USBC's Response to AAP SIDS
Recommendations
FOR IMMEDIATE
RELEASE
Mixed Credibility of the
Revised AAP SIDS Prevention Recommendations
Contact: United
States Breastfeeding Committee
Chair: Audrey Naylor, MD, PhD.
AJNaylor@aol.com, 619-574-8174
Vice Chair: Ruth
Lawrence, MD.
ruth_lawrence@urmc.rochester.edu.
585-275-4354
Washington, DC, October 14,
2005
The American
Academy of Pediatrics (AAP) released revised recommendations for
SIDS prevention last week, one of which provides valuable new
information to help parents protect their infant, while some
others not only lack a solid scientific basis but also entail
some risks.
The AAP now
recommends that infants sleep in the same room as their parents
because this is associated with a reduced risk of SIDS. While
studies have consistently found that isolating infants for sleep
(in a separate bedroom) is associated with a higher risk of
SIDS, this information has not previously been widely
disseminated. Sleeping near one’s infant has also been shown to
increase maternal responsiveness to one’s infant’s nighttime
physiologic signals and to make it easier for mother to succeed
with breastfeeding. Breastfeeding, in turn, is linked to a
reduced risk of many acute and chronic illnesses, including a
21% lower all-cause infant mortality rate in an analysis by the
National Institutes of Health, and a reduced risk of SIDS in a
number of studies.
Two
recommendations in the new AAP statement have stirred particular
concern: to give babies pacifiers and remove the infants from
the parental bed prior to sleep. Both recommendations are
problematic in a number of ways, including that they lack a
clear scientific basis, constrain parental choice, complicate
the potentially challenging process of putting infants to sleep,
and impair breastfeeding.
Because early
pacifier use reduces breastfeeding duration, the AAP SIDS
statement recommends waiting until after a month (to allow
breastfeeding to get off to a good start) before starting
pacifiers in breastfed infants. Even beyond this period
pacifiers entail health risks, however, and may undermine
breastfeeding success.
A number of
studies (but not all) have found an association between pacifier
use and lower rates of SIDS. But these studies cannot determine
if the relationship is causal, and therefore whether pacifier
use can reduce the risk of SIDS. Nevertheless, even if the oral
stimulation of sucking were protective, only those infants
lacking the natural source of nighttime suckling, breastfeeding,
would be likely to benefit from an artificial pacifier source of
such stimulation. Only in such “at risk” groups might it make
sense to assume the health risks of pacifier use which include
yeast infections, oral malocclusion, and ear infections.
Data are also
lacking to justify telling parents whether or not they should
sleep with their infants—beyond informing them of the protective
effect of sleeping in the same room as their baby. In the best
controlled studies, infant safety is not associated with whether
the baby in the parents’ bed per se, but on specific
environmental factors that warrant attention whether the baby is
in a bed, a crib, or other sleeping surface. For example, SIDS
has been associated with prone sleep position, maternal smoking,
soft mattresses, and bedding near the baby that could cover the
head. Avoidable exceptions in which bedsharing itself has been
associated with an increased risk of SIDS include the use of
particularly unsafe furniture (e.g. couches, which are
associated with a 25-fold increased risk of SIDS) and if a
parent smokes or is incapacitated by alcohol, drugs, or
exhaustion.
The United
States Breastfeeding Committee recommends caution before
advising pacifiers for breastfeeding infants even after one
month of age. It also emphasizes the importance of closeness to
one’s infant and supports the statement of the Section on
Breastfeeding of the AAP that mother and infant sleep in close
proximity.
The United
States Breastfeeding Committee is a national committee made up
of over 30 organizations that promote, protect and support
breastfeeding.
-
AAP Task
Force on Sudden Infant Death Syndrome. The Changing Concept
of Sudden Infant Death Syndrome: Diagnostic Coding Shifts,
Controversies Regarding Sleeping Environment, and New
Variables to Consider in Reducing Risk. Pediatrics
November 2005; 116(5):1245-1255
-
American
Academy of Pediatrics, Section on Breastfeeding, Policy
Statement: Breastfeeding and the Use of Human Milk.
Pediatrics 2005; 115(2):496-506
-
Chen A,
Rogan WJ. Breastfeeding and the Risk of Postneonatal Death
in the United States. Pediatrics 2004; 113:e435-439
URL:
http://www.pediatrics.org/cgi/content/full/113/5/e435
-
McKenna
JJ, McDade T. Why babies should never sleep alone: A Review
of the co-sleeping controversy in relation to SIDS,
bedsharing and breast feeding. Pediatric Respiratory
Reviews 2005; 6:134-152 (available on line at
www.sciencedirect.com)
