As parents, we instinctively want to keep our kids safe. However instead of following the infant safe sleep guidelines, we often unintentionally create an unsafe sleep environment in an effort to promote better sleep for our babies.

While these unsafe sleeping arrangements may indeed result in better sleep, they also put babies at a greater risk for Sudden Unexpected Infant Death (SUID). This is when an infant previously thought to be healthy unexpectedly dies, usually during a sleep period. Some of these approximately 3,500 per year deaths are ultimately determined to be caused by accidental suffocation or strangulation while others remain unexplained and are classified as Sudden Infant Death Syndrome (SIDS).

What Causes SIDS?

The exact cause of SIDS is unknown, though current research focuses on the Triple Risk Model. This model says that SIDS is more likely to occur when 3 elements combine to create the perfect storm:

1. A vulnerable infant. Researchers are looking at brain stem abnormalities that when combined with external stressors increase the risk of SIDS.

2. Critical developmental period, or the first 6 months of life. 90% of SIDS deaths occur prior to 6 months of age. Two to four months of age is the greatest risk period.

3. External factors: stomach sleeping, bedding in the crib, second-hand smoke, overheating etc.

How Can SIDS Be Prevented?

The American Academy of Pediatrics (AAP) has a set of infant safe sleep guidelines designed to keep infants safe during sleep. In the 1990’s, the AAP launched the Back to Sleep Campaign. The result was a significant decrease in SIDS deaths in the first few years following the Back to Sleep push. However, over the past almost 20 years, infant sleep related deaths have markedly climbed. The majority are contributed to unsafe sleeping arrangements – generally babies do not sleep as well on their backs, and parents often resort to unintentional bed-sharing or using other products in a desperate effort to help their baby sleep.  The latest recommendations for safe sleep were released in 2016 and focus on creating a safe sleep environment.

What Are The Infant Safe Sleep Guidelines?

Back To Sleep

Infants should be placed on their back to sleep for ALL naps and at bedtime. Stomach and side sleeping have been found to double the risk of SIDS. Once the baby is able to independently roll, the AAP recommends they continue to be placed on their back when put in bed until a year of age. If the infant can also roll tummy to back, it is not necessary to flip them to their back each time they roll.

Babies should always sleep on a flat, firm surface designed for infant sleep that meets the Consumer Product Safety Commission’s (CPSC) safety standards; in other words, a crib/bassinet/play yard. Be careful when purchasing or borrowing second-hand products as they may not meet current guidelines. When sleeping on a non-flat surface, babies are at risk of positional suffocation due to the possibility of their chin falling towards the chest and causing airway restriction. This means that while it is tempting to let baby nod off and nap in the swing, or bring him inside in his car seat after a drive, you should instead transfer him to his crib.

The baby’s sleep space should contain a firm mattress, a fitted sheet, and the baby. That’s it. No pillows, stuffed animals, loveys, toys, etc before one year of age. While stuffed animals and blankets seem innocent, they pose a suffocation risk. Infant positioners/loungers such as the Dock A Tot are also not recommended by the AAP due to the risk for suffocation should the infant roll or become trapped with their face against the side/bottom. (Infant positioners/loungers also state that they are not for unsupervised (read: anytime your eyeballs aren’t watching baby) sleep if you read their fine print – contrary to the majority of the marketing images used by such products). 

Room Sharing Is Recommended, Bed-Sharing Is Not

The infant safe sleep guidelines from the AAP say an infant should share a room, but not a bed, with their parents for at least the first 6 months and ideally the first year of life. It is easier for parents to monitor their baby when they share a room. However, according to the July 2017 edition of Pediatrics, it has been found that infants who share a room with their parents are more likely to have unsafe objects in their bed and/or to sleep in their parent’s bed.  Alice Callahan, Ph.D. at Science of Mom does a great job explaining the science behind this recommendation as well as discussing the potential disadvantages such as increased parental sleep deprivation.

Per the AAP guidelines, bed-sharing should be avoided. Adult beds have pillows, blankets, and soft mattresses – all of which pose suffocation risks to infants. Also, there is the risk of a parent rolling onto an infant. While bed-sharing is never recommended, it should especially be avoided if the adult has been drinking alcohol, taking sleeping medication, is very tired, is a smoker, the baby is under 4 months, or the mattress is anything other than very firm.

If a parent worries they will fall asleep while feeding their infant, the AAP recommends making the bed as safe as possible by removing pillows and loose bedding and transferring baby to his own bed as soon as the parent awakens. It advises that parents who may drift off while feeding should opt to feed in their bed over than the couch or recliner due to the risk of positional suffocation or the infant becoming wedged between the parent and cushion; sofas count for 13% of sleep-related infant deaths.

Are There Any Other Infant Safe Sleep Guidelines?

DO encourage pacifier use. While per the AAP it does not need to be replaced after the infant falls asleep, studies have shown that having a pacifier when falling asleep reduces the risk of SIDS.

DO swaddle if you would like, as this can be comforting to baby. However, it is very important to stop swaddling as soon as baby can roll over and to use a swaddle that is sized appropriately and does not restrict the infant’s breathing and cannot cover their face. While the current official recommendation is to stop swaddling when a baby shows signs of rolling, some pediatricians say to stop swaddling at 8 weeks of age. This is because some babies start to roll as early as 2 months, and there is no way to predict when a baby will first roll in his sleep. If you have any questions about how long it is safe to swaddle your child, please ask your pediatrician!

DO keep the room cool, dress baby appropriately, and use a fan. Use of a fan has been shown to reduce the risk of SIDS by approximately 70% according to a study published in JAMA Pediatrics in 2008.

Educate All Caregivers on the Infant Safe Sleep Guidelines

It is important to make sure ALL caregivers are familiar with the infant safe sleep guidelines and how you would like your baby to sleep. Don’t just assume that grandma, the daycare, or the teenage babysitter knows to put your baby on its back for sleep, or to keep blankets and stuffed animals out of the crib. Make sure your caregivers know the ABC’s of safe infant sleep: baby should sleep Alone (no blankets/stuffed animals etc), on his Back, in his Crib.

Bottom Line

While it is impossible to completely eliminate the risk of SIDS, there are many steps that that can be taken to reduce the risk as much as possible. Talk to your baby’s pediatrician if you have questions regarding your child’s health and how it may affect his or her sleep. Be honest with your pediatrician regarding your sleep arrangements, even if you have chosen not to follow these recommendations. Following the infant safe sleep guidelines are just one part of thriving during the newborn period. Another important piece of the newborn puzzle is creating a sleep-friendly environment.

Remember safe infant sleep boils down to the ABC’s: Alone, on Back, and in Crib.

Happy Sleeping!


*As always, nothing in this post is intended to be medical advice or a replacement for medical advice. Please, if you have any questions or concerns about your child’s health or safe sleeping, discuss them with your child’s pediatrician or healthcare provider*

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