First Candle reviews revised AAP Infant Safe Sleep Guidelines

NEW CANAAN, Conn. – First Candle, the leading national nonprofit addressing Sudden Unexplained Infant Death Syndrome, has completed its review of the revised infant safe sleep guidelines released June 21 by the American Academy of Pediatrics, focusing its attention on what the recommendations can mean to parents and their families.

"In the past two months, a great deal of information and legislation has come out about safe sleep and products that are and are not appropriate to use for infant sleep. The Safe Sleep for Babies Act makes it unlawful to manufacture, sell, or distribute crib bumpers or inclined sleepers for infants. Later this week the Consumer Products Safety Commission's rule goes into effect that states the only products that can be marketed for infant sleep are cribs, bassinets, play yards and bedside sleepers. Now, with the new AAP Guidelines having been released, it can be confusing to families what they should and should not do," said First Candle CEO Alison Jacobson, a SIDS mother who lost her son in 1997.

"From our decades of work with care providers and families, we recognize the real-world challenges confronting parents as they care for their babies. We also realize the revised guidelines are appropriately drafted for members of the AAP and not necessarily written for families and caregivers. We support the guidelines and want to be sure that parents, caregivers, and community members understand them as well as how to use infant products safely and as intended."

The revised set of guidelines retains recommendations set forth in the initial Back to Sleep campaign, which contributed to a 50% decrease in SIDS deaths after its launch in the 1990s and introduces new or updated actions parents and caregivers can take to reduce the risk of sleep-related infant death. First Candle, then the SIDS Alliance, was a collaborator in the original campaign.

"Some may recognize previously-known advice in the revised guidelines and wonder what's new," Jacobson said. She noted that while the revision retains the basic evidence-based tenets for infant safe sleep, it references data that may have been compiled since the last revision in 2016, expands language on breastfeeding/human milk feeding, sleep surfaces, bedding and swaddling, and provides information regarding infant safe sleep products and recent actions taken by the Consumer Product Safety Commission (CPSC).

Among the guidelines left in place is placing babies on their backs for night and nap sleeping on their own firm flat surface with no loose bedding or other items; room sharing during the first six months; breastfeeding; and health care guidance for the mother and infant pre- and post-natal.

The revised guidelines also address risky infant sleep environments, including bed sharing. While the revised document acknowledges that parents may decide to share a bed with their infant to help with breastfeeding or for cultural norms, the AAP cannot support bed sharing under any circumstances.

Indeed, the rate of bed sharing is high. The Centers for Disease Control and Prevention analyzed 2009–2015 Pregnancy Risk Assessment Monitoring System data and found more than half of families (61.4%) reported infant bed sharing, with higher rates among American Indians/Alaska Natives, non-Hispanic Blacks or Asians/Pacific Islanders, than non-Hispanic whites or Hispanics.

"Parents are exhausted and while they may know the guidelines are against adult bed sharing, it happens, often for practicality while the mother is breastfeeding and she may fall asleep. For others it's due to socioeconomic factors, cultural beliefs, traditions or personal choice," Jacobson said. "We are disappointed that the rates of SUID have not decreased in over two decades despite the safe sleep guidelines. What that means is that we must change the ways in which these messages are delivered and by whom. Trusted community providers such as doulas, social service agencies and faith-based leaders must be the ones leading the way in having authentic conversations with families, educating, and supporting them in ways that respect their lived experiences."

First Candle incorporates its "common language" approach to the safe sleep guidelines through its website and materials as well as its professional- and family-targeted outreach programs. It draws on the AAP guidelines in its Straight Talk for Infant Safe Sleep program, which trains health care providers including nurses, doulas and social workers on safe sleep and explores how implicit bias impacts education of families.

The guidelines are also central to its Let's Talk Community Chats initiative, which partners with community leaders and advocates to address racial disparities in SUID rates, through extended conversations with families about safe sleep, breastfeeding and the proper use of infant products. The chats are held every month, free of charge, at local gathering places such as churches, community centers, laundromats and retail establishments.

"Both of these programs are opportunities to discuss the applications of each guideline, the "why" behind each in everyday language, free of bias, and to help parents understand how to safely and properly use infant products" Jacobson said.

The results of First Candle's review of the revised guidelines and the "why" information can be found on its website, at https://firstcandle.org/safesleep.

Submitted by First Candle.