How to Keep a Baby Safe While Sleeping

In the face of these grim statistics, the empowering news is that there are safe sleep guidelines that parents and caregivers can follow to help protect sleeping infants. The American Academy of Pediatrics (AAP) has a list of recommendations to reduce the risk of SIDS and other sleep-related infant deaths. And the majority of these SIDS prevention tips are things that can easily be done.

Keeping babies safe starts with information. Since the Safe to Sleep (formerly Back to Sleep) campaign was launched in 1994 to educate parents and caregivers on how to reduce risk, the rate of SIDS has decreased in the United States by almost 50%. However, experts say that many caregivers still don’t always follow the recommendations, because of either a lack of knowledge or they don’t fully understand the risks.

4 Safe Sleep Guidelines

To keep your baby safe and further reduce the risk of SIDS, experts say it’s vital that all caregivers embrace the following safe sleep guidelines.

Babies Should Always Sleep on Their Backs

One of the most important recommendations doctors make to new parents has to do with the baby's sleep position. Infants should sleep on their backs until they reach 1 year of age. That means no side sleeping or face-down tummy sleeping—not even during naps.

“Definitely on the back only,” says Gina Posner, M.D., a board-certified pediatrician at MemorialCare Orange Coast Medical Center in Fountain Valley, California. Posner says that while some parents want their babies to try different positions, she and other experts treat this advice as nonnegotiable. “When parents want them on their side or [other positions], we’re like, ‘Nope.’ Back is super important.”

According to the National Institutes of Health, placing babies on their back to sleep is the “single most effective action that parents and caregivers can take to lower a baby's risk of SIDS.”

Some parents are concerned that spending a lot of time safely face up can flatten the back of a baby’s head. And it does happen, says Daniel Ganjian, M.D., a board-certified pediatrician at Providence Saint John’s Health Center in Santa Monica, California. But flat-head syndrome (plagiocephaly) can be prevented or reduced with lots of tummy time, he says.

“I remind parents that since babies are sleeping on their backs all the time, remember when they’re awake to do tons of tummy time,” Ganjian says. That primarily helps the child learn to hold their head up, helping them develop upper body strength, but it also allows for “a nice round head,” he says. Always supervise your baby during tummy time.

Many parents ask what to do later when the baby starts rolling over, usually around age 4 to 6 months. When that time comes, it’s important that the baby is put down on their back at the beginning of bedtime or their nap, but it’s okay if they roll over on their own. And the good news is that the rate of SIDS goes down around age 6 months, too.

Have Your Baby Sleep in Their Own Bed

Babies should sleep on their own separate sleep surface. It should be a crib, bassinet, or play yard that meets current U.S. Consumer Product Safety Commission (CPSC) standards. (It should be labeled somewhere on the product when you purchase it.)

Posner says this recommendation is hard for some parents to accept. She says many parents love the idea of co-sleeping; they find it convenient and cozy, and many try to come up with solutions they believe will make it safer. But according to Posner and other experts, with infants, there’s no such thing as safe bed sharing—period.

“Once you’ve seen one death from bed sharing, you’ll never forget the agony, the scream of the parent,” Posner says. “It’s just not worth it.” Both the AAP and the CDC caution parents against bed sharing with a sleeping baby of any age.

When selecting a sleep surface for your infant, it’s important to know that cribs with drop sides or that were made before June 2011 don’t meet today’s sleep safety standards.

If you’re having trouble affording a certified-safe crib, you may be able to get one through a local nonprofit organization. Check out Cribs for Kids for more information, and see a state-by-state list of organizations that may be able to help at WeHaveKids.com.

But Sleep in the Same Room As Your Baby

Although infants shouldn’t share a bed with their parents or others under any circumstances, they should share a room, experts say. The AAP recommends that babies sleep on a separate surface in the same room as a parent for at least the first six months of life and, preferably, for up to a year, as it can reduce the risk of SIDS by as much as 50%.

The sleep surface your baby sleeps on should be flat and firm. According to the AAP, softer mattresses, such as those made of memory foam, could increase the risk of suffocation if an infant rolls on their stomach. Inclined sleepers with an angle of over 10 degrees aren’t safe, either, according to the CPSC.

Even napping on a surface that isn’t their safe sleeping area—a couch, a chair, their play mat, or your bed—can be dangerous.

Clear Out the Crib

While baby stores sell many cute stuffed animals, adorable little blankets, and other sweet baby things, not a single one of them belongs in your baby’s crib. The AAP recommends no soft objects or loose bedding in the infant’s sleeping area.

They may be cute, but the sad fact is that they can obstruct an infant’s airway and cause suffocation. This is also true of fabric crib bumpers that some parents may use to pad the inside of the crib and add to the nursery décor. All bumpers, even the ones made out of safer-seeming mesh material, put a baby at higher risk of death due to suffocation, strangulation, or entrapment, Posner says.

The sleep area should only have a fitted sheet that fits its mattress snugly. It’s okay to have a lightweight receiving blanket, but only if your baby is swaddled in it. Make sure the blanket doesn’t cover their face, and stop swaddling once your baby starts rolling over. After that, you can use comfortable pajamas or a sleep sack.

Avoid sleep positioners and other devices that promise to prevent SIDS. According to the Safe to Sleep campaign, “Evidence does not support the safety or effectiveness of wedges, positioners, or other products that claim to keep infants in a specific position or to reduce the risk of SIDS, suffocation, or reflux. In fact, many of these products are associated with injury and death, especially when used in [your] baby's sleep area.”

More SIDS Prevention Tips

Here are a few other things you can do to reduce the risk of SIDS and other sleep-related death:

• Breastfeed or chestfeed, if you can.
• Offer a pacifier for sleep times.
• Avoid smoking during pregnancy and after the baby’s birth. Keep your baby away from secondhand smoke, too.
• Avoid alcohol and illegal drugs during pregnancy and after the birth.
• Keep your baby up to date with checkups and recommended vaccines.

Following these recommendations isn’t a foolproof guarantee against SUID, and there are still occasional unexplained cases, Posner says. However, taking these steps minimizes risk and gives a baby the best chance to stay safe while sleeping.

“At the end of the day, all parents want their babies to be healthy and safe,” Ganjian says. “These [safe sleep] guidelines provide the best evidence-based and research-based tips for parents to be able to raise a healthy and happy child.” He adds, “I always tell parents, ‘Don’t do what’s convenient; do what’s right.’”

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