For at least the first six months of their lives, infants should be sleeping in the same room as their parents, but not the same bed, according to a new report from the American Academy of Pediatrics.
The academy recommends children sleep on separate surfaces within the same room, such as a crib, but never on a soft surface, armchair or couch. Optimally, infants should sleep in the same room as parents up to age 1, the organization said.
The aim is to reduce the risk of sudden infant death syndrome, known as SIDS, and other forms of infant death that can occur when a baby is sleeping, such as suffocation. These types of death among infants are collectively known as sleep-related infant deaths, or sudden unexpected infant deaths.
"The whole phenomenon of SIDS implies that we don't know 100% what is responsible for the death, but we have theories," said Dr. Lori Feldman-Winter, member of the Task Force on SIDS and co-author of the report.
These theories include that a baby's brain may not be developed enough to regulate respiration combined with an environment -- such as soft furnishings -- that aid asphyxia or nasal obstruction and simply that certain infants may just be more vulnerable due to genetics or physical traits.
The AAP report, launched during the the AAP national conference in San Francisco this week, states that evidence shows parents sharing a room with their infant can reduce the risk of SIDS by as much as 50%.
"A baby that is within reach of their mother may have more comfort, or physical stimulation form being in an environment with another person," said Winter, adding that mothers being near their babies also facilitates breastfeeding, which in itself has been shown to reduce the risk of SIDS by 70%.
"Breastfeeding protects against many adverse outcomes," she said.
How common is SIDS?
There are an estimated 3,500 deaths from SIDS and other sleep-related deaths in the United States each year, according to the Centers for Disease Control and Prevention. Forty-four percent of these are caused by sudden infant death, with 25% accidental strangulation or suffocation and the rest unknown.
SIDS is defined as deaths that occur during a baby's first year of life, but they most commonly occur between the age of one month to four months, and 90% of SIDS cases happen before a baby is 6 months old -- hence the timings for the ruling.
"Babies should share that sleep environment for up to one year, because there is a slight risk of SIDS that persists," said Winter.
Increased awareness of SIDS due to safe sleep campaigns in the 1990s led to a decline in their number that decade, but rates have since plateaued. The new recommendations hope to enable this initial decrease to start up again.
"There is an emphasis on room sharing, not bed sharing and the rationale is that data suggests a protective effect against SIDS when the baby is sleeping in the parents' room," said Dr. Ari Brown, an Austin-based pediatrician and author of the Baby411 book series, who was not involved with the report. "I would agree that this is sound advice."
The reasons behind the protective effect are not fully understood.
"People don't know quite why the risk is lowered," said Brown. "I might chalk it up to a parent's sixth sense when a baby is nearby and making erratic noises or not that helps save these babies."
Experts generally believe it's easier to monitor a baby when nearby.
Indiana ranks high on the list for infant mortality and unsafe sleeping accounts for about 15% of those deaths.
"More than 80 babies die in Indiana every year from unsafe sleep. And that's just 80 babies who didn't need to die. So if we can get the word out so parents know what to do and expect because a lot of them just don't know or haven't been told," said Dr. Kim Schneider of Riley Children's Hospital at IU Health.
Who will do it?
The practice of sharing a room with a newborn is not uncommon, and is in fact what most parents already do, according to Dr Jennifer Shu, an Atlanta-based pediatrician and medical editor of the academy's HealthyChildren.org. "It's common that they start out sharing a room, then parents often ask me when its time to take them out of the room."
Shu believes these recommendations help bring clarity to the issue and its timing. "It gives parents and pediatricians some guidelines to follow," she said.
But Shu stresses the need for parents to understand the importance of a separate sleeping surface. "An adult bed is not designed for infants," she said, highlighting the dangers associated with big duvets, pillows and sheets. "If you're going to share a bed, make sure your bed is like a crib."
Beyond the bedroom
The new report further highlights a range of sleeping practices and behaviors that could help protect an infant from SIDS. These include placing babies to sleep on their backs and placing them on a firm sleeping surface with a tight-fitting sheet, while avoiding the use of soft bedding inside a crib, such as pillows and blankets.
"There should be no pillows, sheets, blankets or other items that could obstruct the infant's breathing or cause overheating," said Winter.
Avoiding soft surfaces extends to never placing a baby on a sofa, couch or cushioned chair to sleep.
"We know that these surfaces are extremely hazardous," added Dr. Rachel Moon, who also co-authored of the report.
Also noted is how breastfeeding can reduce risk of SIDS by 70%, but with the caveat that parents should be careful not to fall asleep when feeding their baby on an armchair.
"It's sometimes hard not to fall asleep when you're feeding a baby ... parents are tired," said Shu who admitted having fallen asleep when feeding her son when he was young. "We were lucky because he fell between me and my husband and not on the floor."
"The most hazardous environment is an armchair," said Winter. "So we recommend feeding in bed then placing a baby on a separate sleep surface."
Winter acknowledges there are many recommendations, but believes they can be followed fairly easily. With communication, both authors hope to ease the anxiety of bringing a newborn into your home.
"We know that parents may be overwhelmed with a new baby in the home," Moon said. "We want to provide them with clear and simple guidance on how and where to put their infant to sleep."