Advancing Children's Health

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Infant Care: Sleep Safety

Published by , on Oct 16, 2013

A version of this blog post originally appeared in CHoR’s Fall 2013 TidBits Newsletter. As a pediatrician, lactation consultant and mother of three, Dr. Gauri Gulati shares her knowledge of safe sleep practices to ensure our little ones stay safe through the night.

The number of deaths from Sudden Infant Death Syndrome (SIDS) has decreased significantly since 1992 when the American Academy of Pediatrics (AAP) issues the recommendation that babies be placed on their backs to sleep. However, sleep-related deaths from other causes, including suffocation, choking and babies becoming trapped, have increased since then. To help address this and provide more specific advice on sleep safety, the AAP recently expanded their guidelines on safe sleep for babies and added recommendations for a safe sleeping environment that can reduce the risk of all sleep related infant deaths.

High angle shot of a little baby boy sleeping on a bedThe following are three important additions to the AAP’s safe sleep guidelines:


  • Breastfeeding is recommended. It is associated with a reduced risk of SIDS.

  • Infants should be immunized. Immunization reduces the risk of SIDS by 50 percent.

  • Bumper pads should NOT be used in cribs. There is no evidence that bumper pads prevent injuries and there is a risk of suffocation, strangulation and babies becoming trapped (entrapment) if bumper pads are used.


The AAP recommends the following for creating the safest possible sleep environment:


  • Always place a baby on their back, not sides or tummy, for sleep time. This recommendation applies to both nighttime sleep and nap time. Once and infant can roll from back to stomach and stomach to back, the infant can be allowed to remain in the sleep position that he or she assumes.

  • Always make sure there are no soft objects or loose bedding such as pillows, stuffed animals, blankets and bumper pads in the crib, play yard or bassinet. These items can increase the risk of suffocation and entrapment.

  • Wedges and positioners should not be used. These items are often made of soft materials and have been linked to deaths related to entrapment and suffocation. There is also a lack of evidence that these products are effective against SIDS or digestive issues such as reflux.

  • Cribs should not have drop sides and should meet safety standards of the CPSC, Juvenile Products Manufacturers Association and the ASTM International for slat spacing and firmness and fit of the mattress. If a portable crib, bassinet or play yard is used, it should meet CPSC guidelines which include: a sturdy bottom and wide base, smooth surfaces (no hardware sticking out), legs with locks to prevent folding while in use, and a firm, snug-fitting mattress.

  • There should never be gaps between the mattress and side of the crib, bassinet or play yard. Only mattresses and fitted sheets designed for specific product should be used. The mattress should be firm and should hold its shape when covered with a fitted sheet.

  • The safest place for your baby to sleep is in the room where you sleep, but not in your bed. Place the baby’s crib or bassinet near your bed (within arm’s reach). This makes it easier to breastfeed and to bond with your baby.

  • Avoid covering the infant’s head or overheating the infant.

  • Offer a pacifier at nap time and bedtime once breastfeeding is well established. Several studies have found a protective effect of pacifiers in regard to SIDS.

  • Do not use home monitors or commercial devices marketed to reduce the risk of SIDS. There is no evidence that these are effective in reducing SIDS.


Additional safe sleep recommendations are listed at healthychildren.org/sleep.

SIDS is defined as the sudden death of an infant less than one year of age that cannot be explained after a thorough investigation is conducted. SIDS is the leading cause of death among infants between the ages of 1-12 months and is the third leading cause overall of infant death in the United States.

Be sure to talk about safe sleep practices with everyone who cares for your baby! If a caregiver does not know the best safe sleep practices, share what you have learned about sleep safety and the importance of following these rules when caring for infants. Before leaving your baby with anyone (child care providers, family members, friends, etc.), be sure the person agrees that safe sleep practices will be followed all of the time.

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