New baby sleep guidelines advise against hats and weighted swaddles, blankets

Weighted swaddles and blankets are popular among parents trying to get their infants to sleep, but they should not be used on sleeping babies, according to new recommendations released by the American Academy of Pediatrics (AAP).

The AAP on Tuesday released updates to its safe sleep guidelines for the first time in five years.

The updated guidelines are based on the study of nearly 160 scientific articles since 2015 that cover risk factors and statistical trends for sleep-related infant death.

Among the new AAP's new safe sleep recommendations are that weighted blankets, weighted sleepers and weighted swaddles should not be placed "on or near" a sleeping infant and infants should not wear hats indoors except in the first hours of life or in the neo-natal intensive care unit (NICU).

The AAP also recommends, as it has in the past, that caregivers always place infants to sleep on their backs on a firm, flat surface and should never add "blankets, pillows, padded crib bumpers, or other items to an infant's sleeping environment."

In addition, the AAP strongly advises against co-sleeping with babies. In its updated guidelines, the AAP says babies should sleep in the same room as their parents for at least six months, but should sleep on a separate, firm and flat surface.

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Also, caregivers should not use infant sleep products with inclined seat backs of more than 10 degrees and should not use infant car seats, bouncers and other inclined products for sleep, according to the guidelines.

And only products that are specifically marketed for sleep should be used for infants' sleep, according to the guidelines.

Around 3,400 babies in the U.S. die each year while sleeping in sudden and unexpected deaths, according to the AAP and the Centers for Disease Control and Prevention (CDC).

In May, President Joe Biden signed into law legislation that bans the manufacturing and sales of crib bumper pads and inclined sleepers with an inclined sleep surface of greater than 10 degrees.

Crib bumpers are defined by the law as "padded materials inserted around the inside of a crib and intended to prevent the crib occupant from becoming trapped in any part of the crib's openings."

Earlier this month, the U.S. Consumer Product Safety Commission warned consumers to not let their children sleep in child rockers after at least 14 deaths were linked to certain Fisher-Price and Kids2 rockers.

"Parents and caregivers should never use inclined products, such as rockers, gliders, soothers, and swings, for infant sleep and should not leave infants in these products unsupervised, unrestrained, or with bedding material, due to the risk of suffocation," CPSC said.

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The AAP offers these additional sleep safety recommendations for babies:

1. Until their first birthday, babies should sleep on their backs for all sleep times.

"We know babies who sleep on their backs are much less likely to die of SIDS than babies who sleep on their stomachs or sides. The problem with the side position is that the baby can roll more easily onto the stomach. Some parents worry that babies will choke when on their backs, but the baby's airway anatomy and the gag reflex will keep that from happening. Even babies with gastroesophageal reflux (GERD) should sleep on their backs."

2. Use a firm sleep surface.

"A crib, bassinet, portable crib, or play yard that meets the safety standards of the Consumer Product Safety Commission (CPSC) is recommended along with a tight-fitting, firm mattress and fitted sheet designed for that particular product. Nothing else should be in the crib except for the baby. A firm surface is a hard surface; it should not indent when the baby is lying on it. Bedside sleepers that meet CPSC safety standards may be an option, but there are no published studies that have examined the safety of these products. In addition, some crib mattresses and sleep surfaces are advertised to reduce the risk of SIDS. There is no evidence that this is true, but parents can use these products if they meet CPSC safety standards."

3. Keep baby's sleep area in the same room where you sleep for the first six months or, ideally, for the first year.

"Place your baby's crib, bassinet, portable crib, or play yard in your bedroom, close to your bed. The AAP recommends room sharing because it can decrease the risk of SIDS by as much as 50% and is much safer than bed sharing. In addition, room sharing will make it easier for you to feed, comfort, and watch your baby."

4. Only bring your baby into your bed to feed or comfort.

"Place your baby back in his or her own sleep space when you are ready to go to sleep. If there is any possibility that you might fall asleep, make sure there are no pillows, sheets, blankets, or any other items that could cover your baby's face, head, and neck, or overheat your baby. As soon as you wake up, be sure to move the baby to his or her own bed ... Bed-sharing is not recommended for any babies."

5. Never place your baby to sleep on a couch, sofa, or armchair.

"This is an extremely dangerous place for your baby to sleep."

6. Keep soft objects, loose bedding and other items out of the baby's sleep area.

"These include pillows, quilts, comforters, sheepskins, blankets, toys, bumper pads or similar products that attach to crib slats or sides. If you are worried about your baby getting cold, you can use infant sleep clothing, such as a wearable blanket. In general, your baby should be dressed with only one layer more than you are wearing."

7. Swaddle your baby safely.

"Make sure that the baby is always on his or her back when swaddled. The swaddle should not be too tight or make it hard for the baby to breathe or move his or her hips. When your baby looks like he or she is trying to roll over, you should stop swaddling."

8. Try giving a pacifier at nap time and bedtime.

"This helps reduce the risk of SIDS, even if it falls out after the baby is asleep. If you are breastfeeding, wait until breastfeeding is going well before offering a pacifier. This usually takes 2-3 weeks. If you are not breastfeeding your baby, you can start the pacifier whenever you like. It's OK if your baby doesn't want a pacifier. You can try offering again later, but some babies simply don't like them. If the pacifier falls out after your baby falls asleep, you don't have to put it back."

Youri Benadjaoud, MPH Candidate at Brown University and a contributor to ABC News Medical Unit, contributed to this report.