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The American Academy of Pediatrics currently recommends waiting until age 2 to introduce a pillow into the crib, to reduce suffocation risk, even though the greatest SIDS risk is under age 1. What’s the basis for this recommendation, and is there reason to wait?
—Anonymous
This is a good question. The highest risk of SIDS is between the ages of one month and four months; 90% of SIDS deaths occur before six months. SIDS is, in fact, defined as the unexpected death of a child under 12 months, so it would not apply to a child older than that. Sudden death can occur in children over a year, but it is very, very uncommon.
The AAP has extensive documentation for its recommendation that people not use pillows for babies, and, indeed, this relates to the risk of suffocation. However, I can find no documentation of the continued pillow restriction past the age of 1. Once a child can move their head around, any suffocation risk becomes much more limited. In one summary study, there were no deaths attributable to bedding after seven months.
The combination of the extremely low overall risks to toddlers and the logic around pillows suggests to me that the recommendation to not use a pillow is overly cautious. The AAP may take the view that by drawing the lines very broadly, it lowers the risk that someone uses a pillow for a small baby. But there is no evidence that pillows are a risk for 18-month-olds.
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