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Safe conditions that should prevail during infant sleep.

The time that infants spend sleeping differs significantly from the corresponding time of adults. In general, we would observe that it can occupy 1/2-2/3 of their daily activity and this is because it is vital for their health and development.

In the USA, ~ 3,500 infant deaths/year are reported from sleep-related causes. These include:

• Sudden Infant Death Syndrome
• Accidental suffocation
• Accidental strangulation

If this effect is considered statistically insignificant, we should emphasize that it is VERY IMPORTANT for every family experiencing loss.

Sudden Infant Death Syndrome (SIDS) is the sudden death of an infant <1 year of age in his sleep, which remains unexplained by the individual history (absence of serious illness), autopsy / necropsy and toxicological examination. Taking into account all of the above, in 2022 the American Academy of Pediatrics issued updated guidelines for safe sleeping conditions for infants:

1. Sleeping position

Up to the age of 1 year, sleep should be EXCLUSIVELY in a supine position, i.e. on the back, day and night. We do not place the infant in a lateral position with “sleeping” “slings”. If the infant, as its development progresses, chooses to turn on its own in a lateral or prone position, we do not intervene, but leave it in the position of choice. The supine position is preferred over the prone position, since anatomically in the supine position, the trachea is above the esophagus, thus avoiding any aspiration episode.

2. Encouragement of the prone position in a controlled manner

The prone position (tummy time) should be encouraged when the infant is alert and always with supervision, as it has been shown to enhance psychomotor development, strengthen the back muscles, and prevent the development of plagiocephaly. It is recommended to progressively increase the time spent in the prone position to 15-30 min/24h by the age of 7 weeks.

3. Sleeping surface

Sleeping should be done exclusively on a firm, hard, non-inclined mattress that fits the crib. The mattress is covered only with a fitted sheet underneath. Soft underlays, crib side covers, any cords/straps/cables near the crib, sleeping on a chair/sofa/waterbed/pillow, soft objects inside the crib (pillows, soft teddy bears), loose covers, or any objects that could increase the risk of entrapment, suffocation, or strangulation are prohibited. Wearing multiple fabrics to sleep or a sleeping bag is preferred and swaddling is avoided. We ensure that cribs are intact and not defective, comply with current safety standards, and that the product has not been recalled. If the infant falls asleep in the car seat / stroller / baby carrier / bouncer, it should be transferred to a stable sleeping surface as soon as possible.

4. Emphasis on breastfeeding

Breastfeeding has been found to reduce the risk of sudden infant death syndrome. Exclusive breastfeeding is recommended up to 6 months of age, then continued and after the introduction of solid foods for the 1st year of life, as long as the mother and infant wish.

5. Co-sleeping

It is recommended that the infant sleeps near the parents’ bed (on the mother’s side) but on a separate suitable surface, ideally at least until the first 6-12 months of life. Particular attention should be paid to avoiding co-sleeping in the same bed, especially when:

• the infant is < 4 months or premature
• when the caregiver has reduced alertness due to fatigue or use of medications / substances / alcohol
• when the caregiver is a smoker
• when it is a soft mattress / sofa / armchair
• breastfeeding mother

6. Giving a pacifier

It has been observed that giving a pacifier reduces the risk of sudden infant death syndrome, with an unknown mechanism. It is recommended, of course, after the establishment of breastfeeding. If the infant refuses the pacifier, we do not insist. If the pacifier falls during sleep, there is no need to reinsert it. We never hang the pacifier (or any jewelry) with a string around the child’s neck, due to the risk of strangulation.

7. Avoid smoking, alcohol, drugs

8. Avoid overheating the infant

We dress the infant appropriately for the environment, we do not use >1 extra layer of clothing or bedding compared to an adult. We do not cover the face, we do not use hats inside the house. The use of air conditioning is allowed. The ideal conditions are sleeping positions inside the house at a temperature of 18-20°C and a humidity of max 35-50%.

9. No use of cardiorespiratory monitors

They are only recommended for high-risk infants, e.g. premature or infants with cardiorespiratory problems. They have no indication in the prevention of SIDS. On the contrary, they provide an illusion of security to parents and reduce compliance with real prevention measures.

10. Recommendation for regular mandatory vaccination of infants

To summarize, we would say that Sudden Infant Death Syndrome (SIDS) is a tragic development with a heavy impact on the family. In 2022, the American Academy of Pediatrics updated the recommendations for safe sleep for infants. The goal of all is to better inform and educate caregivers of young infants to ensure an appropriate sleep environment. Continuous research into the causes and mechanisms of SIDS will hopefully offer new, more effective ways of prevention.