AAP says: Put the baby in your room.

The American Academy of Pediatrics (AAP) has revised their infant sleep recommendations for the prevention of sudden infant death syndrome (SIDS).   Notably:

...there is growing evidence that room sharing (infant sleeping in a crib in parent’s bedroom) is associated with a reduced risk of SIDS. The AAP recommends a separate but proximate sleeping environment.

In other words, while it still recommends cribs, the AAP now recommends that babies sleep in the same room as their parents.  I applaud this recommendation, which makes sense on many levels.  Because their waking will be heard sooner, babies will cry less and suffer less.  Perhaps breastfeeding will become well-established for more newborns, so that fewer mothers will have problems that drive them to give up nursing.

Our family cosleeps.   The benefits to us of co-sleeping are apparent, and the risk of SIDS is small (and not at all, to my knowledge, studied in exclusively co-sleeping families --- most of the data comes from families who occasionally co-sleep).  I personally recommend it to every nonsmoking parent who asks me. 

But I am still pleased by the new AAP recommendations.    Because they are palatable to the average American, they stand a good chance of becoming the new norm in nighttime baby care --- I mean, there is a good chance that the typical newborn will move from the nursery down the hall to the crib a few feet away.  That's a tremendous gain in mother-baby closeness.

Here is another interesting statement.  I had no idea that this research even existed:

Research now indicates an association between pacifier use and a reduced risk of SIDS, which is why the revised statement recommends the use of pacifiers at nap time and bedtime throughout the first year of life. The evidence that pacifier use inhibits breastfeeding or causes later dental complications is not compelling enough to discredit the recommendation. However, it is recommended that pacifier introduction for breastfed infants be delayed until one month of age to ensure that breastfeeding is firmly established. In addition, if the infant refuses the pacifier, it should not be forced.

Fascinating!  Why do you suppose that a pacifier should reduce the risk of SIDS?  Does suckling stimulate breathing, or keep the airway open?  Well, my night nursers have always nursed so much when they were small...

I'm pleased to see that they recommend waiting until breastfeeding is firmly established.  Do you suppose that this part will be noticed, or will pediatricians just start telling parents, "Use a pacifier.  It lowers the risk of SIDS."  I hope that they remember that pacifiers do cause problems.

The rest of the recommendations are not very much changed.  One part I disagree with has to do with avoiding flat-head: 

Avoid development of positional plagiocephaly (flat back of head): Encourage “tummy time.” * Avoid having the infant spend excessive time in car-seat carriers and “bouncers.”

Parents certainly should avoid putting the baby too much in car-seat carriers and bouncers, but the solution isn't "tummy time" (which is a pleasant-sounding euphemism for "leaving the infant awake face down on the floor"), it's carrying the baby, in arms or a soft carrier.  Get a sling and use it.  Better yet, get several.  (Here or here are good places to start.)   

All in all, pretty good, but --- as usual --- there's a general lack of perspective.  We should care about total infant mortality, not just SIDS.  And morbidity too:  good quality breastfeeding prevents so many problems that it's hard to see why it's not a higher priority than SIDS.  For a while, a major disposable-diaper manufacturer printed diapers with the "Back to Sleep" slogan.  Nobody printed "Having trouble breastfeeding?  Before you give up, dial 1-800-LALECHE."

Possibility the first:  The unexpected, unexplained nature of SIDS scares people more than other causes of infant death and illnesses.  Possibility the second:  Nobody stands to lose a lot of money if people decide to do what's best for their babies when it comes to sleep.

UPDATE:  Of course, if you look for it on Google News, the headlines are all about the benefits of cribs and pacifiers.  Not about the benefits of putting your child in your room, which is surely the change that has the most significant impact on standard U. S. parenting practices.

UPDATE AGAIN:  Dumbest headline award goes to the Washington Post, for this gem:

To cut crib deaths, separate beds are urged for babies

Think about it.

Comments

[Peter]

Until SIDS rates are studied in families who co-sleep exclusively and practice night nursing, I refuse to pay any heed to the AAP's concern about co-sleeping. My guess is that the co-sleeping death stats (from which they draw their concern) are mostly made up of incidents in which drunk parents fell asleep with the baby in their bed.

[bearing]

Peter, you have identified what I feel is the greatest fault of SIDS/cosleeping research.

The only study I know of that explicitly concludes, based on decent data and statistics, that Western babies are safest in cribs in their parents' rooms is Tappin et al (2005).

The data includes a total of twenty-six children (13 SIDS babies and 13 of the controls --- the equal number is a coincidence, as the controls were not chosen based on this variable) who slept regularly in the parents' bed. But the overwhelming number of babies slept regularly in cribs, including the ones who died in the parents' bed and were counted as co-sleepers.

I do not fault the authors of the study for failing to examine a larger number of regularly cosleeping children. I do not think there are very many in the pool to draw from. But I do fault them for drawing the conclusion that the safety of occasionally taking a baby into your bed reflects accurately the safety of sleeping with a baby every night.

I think that it's pretty well established by now that if you and your child are used to them sleeping in a crib, it's not safe to take them into your bed "just for one night." This isn't the same as sleeping with them every night, and both of you being accustomed to it.