Speaking Out on Safe Sleep: Evidence-Based Infant Sleep Recommendations
Speaking Out on Safe Sleep: Evidence-Based Infant Sleep Recommendations
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DOI：
10.1089/bfm.2014.0113
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发表时间：
2014-11-01
影响因子：
2.7
通讯作者：
Smith, Linda J.
中科院分区：
文献类型：
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作者：
Bartick, Melissa;Smith, Linda J.
美国儿科学会（AAP）在2005年和2011年发布了减少与睡眠相关的婴儿死亡的建议，这些建议反对所有共床睡眠的行为。这些建议过度强调了共床睡眠的风险，而这种过度强调产生了严重的意外后果。当疲惫的父母试图避免在床上给婴儿喂奶时，可能会导致在沙发上死亡的案例增加。目前的证据表明，其他风险因素的影响要大得多，比如吸烟、在沙发上共睡、睡在有行为能力受损的照顾者旁边以及使用配方奶喂养。对分床睡眠的强调使得资源从解决这些关键风险因素上转移开了。避免共床睡眠的建议可能也会干扰母乳喂养。我们研究了美国儿科学会建议背后的证据以及那些建议中遗漏的证据。我们得出的结论是，到目前为止，唯一有循证依据的通用建议是沙发是成人与婴儿同睡的危险场所；产前和产后接触烟雾都会增加死亡风险；睡在有行为能力受损的照顾者旁边会增加死亡风险。没有哪种睡眠环境是完全安全的。公共卫生工作必须考虑到疲惫的父母必须在夜间某个地方给婴儿喂奶这一现实，以及沙发是父母与婴儿一起入睡的高风险场所，尤其是当父母是吸烟者或受到酒精或药物影响时。所有的宣传信息都必须精心制定和重新评估，以避免意外的负面后果，包括对母乳喂养率的影响，或者在比父母的床更危险的情况下入睡。我们必须重新调整我们的资源，以关注更大的风险因素，这可能包括加大对戒烟的投入以及杜绝激进的配方奶营销。这包括消除配方奶营销公司与致力于儿童健康的组织之间的利益冲突。
The American Academy of Pediatrics (AAP) issued recommendations in 2005 and 2011 to reduce sleep-related infant death, which advise against all bedsharing for sleep. These recommendations overemphasize the risks of bedsharing, and this overemphasis has serious unintended consequences. It may result in increased deaths on sofas as tired parents try to avoid feeding their infants in bed. Current evidence shows that other risks are far more potent, such as smoking, shared sleep on sofas, sleeping next to impaired caregivers, and formula feeding. The emphasis on separate sleep is diverting resources away from addressing these critical risk factors. Recommendations to avoid bedsharing may also interfere with breastfeeding. We examine both the evidence behind the AAP recommendations and the evidence omitted from those recommendations. We conclude that the only evidence-based universal advice to date is that sofas are hazardous places for adults to sleep with infants; that exposure to smoke, both prenatal and postnatal, increases the risk of death; and that sleeping next to an impaired caregiver increases the risk of death. No sleep environment is completely safe. Public health efforts must address the reality that tired parents must feed their infants at night somewhere and that sofas are highly risky places for parents to fall asleep with their infants, especially if parents are smokers or under the influence of alcohol or drugs. All messaging must be crafted and reevaluated to avoid unintended negative consequences, including impact on breastfeeding rates, or falling asleep in more dangerous situations than parental beds. We must realign our resources to focus on the greater risk factors, and that may include greater investment in smoking cessation and doing away with aggressive formula marketing. This includes eliminating conflicts of interest between formula marketing companies and organizations dedicated to the health of children.