Updated: July 16, 2020
By Mary Sweeney RN, BSN, CEN, ONN-CG
Infant Sleep Safety: What Parents Need to Know
Cribs, strollers, bottles, blankets – there’s a lot to prepare for as a new or expecting parent! You may have a laundry list of things to do and consider, but number one among them must be sleep safety. According to the American Academy of Pediatrics (AAP), 3500 infants die annually from Sudden Infant Death Syndrome (SIDS) -- that’s roughly 9 infants per day. While the exact cause is not known, there have been recent studies linking SIDS to unsafe sleeping environments, something that is entirely preventable.
In the following sections, we will talk about the current guidelines for safe sleep that have been put forth by the American Academy of Pediatrics (AAP), SIDS and how to prevent it, other sleep-related safety issues, and a helpful guide for new parents navigating the world of infant sleep.
What is Sudden Infant Death Syndrome (SIDS)?
SIDS, also referred to as Sudden Unexpected Infant Death (SUID), is when a child that is less than one year old dies unexpectedly and from no obvious cause. This often occurs while they are asleep or in an area used for sleeping, sometimes even with a parent present.
In 2016, the American Academy of Pediatrics (AAP) released a revised set of guidelines governing safe infant sleep. Although there is no one surefire way to prevent SIDS or SUID, there are several steps you can take to ensure your little one has a safe sleeping environment.
Back is best. Place your infant on his or her back to sleep, every time. Scientific evidence suggests that placing an infant to sleep on their back reduces the risk of SIDS. The exact reasoning for this is not known, but it has been suggested that infants that sleep on their stomachs may not get enough oxygen and instead rebreathe exhaled carbon dioxide. Recent studies have also shown that infants that have died of SIDS are found to have underdeveloped parts of their brain that alert them to danger, even while sleeping. When this “alert system” fails, babies are unable to wake up enough to move their heads away from objects that may be obstructing their ability to get enough oxygen. For these reasons, the AAP recommends that infants be placed on their backs for sleeping. If your baby ends up on their stomach, it’s okay to leave them there if they are able to roll from back to stomach and stomach to back independently.
Provide a firm sleep surface with no loose bedding or accessories. Infants should sleep on a firm mattress without padding, even if that padding is covered by a crib sheet. The crib or sleeping area should be free from stuffed animals, pillows, and crib bumpers. If you are not putting your baby in a traditional crib, steer clear of portable bed rails – babies can get caught between the mattress and the rail and can suffocate. Never let your baby sleep unattended in a car seat or swing, even for short periods of time. If you plan on swaddling your baby for sleeping or if you worry your baby may be cold, use a sleep sack instead of a blanket. HALO sleep sacks are available in both fleece and thinner cotton material, and many come with an attached piece for swaddling.
*Special note: There has been a massive recall of all Fisher-Price Rock n’ Play sleepers. DO NOT use these as a place for your baby to sleep, as there have been several infant deaths reported with their use. For more information, see here.
Make sure baby’s room is safe. This means ensuring that all cords, wires, and curtains are at least three feet away from your baby’s sleep surface.
Share your room. The AAP guidelines recommend sleeping in the same room as your baby for the first year of life. You are in-tune to your baby’s needs from the moment they enter the world, even when you’re sleeping. If your baby is in the same room as you, you may be able to recognize if they are in distress and correct the problem quickly. Many parents opt to have a bassinet right next to or attached to their bed (HALO swivel sleeper and SNOO smart sleeper are great options). If you want to have your baby in your bed with you, a popular option is the Dock-a-Tot. While there are no recommendations for or against products like the Dock-a-Tot, it will decrease the likelihood of rolling over onto your baby while sleeping in the same bed.
Use a pacifier. Pacifiers are a new parent’s best friend when it comes to soothing little ones, and they have also been shown to reduce the likelihood of SIDS. A couple of things to remember, though – if your baby refuses the pacifier or drops it from their mouth after a little while, don’t force it. If you’re breastfeeding, it’s best to wait until your baby establishes a good feeding schedule before starting pacifier use, usually around four weeks of age.
Make time for tummy time. It’s important to start tummy time early and do it often. Not only is this a great opportunity to bond with your little one, but it’s also incredibly important for their ability to develop neck strength. The stronger your baby’s neck muscles are, the better able they are to move their faces away from things that may block their nose and mouth.
Be mindful of where you sit. One of the most dangerous places to bottle or breastfeed your baby is your bed. Since you are most likely sleep deprived, there is a chance that you could fall asleep while holding and feeding your infant in bed, and they may end up in a dangerous position with soft bedding. This can also happen on a couch or sofa, so take care to stay awake while holding and feeding your infant. Never place an infant unattended on a sofa, couch, armchair, or bed.
Ensure a smoke-free environment. This should start before birth. Exposure to cigarette smoke both before birth and in infancy can increase the risk of SIDS dramatically. Even if you are not smoking around your baby, your clothes and skin can have smoke on them and can be a method of exposing your baby to secondhand smoke.
Beware of “monitoring” products. One of the new trends in the baby product market are devices that monitor your baby’s breathing and oxygen levels. While this can sound like a great way to have some peace of mind, these products are not 100% reliable. They can give less than accurate readings that either causes alarm when there is no danger or can give you false reassurance when there actually is a problem. The only time you should use products like this is if your child’s medical provider recommends it.
The American Academy of Pediatrics is comprised of board-certified pediatricians, and is the leading authority on safe sleep for infants. This page goes into great detail explaining the current guidelines and recommendations for safe infant sleep.
The AAP partnered with several child safety organizations including the U.S. Product Safety Commission to create this video. It’s geared towards helping new parents understand crib safety and how to create a safe sleep environment.
This “frequently asked questions” page hosted by the NIH is a wealth of information about safe sleep and SIDS prevention. It also addresses common concerns about sleep positioning and popular products that parents may be interested in using.
The March of Dimes organization is known for their campaigns for premature babies. This is an informative, executive summary page of safe sleep recommendations for new parents.