The New AAP Sleep Guidelines

If you have been online this week, you have likely come across reports of new guidelines on infant sleep from the American Academy of Pediatrics. And because we aren’t American, you might be wondering how and if these changes affect us.

First, let’s understand exactly what the new recommendations are:

• infants should sleep in the same room as a parent for 6 months at minimum, or 12 months ideally
• skin-to-skin contact beyond the initial hours after birth is beneficial and recommended as a means of SIDS reduction
• infants should sleep on a separate, firm, surface that is free of any soft objects including bumpers, toys, or blankets
• now recommended that the introduction of soft objects be delayed until 1 year of age (from 4 months previously)
• couches and armchairs are one of the most risky places to fall asleep with an infant and as such, it is now being recommended that parents who are feeding infants during the night and are at risk of falling asleep, do so in their bed without blankets, sheets, or pillows
• move the baby back to their own sleep surface as soon as the parent wakes
• infants should be placed on their backs to sleep

How are they different from Canadian recommendations?

• both countries follow Back to Sleep campaign guidelines
• both countries recommend infants sleep in the same room as a parent for six months, the AAP is simply recommending longer than six months
• both countries recommend a separate, firm surface for infant sleep
• both countries recommend the removed of soft objects in the crib

So what is the biggest change?

The biggest and most widely commented on change is the acknowledgement from the AAP that bed-sharing does occur, and that it is often unintentional. Unintentional bed-sharing is more dangerous because the bed may not be set up for safe infant sleep. The presence of pillows and bed linens creates a suffocation risk. Even more dangerous is that parents who are trying to avoid bed-sharing are falling asleep on couches or chairs with their infants.

By providing guidelines on how to address middle-of-the-night feedings with sleep-deprivation, the AAP is acknowledging the reality of over-tired parents. Knowing that it is likely parents will fall asleep while feeding the infant during the night, they recommend feeding in bed instead of a couch or chair, but making sure that the bed is free of risk factors.

This recommendation will hopefully prevent tragedies with parents who fell asleep on a couch because the bed is “more dangerous”.

How does this affect us?

Short answer, it doesn’t. Many of the recommendations are the same ones that Health Canada has been following for years. Longer answer, you are welcome to adopt these guidelines in your own life if they make sense for you. Safer sleep and more sleep is always a good thing.

Hold up! My baby has to sleep in my room?

This is part of the recommendation that is receiving the most criticism. Despite also being a part of Health Canada’s guidelines, it is one that many people have been unaware of. There are studies which suggest that room-sharing with an infant for the first six months can reduce the risk of SIDS by as much as 50%. Keep in mind that SIDS tragedies occur in less than 0.5% of infants 0-12 months.

For some families, having an infant sleep in the same room as parents is simply not an options. Babies are noisy in their sleep. For parents that require adequate sleep, room-sharing may not be an option. Anxiety can also increase when parent and baby share a room. Parents who are prone to anxious or intrusive thoughts may find it very disruptive to have their baby share a room.

So what are the options?

You do not have to share a room with your baby. There are many other ways to reduce the risk of SIDS, such as regular prenatal care, breastfeeding, a safe sleep surface, and a smoke-free environment. Ultimately, the decision on room-sharing is yours. There are many other families who will be making similar decisions.

If the idea of room sharing makes you uncomfortable, but you want the potentially protective benefits, our postpartum doulas are available for overnight shifts.