Updated Safe Sleep Recommendations 2022

The AAP recently updated their safe sleep recommendations for the first time in 2016. A lot stayed the same, with just a few things added and/or clarified.

The ABC’s of sleep continue to be the standard for “safe sleep”. Those include: 

  • Sleeping alone

  • Placing your infant (less than 12 months) on their back for every sleep

  • And the use of a crib (or other safe sleep space like a bassinet or playard)

They list these as their “strong” recommendations:

  • Feeding breastmilk (even a little) can help to prevent SIDS *unknown about the safety mechanism here

  • Use of a pacifier

  • Room sharing

  • Keep their sleep space empty

  • Avoid exposure to smoke and other drugs

  • Avoid overheating

  • Continue regular prenatal care while expecting

  • Stay up to date on vaccinations

  • Not to use home monitors that claim to reduce the risk of SIDS

  • Provide supervised awake tummy time

In the updated guidelines, this is what they’ve added or clarified:

  • In regard to a sleep surface, in 2016, they stated “use a firm sleep surface”. In 2022, it now says, “use a firm, flat, noninclined sleep surface.” And goes on to clarify that an incline greater than 10 degrees is unsafe for infant sleep. It also lists other “in an emergency” type devices you can use like a box or dresser drawer but states to use a CPSC-approved sleep device ASAP.

  • In regard to sleep location, in 2016, the guidelines were to “room share for the first 6 months, ideally the first year of life with parents without bedsharing.” Now it has been lowered to just 6 months, ideally. We will discuss their research about this further down.

  • Regarding “soft bedding”, there was no recommendation in 2016, but in 2022, they added that “it is recommended that weighted blankets, weighted sleepers, weighted swaddles, or other weighted objects not be placed on or near the sleeping infant.” and this too, “weighted swaddle clothing or weighted objects within swaddles are not safe and therefore not recommended.” We will also discuss this research further down!

  • They’ve always recommended avoiding overheating, however in 2022, they added a new recommendation to not use a hat indoors (at all) except in the first hours of life or in the NICU.

  • Regarding the discontinued use of swaddling, the AAP’s stance has always been at the first sign of rolling, however one of the physicians for the SIDS task force was quoted to discontinue swaddling at 8 weeks. The AAP added some more clarification to their swaddling recommendation in 2022, “when an infant exhibits signs of attempting to roll (which usually occurs at 3–4 mo but may occur earlier), swaddling is no longer appropriate because it could increase the risk of suffocation if the swaddled infant rolls to the prone position.”

So the biggest changes seem to be:

  • The room sharing recommendation

  • No hats indoors

  • No Weighted products

Let’s talk about the room sharing recommendation.

There are 3 studies cited for this recommendation. They made some BOLD claims about the effectiveness as a protective factor, but with how bold the claims are, I’d honestly expect this to be more of a preventative that’s in line with the ABC’s of sleep (and it’s not). I don’t even want to repeat them because it’ll only stress you out!

That’s because the studies they used to make this claim are very low quality. Let’s break those down.

This first study is about bedsharing, not roomsharing, so I don’t understand how they used it to make their recommendations. Direct quote from the conclusion, “There are certain circumstances when bed sharing should be avoided, particularly for infants under four months old. Parents sleeping on a sofa with infants should always be avoided. There is no evidence that bed sharing is hazardous for infants of parents who do not smoke.”

Again, no mention of roomsharing.

Unfortunately, I cannot find the full article for the second study they cite, but I would venture to say that it doesn’t paint the full picture either.

The third study is titled, “The combination of bed sharing and maternal smoking leads to a greatly increased risk of sudden unexpected death in infancy: the New Zealand SUDI Nationwide Case Control Study”.

This study is primarily focusing on the increased risk of smoking while bedsharing…. And has nothing to do with roomsharing.

Again, 3 studies cited (one I can’t read) and none of them actually address the roomsharing component.

Moving on to the “no hats indoors” recommendation.

While there aren’t any definitions in the studies specifically about overheating, this is one of those “better safe than sorry” situations. 

Finally, the weighted products recommendation.

I know this raised some red flags and maybe caused some companies to scramble, but what I find really interesting is that the AAP didn’t link any studies with this recommendation. 

Here are my thoughts: weighted products (especially for infants) are a relatively new thing. Which means, we don’t have a ton of research about them. There was one study of 16 infants (very very small sample size) where they wore the weighted product for 30 mins and nothing bad happened. That still doesn’t tell us anything.

However…. This is really hard to study and actually, unethical. Because they’d have to have a large sample size of babies who wear the weighted product and babies who don’t. They’d then have to see which babies died of SIDS and which ones didn’t.

I think this is one of those “wait and see” if weighted products are a factor in SIDS deaths whenever parents choose to use them. As opposed to designing a trial for that, they just have to use data as it comes in.

I also have an unpopular opinion to share and we will end with that.

I think it’s unfortunate that the AAP is seen as the end all/be all for all recommendations for our children. If that’s how they want to treat things, then their recommendations need to be from really great quality studies (and ones that pertain to the recommendation no less). 

It’s hard to take them seriously when you read the studies for the room sharing recommendation, for example. And if you’re trying to keep babies safe, you want to be taken seriously!

So that’s how I feel about that. I hope that cleared up any confusion you may have about the newest recommendations!

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