11 Essential Guidelines of Safe Sleep for Babies

Following safe sleep practices can reduce your baby's risk of sudden infant death syndrome (SIDS) and other sleep-related infant deaths. Amy Ferguson, MD, UnityPoint Health, explains how to create a safe sleep environment for a newborn. 

What is Sudden Infant Death Syndrome (SIDS)?

SIDS is the sudden, unexpected death of an otherwise healthy infant under one year old, which remains unexplained even after a thorough medical investigation. It's the leading cause of death for infants between one month and one year of age.

According to the Centers for Disease Control and Prevention (CDC) in 2022, there were about 3,700 sudden, unexpected infant deaths (SUID) in the United States, that includes:

• 1,529 deaths from SIDS
• 1,131 deaths from unknown causes
• 1,040 deaths from accidental suffocation and strangulation in bed

SIDS has no immediately obvious causes. While there's no exact way to prevent SIDS, there are steps parents can take to lower the risk.

Safe Sleep For Babies

1. Place Baby on Their Back to Sleep

Always place your baby flat on their back to sleep, for naps and at night, to reduce the risk of SIDS.

When Can Babies Sleep on Their Stomach?

To reduce risk of SIDS, don't put your baby on their side or stomach to sleep. Parents may be afraid babies placed on their back will choke if they spit-up. However, since the Back to Sleep Campaign in 1994, the SIDS rates in the US have been reduced by more than 50% with no increase in choking deaths. Car seats, swings, Rock n’ Plays, bouncy chairs, slings and boppy pillows should not be used for routine sleep.

2. Provide Supervised Tummy Time When Baby is Awake

When Can Babies Start Tummy Time?

Most newborns can start tummy time a day or two after birth. Regular tummy time helps strengthen baby’s head, neck and shoulder muscles. It also aids in minimizing flat spots on the back of their head. Try two or three tummy sessions for a few minutes at a time.

3. Use Proper Newborn Bedding

Use a safety approved crib containing a flat, firm mattress and only a tight fitted sheet. If you don't have a crib or pack and play, put your baby to sleep on a clean, thin blanket placed on the floor in a safe area of your home. This is always a better option than placing your baby to sleep on a couch, recliner or other adult sleep surface.

4. Remove Blankets or Loose Bedding from Your Baby's Sleep Area

Never use blankets, soft mattresses or other loose bedding in the crib or sleep area. These items can block your baby's airway, causing them to re-breathe carbon dioxide they just exhaled. This is dangerous because infants vulnerable to SIDS often can't wake up or move their heads to get fresh air. This is a potential hazard for infants vulnerable to SIDS as they are unable to respond appropriately.

When Can Babies Sleep with Blankets?

To reduce the risk of SIDS, babies should sleep without blankets until age one. The recommended alternative is a wearable blanket, such as a sleep sack, or dress your baby in layers. Both options keep your baby warm and safe.

5. Baby Should Sleep in Your Room

Keep your baby's crib or bassinet in the same room where you sleep. However, co-sleeping is not advised. According to the American Academy of Pediatrics, for the first six to twelve months, you should not co-sleep or sleep in the same bed as your infant.

How Long Should Baby Sleep in Your Room?

our baby should sleep in your room, but not your bed, for at least the first six months..

6. Stop Swaddling When Baby Tries to Roll Over

Stop swaddling your baby when they show signs of trying to roll over. This usually happens around four to five months. To properly dress baby for sleep, use a wearable blanket while keeping your baby's arms free until they're older than 12 months. 

7. Use a Sleep Sack

To keep your baby warm, use a wearable sleep sack instead of a loose blanket, and always keep their face uncovered. If you use an infant carrier or wrap, follow the product guidelines to prevent suffocation by ensuring your baby’s mouth, nose and airway stay open to fresh air.

Are Weighted Sleep Sacks Safe?

The American Academy for Pediatrics states weighted clothing or objects near the baby aren't safe.

8. Use a String-Free Pacifier When Baby is Sleeping

Give your baby a pacifier that isn't attached to a string for naps and at night. It's recommended once breastfeeding is well established, or you can follow your healthcare provider's advice.

9. Be Cautious of Products Claiming to Prevent SIDS

Avoid sleep products and positioners that claim to prevent SIDS and other accidental sleep-related deaths. There's no evidence to prove that any specific baby sleep product can prevent SIDS. Relying on these products can create a false sense of security and reduce the diligence of caregivers.

10. Create a Smoke-Free Environment

Don't smoke, use illicit drugs or drink alcohol during pregnancy. Avoid exposing your baby to secondhand smoke to help reduce the risk of SIDS.

11. Educate Yourself and Others on Safe Sleep Practices

Learning safe sleep practices is important for all caregivers. Help educate all individuals who care for your baby on how to be responsible for safe sleep.

ABCs of Safe Sleep for Infants

• Alone. Your baby should always sleep alone.
  
• Back. Your baby should always sleep on their back.
  
• Crib. Your baby should sleep in a crib or bassinet without bumper pads, blankets, pillows and toys.
  

Talk with your pediatrician if you have any questions or concerns about the safety of your baby's sleep environment.