11 Essential Guidelines of Safe Sleep for Babies

Following safe sleep practices can help your baby sleep safely and reduce their 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 and unexplained death of an apparently healthy infant younger than one year of age that remains unexplained after an autopsy, thorough death scene investigation, and medical health history review. SIDS is the most common, and the leading causes of death, among infants one month to one year of age. In the United States, there are around 3,400 sudden unexpected infant deaths (SUID) every year. Of these, over 1,300 deaths were due to SIDS, in 2020.

What Causes SIDS?

SIDS has no immediately obvious causes. There currently is no exact way of preventing SIDS but there are steps parents can take to lower the risk.

Safe Sleep For Babies

How to Reduce SIDS Risk 

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 as soon as a day or two after birth. Providing two or three tummy sessions for a few minutes at a time. Regular tummy time helps strengthen baby’s head, neck and shoulder muscles and aids in minimizing flat spots on the back of their head.

3. Use Proper Newborn Bedding

Use a safety approved crib containing a flat, firm mattress and only a tight fitted sheet. If you do not 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 Sleep Area

Never use blankets, soft mattresses or other loose bedding in the crib or sleep area. These could cover your baby’s airway and create an opportunity for your baby to rebreathe the air that was recently exhaled and high in carbon dioxide. 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 risk of SIDS, babies should sleep without blankets until age 1. The recommended alternative is a wearable blanket, such as a sleep sack or dress your baby in layers. Both options will keep your baby warm and safe.

5. Baby Should Sleep In Your Room

Share a room, not a bed. Keep your baby's crib or bassinet in the same room where you sleep. 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. Your baby should sleep in the same room as you but alone in a safe sleep space with no soft objects such as toys, stuffed animals, blankets, pillows and bumper pads. They should not sleep on a couch, chair, bed or other adult sleep surface alone or with anyone else. Placing your baby to sleep on these types of surfaces not only increases the risk of SIDS but other accidental sleep-related deaths.

How long should baby sleep in your room?

According to the American Academy for Pediatrics, parents should not share a bed, but should sleep in the same room as their baby for at least the first six months.

6. Stop Swaddling When Baby Tries to Roll Over

Stop swaddling as soon as your baby shows any signs of trying to roll over. This will usually occur by 4-5 months of age. At this age, a wearable blanket with the infant’s arms out is a great option until they are older than 12 months.

If you swaddle your infant, make sure to place them on their back. Stop swaddling as soon as baby shows sights of trying to roll over – this is typically around 4-5 months of age. After this age, use a non-weighted sleep sack to ensure baby’s face is uncovered at all times.

7. Use a Sleep Sack

To keep your baby warm, use a wearable sleep sack. Keep your baby’s face uncovered at all times and do not use a loose blanket. Follow the product guidelines for safe placement of your baby in wearable infant carriers and wraps to reduce the risk of suffocation. It is important to ensure your baby’s mouth, nose and airway remain open to fresh air while being carried.

Are weighted sleep sacks safe?

Weighted clothing or objects near the baby are not safe or recommended, according to The American Academy for Pediatrics.

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

Give your baby a pacifier that is not attached to a string for naps and at night. Pacifier use during naps and nighttime is recommended once breastfeeding is well established. However, pacifier use should be delayed until breastfeeding is established or follow your healthcare providers recommendations.

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 is no evidence to prove that any specific baby sleep product can prevent SIDS. Relying on these products can create false sense of security and reduce the diligence of baby caregivers.

10. Create a Smoke-Free Environment

Do not smoke, use illicit drugs or drink alcohol during pregnancy and avoid exposing your baby to second hand 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 will care for your baby on how to be knowledgeable and 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.