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Table 2 Summary of recommendations and strength of recommendations by PrevInfad and the AAP

From: Sudden infant death syndrome prevention

Effective strategies to reduce SIDS PrevInfad 2016a AAP 2016a
Modifying behaviours and care related to the sleeping environment and nutrition
 Supine position for sleeping Grade A Grade A
 Supervised awake tummy time Recommended but not graded Grade B
 Firm surface for sleeping Recommended but not graded Grade A
 Soft objects and loose bedding away from the sleep area Recommended but not graded Grade A
 Avoid overheating and head covering Grade I Grade A
 Room-sharing with the infant on a separate sleep surface Grade B Grade A
 No bed-sharing if father or mother are tobacco smokers, have consumed alcohol, anxiolytic, antidepressant or hypnotic drugs and in case of extreme exhaustion. Grade B Recommended but not graded
 No routine use of commercial devices that are inconsistent with safe sleep recommendations. Not reported Grade B
 Consider offering a pacifier at naptime and bedtime Grade B Grade A
 Breastfeeding on demand Grade A Grade A
Counselling to modify behaviours and care related to maternal factors
 Regular prenatal care Grade B Grade A
 Avoid smoke exposure during pregnancy and after birth Grade A Grade A
 Avoid alcohol and illicit drug use during pregnancy and after birth Grade B Grade A
Infant-related factors
 Prematurity and low birth weight Not graded Not reported
 Sibling with SIDS Not graded Not reported
Other strategies to modify behaviours
 Infants should receive immunizations following respective national immunization programme Grade I Grade A
 No use of cardiorespiratory monitors at home as a strategy to reduce the risk of SIDS Grade I Grade A
 Health care providers, staff in newborn nurseries and neonatal intensive care units, and childcare providers should endorse and model the SIDS risk-reduction recommendations from birth. Not reported Grade A
 Media and manufacturers should follow safe sleep guidelines in their messaging and advertising. Not reported Grade A
 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. Paediatricians and other primary care providers should actively participate in this campaign. Not reported Grade A
 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. Not reported Grade C
 There is no evidence to recommend swaddling as a strategy to reduce the risk of SIDS. Not reported Grade C
  1. Abbreviations: AAP American Academy of Pediatrics, PrevInfad PrevInfad workgroup from the Spanish Association of Primary Care Pediatrics; SIDS: sudden infant death syndrome
  2. aThe definitions of the five grades to describe the strength of the recommendations are reported in (Jullien S, Huss G, Weige R. Supporting recommendations for childhood preventive interventions for primary health care: elaboration of evidence synthesis and lessons learnt. BMC Pediatr. 2021.