Guidelines For Infant Sleep Safety Expanded
October 18, 2011

Guidelines For Infant Sleep Safety Expanded

Reports of Sudden Infant Death Syndrome (SIDS) have declined significantly since 1992 when the American Academy of Pediatrics (AAP) recommended that all babies should be placed on their backs to sleep. But other sleep-related deaths have continued to rise.

One of those sleep-related deaths, suffocation, is being tackled head-on by the AAP. The academy is expanding its guidelines on safe sleep for babies and calls for parents to not use bumper pads in cribs because babies can suffocate against or be strangled by the bedding product.

The AAP states there is no evidence that crib bumpers protect against injury, but they do carry an increased risk of suffocation because infants lack the necessary motor skills or strength to turn their heads should they roll into something that obstructs their breathing.

The AAP recommended in 2005 that parents use bumpers that were thin, firm, well secured, and not “pillow-like.” But the academy is now retracting that recommendation based on recent studies that have shown that bumper pads may be far more dangerous than previously thought.

“In 2005, when we last published a policy statement and recommendations, we had some concerns about bumper pads, but we didn´t really have a lot of evidence that this was a real problem,” Rachel Moon, M.D. told Moon is from the Children´s National Medical Center in Washington, D.C. and chairperson of the AAP SIDS task force and lead author of the new guidelines.

“Since then, there have been some published studies looking at bumper pads, and we concluded that if there's no reason for them to be in the crib, it's better to just have them out of there, particularly in light of the deaths that have been reported, that have been associated with the bumper pads,” said Moon.

The recent study in question is one published in the September 2007 issue of The Journal of Pediatrics that examined the deaths and injuries attributed to infant crib bumper pads. The data was based on information from the Consumer Product Safety Commission for 1985 through 2005.

Researchers in that study found reports from medical examiners and coroners of 27 accidental deaths of children between 1 month and 2 years, that were attributed to suffocation when they became wedged against a padded bumper or strangled by a bumper tie around the neck. Eleven of the deaths were most likely attributed to suffocation when the babies rested their face against a bumper pad; 13 died when they became wedged between the bumper pad and another object; and three were strangled by a bumper pad tie.

“These findings suggest that crib and bassinet bumpers are dangerous. Their use prevents only minor injuries. Because bumpers can cause death, we conclude that they should not be used,” according to the study findings.

Initially, the CPSC interpreted this data differently and in the summer of 2010 reached the same conclusion as the Juvenile Products Manufacturers Association (JPMA), which had conducted its own analysis of an unpublished CPSC review of crib deaths involving suffocation or strangulation.

The JPMA asserted that other factors, like babies sleeping on their stomachs, or a crib filled with pillows, might have been the driving factor in the deaths reported, and not the bumper pads.

However, less than a year later, the CPSC announced it would take a closer look at crib bumper pads in response to consumer advocates and news reports, especially those from the Chicago Tribune, highlighting potential dangers of bumper pads and other baby sleep products.

While the Tribune reports pushed the CPSC to take a closer look at the safety of crib bumper pads, local governments also started to act. Last month (September 8), Chicago became the first city in the US to ban the sale of crib bumpers. Less than three weeks later (September 28), Maryland became the first state to propose a ban on sales of crib bumpers.

Despite the growing evidence that crib bumper pads are dangerous to the safety of babies, many parents still use them, with the belief they are protecting their children from hitting their head on the sides of the crib, or from getting their limbs stuck in the slats. Despite the initial reviews that crib bumpers saved babies from harm, such is not the case anymore.

Moon said that parents´ reliance on crib bumper pads is upsetting based on the amount of evidence showing their harm. She admits that while it is possible for babies to get their arms or legs stuck between crib slats, it´s virtually impossible to break a limb doing so -- which means that at most, the experience is uncomfortable and upsetting, but not life threatening.

Another reason parents use bumper pads, Moon believes, is because they think they are supposed to, given the fact they are usually sold in bedding sets, and also because they look good. But she hopes that will change once pediatricians start to advice against them and manufacturers stop making them.

“We have tried to make it easier for parents and providers to understand the recommendations by providing specific answers to common questions,” said Moon in a statement. “As a health care community, we need to do a better job translating what the research identifies as ℠best practices´ into the day-to-day practice of caring for infants in both the hospital and home environment.”

The AAP will release a policy statement -- “SIDS and Other Sleep-Related Infant Deaths: Expansion of Recommendations for a Safe Infant Sleeping Environment” -- and an accompanying technical report on Tuesday at the AAP National Conference & Exhibition in Boston. It will be published in the November issue of Pediatrics.

Moon will discuss the new guidelines during a restricted news briefing for reporters at 11 a.m. (EDT) this morning at the center in Boston. During the briefing, a crib with objects such as crib bumpers, baby blankets, pillows and toys will be set up for Moon to demonstrate safe vs. unsafe sleep practices.

Although the JPMA warned that should sales of bumper pads be banned, parents might start to make their own bumpers, Moon said.

“There´s always concern that parents are going to create things and make things when they see the need to do that. Our responsibility is to let parents know that some of these products are not safe, and we need to understand that this may be an issue and proactively talk to parents about these concerns so that perhaps they´ll be less likely to do things like that,” she said. “My hope is that parents learn about these things in prenatal classes, through their obstetrician´s offices, through other places like that before the baby is born and before they've actually gone out and purchased these products.”

The AAP now recommends that infants sleep on their backs, alone in a crib on a firm mattress, without any soft objects or loose bedding, which can also be hazardous. All that´s necessary when it comes to baby bedding is a fitted sheet.

“We weighed the pros and cons and the evidence, and felt that the safest thing would be to keep bumpers out of the crib altogether,” Dr. Fern R. Hauck, a member of the AAP´s SIDS task force and a professor of family medicine at the University of Virginia, told the Tribune.

Dr. Michael Goodstein, also a member of the AAP´s SIDS task force and a neonatologist at York Hospital in Pennsylvania, said parents who remove bumpers from cribs should not add other soft bedding like pillows or blankets instead. “Soft is just bad,” he said.

“It is important for health care professionals, staff in newborn nurseries and neonatal intensive care units, and child care providers to endorse the recommended ways to reduce the risk of SIDS and other sleep-related deaths, starting at birth,” Moon said. “There needs to be more education for health care providers and trainees on how to prevent suffocation deaths and to reduce SIDS and other sleep-related infant deaths - our goal is to ultimately eliminate these deaths completely.”

The JPMA says that at least $50 million worth of infant bedding sets that include bumpers are sold each year, as well as more than 200,000 bumper pad sets.

Moon said that she hopes retailers will stop selling crib bumpers in response to the AAP´s updated guidelines. “The problem is that a lot of parents don´t understand that the Consumer Products Safety Commission is not a proactive agency; it's a reactive agency. So, it only recalls things if there's a problem. It doesn't approve products before they go on the market. And a lot of parents have this perception that if stores sell it, it must be safe.”

“I think that it´s important that parents realize that these things are not safe for their babies,” said Moon.


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