Alison Jacobson

In addition, the updated American Academy of Pediatrics (AAP) Guidelines have been released and are being published in the July issue of Pediatrics.

All this new information can be confusing to families as they consider what they should and should not do. From our decades of work with care providers and families, we recognize the real-world challenges confronting parents as they care for their babies.

We also realize that the language of the revised guidelines is appropriately drafted for AAP members and not necessarily for families and caregivers. We support the guidelines and want to ensure that parents, caregivers, and community members understand them and how to use infant products safely and as intended.

The revised set of guidelines retains recommendations outlined in the initial Back to Sleep campaign, which contributed to a 50 percent decrease in SIDS deaths after its launch in the 1990s, and introduced new or updated actions parents and caregivers can take to reduce the risk of sleep-related infant death. First Candle, known as the SIDS Alliance, was a collaborator in the original campaign. 

Some may recognize previously known advice in the revised guidelines and wonder what is new. While the revision retains the basic evidence-based tenets for safe infant sleep, it references data that may have been compiled since the last revision in 2016, expands language on breastfeeding/human milk feeding, sleep surfaces, bedding, and swaddling, and provides information regarding infant safe sleep products and recent actions taken by the Consumer Product Safety Commission (CPSC). 

Among the guidelines left in place are placing babies on their backs for night and nap, sleeping on their firm, flat surface, with no loose bedding or other items; room sharing during the first six months, breastfeeding; and healthcare guidance for the mother and infant pre- and post-natal. 

The revised guidelines also address risky infant sleep environments, including bed-sharing. While the revised document acknowledges that parents may decide to share a bed with their infant to help with breastfeeding or for cultural norms, the AAP cannot support bed-sharing under any circumstances. 

Indeed, the rate of bed-sharing is high. The Centers for Disease Control and Prevention (CDC) analyzed 2009–2015 Pregnancy Risk Assessment Monitoring System (PRAMS) data. They found that more than half of families (61.4 percent) reported infant bed sharing, with higher rates among American Indians/Alaska Natives, non-Hispanic Blacks, or Asians/Pacific Islanders than non- Hispanic whites or Hispanics. 

Parents are exhausted, and while they may know the guidelines are against adult bed-sharing, it often happens for practicality while the mother is breastfeeding, and she may fall asleep. For others, it is due to socioeconomic factors, cultural beliefs, traditions, or personal choices. 

We are disappointed that the rates of SUID have not decreased in more than two decades despite the safe sleep guidelines. That means we must change how these messages are delivered and by whom. Trusted community providers such as doulas, social service agencies, and faith-based leaders must lead the way in having authentic conversations with families, educating and supporting them in ways that respect their lived experiences. 

First Candle incorporates its “common language” approach to the safe sleep guidelines through its website and materials and its professional- and family-targeted outreach programs. It draws on the AAP guidelines in its Straight Talk for Infant Safe Sleep program, which trains health care providers, including nurses, doulas, and social workers, on safe sleep and explores how implicit bias impacts the education of families. 

The guidelines are also central to its Let’s Talk Community Chats initiative, which partners with community leaders and advocates to address racial disparities in SUID rates through extended conversations with families about safe sleep, breastfeeding, and the proper use of infant products. The chats are held monthly, free of charge, at local gathering places such as churches, community centers, laundromats, and retail establishments. 

Both of these programs are opportunities to discuss the applications of each guideline, the “why” behind each in everyday language, free of bias, and to help parents understand how to safely and properly use infant products. 

The results of First Candle’s review of the revised guidelines and the “why” information can be found on its website at https://firstcandle.org/safesleep/. Additional graphics, video, and other media assets are available at www.firstcandle.org/media.