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Risk Reduction Education

AAP SIDS Risk Reduction Recommendations

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Despite major decreases in the incidence of SIDS during the past decade, SIDS is still responsible for more infant deaths during the postneonatal period than any other cause of death during infancy in the United States. In the 2005 policy statement, The Changing Concept of Sudden Infant Death Syndrome: Diagnostic Coding Shifts, Controversies Regarding the Sleeping Environment, and New Variables to Consider in Reducing Risk, the American Academy of Pediatrics (AAP) addresses several issues that have become relevant since they last published a statement in 2000.

The AAP no longer recognizes side sleeping as a reasonable alternative to fully supine (lying on back) sleeping. The AAP also does not recommend bedsharing during sleep. Infants may be brought into bed for nursing or comforting, but should be returned to their own crib or bassinet when the parent is ready to return to sleep. However, there is growing evidence that roomsharing (infant sleeping in a crib in the parent’s bedroom) is associated with a reduced risk of SIDS. The AAP recommends a separate but proximate sleeping environment.

Research now indicates an association between pacifier use and a reduced risk of SIDS, which is why the revised statement recommends the use of pacifiers at nap time and bedtime throughout the first year of life. The evidence that pacifier use inhibits breastfeeding or causes later dental complications is not compelling enough to discredit the recommendation. However, it is recommended that pacifier introduction for breastfed infants be delayed until 1 month of age to ensure that breastfeeding is firmly established. In addition, if the infant refuses the pacifier, it should not be forced. There is a slight increased risk of ear infections associated with pacifier use, but the incidence of ear infection is generally lower in the first year of life, especially the first 6 months, when the risk of SIDS is the highest.

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