1. Mennick, Fran BSN, RN

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When the American Academy of Pediatrics (AAP) released the first guidelines on preventing sudden infant death syndrome (SIDS) in 1992, the SIDS rate was 1.2 deaths per 1,000 live births. According to the National Institute of Child Health and Human Development, since the launch in 1994 of the public health campaign Back to Sleep, which promotes the supine position as best for infant sleep, SIDS rates have declined more than 50%, to 0.49 deaths per 1,000 live births (according to data from 2004). Recently, the AAP's Task Force on Sudden Infant Death Syndrome revisited the guidelines and in October released an update (


The newer guidelines reiterate the importance of supine positioning for sleep and recommend against the side-sleeping position. In its policy statement, the AAP cites studies showing the importance of following this practice consistently, since infants who usually sleep in the supine position are at especially high risk for SIDS when they are placed in the prone position instead. It attributes disparities in SIDS rates between black and white infants (in 2001 the rate of SIDS among black infants was more than double that of whites) to differences in positioning: black infants were almost twice as likely to be placed in the prone position to sleep. And the October 18, 2005, New York Times reported that many parents are deliberately disregarding the "back to sleep" mnemonic because their infants don't seem to be as comfortable or to sleep as well when supine.


New to the recommendations is the suggestion that parents give infants a pacifier when they're put down to sleep (beginning at one month of age in breastfed infants; the delay allows for breastfeeding to become established).


Recommendations against the use of soft sleeping surfaces, pillows, and other soft bedding remain, as does a warning against bed sharing, which is common in the United States, even though the task force acknowledged that "studies offer a strong case for its effect in facilitating breastfeeding." The AAP noted that infants who slept in their mother's room but in a separate bed had lower risk of SIDS and so suggests a sleeping arrangement in which the baby is nearby but separate.


La Leche League International, the breast-feeding advocacy group, takes issue with the AAP's positions on bed sharing and the use of pacifiers, arguing that they might make a mother's attempts to breastfeed more difficult. That opinion is echoed by the Academy of Breastfeeding Medicine (ABM), a physician group dedicated to promoting breastfeeding. It recommends that parents be educated on safe and unsafe bed-sharing practices rather than warned away from bed sharing altogether. The ABM's recommendations on bed sharing are available at


American Academy of Pediatrics Task Force on Sudden Infant Death Syndrome. Pediatrics 2005; 116(5):1245-1255. Available at

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