For more than 30 years, parents have been hearing that babies should be put to sleep on their back to reduce the risk of sudden infant death syndrome (SIDS). But providing a safe sleep space for your baby involves more than just placing her on her back when you put her down to sleep for a nap or for the night.
The American Academy of Pediatrics (AAP) stresses the need for infants to sleep close to their parents, ideally for 1 year but at least for the first 6 months. That strategy has been shown to cut the risk of SIDS by as much as 50 percent. Mothers who need to breastfeed during the night are encouraged to bring their baby into bed, since this poses less risk than falling asleep on a sofa or an armchair. But your baby should be returned to their crib as soon as possible after feeding, since bedsharing can pose serious safety risks.
Position your baby’s crib out of reach of long curtains, “canopy-style” drapes, window blinds, and cords of any kind. Hang any mobile high enough above your baby’s crib so that he can’t possibly reach it. And don’t leave your baby sleeping in his car seat when you arrive at your destination.
Always place your baby on her back to sleep, never on her tummy or side, to reduce the risk of SIDS. Despite what family members or other caregivers may tell you, babies who sleep on their back are at no higher risk of choking or similar problems. According to the National Institutes of Health (NIH), healthy babies naturally swallow or cough up fluids that they spit up or vomit –it's a reflex to clear their airways. Studies show no increase in choking deaths among babies who sleep on their back, and this position may actually clear such fluids better. Consult your baby's pediatrician if you have concerns about her sleep position.
Parents are urged to put their babies to sleep on a surface designed for sleep. Some locations—waterbeds, sofas, armchairs, or recliners—are never safe for sleep. Babies can fall into cracks between cushions or sink into soft surfaces, which can make it difficult for them to breathe. Here’s an overview of some options:
- Cribs. Most cribs are suitable for a newborn and can handle the weight and size of a baby throughout the toddler years. Check cribs against new and improved Consumer Product Safety Commission (CPSC) standards.
- Cradles, bassinets, and Moses baskets. These compact sleep surfaces are designed for use with babies during their first few weeks or months. But they are quickly outgrown and parents are cautioned to observe their weight limits.
- Co-sleeper. A co-sleeper is a bed designed to attach to the side of the parents’ bed. Parents should use only bedside co-sleepers that meet safety standards of the CPSC.
- In-bed co-sleepers. In the past, some products were marketed for in-bed co-sleeping. In response to public health efforts from the AAP, CPSC, and many other safety experts, who cited more than 250 incidents with the products between January 2019 and December 2020, the Safe Sleep for Babies Act was signed into law in May 2022. This law bans in-bed sleepers as hazardous products and notes they should no longer be used with babies.
Bare is best. Keep it simple: firm and tight-fitting mattress, fitted sheet, and fitted mattress protector (optional). In the cooler months, consider having your baby dressed in a wearable sleep sack for warmth instead of using a blanket. Babies who can’t roll over on their own can become entangled in cushy or padded fabrics, which can interfere with their ability to breathe. Babies who manage to pull a blanket over their face or bury their face in a stuffed animal may not be able to turn away, making breathing difficult. Avoid crib bumpers, in-bed wedges, and sleep positioners.
Sleeping at a care provider’s
If your baby spends time in a child care setting away from your home, make sure he has a safe place to sleep. Licensed child care facilities are required to have cribs that adhere to safety guidelines, but parents are advised to double-check. Examine your baby’s sleep space to ensure it meets safety recommendations. First Candle, a nonprofit organization dedicated to reducing SIDS, recommends asking potential child care providers these questions:
- Will the sleep space be an approved crib, play yard or other approved sleep surface?
- Will my child have his/her own sleep space that is the same each day?
- Since it is NOT recommended, if my baby falls asleep in a swing, car seat or bouncy seat, will he/she be moved to an approved sleep surface?
- Is the caregiver within sight and sound of my baby during sleep?
- Is the sleep area inspected before each sleep session?
- Does the child care have safe infant sleep policy/practices in place?
- Are all caregivers, including regular staff, volunteers, floaters, and substitutes trained in and following safe infant sleep guidelines?
Things to look for (always ask to see the sleep area):
- Babies always placed on their backs to sleep
- Firm sleep surface, such as a mattress in a safety approved crib, play yard other sleep surface covered by a fitted sheet with no other bedding
- EMPTY CRIB – No soft objects, pillows, blankets, toys, bumper pads, bottles or any other items in baby’s sleep area
- Babies dressed appropriately for the room temperature, and not in clothes that could cause overheating
- Nothing with ties such as bibs, pacifiers, cords or other attachments on infants while sleeping
- No use of products in the sleep space that claim to reduce the risk or prevent SIDS (such as wedges, positioners, or other products that claim to keep infants in a specific position)
- Posted safe sleep guidelines to remind all staff, volunteers, floaters and substitutes of these important practices
- Make sure no electrical cords or window blind cords are near the crib where they can create a safety hazard