to know and what you tell them every day about the new guidelines from the American Academy of Pediatrics about children sleeping and safe sleeping. Tell them what you want them to know.

Dr. Moon:  I want them to know that the baby should be on their back, in a crib in the parents' room, ideally close to the parents' bed. There should be nothing in the crib except for a tight fitting mattress with a tight fitting sheet on it and the baby.

Melanie:  Is there a time when parents can stop worrying about SIDS?

Dr. Moon:  The definition of SIDS is up to a year. Technically, it goes up to a year, but ninety percent of SIDS occurs by the time that the baby is six months of age, and the peak period of time is between one and four months. Once the baby gets to be four, five, six months of age, I think you don't have to worry quite as much. The first few months are definitely when the baby is most vulnerable. Then, as the baby becomes a little bit older our concern drops a little bit, but you're not out of the woods yet until the baby is one.

Melanie:  When is it safe for the child to be in their own room? Parents have video monitors these days, and, of course, monitors have been around a long time. When is it safe to put them in a crib in their own room?

Dr. Moon:  I would say definitely not until at least the first few months of life and what we've said in this iteration is that at least for six months and ideally for a year. I know that's difficult for some families but the first six months are actually pretty critical because, again, this is when the vast majority of the SIDS occurs. We know that sleep location is very critical at this period of time and there's something protective about the baby and the parent being in the room together. We think that it actually changes a little bit how the baby sleeps because every time they hear the parent move, they'll wake up a little bit, maybe not fully awake but they'll arouse a little bit and what we believe is going on with SIDS is that it's a failure of arousal, so the babies can't wake up. This is actually why babies who are on their stomachs are more likely to die of SIDS because babies who are on their stomachs, they sleep more deeply and they sleep longer which is why parents and everybody likes their babies to be on their stomachs but that actually is what is probably dangerous about sleeping on the stomach. The same thing is true for the babies who sleep in the parents' room--they sleep differently, and they have these little awakenings and that, we think, is protective.

Melanie:  Thank you so much for being with us today. It's such great information for parents. You're listening to UVA Health Systems Radio and for more information you can go to www.uvahealth.com. That's www.uvahealth.com. This is Melanie Cole. Thanks so much for listening.