Safe Sleep Guidelines for Babies

In 2022, the American Academy of Pediatrics (AAP) published updated safe sleep guidelines for infants in an effort to help prevent sudden infant death syndrome (SIDS) and other sleep-related deaths like strangulation and suffocations.

The basics are that you should follow all health and safety guidelines, including prenatal care and well care, for you and your baby. This includes infant vaccines using the Centers for Disease Control and Prevention (CDC) guidelines. You should be wary of and avoid using most infant sleep devices that make claims to protect against SIDS and other risks during sleep for babies as there is no research supporting those claims. In addition, the report details the risks of bed-sharing.

Breastfeeding is protective and helps reduce the risk of death. If you breastfeed your baby at night, a safely prepared adult bed is safer than a couch or chair should you accidentally fall asleep. You can read more details below, including other helpful tips for both you and those who care for your baby.

Pregnancy

What may be a surprise is that some of the AAP's recommendations involve things you can do before your baby is even born. Getting timely prenatal care and avoiding certain substances can all help in making sleep safer for your baby after they are born.

Prenatal Care

Pregnant people should seek and obtain regular prenatal care. Prenatal care is beneficial well beyond the 40 weeks of pregnancy. Not only does the process of prenatal care help to provide a pregnant person and their baby or babies the best chance at a healthy pregnancy and problem-free birth, but it also helps to set the tone of the baby's health status for life.

Research shows that babies born after high-risk pregnancies may experience more risk from complications, including SIDS. By preventing some pregnancy complications, the benefits go on well past pregnancy and infancy.

Substance Use

Avoid smoke exposure during pregnancy and after birth. Avoid alcohol and illicit drug use during pregnancy and after birth. Smoking and the use of drugs and alcohol in pregnancy have long been known to cause potential problems with pregnancy, including preterm labor, small for gestational age (SGA) babies, and placental complications. There is now evidence that beyond the risks that they can cause in pregnancy, there are potential problems later in life as well, including an increased risk of SIDS.

Infancy

After your baby is born, there are a number of things you can do to make sleep safer. Keeping their sleep space firm and free from clutter, breastfeeding, and keeping your child up to date on their vaccines are all proactive ways to decrease the risk of SIDS.

Sleep Environment

Back to sleep for every sleep. Since the implementation of the Back to Sleep Campaign (now the Safe to Sleep campaign) from the AAP and partners, having a baby sleep on their back has been shown to drastically reduce the number of deaths from SIDS. This recommendation is for all sleep with all care providers. Be sure that anyone that cares for your baby does the same, including grandparents and daycare providers.

Use a firm sleep surface. Be sure your baby sleeps on a firm crib mattress or pack n' play. Additionally, avoid some surfaces for infant sleep like couches, soft mattresses, and water beds. These surfaces have been shown to increase the risk of suffocation and death in infants.

Room-sharing with the infant on a separate sleep surface is recommended. Keeping your baby in your room for the first six months can help protect your baby, too. The AAP recommends that this should be in a separate bed, like a crib, a bassinet, or a side sleeper.

Keep soft objects and loose bedding away from the infant’s sleep area. All sleep surfaces should be free of soft items, including extra bedding. This means you should ditch the toys, infant pillows, bumpers, and other crib blankets. It's much better to keep your baby covered with layers of clothing rather than with blankets that can tangle and strangle the baby.

Breastfeed

Breastfeeding is protective and helps prevent SIDS, in addition to many other benefits. This protection increases the longer you breastfeed and is higher when you are giving your baby only breast milk. But it is important to note that any amount of breast milk is protective and your baby will get these benefits when getting breast milk via a bottle or cup as well. However, fed is best, and for some families, using formula is the right choice.

Offer a Pacifier

There are some studies that show a baby with a pacifier may have less of a risk of SIDS. However, it is noted that you should not force a child to take a pacifier. You may also want to offer the pacifier only once breastfeeding is well established to protect your milk supply.

Avoid overheating 

Babies are often seen decked out in a ton of extra clothes, even in the summertime. While newborns do have issues with temperature regulation, they rarely need more than one light layer extra than what an adult would wear. Though it's better to use a sleeper for the baby than a blanket, just make sure it's weather appropriate.

Vaccinate

Infants should be immunized in accordance with AAP and CDC recommendations. A healthy infant is less likely to die of SIDS in addition to the diseases that the vaccines are protecting against.

Products

Avoid the use of commercial devices that are inconsistent with safe sleep recommendations.  There are a lot of products that are sold to new parents. Many of these products make claims that are not actually verifiable with scientific research. This can lead to accidents that cause harm or death to your baby. There have been several recalls in the past years of these types of products.

Swaddling

There is no evidence to recommend swaddling as a strategy to reduce the risk of SIDS. Swaddling has been held up as a way to prevent SIDS. This has not been found in the research. So, if your baby hates swaddling, don't stress about it. If you do swaddle your baby, be sure to watch for overheating and protect their hips among other safe swaddle strategies.

Cardiorespiratory Monitors

Do not use home cardiorespiratory monitors as a strategy to reduce the risk of SIDS. Some parents have thought that monitors to watch the baby would be helpful, but this has not been found to be the case. Talk to your practitioner before using home medical-type equipment.

Policy

The "Safe to Sleep" campaign focuses on ways to reduce the risk of all sleep-related infant deaths, including SIDS, suffocation, and other unintentional deaths. The campaign is important to ensure that all parents know the ways to keep their babies safe. By continuing it, we can help to ensure that all parents get this message. 

Pediatricians and other primary care providers should actively participate in this campaign. The goal of this educational campaign is to reach every adult.

Research

The AAP will continue research and surveillance on the risk factors, causes, and pathophysiologic mechanisms of SIDS and other sleep-related infant deaths, with the ultimate goal of eliminating these deaths entirely. The research in the last 20 years has done so much for preventing infant death as it relates to sleep. We need to be vigilant and continue looking for ways to prevent these deaths.

Media's Role

Media and manufacturers should follow safe sleep guidelines in their messaging and advertising. The AAP is stepping up its call on product manufacturers to use truthful, research-backed advertising and claims so that they do not prey on families who seek to protect their babies from SIDS.

Health Care Workers' Role

Health care providers, staff in newborn nurseries and NICUs, and child care providers should endorse and model the SIDS risk-reduction recommendations from birth. Part of the educational efforts of the campaign is to reach people other than parents who may care for your children, such as doctors, nurses, relatives, babysitters, and daycare workers.