New Safe-Sleep Guidelines During Breastfeeding

Introduction

Breastfeeding is a beautiful and essential bonding experience between a mother and her baby, providing numerous health benefits for both. It is crucial to prioritize safety during this intimate time, especially when ensuring a safe sleeping environment for the baby. The Safe Sleep Guidelines were given by the American Academy of Pediatrics (AAP) in 2016. The AAP issued revised safe sleeping recommendations for infants younger than one year old in July 2022 to minimize the likelihood of sleep-related fatalities among babies.

What Is the Importance of Safe Sleep Guidelines?

Sudden unexpected infant death (SUID) is a broader term that encompasses various causes of unexpected deaths in infants. It includes sudden infant death syndrome (SIDS), accidental suffocation, and other unexplained causes. SUID is used when the exact cause of death cannot be determined even after a thorough investigation.

To reduce the risk of SUID and promote a safe sleep environment, it is recommended to follow the safe sleep guidelines provided by the American Academy of Pediatrics. Educating caregivers, family members, and childcare providers about safe sleep practices is vital to ensuring consistent adherence to these guidelines. By following the recommended safe sleep practices and remaining vigilant about creating a safe sleep environment, the risk of SUID can be significantly reduced.

What Are the Main New Safe Sleep Guidelines During Breastfeeding?

Sleep Position

• It is advised that infants be put to sleep on their backs by all caregivers for every sleep until they are one year old to lower the likelihood of sleep-related fatalities. It is not recommended to sleep on the side, as it is considered unsafe.

• Babies who can roll over both from their back to their stomach and vice versa can continue sleeping in whatever position they naturally choose.

Sleep Surface

• The baby's sleeping surface should be flat, firm, and non-inclined.

• If the inclination of the sleep surface is greater than 10 degrees, it is considered unsafe for the babies to sleep in.

• It is advisable to avoid using seating equipment such as strollers, swings, infant carriers, and slings for regular sleep in both healthcare facilities and at home, especially for babies under the age of four months.

• Cribs, play yards, bedside sleepers, and bassinets should adhere to the rules given by the U.S. Consumer Product Safety Commission (CPSC). Infant sleep products that do not follow the guidelines are unsafe to use.

Breastfeeding Guidelines

• Breastfeeding is recommended for infants as it reduces the risk of SIDS. It is suggested to exclusively breastfeed infants for 6 months without offering formula or nonhuman milk-based supplements. It is recommended that breastfeeding continue for a year or longer if mutually desired by the parent and infant, as advised by the AAP.

• Due to the increased risk of SIDS for preterm and low birth weight babies, it is crucial to promote the benefits of breast milk, identify obstacles and solutions for families, and provide extra aid during extended NICU stays.

• Some parents cannot or choose not to breastfeed. In such cases, respectful communication is advised between healthcare professionals and parents. Advise families to follow other safe sleep guidelines.

Sleep Location

• Infants should sleep in their parent's room but on separate surfaces for 6 months.

• If a parent chooses to bedshare, the following things should be noted to reduce the risk of SUID.

  • Bed sharing should be avoided in the case of persons who smoke, who use sedative medications, who have impaired alertness, or who abuse substances.

  • Bed sharing should be avoided on soft surfaces like sofas, couches, water beds, armchairs, etc., and with soft bedding accessories like blankets and pillows.

  • Sharing with people other than the parents, including siblings and other caregivers, is not advisable.

  • Bed sharing should be avoided in preterm and low-birth-weight babies.

• Bed sharing can occur inadvertently when parents doze off while nurturing their baby, when they are especially worn out, or when the child is irritable. Based on available information, sleeping with an infant in an adult bed is considered less risky, although still not ideal, compared to sleeping on a sofa or armchair in case the parent accidentally falls asleep.

• Babies should be returned to their bed or crib after the parent feeds or comforts them.

• While nursing the baby on a couch or in an armchair, the parent should be extra cautious to avoid falling asleep, which may increase the risk of suffocation and SIDS.

Soft Bedding

• To keep infants warm and avoid the risks associated with using blankets, it is recommended to dress them in layered clothing instead of covering them with blankets or other items that could cause suffocation or entrapment.

• Experts advise against using heavyweight bedding, clothing, wraps, or any other heavy items that could come into proximity to an infant during sleep time.

• Soft items like pillows, quilts, furry materials, and loosely fitted bedding (such as blankets and sheets) can cause a baby's airway to become blocked, potentially leading to suffocation. This is the most frequent cause of unintentional suffocation in infants.

What Are the Other Miscellaneous Safe Sleep Guidelines?

Pacifiers

• Pacifiers used during sleep and naps are associated with a low risk for SIDS.

• Pacifier use should be delayed in breastfed babies until breastfeeding is well-adapted.

• Pacifiers should not be hung around the neck, and nothing should be attached to it to reduce the risk of strangulation.

Smoking and Alcohol

• Smoking by pregnant mothers should be avoided. No one should smoke in the presence of a pregnant mother or an infant.

• The use of alcohol or any other illegal drugs should be avoided during pregnancy and after birth.

Head Covering and Overheating

• Overheating has been associated with an increased risk of SIDS. Overbundling and covering the face and head of the baby should be avoided.

• Keeping the baby's sleeping environment at a moderate temperature was emphasized to prevent overheating. Dressing the baby appropriately and avoiding excessive clothing or blankets were recommended.

• Use of home cardiorespiratory devices and other commercial devices should be avoided.

Conclusion

Breastfeeding mothers were advised to adhere to safe sleep guidelines, including room-sharing, separate sleep surfaces, a back sleeping position, cautious bed-sharing, and preventing overheating. These guidelines aimed to promote a secure sleeping environment for infants while reaping the numerous benefits of breastfeeding. Breastfeeding mothers need to stay updated with current recommendations to ensure the well-being and safety of their babies during sleep.