Episode 4: The AAP Safe Sleep Practices

Not just "back to sleep" - learn all the updated advice!

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  By: Tali Ditye, Ph.D., Co-founder

  Updated: October 14, 2024

Mommyhood101 independently tests and curates baby gear to help you make informed decisions. If you buy products through links on our site, we may earn a commission.

We take a deep dive into the recently updated AAP safe sleep guidelines, with practical advice for all parents.

For even better sleep, be sure to check out our lists of the:

• Best baby cribs
• Best travel cribs
• Amazing crib mattresses
• Awesome sleep sacks
• Top-rated sound machines

Transcript

All right. So, today we're diving into something, well, pretty crucial when it comes to babies, and that's safe sleep.

Huge topic.

It really is. I mean, we've all heard the basics, right? Like, put babies on their backs to sleep and all that.

Yeah. Back to sleep. Make sure they've got a nice firm sleep surface. No loose blankets or anything like that in the crib.

All those things our parents and grandparents probably, you know, maybe didn't know back in the day,

right? Yeah.

But we do now. But what's interesting is what happened happens when you dig a little deeper. You know, we've got years and years of research on this. So, what does it actually tell us about what works to keep babies safe during sleep and what doesn't

and why those recommendations even exist, like where they come from.

Exactly. So, that's our big mission today. We're going beyond those headlines, getting into the nitty-gritty of safe sleep interventions.

Love it.

We've got two main sources we're looking at today. A big 2016 review, like a really in-depth look at a ton of international research that had been done on this, and then We're also going to the latest guidelines, the 2022 guidelines from the American Academy of Pediatrics.

The AAP, they're like the experts. It's a really big deal because unfortunately thousands of infant deaths happen every single year just in the US alone. And the thing is a lot of these they're sleepreated and a lot of them we could actually prevent.

That's the heartbreaking part.

It is. And you know, we can't just say, "Oh, it's just bad luck." There's actual science behind why this is happening.

So like What kind of science are we talking about?

So, there's this thing called the triple risk model of SIS, right?

And basically, it's this perfect storm of three things. Okay?

First, you've got the baby's own vulnerabilities, right? Like how well they breathe, how easily they wake up, that kind of stuff.

Okay, makes sense.

Then you've got some sort of external trigger. Often that's an unsafe sleep environment, something in the environment that's making it dangerous. And then you've got this critical developmental period, which is mainly that first year of life. That's when babies are most vulnerable to all of this.

So, it's not just one thing, it's like all these things sort of colliding.

Yeah. It's this perfect storm,

which makes it tricky to fix, but I guess it also means there are more things that we can look at to try to prevent it.

Absolutely. More things we can control, more things we can do,

and that's where these interventions come in. Right.

Exactly. Yeah.

This 2016 review we were talking about, it looked at all sorts of interventions that researchers were trying from like 1990 to 2015.

A long time. A lot of research.

Yeah.

And it's fascinating to see all the different things they tried. I mean, everything. They did one-on-one education. They did group sessions with parents. They were giving out free cribs, pacifiers. I even read about some places giving out t-shirts with safe sleep messages on them.

You're kidding. What? Like for the parents to wear?

Yeah. Like a walking billboard for safe sleep.

That's amazing. So, they were really trying everything.

They were. And it wasn't just parents they were focusing on either. They also did interventions for healthcare providers, childare prov providers. They even tried to get peers involved.

Wow. So, like friends of new parents, that kind of thing.

Exactly. It's like they were trying to create this whole network of people promoting safe sleep.

It really does sound like they were throwing everything at the wall to see what would stick.

And you know what? Some things did stick, some things didn't.

That's interesting because one thing that I was surprised to read in the study was even when they did these interventions and you know, people learn more about safe sleep, it didn't always mean they changed what they were doing.

Yeah, that's a really common thing in public health. Just knowing what's good for you doesn't magically make you do it, right?

Yeah. True.

There's so much more to it.

I mean, you've got fear, you've got misconceptions. People have different priorities. Life gets in the way. And so, this review really highlighted

that we need to go beyond just handing people information and figure out how to actually promote behavior change.

Yeah. Makes you wonder like what is going on there? Why? Even when parents know what they're supposed to do, do to keep their babies safe during sleep? Why aren't they doing it?

It's a great question and I think it often comes down to like some really deep-seated fears and misconceptions that people have. Okay.

Like take sleep position for example.

Yeah.

We know that putting babies on their backs to sleep is the safest thing. Right.

Right.

But even now, even with all the research, this 2016 review found that a lot of parents were still really scared that their babies would choke if they put them on their backs.

See, that always seemed counterintuitive to me. cuz I feel like if they were on their backs, that's when they would be more likely to choke.

You'd think, right?

Yeah.

But here's the thing. It's all about the anatomy. And the 2022 AAP statement, they actually have a really cool little anatomy lesson in there explaining why backs sleeping is actually safer for a GD's airway.

Oh, interesting.

It all comes down to the the wind pipe.

Yeah. Yeah.

And where that sits compared to the esophagus, which is, you know, the food pipe.

So, when a baby's on their back. The trachea is actually higher than the esophagus.

Oh.

So, if they spit up or vomit, it's way less likely to go down the wrong pipe, so to speak.

Wow. Okay. I never knew that.

Yeah. It's like this like built-in safety feature.

That makes so much more sense now. So, it's not just like, oh, we just tell you to do this. There's a reason.

There's a reason.

Okay. So, education is important. Like explaining that to parents could be really effective. What about this whole bed sharing thing? Because I know that's another one where people have really strong feelings. And there are some cultural practices around it.

Yeah, absolutely. And you know, the AAP is very very clear. They say no bed sharing no matter what. Like you shouldn't be bed sharing with your baby. And the review did acknowledge that there are cultural and personal factors at play.

Of course. Yeah.

But ultimately, they say the risks are just too high to ignore.

And the 2022 statement, they get into even more specifics about the risks of bed sharing, right?

They do. They actually break them down into these different categories based on how much they increase the risk. Wow. Okay.

So, for example, they say if you're sharing a bed with a baby and you've had a couple of drinks or you've used any drugs or even if you've been smoking or if you're just really really exhausted.

Oh, wow.

Those things make the risk of SIDS and suffocation way way higher.

Wow.

And they say that bed sharing on a soft surface like a couch or an armchair is super dangerous.

Yeah, that makes sense.

So, like don't fall asleep with your baby on the couch,

right? I think especially when you have a newborn and you're super sleepd deprived. It's easy to do that, but a separate sleep surface for the baby is the best way to go,

the safest option. And you know, I think it's important to acknowledge like that's hard. It's hard on parents, especially when you're exhausted, you're going back to work, you just want to be close to your baby.

Yeah.

All those things are totally understandable. So, it's about how do we support parents to make those safe choices even when it's hard.

Yeah. Absolutely. So, we've got sleep position, we've got bed sharing.

What about other stuff in the crib? Because cuz I know that a lot of parents still use things like blankets and pillows and stuff even though that's not recommended.

Yeah, they found that in the review too. So, it seems like that's another area where like the messaging around safe sleep really needs to be super clear and consistent. All that stuff, the stuffed animals, the loose blankets, bumper pads, they can all be suffocation hazards, enttrapment hazards,

right? Yeah. It's so easy to think, oh, it's just one little blanket, but

that seems so harmless.

Yeah. This was interesting. The 2016 study actually looked at at whether people who had learned the safe sleep information were sharing it with other people like grandparents or babysitters.

Well, that's a good question.

And they found really mixed results.

Interesting.

Some people were, some people weren't. So, it seems like there's a real opportunity there for interventions to focus on building up that whole network of people who are promoting safe sleep.

Yeah, totally. It's about creating a culture of safe sleep, getting everyone on board.

Yeah.

And that's a big task, but so so important.

Okay. So, speaking of getting everyone on board and making sure we're all on the same page, let's talk about the latest recommendations from the AAP.

Okay. Yeah.

So, the 2022 statement, this came out after that 2016 review that we've been talking about. So, they've got even more recent research in there. They made some updates. What were some of the key changes that you saw?

Well, one of the big ones is that they're really emphasizing now this firm, flat, non-inclined sleep surface.

Okay.

So, before there was a little wiggle room, like a slight incline was Okay. But now they're saying, "No, it needs to be completely flat."

Interesting.

Even a small incline can increase the risk of the baby rolling into a position that's dangerous.

That makes sense.

And another thing they added were more specific recommendations for emergency situations.

Oh, okay.

Like if a family's been displaced because of a natural disaster or something like that and they don't have access to a crib, right?

They might be using a cardboard box or a dresser drawer as a temporary sleep surface.

And the AAP really emphasizes that that should only be a last resort. We need to get these families access to a safe, approved crib as quickly as possible.

Yeah, absolutely.

Because obviously that's not ideal.

No, it's about recognizing that not everybody has the same resources.

Exactly. Equity is a really important part of this, too.

For sure.

They also go into even more detail about the risks of bed sharing in this new statement.

Yeah, they do.

And they specifically call out marijuana and vaping now in their recommendations about substance use.

Oh. Okay.

So, again, reflecting that the world is changing, the things that people are using are changing, and they can all impact infant sleep.

Yeah, that's a good point. I didn't even think about that. I also noticed they have a new recommendation about those home cardiorespiratory monitors.

Yes.

So, you know, some parents use those because they think it'll help reduce the risk of SIDS,

right?

But the AAP is now saying, don't use them.

Don't use them

because the research actually shows that they don't actually reduce the risk and they might even make parents less vigilant about the other safe sleep recommendations because they think that they're covered.

Yeah. It's like a false sense of security.

Yeah.

And it really highlights how sometimes technology is not the answer,

right?

Sometimes the simplest solutions like putting your baby on their back in a safe crib are the most effective.

It's back to basics, but it works. And then I guess one last thing I noticed is they're really shining a light on the role of media and manufacturers in promoting safe sleep.

Yes. So important. We're basically calling on them to make sure that their marketing, their advertising, the messages that they're putting out there that they all align with the AAP's guidelines.

Love it. It's about normalizing it, you know?

Yeah.

Making these safe sleep practices just the expected thing, not the exception. Like this is just what you do.

Wow. So much to think about. We've covered a lot of ground here with all this safe sleep info. Like from all that research to the latest guidelines, if we were going to boil it all down, like what are the biggest takeaways? What should our listeners really Remember,

I think the biggest most important thing is that consistent messaging is key.

Okay?

Everybody who's involved in taking care of a baby, parents, grandparents, babysitters, friends, healthcare providers, they all need to be on the same page,

right?

And that messaging, it it has to be clear. It has to be accurate and it has to be presented in a way that like respects people's cultural differences.

Yeah. Like we were saying before, it's like this whole culture of safe sleep we're trying to build. Exactly. And then the second thing is remembering that just knowing stuff isn't always enough, right?

Yeah, we talked about that.

We can't just throw information at people and expect them to change their behavior,

right?

We have to think about those deeper barriers, the fears, the misconceptions, the challenges people face in their everyday lives

and be understanding. Like sometimes life is hard, parenting is hard, and you just got to do what you got to do.

Absolutely. It's about meeting people where they're at with empathy and support, not judgment.

Yeah. Totally. And then I think lastly, this whole area of safe sleep, it's something that we need to keep researching. We need to keep monitoring it really closely. We got to keep learning more and more about why these sleepreated deaths are happening and how to prevent them even better.

Yeah, there's always more to learn and it's changing all the time. The research is always being updated,

right? It's like this ongoing quest for knowledge, always trying to do what's best for babies.

It really is. So, you know, we've given our listeners a lot to think about today, but I think a big question kind of a takeaway question for them is with all this information out there, how do we make sure that the right messages about safe sleep are getting through,

right? It's not just about more information, it's about the right information.

Yeah. And how do we like make it stand out? How do we get past all that other noise and make sure those messages are really sticking with parents and caregivers?

Such a great question because ultimately every baby deserves a safe and healthy sleep environment.

Absolutely.

And every parent, every caregiver deserves that peace of mind that comes with knowing they're doing everything they can to make that happen.

Well said. This is so important and I'm really glad we got to dive into it today.

Me, too. It's a conversation we all need to be having.

Thanks for listening everybody and we'll see you next time for another deep dive.

See you then.