Resources to Support AAP's Policy Statement
on SIDS and Other Sleep-Related Infant Deaths

The U.S. Maternal and Child Health Bureau's National SUID/SIDS Consortium supports the American Academy of Pediatrics' (AAP) 2011 policy statement, SIDS and Other Sleep-Related Infant Deaths: Expansion of Recommendations for a Safe Infant Sleeping Environment (Policy Statement | Technical Report), with the following resources:

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Resources Based on AAP's Recommendations

Level A Recommendations

These recommendations are based on good and consistent scientific evidence. There is high certainty that the net benefit is substantial, and the conclusion is unlikely to be strongly affected by the results of future studies.*

1. Back to sleep for every sleep

• Helping Baby Back To Sleep: In English | En Español (Resource Center, 2009)
• Babies Sleep Safest on Their Back: A Resource Kit for Reducing SIDS in African American Communities (Back to Sleep Campaign, 2009)

2. Use a firm sleep surface

• Guidelines for Products Intended for Sleeping Babies (Program Support Center/First Candle, 2009)
• Soft Bedding May Be Hazardous To Babies. (U.S. Consumer Product Safety Commission, 2012)

3. Room-sharing without bed-sharing is recommended

• Room Sharing is Safer than Bed Sharing (English/Spanish) (Program Support Center/First Candle, 2008)
• Bed Sharing, Co-sleeping and SIDS Research Bibliography: SEE SUID/SIDS Research Bibliographies. (Resource Center)

4. Keep soft objects and loose bedding out of the crib

• Suffocation and SIDS Research Bibliography: SEE SUID/SIDS Research Bibliographies. (Resource Center)
• First Candle's Frequently Asked Questions: Information on Bedding (Program Support Center/First Candle, 2012)

5. Pregnant women should receive regular prenatal care

• Preconception and Pregnancy Knowledge Path (NCEMCH, 2012)
• Kicks Count Brochure and Chart, also available in Spanish (Program Support Center/First Candle)

6. Avoid smoke exposure during pregnancy and after birth

• Smoking and SIDS Research Bibliography: SEE SUID/SIDS Research Bibliographies. (Resource Center)
• Tobacco, Alcohol, and Substance Use During Preconception and Pregnancy. Resource Brief. (NCEMCH, 2012)

7. Avoid alcohol and illicit drug use during pregnancy and after birth

• Fetal Alcohol Spectrum Disorders (FASDs) Resource Brief (NCEMCH, 2009)

8. Breastfeeding is recommended

• Breastfeeding Resource Brief (NCEMCH, 2010)
• Breastfeeding and SIDS Research Bibliography: SEE SUID/SIDS Research Bibliographies. (Resource Center)

9. Consider offering a pacifier at nap time and bedtime

• Pacifiers and SIDS Research Bibliography: SEE SUID/SIDS Research Bibliographies. (Resource Center)
• Pacifier Use and SIDS: Evidence for a Consistently Reduced Risk (Children's Safety Network, 2011)
• Pacifiers Can Help Reduce the Risk of SIDS (Program Support Center/First Candle, 2006)

10. Avoid overheating

• Helping Babies, Healing Families: Program Manual and Trainer's Guide -- Modifiable Risk Factors: Overheating
• Safe Sleep for Your Baby Around the Clock: Birth to 12 Months (Resource Center, 2009)

11. Do not use home cardiorespiratory monitors as a strategy for reducing the risk of SIDS

• Apnea Monitoring and SIDS Research Bibliography: SEE SUID/SIDS Research Bibliographies. (Resource Center)
• First Candle's Frequently Asked Questions: Can Home Monitors Help Prevent SIDS? (Program Support Center/First Candle)

12. Expand the national campaign to reduce the risks of SIDS to include a major focus on the safe sleep environment and ways to reduce the risks of all sleep related infant deaths, including SIDS, suffocation, and other accidental deaths; pediatricians, family physicians, and other primary care providers should actively participate in this campaign

• Back to Sleep Public Education Campaign (National Institutes of Health Eunice Kennedy Shriver National Institute of Child Health and Human Development)
• Healthy Child Care America Back to Sleep Campaign (American Academy of Pediatrics)

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Level B Recommendations

These recommendations are based on limited or inconsistent scientific evidence. The available evidence is sufficient to determine the effects of the recommendations on health outcomes, but confidence in the estimate is constrained by such factors as the number, size, or quality of individual studies or inconsistent findings across individual studies.*

13. Infants should be immunized in accordance with recommendations of the AAP and Centers for Disease Control and Prevention

• Vaccines and Immunizations Center (Centers for Disease Control and Prevention)
• Immunization and SIDS Research Bibliography: SEE SUID/SIDS Research Bibliographies. (Resource Center)

14. Avoid commercial devices marketed to reduce the risk of SIDS

• Baby Products with SIDS Prevention Claims (U.S. Food and Drug Administration, 2011)
• Crib Safety and SIDS Reduction (U.S. Consumer Product Safety Commission)

15. Supervised, awake tummy time is recommended to facilitate development and to minimize development of positional plagiocephaly

• Back to Sleep, Tummy to Play: In English | En Español (American Academy of Pediatricians, 2008)
• Early Head Start Tip Sheet No. 41: Tummy Time & Infants (Early Head Start National Resource Center, 2010)

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Level C Recommendations

These recommendations are based primarily on consensus and expert opinion.*

16. Health care professionals, staff in newborn nurseries and NICUs, and child care providers should endorse the SIDS risk-reduction recommendations from birth

• Hot Topics in Infant Safe Sleep with Rachel Moon, M.D. (Project IMPACT, 2010-2011)
• Professional Resources (Resource Center, 2011)

17. Media and manufacturers should follow safe-sleep guidelines in their messaging and advertising

• Helping Babies, Healing Families: Program Manual and Trainer's Guide: Public Relations and the Media
• Juvenile Products Manufacturers Association

18. Continue research and surveillance on the risk factors, causes, and pathophysiological mechanisms of SIDS and other sleep-related infant deaths, with the ultimate goal of eliminating these deaths entirely

• Genetics Resource Brief (NCEMCH, 2012)
• Racial and Ethnic Disparities in Health Knowledge Path (NCEMCH 2011)

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General Resources for Professionals

• Helping Babies, Healing Families: Program Guide and Trainer's Guide - The purpose of the Program Manual is to support the staff of local and State programs to provide comprehensive SUID/SIDS risk reduction and bereavement program services. The manual also includes a trainer’s guide, specifically adapted from the National Cancer Institute, which focuses on how to conduct trainings, presentations and informational sessions to a variety of audiences (resources updated 2010).
• Sudden Unexplained Infant Death Investigation Training Materials (Centers for Disease Control and Prevention, 2011)
• Sudden Unexpected Infant Death Case Registry (Centers for Disease Control and Prevention, 2011)
• Injury Topics: Asphyxia (Children's Safety Network)
• Training Toolkit - The toolkit includes materials on risk reduction and health promotion, on culturally competent services, and for first responders, as well as resources to support and enhance training (Resource Center, 2009).
• Health Education Specialist Corner. Currently highlighted is the CEU online training for pharmacists (Program Support Center, 2011).
• Nationwide Calendar - a list of upcoming conferences from organizations covering SIDS/infant death and other maternal and child health and public health topics (Project IMPACT, ongoing updates).
• State MCH and SUID Contacts - professionals working in SIDS and infant death programs at the State and local levels (Project IMPACT, ongoing updates).
• Links to SUID and SIDS Partners - links to state and national organizations as well as federal agencies (Resource Center, 2011).
• First Candle Member and Partner Organizations - national, state, and local organizations concerned with infant health and survival (First Candle, ongoing updates).

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General Resources for Families

• First Candle's Facebook Page Join the conversation with other families to discuss the latest policy statement from AAP.
• What Does a Safe Sleep Environment Look Like? (Eunice Kennedy Shriver National Institute of Child Health and Human Development, 2013) | En Español.
• Helping Baby Back to Sleep: In English (Resource Center, 2009) | En Español (2010).
• First Candle Grief Resources: Local Support - state by state listing of grief resources for those affected by an infant death, whether during pregnancy or after birth.
• Expert Insights: Grief Support After Preventable Infant Death -- Interview with Sarah Kye Price (Project IMPACT)
• The Death of a Child, the Grief of the Parents: A Lifetime Journey (Resource Center, 2011).
• The Grieving Child: Helping Children Cope When an Infant Dies (Resource Center, 2011).

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Translating Recommendations into Action

The challenge for the field is to effectively communicate the new AAP recommendations and to engage families and communities in implementing the array of behaviors that will address SIDS and suffocation deaths. Meeting this challenge requires a range of approaches and resources that address the varied cultural values, beliefs and practice that inform child-rearing practices:

• Safe Infant Sleep videos analyzed by AAP recommendations. (National SUID/SIDS Resource Center)
• What Works: Changing Knowledge and Behavior to Reduce Sudden Unexpected Infant Death (Resource Center)
• Promising Practices for Cultural and Linguistic Competence in Addressing Sudden Infant Death Syndrome and Other Infant Death (National Center for Cultural Competence)
• Infusing Cultural and Linguistic Competence in to Health Promotion (Video) (National Center for Cultural Competence)
• A Guide to Choosing and Adapting Culturally and Linguistically Competent Health Promotion Materials (National Center for Cultural Competence)
  
• In Their Own Voices: Cultural Competence and Health Promotion (National Center for Cultural Competence)

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* Note: AAP's recommendations are based on the US Preventive Services Task Force levels of recommendation.

Level A: Recommendations are based on good and consistent scientific evidence (ie, there are consistent findings from at least 2 well-designed, well-conducted case-control studies, a systematic review, or a meta-analysis). There is high certainty that the net benefit is substantial, and the conclusion is unlikely to be strongly affected by the results of future studies.

Level B: Recommendations are based on limited or inconsistent scientific evidence. The available evidence is sufficient to determine the effects of the recommendations on health outcomes, but confidence in the estimate is constrained by such factors as the number, size, or quality of individual studies or inconsistent findings across individual studies. As more information becomes available, the magnitude or direction of the observed effect could change, and this change may be large enough to alter the conclusion.

Level C: Recommendations are based primarily on consensus and expert opinion

Developed October 2011; Updated July 2012