Ways to Reduce Baby’s Risk

A baby is on her back in a bassinet, which is next to her mother's bed. Her mother lies in her own bed and rests her hand on the side of the baby's bassinet.

The American Academy of Pediatrics (AAP) Task Force on SIDS reviews all the latest scientific and clinical evidence about SIDS and other sleep-related infant deaths and makes recommendations about the most effective ways to reduce baby’s risk of Sudden Infant Death Syndrome (SIDS), and sleep-related deaths, 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 from the AAP Task Force on SIDS .

It’s important for all caregivers—parents, grandparents, aunts, uncles, babysitters, child care providers, and everyone 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 for a nap or at night,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.

Both the sleep surface (such as a mattress) and the sleep space (like a crib, bassinette, 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, like 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 from due to:
- Entrapment or wedging. Baby’s body or head gets stuck between two objects, such as a mattress and wall, bed frame, or furniture
- Suffocation. Something, such as a pillow or an adult’s arm, covers baby’s face and nose.
- Strangulation: Something presses on or wraps around baby’s neck or head.
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, like 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 a 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 are at high risk for suffocation and death from sitting this way.
Keep comforters, quilts, pillows, and blankets out of baby’s sleep area.

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.
Feeding babies human milk by direct breastfeeding, if possible, or by pumping from the breast, reduces the risk of SIDS. Feeding only human milk, with no formula or other things added, for the first 6 months provides the greatest protection from SIDS.
Feeding baby any human milk, even with other foods added, is more protective than not feeding them human milk at all.
The longer a baby gets human milk, the lower the SIDS risk.
Feeding human milk also has other benefits for babies, such as reduced risks of diarrhea, asthma, and ear infections.

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 your baby than putting 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. When finished, put baby back in their own sleep space close to your bed.
Babies with their own sleep space are at lower risk for injury and death from situations like an adult accidentally rolling over them.
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:
  - Sleep surface is soft, such as a waterbed, old adult mattress, couch, or armchair
  - Adult is very tired, taking medication that makes them drowsy, using substances like alcohol, or whose ability to respond is is affected in some way
  - 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)
  - Adult is not the baby’s parent, but is another caregiver, such as a grandparent or sibling
- Higher-than-normal risk:
  - Baby was born preterm (before 37 weeks) or born at a low birth weight
  - Sleep area includes unsafe items, such as pillows or blankets

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 (pillows, stuffed toys, crib bumpers)
- Under or over baby (comforters, quilts, blankets)
- Non-fitted, even if lightweight, small, or “tucked in”(loveys/cloths, non-fitted sheets, tucked-in blankets)
- Weighted (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 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.
Second-hand smoke in baby’s home, 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 hats when baby is 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.
Dressing baby in a wearable blanket or an extra layer of clothing can keep them warm without adding items in the sleep area.
Do not leave babies should not sleep or be left 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 protext 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.

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 deaths.
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 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 because sleeping on the stomach or side positions, which puts them at greater risk when swaddled increases the risk for SIDS and other sleep-related infant death than the back sleep position.

Supervised tummy time helps strengthen your baby's neck, shoulder, and arm muscles.
Tummy time also helps prevent flat spots on the back of your baby's head.
Tummy time is an important way to help improve baby’s motor skills and movement.
Tummy time sessions can start within a few days of birth, for 3 to 5 minutes, 2 or 3 times a day. As baby grows stronger, you can slowly make tummy time longer and practice it more times a day.
Pediatricians recommend that, by about 2 months of age, babies should be getting at least 15 minutes to 30 minutes of total tummy time daily.
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/SafeSleep.

Ways to Reduce Baby’s Risk

Place babies on their backs to sleep for naps and at night.

Use a sleep surface for baby that is firm (returns to original shape quickly if pressed on), flat (like a table, not a hammock), level (not at an angle or incline), and covered only with a fitted sheet.

Feed your baby human milk, like by breastfeeding.

Share a room with baby for at least the first 6 months. Give babies their own sleep space (crib, bassinet, or portable play yard) in your room, separate from your bed.

Keep things out of baby’s sleep area—no objects, toys, or other items.

Offer baby a pacifier for naps and at night once they are feeding well.

Stay smoke- and vape-free during pregnancy, and keep baby’s surroundings smoke- and vape-free.

Stay drug- and alcohol-free during pregnancy, and make sure anyone caring for baby is drug- and alcohol-free.

Avoid letting baby get too hot, and keep baby’s head and face uncovered during sleep.

Get regular medical care throughout pregnancy.

Follow health care provider advice on vaccines, checkups, and other health issues for baby.

Avoid products and devices that go against safe sleep guidance, especially those that claim to “prevent” SIDS and sleep-related deaths.

Avoid using heart, and breathing , motion, or other monitors as your main way to reduce the risk of SIDS.

Avoid swaddling once baby starts to roll over (usually around 3 months of age), and keep in mind that swaddling does not reduce SIDS risk.

Give babies plenty of “tummy time” when they are awake, and when someone is watching them.