Safe Sleep for Babies: The ABCs of Reducing SIDS Risk

Every year, about 3,400 babies in the US die from sleep-related causes, including SIDS. The good news? Following safe sleep guidelines significantly reduces risk. These recommendations are based on extensive research and save lives.

This guide covers everything you need to know about creating a safe sleep environment for your baby.

What You Need to Know AAP

The ABCs of Safe Sleep:

• Alone: Baby sleeps alone in their own sleep space
• Back: Baby sleeps on their back
• Crib: Baby sleeps in a crib, bassinet, or play yard with firm, flat surface

Why this matters:

• SIDS (Sudden Infant Death Syndrome) risk peaks at 2-4 months
• Most sleep-related deaths are preventable
• Back sleeping has reduced SIDS by over 50% since 1994
• Safe sleep environment is the most important modifiable factor AAP

Back to Sleep—Every Time

Why back sleeping:

• Safest position for sleep
• Reduces SIDS risk significantly
• Babies on back can turn head if they spit up
• Side sleeping is NOT safe—babies can roll to stomach

What about flat head?

• Tummy time when awake prevents flat spots
• Alternate which direction baby faces
• Flat spots usually resolve on their own
• Safety is more important than head shape

When baby starts rolling:

• Continue placing on back
• If baby rolls to stomach on their own, it's okay to leave them
• Stop swaddling once rolling begins
• Ensure sleep surface is completely clear AAP

The Safe Sleep Surface

What's safe:

• Firm, flat mattress
• Fits snugly in crib/bassinet
• Tight-fitting sheet only
• Nothing else in sleep space

What's NOT safe:

• Soft mattresses or mattress toppers
• Pillows, blankets, or quilts
• Bumper pads (even mesh)
• Sleep positioners or wedges
• Stuffed animals or toys
• Loose bedding of any kind

Approved sleep surfaces:

• Safety-approved crib
• Bassinet
• Portable play yard
• Bedside sleeper attached to adult bed
• All should meet current safety standards

NOT safe for sleep:

• Adult beds
• Couches or armchairs
• Car seats (except while traveling)
• Swings or bouncers
• Inclined sleepers (recalled—do not use)
• Any soft surface AAP

Room Sharing vs. Bed Sharing

Room sharing (recommended):

• Baby sleeps in own space in parents' room
• Recommended for at least 6 months, ideally 12 months
• Reduces SIDS risk by up to 50%
• Makes nighttime feeding easier
• Baby has own safe sleep surface

Bed sharing (not recommended):

• AAP recommends against bed sharing
• Increases risk of SIDS, suffocation, entrapment
• Adult beds are not designed for infant safety
• Risk is highest with:
• Babies under 4 months
• Premature or low birth weight babies
• Soft bedding present
• Parent smoking, alcohol, or sedating medications

If bed sharing happens unintentionally:

• Remove all soft bedding and pillows
• Keep baby away from headboard, footboard
• Don't bed share on couch or armchair (highest risk)
• Return baby to safe sleep space as soon as possible AAP

Creating a Safe Sleep Environment

Temperature:

• Room temperature 68-72°F ideal
• Dress baby in one layer more than you'd wear
• Use sleep sack instead of blankets
• Watch for overheating signs (sweating, hot chest)

What baby should wear:

• Sleep sack or wearable blanket
• No loose blankets ever
• Don't overbundle
• Check that baby isn't too hot

Crib setup:

• Crib should meet current safety standards
• Slats no more than 2 3/8 inches apart
• No corner posts or cutouts
• Mattress fits snugly (no gaps)
• Only fitted sheet—nothing else

Room considerations:

• Keep room smoke-free
• Maintain comfortable temperature
• Fan may help (improves air circulation)
• Darker room may help sleep (not required for safety)

Common Questions About Safety

Swaddling:

• Can be done safely for newborns
• Must stop when baby shows signs of rolling
• Should not be too tight around hips
• Face must remain uncovered
• Many hospitals teach proper technique AAP

Pacifiers:

• Reduce SIDS risk
• Offer at sleep time once breastfeeding established (3-4 weeks)
• Don't reinsert if it falls out
• Don't force if baby refuses
• No clips or strings attached

Breastfeeding:

• Associated with reduced SIDS risk
• Any breastfeeding is protective
• Safe to breastfeed lying down, but return baby to safe surface

Tummy time:

• Important for development
• Only when baby is AWAKE and supervised
• Prevents flat head
• Strengthens muscles
• Not for sleep—ever

Dispelling Myths

Myth: Side sleeping is safe
Truth: Side sleeping is NOT safe—babies can roll to stomach. Only back sleeping is recommended.

Myth: Babies will choke on their back
Truth: Babies have reflexes that prevent choking. They're more likely to choke on stomach. Back is safest.

Myth: Once baby can roll, I should prop them on their back
Truth: Continue placing on back, but if baby rolls on their own, leave them. Don't use positioners (they're dangerous).

Myth: Bumper pads prevent injury
Truth: Bumper pads increase suffocation risk. Babies rarely injure themselves on crib slats. No bumpers—ever.

Myth: My baby sleeps better on stomach
Truth: Some babies may seem to, but stomach sleeping dramatically increases SIDS risk. Back sleep is safest.

Special Situations

Premature babies:

• Same safe sleep rules apply
• May need medical monitoring
• Extra important to follow guidelines
• Higher risk means extra vigilance

Babies with reflux:

• Back sleeping is still recommended
• Elevating head of mattress is NOT recommended
• Work with pediatrician on management
• Safe sleep still applies AAP

Twins or multiples:

• Each baby needs own sleep space
• Don't put twins in same crib
• Same safe sleep rules for each baby

Daycare and grandparents:

• Ensure all caregivers follow safe sleep
• Communicate guidelines clearly
• Many SIDS deaths occur in new sleep environment
• Every sleep, every time

What Other Parents Ask

Q: My baby seems uncomfortable on their back. What should I do?
A: Many babies fuss initially on their back but adapt. Try swaddling (if not rolling), white noise, or putting down drowsy but awake. The discomfort they show is not dangerous, but stomach sleeping is. Persist with back sleeping.

Q: Can I use a DockATot or similar lounger for sleep?
A: No. These are not safe for sleep—they have soft sides and baby can roll into them. The FDA has warned against them for sleep. Use only for supervised awake time. AAP

Q: My mother says we slept on our stomachs and were fine. Is back sleeping really necessary?
A: Yes. Since the Back to Sleep campaign began in 1994, SIDS rates have dropped over 50%. We now know more about safe sleep. Following current guidelines is critical.

Q: When can I stop worrying about safe sleep?
A: SIDS risk decreases significantly after 6 months and continues to drop after 12 months. Continue back sleeping until age 1. After that, most babies can safely sleep in various positions and with soft items.

Q: Is it okay if my baby sleeps in the car seat during a road trip?
A: For travel, yes—but monitor baby and take breaks. For routine sleep at home, no. Car seats can put baby in position that restricts breathing. Transfer to flat, safe surface upon arriving. AAP

The Bottom Line

Safe sleep is simple: Alone, Back, Crib (ABCs). Every sleep, every time—naps and nighttime, at home and elsewhere. These guidelines save lives. Share them with every caregiver who watches your baby. AAP

Safe sleep checklist:

• Baby on back
• Firm, flat surface
• Nothing in sleep space
• Room sharing, not bed sharing
• No overheating
• Pacifier offered
• Smoke-free environment

Clara is here to help you keep your baby sleeping safely.