New recommendations published by the American Academy of Pediatrics for reducing sleep-related infant deaths

By: Libby Reed 
Risk Solutions Specialist 

Child care providers are responsible for children’s safety and well-being while in their care. Therefore, following all requirements issued by regulating authorities over your child care center (e.g., state departments) is essential for a successful business and maintaining a safe environment. Additionally, practicing evidence-based safety recommendations from reputable organizations puts your center in a position to keep children safe and healthy. 

In July 2022, the American Academy of Pediatrics (AAP) released updated safe sleep recommendations to reduce infant deaths. The organization developed these recommendations following a technical report detailing information from a literature review of relevant research papers published since 2015. 

The technical report stated, “Each year in the United States, approximately 3,500 infants die of sleep-related infant deaths, including sudden infant death syndrome (SIDS), ill-defined deaths, and accidental suffocation and strangulation in bed” (Moon et al., 2022). While the rate of sleep-related infant deaths declined substantially in the 1990s due to a national educational campaign recommending putting babies on their backs to sleep, the numbers have not changed much since 2000 (American Academy of Pediatrics [AAP], 2022). As a result, researchers have sought to gain more information on preventing infant deaths, and findings in recent years established a basis for the updated guidelines. 

Summary of recommendations 

The following list from the AAP (2022) summarizes the recommendations but is not comprehensive. Click here to view a complete list with descriptions. 

  • The baby should sleep on a firm, flat non-inclined surface that, at a minimum, adheres to the June 2021 Consumer Product Safety Commission’s rule that any infant sleep product must meet existing federal safety standards for cribs, bassinets, play yards, and bedside sleepers. Parents should not use products for sleep that aren’t specifically marketed for sleep. 

  • Sitting devices, such as car seats, strollers, swings, infant carriers, and infant slings, are not recommended for routine sleep in the hospital or at home, particularly for infants younger than four months. 

  • Avoid parent and infant exposure to nicotine, alcohol, marijuana, opioids, and illicit drugs. 

  • Make sure the baby receives routine immunizations. 

  • Pacifier use is associated with reducing risk. 

  • Avoid the use of commercial devices that claim to reduce the risk of SIDS or other sleep-related deaths. There is no evidence that any of these devices reduce the risk of these deaths. Importantly, the use of products claiming to increase sleep safety may provide a false sense of security and complacency for caregivers. Do not use home cardiorespiratory monitors as a strategy to reduce the risk of SIDS. 

  • Supervised, awake tummy time is recommended to facilitate infant development and minimize the development of positional plagiocephaly. Parents are encouraged to place the infant in tummy time while awake and supervised for short periods of time beginning soon after hospital discharge, increasing incrementally to at least 15 to 30 minutes total daily by seven weeks of age. 

  • There is no evidence to recommend swaddling as a strategy to reduce the risk of SIDS. If infants are swaddled, always place them on the back. Weighted swaddles, weighted clothing, or weighted objects on or near the baby are not safe and not recommended. When an infant exhibits signs of attempting to roll (which usually occurs at three to four months but may occur earlier), swaddling is no longer appropriate, as it could increase the risk of suffocation if the swaddled infant rolls to the prone position. 

American Academy of Pediatrics. (2022, June 21). American Academy of Pediatrics updates safe sleep recommendations: Back is best. 
Moon, R. Y., Carlin R. F., Hand, I., & The Task Force on Sudden Infant Death Syndrome and the Committee on Fetus and Newborn. (2022). Sleep-related infant deaths: Updated 2022 recommendations for reducing infant deaths in the sleep environment. Pediatrics, 150 (1). 


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