About AAP Policy Makers and Scientific Limitations
Our goal is to help you distinguish fact from fiction and offer you and your organization an insider’s perspective on AAP policy makers, safe sleep advocates, and scientific limitations that cannot be overlooked.
We Encourage and Support the A,B,Cs of Safe Sleep for Every Sleep
Scientific data strongly support supine (back) sleep as the safest position for infants. Secure Beginnings supports this data and encourages parents and caregivers to place baby to sleep on his/her back for sleep including nap time. The FDA describes the ideal sleep environment for an infant as free of anything that could block the infant’s movement or breathing. You should make your baby’s crib a safe place to sleep and move, with NOTHING to get in the way. Your baby's crib should be free of any type of soft bedding that may become loose including but not limited to pillows, sheets, mattress pads, bumpers, quilts, blankets, and soft toys. Soft loose bedding and objects can put your infant at risk for re-breathing exhaled air that is high in carbon dioxide and low in oxygen, leading to extreme drowsiness, coma or even death. Many of these items can also pose a strangulation or suffocation risk to your baby.
Babies should be placed to sleep in a crib that is free from hazardous or broken parts that comply with ASTM standards.
Sudden Infant Death (SIDS) rates have decreased since the popularization of back sleeping. However, the Back-to-Sleep Campaign has reached a plateau in further reducing infant sleep-related deaths. In particular, it does not address the infant whose parents followed all of the American Academy of Pediatric (AAP) guidelines, who rolls prone and dies face down on their fiberfill crib mattress or play yard pad. This is where the AAP guidelines fall short. Secure Beginnings is proud to be an organization that challenged these guidelines and influenced change to the 2016 Safe Sleep Technical Report that now recognizes air permeable sleeping surfaces as a preferrable alternative for the infant who rolls prone during sleep.
About the American Academy of Pediatrics (AAP) Safe Sleep Task Force
The AAP Safe Sleep Task Force Members, who write safe sleep guidelines, are physicians who volunteer their time and expertise trying to make some sense of the available data. To some zealous safe sleep advocates, the AAP policy guidelines have become more like biblical text not open for interpretation or consideration. This was not and cannot be the intended use of these guidelines due to their inherent scientific limitations. And pediatricians, parents and safe sleep advocates need to realize that the guidelines are just that—guidelines.
The AAP, including the Safe Sleep Task Force, does not endorse, certify, or recommend specific products.
There are NO products on the market that cure or prevent SIDS. Be cautious about products that claim they do. There are no crib mattresses that have FDA approval. Even if a crib mattress is considered a “medical device," a crib mattress is considered a “Class 1" medical device. Class 1 medical devices are not eligible for “FDA approval."
The AAP safe sleep policies are based heavily on retrospective analysis such as infant death scene investigations which can be flawed. Actual scientific testing is not conducted to prove SIDS theories because unethical testing would be required.
These scientific limitations often result in policy based on non-supporting scientific studies. For example, it is recommended that infants wear wearable blanket sleepers instead of using a loose blanket in the crib. No scientific studies exist to conclusively show if a wearable blanket will prevent SIDS deaths. However, many death scene investigations revealed that infants who died compared to infants in a similar setting who did not, had loose blankets in their cribs, suggesting they are an increased risk for SIDS. The same goes for back sleeping. No gold-standard scientific studies have been conducted to show if an infant is at increased risk of dying if on their tummy. However, retrospective data show infants who were on their back were much less likely to die during sleep, suggesting back sleep reduces the risk for SIDS.
For years, the AAP has recommended a firm crib mattress with a tight-fitting sheet. No testing has ever been conducted to see if the firm mattress with the tight sheet could save a baby from dying of SIDS. However, we know through death scene investigations that more infants who died, compared to similar infants who did not, were on what was noted as a “soft surface.” The lack of cohort studies on sleep surfaces precludes researchers from saying a particular sleep surface will reduce SIDS deaths making it difficult to say with scientific certainty that a firm crib mattresses reduce SIDS deaths. One thing we do know, is that deaths of infants found face down on firm mattresses, play yard pads, and bassinet pads continue to occur. No deaths have ever been reported of an infant on a breathe-through crib mattress since their invention in early 2005.