Once thought to protect babies from injury, bumper pads on cribs may lead to suffocation, according to new guidelines for sleeping babies released on Tuesday.
The American Academy of Pediatrics said cribs should not be lined with the protective cushion and said there is no evidence the bumper pads prevent injuries.
The bumper pad guideline is among a few major additions to the recommendations list since the group's last statement on sudden infant deaths in 2005.
Immunizing all infants and breast-feeding are other notable additions, the group said.
According to the report, evidence suggests that immunization reduces the risk of sudden infant death syndrome by 50 percent.
Health effects from breast-feeding also help protect infants from sleep-related death, the report said.
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The American Academy of Pediatrics first said in 1992 that infants should be placed in a non-prone position for sleeping to curb sudden infant deaths.
Since that time, sudden infant death syndrome rates have declined by more than 50 percent. Sleeping deaths from other causes, including suffocation, entrapment and asphyxia have increased.
The latest report reiterates the recommendation that infants always sleep on their back, adding that side sleeping is unsafe. Some supervised awake-time spent on the stomach is recommended.
A series of 18 recommendations from the academy are intended to help guide parents, health care providers and others who care for infants following an increase in sleep-related deaths over the last few years.
The expanded recommendations aim to reduce the risk of sudden infant death syndrome, suffocation, entrapment and asphyxia, the report said.
The guidelines also recommend soft objects and loose bedding such as quilts and pillows not be kept in cribs.
Babies should sleep on a firm surface and should sleep in the same room as parents, but not in the same bed, according to the guidelines.
Infants should not regularly have routine sleep time in sitting devices such as car seats and strollers and should not sleep in a bed where they might suffocate, according to the guidelines.
The recommendations, geared to infants up to one year of age, emphasize the importance of regular prenatal care for pregnant women and encourage smoke-free environments for pregnant women and children.