AAP Issues Hospital Guidelines for Safe Skin-to-Skin Care and Sleep for Newborns

The American Academy of Pediatrics has issued guidelines for hospitals and birth centers on how to most safely execute skin-to-skin care (SSC) and safe sleep for term newborns in the hospital setting. The report is “intended for birthing centers and delivery hospitals caring for healthy term newborns to assist in the establishment of skin-to-skin care and safe sleep policies.


The advice comes in the wake of concerns from several case reports of sudden unexpected postnatal collapse (SUPC) in otherwise healthy newborns, falls from adult hospital beds, and fatal or near fatal events related to sleep in this setting. SSC is an important evidence-based feature of the Ten Steps to Successful Breastfeeding, and the AAP notes it is “is recommended for all mothers and newborns, regardless of feeding or delivery method.” As noted by AAP, skin-to-skin care helps stabilize blood glucose concentrations and newborn body temperature, can prevent hypothermia, decreases crying, and provides cardiorespiratory stability, especially for late preterm newborns. For mothers, SSC decreases maternal stress, and SSC and breastfeeding within 30 minutes of birth may reduce postpartum hemorrhage. By contrast, the AAP notes that experimental models note that mother-infant separation causes significant stress, especially on the mother.


AAP’s guidance includes identifying mothers who may be at particularly high risk for falling asleep with their newborn, and how to specifically position the newborn on the mother for maximum safety while skin-to-skin. Side car bassinets are among the options mentioned for safe sleeping, and the guidelines picture a hospital bed with a side-car bassinet attached.


The AAP guidelines come one day after two opinion pieces in JAMA Pediatrics on the Ten Steps. In one piece, Implementation of the Ten Steps to Successful Breastfeeding Saves Lives, Drs. Joan Meek and Lawrence Noble cite literature showing the hundreds of thousands of lives that breastfeeding saves globally and the billions of dollars in the US that are saved by breastfeeding. They link breastfeeding success to the implementation to the Ten Steps and the Baby-Friendly Hospital Initiative.


In the other piece, Unintended Consequences of Current Breastfeeding Initiatives, Drs. Joel Bass, Tina Gartley and Ronald Kleinman express concern over the risk of SUPC, falls and sleep associated risks in the newborn hospital period. Hopefully, the AAP recommendations published the following day have adequately addressed their concerns.