Recommendations from the American Academy of Pediatrics

Last Updated October 2005

• Back to sleep: Infants should be placed for sleep in a supine (wholly on back position) for every sleep.
• Use a firm sleep surface: A firm crib mattress, covered by a sheet, is the recommended sleeping surface.
• Keep soft objects and loose bedding out of the crib: Pillows, quilts, comforters, sheepskins, stuffed toys and other soft objects should be kept out of an infant’s sleeping environment.
• Do not smoke during pregnancy: Also avoiding an infant’s exposure to second-hand smoke is advisable for numerous reasons in addition to SIDS risk.
• A separate but proximate sleeping environment is recommended such as a separate crib in the parent’s bedroom. Bed sharing during sleep is not recommended.
• Consider offering a pacifier at nap time and bedtime: The pacifier should be used when placing infant down for sleep and not be reinserted once the infant falls asleep.
• Avoid overheating: The infant should be lightly clothed for sleep, and the bedroom temperature should be kept comfortable for a lightly clothed adult.
• Avoid commercial devices marketed to reduce the risk of SIDS: Although various devices have been developed to maintain sleep position or reduce the risk of rebreathing, none have been tested sufficiently to show efficacy or safety.
• Do not use home monitors as a strategy to reduce the risk of SIDS: There is no evidence that use of such home monitors decreases the risk of SIDS.
• Avoid development of positional plagiocephaly (flat back of head): Encourage “tummy time” during the day.
• Avoid having the infant spend excessive time in car-seat carriers and “bouncers.” Place the infant to sleep with the head to one side for a week and then changing to the other. Ensure that others caring for the infant (child care provider, relative, friend, babysitter) are aware of these recommendations.

The risk for strangulation or death from bumper pads in cribs
outweighs the uncertain benefit.

Published in Journal Watch Pediatrics and Adolescent Medicine November 14, 2007

The Back to Sleep campaign has markedly reduced the incidence of sudden infant death syndrome (SIDS), but the overall safety of infant sleep environments still doesn’t receive appropriate attention. Bumper pads are popular crib accessories purchased by caregivers for protective or aesthetic reasons. To examine the risks associated with bumper pads, investigators searched U.S. Consumer Product Safety Commission databases for crib-related deaths and injuries in infants younger than 6 months.

From 1985 through 2005, 27 infant deaths by suffocation or strangulation were associated with bumper pads: 23 in cribs and 4 in padded bassinettes. Death-scene investigation attributed 11 deaths to the infant’s face pressed against a bumper pad, 13 deaths to the infant wedged between the bumper pad and another object, and 3 deaths to a bumper pad tie caught around the infant’s neck. From 2000 through 2004, 25 nonfatal crib-related injuries were reported (including closed head injuries, extremity fractures, contusions, abrasions, and strains). However, most reports did not specify whether bumper pads were in place at the time of injury.

Comment: This report likely represents an underestimate of crib-related deaths and injuries because reporting of such incidents is incomplete. The AAP Task Force on SIDS (Pediatrics 2005; 116:1245) recommends that bumper pads be "thin, firm, well-secured, and not pillow-like," but the authors’ review of retail bumper pads led them to suggest that even firm bumper pads may cause entrapment of an infant’s head and suffocation. They conclude that bumper pads should not be used in cribs. Pediatricians should let parents know the uncertain benefits and potential dangers of crib bumper pads.

— Cornelius W. Van Niel, MD