Reviewing the AAP's sudden infant death syndrome 2022 guidelines

David Turkewitz, MD, medical director of Newborn Nurseries at Allegheny Health Network in Pittsburgh, Pennsylvania, emphasized the critical role of pediatricians in educating families about strategies to prevent sudden infant death syndrome (SIDS) and sudden unexpected infant death (SUID). He underscored the importance of staying informed about the latest guidelines to better support families during well-infant visits.

“Parents depend on pediatricians for advice to keep their children safe and healthy,” Turkewitz said. He noted that the 2022 American Academy of Pediatrics (AAP) policy statement provides a comprehensive roadmap for preventing sleep-related infant deaths.

“Prior to 1994, infant sleep-related deaths were all lumped into the category of sudden infant death syndrome,” Turkewitz explained. Advances in research and a better understanding of contributing factors have led to more nuanced classifications and targeted prevention strategies.

One critical recommendation highlighted in the guidelines is the importance of always placing infants on their backs to sleep. “Every baby is put on their back to sleep, every nap and for every evening. That one strategy… reduces SIDS more than 50%,” Turkewitz said.

He also emphasized the need for a safe sleep environment, advising parents to use a flat, firm surface for their infants. “While a soft mattress might be appropriate for an adult, it’s totally inappropriate for a baby,” he said.

Breastfeeding was another key preventative measure Turkewitz discussed, highlighting its benefits beyond infection reduction. “One of the more powerful benefits of breastfeeding is SIDS reduction,” he noted.

The guidelines also recommend room sharing, but not bed sharing, to create the safest sleep environment for infants. “The safest area for a baby to sleep is in a parent’s room,” Turkewitz said. "So again, just just having the baby sleep in another area, even if it's in an appropriate crib, dramatically increases its [SIDS risk]."

Additionally, Turkewitz pointed to pacifier use starting at 2 weeks of age as an effective strategy. While the exact mechanism is uncertain, he said, “evidence-based literature is very clear cut” that pacifier use significantly reduces the risk of sleep-related deaths.

Turkewitz cautioned against the use of unapproved devices or monitors, noting, “If it’s not government approved, don’t go there,” he advised.

He encouraged clinicians to familiarize themselves with the 2022 AAP guidelines, describing the document as “a great condensation of a tremendous amount of information.”

Reference:

Moon RY, Carlin RF, Hand I. The task force on sudden infant death syndrome and the committee on fetus and newborn; Sleep-related infant deaths: Updated 2022 recommendations for reducing infant deaths in the sleep environment. Pediatrics. July 2022; 150 (1): e2022057990. 10.1542/peds.2022-057990