Friday, October 21, 2011

New AAP recommendations: No crib bumpers (and other useful sleep safety tips)

Have you heard, Peeps? The American Academy of Pediatrics has come out against the use of crib bumpers for children of any age, and that includes the mesh, breathable ones. 

I’ll admit: I've always liked the look of bumpers. Cribs resemble prisons without them. [Benjamin certainly thinks of his little bed as a jailhouse, on occasion]. But we’ve not had one in his crib and it looks like we’ll do without them in the future. They were pretty dang expensive, anyway. 
Also in the report:
The recommendations described in this report include supine positioning, use of a firm sleep surface, breastfeeding, room-sharing without bed-sharing, routine immunization, consideration of a pacifier, and avoidance of soft bedding, overheating, and exposure to tobacco smoke, alcohol, and illicit drugs. The rationale for these recommendations is discussed in detail in this technical report. The recommendations are published in the accompanying “Policy Statement—Sudden Infant Death Syndrome and Other Sleep-Related Infant Deaths: Expan- sion of Recommendations for a Safe Infant Sleeping Environment,” which is included in this issue ( peds.2011-2220). Pediatrics 2011;128:e000
Read the full report here. Also, see a few of the highlights after the break.
Some interesting additional tidbits:

Ninety percent of SIDS cases occur before an infant reaches the age of 6 months. The rate of SIDS peaks between 1 and 4 months of age. Although SIDS was once considered a rare event during the first month of life, in 2004 – 2006, nearly 10% of cases coded as SIDS occurred during the first month. SIDS is uncommon after 8 months of age (Fig 6).14 A similar age distribution is seen for ASSB (Fig 7).
From the very minute a baby is born today, doctors tell the new parents “Always, always, always have your baby sleep on his back!” [Side note: isn’t if funny how this has changed over the years?]. Fortunately:
Once an Infant Can Roll From the Supine [on the back] to Prone [on the front] and From the Prone to Supine Position, the Infant Can Be Allowed to Remain in the Sleep Position That He or She Assumes
Parents and caregivers are frequently concerned about the appropriate strategy for infants who have learned to roll over, which generally occurs at 4 to 6 months of age. As infants mature, it is more likely that they will roll. In 1 study, 6% and 12% of 16- to 23-week-old infants placed on their backs or sides, respectively, were found in the prone position; among infants aged 24 weeks or older, 14% of those placed on their backs and 18% of those placed on their sides were found in the prone position.112 Repositioning the sleeping infant to the supine position can be disruptive and might discourage the use of supine position altogether. Although data to make specific recommendations as to when it is safe for infants to sleep in the prone position are lacking, the AAP recommends that these infants continue to be placed supine until 1 year of age. If the infant can roll from supine to prone and from prone to supine, the infant can then be allowed to remain in the sleep position that he or she assumes.
And stuff we already knew:
  • Supervised, Awake Tummy Time on a Daily Basis Can Promote Motor Development and Minimize the Risk of Positional Plagiocephaly
  • Infants Should Sleep in a Safety- Approved Crib, Portable Crib, Play Yard, or Bassinet
  • Car Seats and Other Sitting Devices Are not Recommended for Routine Sleep at Home or in the Hospital, Particularly for Young Infants
  • Bumper Pads and Similar Products Are not Recommended
This was surprising to me: 
Several studies have found a protective effect of pacifiers on the incidence of SIDS, particularly when used at the time of last sleep. Two meta-analyses revealed that pacifier use decreased the risk of SIDS by 50% to 60% (summary adjusted OR: 0.39 [95% CI: 0.31– 0.50]263; summary unadjusted OR: 0.48 [95% CI: 0.43– 0.54]264). Two later studies not included in these meta-analyses reported equivalent or even larger protective associations. The mechanism for this apparent strong protective effect is still unclear, but lowered arousal thresholds, favorable modification of autonomic control during sleep, and maintaining airway patency during sleep have been proposed.
Unfortunately, Ben won’t take a pacifier so I guess we’re a no-go on that one. 
Here’s another interesting tidbit:
Infants Should Be Immunized in Accordance With Recommendations of the AAP and Centers for Disease Control and Prevention
The incidence of SIDS peaks at a time when infants are receiving numerous immunizations. Case reports of a cluster of deaths shortly after immunization with diphtheria-tetanus-pertussis in the late 1970s created concern of a possible causal relationship between vaccinations and SIDS. Case- control studies were performed to evaluate this temporal association. Four of the 6 studies found no relation- ship between diphtheria-tetanus- pertussis vaccination and subsequent SIDS, and results of the other 2 studies suggested a temporal relationship but only in specific subgroup analysis.  In 2003, the Institute of Medicine of the National Academy of Sciences reviewed available data and concluded that “[t]he evidence favors rejection of a causal relationship between exposure to multiple vaccinations and SIDS.” Additional subsequent large population case-control trials consistently have found vaccines to be protective against SIDS; however, confounding factors (social, maternal, birth, and infant medical his- tory) might account for this protective effect.  It also has been theorized that the decreased SIDS rate immediately after vaccination was attributable to infants being healthier at time of immunization, or “the healthy vaccinee effect.” Recent illness would both place infants at higher risk of SIDS and make them more likely to have immunizations deferred.
Recent studies have attempted to control for confounding by social, maternal, birth, and infant medical history. In a meta-analysis, Vennemann et al found a multivariate summary OR for immunizations and SIDS to be 0.54 (95% CI: 0.39– 0.76), which indicates that the risk of SIDS is halved by immunization. The evidence continues to show no causal relationship between immunizations and SIDS and suggests that vaccination may have a protective effect against SIDS.
The article, while long, is a easy read and very, very informative. Very handy for all those new-parent sleep safety questions. 
Read the full report here.