Infant safe sleeping practices

Of the 3,700 sudden unexpected infant deaths each year, many are associated with the baby being asleep at the time of death.  

The way a baby sleeps can raise or reduce the risk of Sudden Infant Death Syndrome (SIDS), as well as the risks of suffocation or entrapment (for example, when the infant is trapped in a position in which he or she can’t breathe). 

Recommendations

The following are recommendations from the American Academy of Pediatrics on how to make sure a baby is sleeping safely:

• Have babies sleep on their backs, both at night and for naps, until they are at least a year old. Experts say babies who sleep on their backs are at far less risk to die of SIDS; while some parents might fear that back sleeping can lead to choking, the risk of SIDS outweighs any risk of sleeping on the back. Side sleeping is unsafe, researchers say.
• Use a firm sleeping surface that’s hard enough that it doesn’t indent when the baby lies on it. The infant’s lying face-down on a soft surface could create an indentation that restricts airflow. The American Academy of Pediatrics recommends a Consumer Products Safety Commission-approved mattress that fits tightly into the crib, bassinet or play yard. It’s recommended that sitting devices such as a stroller, car seat or swing not be used as the baby’s usual sleeping location. Also, it’s inadvisable to have the baby sleep on a couch, pillow, waterbed or blanket.
• Keep all items, including blankets, out of the crib while the baby is sleeping. Soft items such as blankets or stuffed animals create added risk of suffocation. Also, avoid crib bumpers, which have been identified as risks for suffocation, strangulation and entrapment. (Newer cribs are made with slats close enough together that the baby’s head can’t get stuck between them.) If you are concerned about the baby getting cold, dress him or her in warmer clothing.
• Make sure the baby does not overheat while sleeping. While there are no specific temperature guidelines, watch to make sure the infant is not sweating or hot to the touch. Dress the baby in no more than one layer more than an adult would wear in the conditions in which the baby is sleeping.
• Keep the baby’s sleeping area in the room where an adult sleeps, ideally for the entire first year. A baby sharing a room with an adult has been shown to reduce the risk of SIDS, as well as the risks of entrapment and suffocation.
• Bring a baby into an adult’s bed only for feeding or comfort; it’s recommended that the baby not sleep with an adult. Bed-sharing has been shown to be particularly risky with an infant 4 months old or younger. Infants brought into the adult’s bed should be returned to their own sleeping surface after feeding or comforting. Because bedding in the adult’s bed is a primary risk for suffocation, minimize loose pillows, sheets, blankets or comforters around the infant.
• Give the baby a pacifier to use while sleeping. The pacifier appears to reduce the risk of SIDS, even if the pacifier falls out of the infant’s mouth (there is no need to reinsert it if it falls out during sleep). Put the pacifier in the infant’s mouth when putting him or her down to sleep. Don’t hang the pacifier around the infant’s neck, and don’t use a pacifier that attaches to the baby’s clothing.
• Breastfeed the baby. Since breastfeeding is associated with a reduced risk of SIDS, try to breastfeed exclusively if possible. If it’s not possible to breastfeed exclusively, supplement with expressed breast milk. Any breastfeeding is beneficial than none at all.
• Avoid cigarette smoking. In addition to a mother’s cigarette smoking being harmful to her baby before birth, an infant’s SIDS risk goes up when bed-sharing with a smoker, even if the smoker is not smoking in bed.

Resources

HealthyChildren.org: How to Keep Your Sleeping Baby Safe: AAP Policy Explained

NIH Safe to Sleep campaign