The American Academy of Pediatrics (AAP) has released the Updated 2016 Recommendations for a Safe Infant Sleeping Environment. The recommendations are published as a policy statement. There is also an accompanying technical report outlining the evidence used in revising the recommendations. The updated recommendations include new evidence and rationale for for skin-to-skin care for newborn infants, bedside and in-bed sleepers, sleeping on couches/armchairs and in sitting devices, and use of soft bedding after 4 months of age. In addition, expanded recommendations for infant sleep location are included.

The 2016 recommendations are as follows:

• Back to sleep for every sleep.
• Use a firm sleep surface.
• Breastfeeding is recommended.
• Room-sharing with the infant on a separate sleep surface is recommended.
• Keep soft objects and loose bedding away from the infant’s sleep area.
• Consider offering a pacifier at naptime and bedtime.
• Avoid smoke exposure during pregnancy and after birth.
• Avoid alcohol and illicit drug use during pregnancy and after birth.
• Avoid overheating.
• Pregnant women should seek and obtain regular prenatal care.
• Infants should be immunized in accordance with AAP and CDC recommendations.
• Do not use home cardiorespiratory monitors as a strategy to reduce the risk of SIDS.
• Health care providers, staff in newborn nurseries and NICUs, and child care providers should endorse and model the SIDS risk-reduction recommendations from birth.
• Media and manufacturers should follow safe sleep guidelines in their messaging and advertising.
• Continue the “Safe to Sleep” campaign, focusing on ways to reduce the risk of all sleep-related infant deaths, including SIDS, suffocation, and other unintentional deaths. Pediatricians and other primary care providers should actively participate in this campaign.
• Avoid the use of commercial devices that are inconsistent with safe sleep recommendations.
• Supervised, awake tummy time is recommended to facilitate development and to minimize development of positional plagiocephaly.
• Continue research and surveillance on the risk factors, causes, and pathophysiologic mechanisms of SIDS and other sleep-related infant deaths, with the ultimate goal of eliminating these deaths entirely.
• There is no evidence to recommend swaddling as a strategy to reduce the risk of SIDS.