·The AAP no longer recognizes side sleeping as a reasonable alternative to placing a baby completely flat on his/her back

·Bed sharing is not recommended during sleep. Infants may be brought into bed for nursing or comforting, but should be returned to their own crib or bassinet when the parent is ready to return to sleep. However, sleeping in the same room is recommended.

·The revised statement recommends the use of pacifiers at nap time and bedtime throughout the first year of life. However, it is recommended that pacifier introduction for breastfed infants be delayed until one month of age to ensure that breastfeeding is firmly established. In addition, if the infant refuses the pacifier, it should not be forced.

Perhaps the biggest opposition to the recommendations comes among breastfeeding advocates, who note that pacifier use and separate sleeping may present mothers with boundaries to successful breastfeeding. In a press release out October 14th, La Leche League International states, "the recommendations about pacifiers and co sleeping in the statement reflect a lack of basic understanding about breastfeeding management." The release goes on to quote Dr. Nancy Wight, President of the Academy of Breastfeeding Medicine, as saying that the new policy, "represents a truly astounding triumph of ethnocentric assumptions over common sense and medical research. There are many physician members of the AAP who do not agree with these recommendations."

And about that pacifier... a year 2000 study linking heavy pacifier use to increased incidence of ear infections was all over the news media. Parents were warned to limit the time babies spend using a pacifier. Dr. Alan Greene states that, "stopping the pacifier alone can drop ear infections by 50 percent for children in day care."

So who's right? What's a mom to do?

In the final section of the AAP statement, the authors explain that the recommendations were developed to reduce the risk of SIDS among the general population. They state that while SIDS has been associated with certain risk factors, that does not necessarily mean that those factors are proven to cause SIDS. Doctors and scientist do not currently know what causes SIDS and they believe that perhaps multiple preexisting conditions and triggers may exist.

The authors of the new AAP policy statement say that, "when considering the recommendations in this report, it is fundamentally misguided to focus on a single risk factor or to attempt to quantify risk for an individual infant. Individual medical conditions may warrant a physician to recommend otherwise after weighing the relative risks and benefits." Babies are unique individuals and families are unique entities. One rigid guideline will never apply to all people in all circumstances.

If you would like to read the report for yourself, it is available online at <http://www.aap.org/ncepr/revisedsids.pdf>.

This article is intended for educational purposes only. It is not intended to serve as medical advice or as a substitute for professional medical advice and should not be interpreted as recommendation for treatment. If you have questions or concerns regarding your physical or mental health or the health of your child, please seek assistance from a qualified health care provider before using any health information.

© Christine Climer
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