New parents get plenty of advice, but few topics are as important as how your baby sleeps. In the United States, about 3,500 babies die each year from sleep-related causes, including sudden infant death syndrome (SIDS) and accidental suffocation. Many of these deaths can be prevented by following a few simple, consistent steps every time your baby sleeps, for naps and at night.
This article summarizes the safe sleep recommendations of the American Academy of Pediatrics (AAP) and answers the questions we hear most often from parents.
The ABCs of Safe Sleep
An easy way to remember the basics is A-B-C: your baby should sleep Alone, on their Back, in a Crib (or bassinet or play yard) that is safe and empty.
1. Always Place Your Baby on Their Back
Put your baby to sleep on their back for every sleep until their first birthday. Back sleeping is the single most important step for reducing the risk of SIDS. Babies who are used to sleeping on their backs and are then placed on their tummies, for example by a relative or babysitter, face a much higher risk, so make sure everyone who cares for your baby follows the same rule.
Healthy babies who spit up are not more likely to choke when sleeping on their backs. Their natural reflexes protect the airway.
Once your baby can roll from back to tummy and tummy to back on their own, you can let them stay in the position they choose, but keep placing them on their back at the start of sleep.
2. Use a Firm, Flat Sleep Surface
Babies should sleep on a firm, flat, level mattress covered only by a fitted sheet, in a crib, bassinet or portable play yard that meets current U.S. Consumer Product Safety Commission standards. A surface is too soft if it indents when your baby lies on it.
- Do not use inclined sleepers, nests, loungers or positioners. Inclined sleepers and padded crib bumpers can no longer be sold in the U.S. because of infant deaths.
- Car seats, strollers, swings and baby carriers are not safe for routine sleep. If your baby falls asleep in one, move them to a firm, flat sleep surface as soon as you can.
- Never let your baby sleep on a couch, sofa or armchair, either alone or with an adult. These are among the most dangerous places for infant sleep.
- Check secondhand cribs for missing hardware, recalls or drop sides. See our page on children's product recalls.
3. Keep the Sleep Space Empty
Pillows, quilts, blankets, bumper pads, stuffed animals and other soft items can block a baby's airway. Keep them out of the sleep area. To keep your baby warm, use a wearable blanket or sleep sack instead of loose blankets. Avoid weighted sleep sacks, weighted swaddles and other weighted products.
4. Share a Room, Not a Bed
The AAP recommends that babies sleep in the parents' room, close to the parents' bed but on a separate surface designed for infants, ideally for at least the first 6 months. Room sharing makes nighttime feeding and monitoring easier and lowers the risk of SIDS.
Bed sharing is not recommended. The risk is especially high if your baby is younger than 4 months, was born prematurely or at low birth weight, or if the adult in the bed is very tired, smokes, has consumed alcohol or is taking medicines or drugs that cause drowsiness. If you bring your baby into your bed to feed or comfort them, return them to their own sleep space when you are ready to sleep.
5. Other Ways to Lower the Risk
- Breastfeed if you can. Breastfeeding is linked to a lower risk of SIDS. Any amount helps. Read our breastfeeding basics.
- Offer a pacifier at nap time and bedtime. If you are breastfeeding, wait until breastfeeding is going well. Don't force it, and don't reinsert it once your baby is asleep.
- Avoid smoke, alcohol and drugs during pregnancy and after birth, and keep your baby's environment smoke-free and vape-free.
- Don't overheat your baby. Dress your baby in no more than one layer more than an adult would wear to be comfortable, and keep the head and face uncovered.
- Keep up with well-child visits and vaccines. Immunizations are associated with a lower risk of SIDS.
- Be cautious of products that claim to prevent SIDS. Home heart and breathing monitors and "smart" sleep products have not been shown to reduce the risk of SIDS and should not replace safe sleep practices.
Swaddling Safely
Swaddling can calm newborns, but it must be done safely. Always place a swaddled baby on their back, make sure the swaddle is snug around the chest but loose around the hips so the legs can bend, and stop swaddling as soon as your baby shows signs of trying to roll over. Never use a weighted swaddle.
Tummy Time While Awake
Babies need supervised tummy time every day while they are awake. It builds the neck, shoulder and arm muscles they need to roll, sit and crawl, and helps prevent flat spots on the back of the head. Start with a few minutes several times a day soon after coming home from the hospital and gradually increase the time as your baby grows.
Common Questions
What if my baby only sleeps in the swing or on me?
Many babies prefer to be held, and it's normal for this stage to feel exhausting. Try putting your baby down drowsy but awake, use white noise and a dark room, and keep bedtime routines consistent. If you feel yourself falling asleep while holding your baby, put them in their crib or bassinet first. Talk with us if sleep is a struggle; we can help.
Is it okay to use a baby monitor?
Audio and video monitors can be convenient for hearing your baby, but they do not prevent SIDS.
When can my baby have a blanket or pillow?
Keep soft bedding out of the crib for at least the first year. Ask us at your child's checkup when it is appropriate to add a small pillow or blanket.
Share These Rules With Every Caregiver
Grandparents, babysitters and child care providers may have learned different advice years ago. Share this article with anyone who puts your baby to sleep. You can also find more safe sleep information from the AAP at HealthyChildren.org and from the National Institutes of Health's Safe to Sleep campaign.
Have questions about your newborn's sleep, feeding or development? Bring them to your baby's next visit. Our articles on caring for your newborn and preparing for your baby are good places to start.
This article is general health information for parents and is not a substitute for medical advice. If you are worried about your child, contact your pediatrician; in an emergency, call 911.
Questions about your child's health?
Our Chestertown pediatric team cares for newborns, children and teens. Request an appointment, read our new patient information or browse more articles on the pediatric health blog.