I felt that one of the recommendations was cruel and may have given a false sense of security because the content overly emphasized the importance of "room sharing" or having your child in a "separate sleep space" in the role of reducing Sudden Infant Death.
The separate sleep space is key to reducing "laying aside" deaths where parents accidentally suffocate their children by rolling over on them. Safe sleep practices also includes not swaddling your baby, putting your child on its back in a cooler room without blankets and "fluffy" bedding that might suffocate them. But, there are other issues.
I felt that the emphasis was cruel because parents of babies who died from SIDS would hold themselves accountable when, in reality, brainstem abnormalities, in conjunction with other subtle problems, were likely responsible for the babies' deaths. These abnormalities have been found in the autopsies of many babies for whom suffocation from laying aside or the interference of bedding was not an issue.
When the goal is to "control the controllable", certainly controlling where and how your baby sleeps gives you an advantage. These issues are "extrinsic" or are controllable. However, as I said in the October article, if your child is male, African-American, is less than 4 months old, has a mild viral infection or a brain stem abnormality, these factors are not controllable and are considered to be "intrinsic".
Baby monitors, heart monitors and emergency medical support cannot save babies with brainstem problems who die of SIDS. Increasing our anxiety is the fact that brain stem abnormalities and mild viral infections are not detectable.
Parents who use alcohol or illegal drugs also place their infants at greater risk of the biologically-based SIDS (not the safe-sleeping/suffocation) variety. Marijuana and cigarette smoke is unhealthy for fetus and baby. While this may seem to be a controllable issue, I've read research suggesting that mother abstain from illegal drugs and those medications known to cause problems for fetuses for at least 3 years before conception. Reasonable? Unreasonable? Not for me to say.
The American Academic of Pediatrics has made a number of recommendations that reflect the concept of "kangaroo care" or "skin-to-skin care" used for pre-term babies. A great deal has been learned about the benefits of "kangaroo care" from years of studying these practices.
At least one hour of skin-to-skin contact under a garment immediately after birth helps baby to maintain physiological warmth and improves "psychological warmth" and bonding because baby essentially "rents" parents' bodily warmth. Bodily warmth regulates baby's temperature more smoothly than an incubator and allows baby to easily nurse. It also reduces baby's crying. Baby is more comfortable, so mother sleeps more soundly whcih may have an effect on reducing the incidence of postpartum depression.
Mother's milk supply is increased and baby's gut health and immunity is improved.
Kangaroo position means that baby is upright on parents' (or surrogates') chest with a clear airway (head uprigth and not flopping over). Kangaroo nutrition implies only breastfeeding if baby has a competent suck response.
The updated recommendation reads: "Co-sleeping is not recommended, but parents are strongly encouraged to place their child in a crib or Pack 'n Play close to their bed".
The AAP still did not offer an explanation about the cooler room but perhaps it is related to the brainstem issue. The need to reduce smoke exposure during pregnancy and after birth is obvious as is tummy time. While they did not offer an explanation regarding giving a baby a pacifier at naptime and bedtime, sucking intensely is likely to stimulate brainstem activity and improve breathing.
Above all, learn as much as you can and use common sense. If in doubt, ask other mothers you respect and your pediatrician. As I said previously, so much of life is a "roll of the dice". Just do the best you can, Claudia