In recent years, remarkable progress has been made in reducing the risk of sleep-related deaths and SIDS in infants. Research has shown a number of factors related to the risk of death while sleeping, and effective changes that reduce the risk. The two greatest changes involve babies always sleeping on their backs in a clear, flat sleep space that is smoke free.
The ABCs of Safe Sleep
Sleep on back, always
Your baby should always sleep safely (on their back). Every time.
Babies who normally sleep on their backs and are put on their tummies at daycare or by a babysitter or family member are at increased risk of death. You must be sure that everyone who cares for your baby knows to put her on her back to sleep, every time.
Your baby should sleep on their back. This has dramatically reduced the number of SIDS deaths in every country that has implemented this change, including the United States.
Babies should not sleep on their sides. Do not use wedges or props to put your baby on her side. Even babies who spit up are safer on their backs.
In a clear, flat space
Your baby should sleep in a clear, flat sleep space.
Your baby should always sleep on a firm surface, with nothing soft or fluffy added to the sleep area. That means a firm mattress or pad with only a sheet that fits securely over it. Do not use blankets, pillows, crib bumpers, stuffed animals, or anything else soft and fluffy in the bed area with the baby.
Sleep in an area free of smoke
Your baby should sleep in a smoke-free area day and night.
Falling asleep other places
It is natural for your baby to fall asleep on you, in your arms, skin to skin or feeding, but this can be very dangerous, especially lying down on couch or in chair, or lying in bed with baby on you.
Never put your baby to sleep on a sofa, couch, waterbed, armchair, pillow or cushion.
If your baby falls asleep in her car seat, swing, bouncy seat, during tummy time, or other areas, move her to a safe sleep location.
Avoid overheating
Don’t let your baby get overheated. Be sure she is not dressed too warmly, and don’t put the crib or bassinet near a window or a vent. Dress your baby lightly, and keep the room temperature at a level comfortable for a lightly dressed adult. If your baby looks red or flushed, has damp hair or sheets, is sweating, or is getting heat rashes, then she is probably getting too warm while sleeping.
You can wrap your baby in a blanket, but even better is a sleeper made for bundling babies. If necessary, you can lay a light blanket over your baby and tuck it into the sides of the crib, but it is better just to dress and wrap your baby warm enough and not use a blanket over her.
Using infant sleepers is safer than blankets or other coverings to keep the baby warm. Also, overheating increases the risk of SIDS. Never use any kind of head covering.
Bed-sharing
Many parents, particularly in certain cultures, have babies sleep next to them in bed. This is called bed-sharing and is somewhat of a controversial topic. (It is sometimes called co-sleeping but that refers to the baby in the same room whether in the same or a separate bed).
Research shows that there is an association between bed-sharing and sleep-related death and is not recommended by the American Academy of Pediatrics. Breastfeeding or other feeding at night can be made easier by having the baby sleep in a bassinet or crib near or attached to your bed.
Current international guidelines emphasize the fact that bed-sharing will happen at some point in almost every family. There are clear guidelines about when the risk is highest and should not be done; following these guidelines would likely dramatically decrease the rate of sleep-related death during bed-sharing.
Unplanned bed-sharing is a higher risk, so be sure to educate yourself on safer bed-sharing before the middle of one night!
As many as half of SIDS deaths happen while bed-sharing. However, 90% of those deaths happen with UNSAFE bed sharing. These risk factors make bed-sharing much higher risk for infant death. Parents who bed share could choose to stop these activities and reduce the risk of bed-sharing, or choose not to bed-share if they continue them.
If you bed-share:
- Be sure your baby is kept away from pillows and soft bedding, blankets, and any other soft materials. Make sure nothing can cover your baby’s head and face.
- Your baby should still sleep on her back.
- You can make a sheltered area for baby by lying on your side with knees up and having baby in the area your body makes (C-position or “cuddle curl”)
- Be absolutely sure baby cannot fall off the bed or get trapped between mattress and wall, headboard or anything else.
- Don’t leave baby alone in bed.
- Don’t bed-share in water bed or non-firm surface.
- Never fall asleep or share sleep with baby on a sofa or in a chair.
- Bed-sharing is safer if the baby is breast-fed
DO NOT bed-share if:
- Your baby was preterm or very small
- You smoke or anyone in your house smokes
- You drink alcohol or use any kind of drugs
- You take medication that makes you sleepy or helps you sleep
Other ways to reduce the risk of sleep-related death & SIDS
In addition to the ABCs of safe sleep, there are other ways to decrease the risk of sleep-related death:
- Breastfeeding
- Using a pacifier
- Not smoking while pregnant
- Not using alcohol or drugs while pregnant or after the baby is born
- Taking baby to all recommended well-child visits