Bringing a new baby home comes with a flood of advice, and sleep is one area where the guidance really matters. According to the American Academy of Pediatrics (AAP), about 3,500 babies in the United States die suddenly and unexpectedly during sleep each year, most often from sudden infant death syndrome (SIDS) or accidental suffocation or strangulation. There is no guaranteed way to prevent SIDS, but following safe sleep practices lowers the risk significantly. This guide summarizes the AAP’s recommendations in plain language, with practical tips for cold-weather months when the urge to add blankets is strongest.
Back to Sleep, Every Sleep
Place your baby on their back for every nap and every night, until their first birthday. The AAP notes that side sleeping is just as risky as stomach sleeping. Once a baby can roll from back to tummy and tummy to back on their own, you do not need to reposition them if they roll during sleep, but always start them on their back.
Make sure every caregiver, including grandparents, babysitters and child care providers, knows this rule. Babies who usually sleep on their backs but are placed on their stomachs by someone else are at higher risk.
A Firm, Flat, Bare Sleep Space
Your baby should sleep on a firm, flat surface in a crib, bassinet or play yard that meets federal safety standards from the U.S. Consumer Product Safety Commission (CPSC), with only a fitted sheet.
- Keep it bare. No pillows, blankets, quilts, bumper pads, stuffed toys or loose sheets.
- Avoid inclined products. The AAP advises against any sleep surface inclined more than 10 degrees. Car seats, strollers, swings and loungers are not for routine sleep; if your baby falls asleep in one, move them to a flat sleep space when you can.
- Skip weighted products. The AAP recommends against weighted sleep sacks, weighted swaddles, weighted blankets and other weighted objects on or near a sleeping baby.
- Check secondhand cribs. Avoid drop-side cribs and anything with missing hardware or wide slat gaps, and check the CPSC’s recall database.
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 six months. Room sharing can reduce the risk of SIDS by as much as 50%.
The AAP does not recommend bed sharing under any circumstances, including with twins or other multiples. The risk is especially high if a parent has been drinking alcohol, has used drugs or certain medications, smokes or vapes, or if the baby is very young, small or premature. Couches and armchairs are particularly dangerous places to fall asleep with a baby. If you are feeding your baby in bed at night and might doze off, remove pillows and blankets from the area and move your baby back to their own sleep space as soon as you wake.
Keeping Babies Warm Without Blankets
In winter it is tempting to bundle up, but overheating is also linked to SIDS. The AAP suggests dressing your baby in no more than one layer more than an adult would wear to be comfortable in the same room, and avoiding hats indoors.
- Use a wearable blanket or sleep sack instead of loose blankets.
- Check for overheating: sweating, flushed skin or a hot chest are signs your baby is too warm.
- Keep the room at a temperature that is comfortable for a lightly dressed adult.
What about swaddling?
Swaddling is optional and does not reduce SIDS risk. If you swaddle, always place your baby on their back, keep the wrap snug around the chest but loose at the hips, and stop as soon as your baby shows signs of trying to roll, which often happens around 3 to 4 months.
Other Protective Steps
- Breastfeeding: breast milk is associated with a lower SIDS risk. Any amount helps.
- Pacifiers: offering a pacifier at naps and bedtime may lower risk. For breastfed babies, wait until breastfeeding is well established. Never hang a pacifier around your baby’s neck or attach it to clothing during sleep.
- Smoke- and nicotine-free: avoid smoking, vaping and nicotine during pregnancy and around your baby.
- Routine checkups and vaccines: keep up with well-baby visits and talk with your pediatrician about recommended immunizations.
- Supervised tummy time: when your baby is awake and watched, tummy time helps build neck and shoulder strength.
Safe Sleep When You Are Away From Home
Holiday travel and visits to relatives can disrupt routines and introduce unfamiliar sleep setups. Plan ahead so your baby can sleep safely wherever you are. A portable play yard or travel crib that meets current safety standards, used with the sheet designed for it, is a good option. Do not add an extra mattress or padding that did not come with the product. Avoid letting your baby sleep on an adult bed, sofa or air mattress, or in a car seat once you have arrived. Check hotel cribs for missing parts, broken slats or loose sheets, and ask for a replacement if anything looks wrong. When staying with family, share your safe sleep plan with everyone who might put your baby down for a nap. A short note on the crib, such as “back, bare, no blankets,” can help grandparents and other caregivers who learned different advice years ago.
FAQ
Are baby monitors that track breathing or heart rate recommended?
The AAP does not recommend home cardiorespiratory monitors as a way to reduce SIDS risk. If you use a consumer monitor, do not let it replace safe sleep practices.
My baby spits up. Is back sleeping still safe?
Yes. Healthy babies have reflexes that protect their airway. Talk to your pediatrician if you have concerns about reflux.
When can I add a blanket or pillow?
Keep soft bedding out until at least your baby’s first birthday, and ask your pediatrician when your child is ready.
Sources
- HealthyChildren.org (AAP): A Parent’s Guide to Safe Sleep
- NIH Safe to Sleep Campaign
- CDC: Helping Babies Sleep Safely
Featured image: Paul Goyette from Chicago, USA / Wikimedia Commons, CC BY-SA 2.0