Bumper pads are the latest cuplrit the American Academy of Pediatrics is targeting to protect infants from Sudden Infant Death Syndrome (SIDS) and deaths related to suffocation and entrapment. The new recommendation against bumper pads was issued Tuesday morning as part of the organization's routine update to its SIDS prevention policy.

A Chicago Tribune story this morning looks into this controversial decision, which upset manufacturers who believe their bumper pads protect infants from bumping their heads or having their arms or legs caught between crib slats.

"We weighed the pros and cons and the evidence, and felt that the safest thing would be to keep bumpers out of the crib altogether," Dr. Fern R. Hauck, a member of the academy's SIDS task force and a professor of family medicine at the University of Virginia, told the Tribune.

SIDS deaths have decreased dramatically over the past two decades -- following the academy's recommendation in 1992 that infants be placed to sleep on their backs -- but infant deaths due to suffocation and entrapment have increased. The academy also recommends against loose blankets, pillows and positional wedges in cribs that could present suffocation hazards to infants.  

There is growing evidence that simply putting infants to sleep on their backs isn't enough, even to protect them against SIDS. A study out of New Mexico, released Monday, examined 91 infant deaths due to SIDS and related causes in that state, and found that 71 percent involved unsafe sleep surfaces. Some of the surfaces included cribs with inadequate mattresses or suffocation hazards. In other cases, the infants were sleeping on beds or sofas, even though there were cribs available in their homes. Just 52 percent of the infant deaths involved children sleeping in positions other than on their backs.

As I wrote about on Saturday, an Alabama physical therapist believes too much emphasis has been placed on the Back to Sleep campaign. She cited a study showing that infants were at 5 times the risk of SIDS deaths if they had soft bedding as opposed to firm bedding, and that sleeping on their stomachs only incresed the risk 2.4 times. Of course, the greatest risk was for babies sleeping on their stomachs AND on soft mattresses. Then the risk was 21 tiimes greater. The physical therapist, Stephanie Pruitt, who wrote a new book called The Truth About Tummy Time, believes parents have focused too much on the back to sleep recommendation. The consequence, she said, is they have ignored the importance of firm bedding, and denied their children needed tummy time even when awake. Some children suffer physical and developmental problems if they spend too much time on their backs.

“Most parents are hearing ‘put your baby on the back,’” she said. “What that translates to is ‘never put your baby on the stomach.’”

Pruitt goes as far as questioning whether the decline in SIDS deaths over the past two decades is really progress. The increase in infant suffocation deaths has erased much of that progress, she noted.

Officials with the American Academy of Pediatrics acknowledged Tuesday that they must do a better job of communicating the latest evidence regarding how to keep sleeping infants safe.

"We have tried to make it easier for parents and providers to understand the recommendations by providing specific answers to common questions," said Dr. Rachel Moon, chair of the AAP SIDS task force and lead author of the new guidelines, in a news release. "As a health care community, we need to do a better job translating what the research identifies as 'best practices' into the day-to-day practice of caring for infants in both the hospital and home environment."

The new policy statement, "SIDS and Other Sleep-Related Infant Deaths: Expansion of Recommendations for a Safe Infant Sleeping Environment" lists the following new recommendations:

  • Breastfeeding is recommended and is associated with a reduced risk of SIDS.
  • Infants should be immunized. Evidence suggests that immunization reduces the risk of SIDS by 50 percent.
  • Bumper pads should not be used in cribs. There is no evidence that bumper pads prevent injuries, and there is a potential risk of suffocation, strangulation or entrapment.

The report also includes the following recommendations:

  • Always place your baby on his or her back for every sleep time.
  • Always use a firm sleep surface. Car seats and other sitting devices are not recommended for routine sleep.
  • The baby should sleep in the same room as the parents, but not in the same bed (room-sharing without bed-sharing).
  • Keep soft objects or loose bedding out of the crib. This includes pillows, blankets, and bumper pads.
  • Wedges and positioners should not be used.
  • Pregnant woman should receive regular prenatal care.
  • Don't smoke during pregnancy or after birth.
  • Breastfeeding is recommended.
  • Offer a pacifier at nap time and bedtime.
  • Avoid covering the infant's head or overheating.
  • Do not use home monitors or commercial devices marketed to reduce the risk of SIDS.
  • Infants should receive all recommended vaccinations.
  • Supervised, awake tummy time is recommended daily to facilitate development and minimize the occurrence of positional plagiocephaly.

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