Parents, caregivers, healthcare providers, and others have made great progress in reducing sleep-related deaths in the United States. By placing babies on their backs to sleep for all sleep times, creating a safe sleep environment for baby, and following other evidence-based recommendations from the American Academy of Pediatrics (AAP) Task Force on Sudden Infant Death Syndrome (SIDS), everyone who cares for baby can help reduce baby’s risk of SIDS and other sleep-related infant death, such as suffocation.
The actions listed here and in Safe to Sleep® materials and publications are based on the AAP Task Force recommendations. You can read the latest Policy Statement on Safe Infant Sleep from the AAP Task Force on SIDS.
It’s important for all caregivers—parents, grandparents, aunts, uncles, babysitters, child care providers, and anyone who might care for baby—to learn about safe infant sleep to help reduce baby’s risk.
- Place all babies—including those born preterm and those with reflux—on their backs to sleep until they are 1 year old.
- It is not safe to place babies on their sides or stomachs to sleep, not even for a nap. The safest sleep position is on the back.
- Babies who sleep on their backs are at lower risk for SIDS than babies who sleep on their stomachs or sides.
- If baby usually sleeps on their back, putting them on the stomach or side to sleep, like for a nap, increases the risk for SIDS by up to 45 times.
- Once babies can roll from back to stomach and from stomach to back on their own, you can leave them in the position they choose after starting sleep on their back. If they can only roll one way on their own, you can reposition them to their back if they roll onto their stomach during sleep.
Learn more about back sleeping and SIDS.
- Both the sleep surface (such as a mattress) and the sleep space (such as a crib, bassinet, or portable play yard) should meet the safety standards of the Consumer Product Safety Commission (CPSC). The CPSC offers more information about mattress and crib safety.
- Soft surfaces, such as couches, sofas, waterbeds, memory foam, air and pillow-top mattresses, quilts, thick blankets, and sheepskins, are not safe for babies to sleep on. Babies who sleep on soft surfaces may not be able to breathe due to entrapment or wedging, suffocation, or strangulation. Learn more about other sleep-related deaths, including entrapment, suffocation, and strangulation.
- Inclined or tilted sleep surfaces, with one end higher than the other, are not safe for babies to sleep on, because baby’s body can slide down and their head can slump forward, which could block their airway and breathing.
- Do not use sitting devices, such as car seats and strollers, or carrying devices, such as carriers and slings, for baby’s regular sleep area or for naps. If baby falls asleep in a sitting or carrying device, move them to their regular sleep space as soon as possible once you are out of the vehicle. The American Academy of Pediatrics offers travel safety tips, such as giving baby breaks from the sitting device every few hours.
- Avoid letting baby sit slumped over, like with their chin on their chest, because it could block their airway and breathing. Young babies and those unable to control their head and neck muscles risk suffocation and death from sitting this way.
- Keep comforters, quilts, pillows, and blankets out of baby’s sleep area.
Learn more about creating a safe sleep area for baby.
Learn the definitions of key terms that can be found on the Safe to Sleep® website.
In most cases, pediatricians and other healthcare providers recommend feeding only human milk, with nothing added, if possible, for at least baby’s first 6 months. Babies born preterm or with certain health conditions may need different care.
Learn more about feeding your baby human milk and how breastfeeding and safe sleep go hand in hand.
- Babies in their own sleep space are at lower risk for injury and death from SIDS and situations like an adult or sibling accidentally rolling over them.
- Room sharing by putting baby’s sleep space near but not in your bed is safer than sharing your bed with baby. It is also safer to share your room with baby than to put baby in their own room.
- Keeping baby’s sleep space close to your bed makes it easy to check on, feed, and comfort baby without having to get all the way out of bed.
- If you are bringing baby into your bed for feeding or comforting, before you start, remove or clear away all soft items and bedding from your side of the bed. This may help prevent suffocation in case you fall asleep. When finished, put baby back in their own sleep space close to your bed.
- If you fall asleep while feeding or comforting baby in your bed, put them back in a separate sleep area as soon as you wake up. Research shows that the longer an adult shares a bed with baby, the higher baby’s risk for suffocation and other sleep-related death.
- Couches and armchairs are never safe places for babies to sleep. These surfaces are extremely dangerous when an adult falls asleep while feeding, comforting, or snuggling with baby. Do not let babies sleep on these surfaces alone, with you, with someone else, or with pets.
- Sharing an adult bed, couch, or armchair with baby can be risky, especially in some situations.
- Very high risk:
- The sleep surface is soft, such as a waterbed, old adult mattress, couch, or armchair.
- The adult is very tired, taking medication that makes them drowsy, or using substances like alcohol, or their ability to respond is affected in some way.
- The adult smokes cigarettes or uses tobacco products (even if they do not smoke in the bed).
- High risk:
- Baby is younger than 4 months old (regardless of adult smoking or sleep surface).
- The adult is a caregiver other than baby’s parent, such as a grandparent or sibling.
- Higher-than-normal risk:
- Baby was born preterm (before 37 weeks) or at a low birth weight.
- The sleep area includes unsafe items, such as pillows or blankets.
- Very high risk:
Learn more about creating a safe sleep environment for baby.
- Remove everything from baby’s sleep area, except a fitted sheet covering the mattress.
- Things in the sleep area can pose dangers for baby, especially if they are:
- Soft or squishy (e.g., pillows, stuffed toys, crib bumpers)
- Under or over baby (e.g., comforters, quilts, blankets, positioners)
- Non-fitted, even if lightweight, small, or “tucked in” (e.g., loveys, cloths, non-fitted sheets, tucked-in blankets)
- Weighted (e.g., weighted blankets, weighted swaddles, weighted objects)
- Research links crib bumpers and bedding other than a fitted sheet covering the baby’s mattress to serious injuries and deaths from SIDS, suffocation, entrapment, and strangulation.
- If feeding baby human milk through direct breastfeeding, wait until breastfeeding is well established, based on your pediatrician’s guidance, before trying a pacifier. Breastfeeding is “well established” when the parent has enough milk to feed and satisfy baby’s hunger, parent and baby are comfortable during breastfeeding, and baby is gaining enough weight to meet growth goals.
- If not breastfeeding, offer baby a pacifier as soon as you like. Research shows that pacifiers are especially helpful for reducing SIDS risk in formula-fed babies.
- To reduce the risk of strangulation, choking, and suffocation, do not attach the pacifier to clothing, stuffed toys, blankets, or other items.
- Do not coat the pacifier with anything, such as a sweetened liquid or honey.
- If the pacifier falls out of baby’s mouth, you don’t need to put it back in.
- It is OK if baby doesn’t want the pacifier; don’t force baby to take it.
- Finger or thumb sucking does not reduce SIDS risk.
- Smoking during pregnancy greatly increases baby’s risk of SIDS.
- Secondhand smoke in baby’s home, the car, or other spaces where baby spends time also increases the risk of SIDS and other health problems.
- Research shows that drug and alcohol use—during pregnancy and by infant caregivers—increases the risk of SIDS.
- Sharing an adult bed with baby when using drugs or alcohol also increases baby’s risk of injury and death.
- Baby can get hot or overheated if they are wearing too many layers of clothes and bedding for the room temperature (sometimes called overbundling). Overheated babies are at higher risk for SIDS and heat-related death.
- Dress baby in clothes suitable for the temperature of the room.
- Wearing hats while indoors can make baby too hot, so take off baby’s hat when inside.
- Watch for signs that baby is too hot, such as sweating, flushing/red or hot skin, or baby’s chest feeling hot to the touch.
- Dress baby in a wearable blanket or an extra layer of clothing to keep them warm without adding items to the sleep area.
- Do not leave baby alone in a vehicle, no matter the temperature outside.
- Visiting a healthcare provider as soon as you find out you are pregnant and then regularly until birth can help promote a healthy pregnancy.
- Research shows that in certain communities, regular prenatal care can also reduce the risk of SIDS.
- Pediatricians and other medical providers have the most up-to-date information about safe sleep, growth and development, and other health topics for baby.
- Research shows that vaccinated babies are at lower risk for SIDS.
- Vaccines also protect people, including babies, from dangerous and deadly diseases.
- Many wedges, positioners, or other products that claim to keep babies in one position or to reduce the risk of SIDS, suffocation, or reflux do not meet federal guidelines for sleep safety. These products, such as inclined sleepers, are linked to injury and death, especially when used in baby’s sleep area. You can help prevent injuries and death by not using these products and devices.
- No product can prevent SIDS.
- The Consumer Product Safety Commission has more information about safety standards for baby products at https://www.cpsc.gov.
Learn about research on home heart and breathing monitors and SIDS.
- These types of monitors are not effective at detecting or preventing SIDS.
- If you choose to use these devices for reasons other than detecting SIDS, make sure to follow safe sleep recommendations to reduce baby’s risk of sleep-related death.
- If you have questions about using these devices for health problems or concerns other than SIDS, talk with your baby’s healthcare provider.
- Even though swaddling does not reduce the risk of SIDS, some babies are calmer and sleep better when they are swaddled.
- If you choose to swaddle your baby, make sure you follow the American Academy of Pediatrics safe sleep recommendations to reduce baby’s risk of sleep-related deaths.
- Once baby starts to roll over on their own, swaddling increases the risk of suffocation and strangulation. Stop swaddling baby when they start rolling over, usually around 3 months of age.
- Using the back sleep position for swaddled babies is especially important. A swaddled baby may have trouble moving out of the stomach or side positions, which puts them at greater risk for SIDS and other sleep-related death than the back sleep position.
Tummy time refers to placing baby on their stomach while they are awake and someone is watching them. Learn more about the benefits of tummy time.
Visit https://healthychildren.org for more information on tummy time.
* The Consumer Product Safety Commission has more information on crib safety at https://www.cpsc.gov.