Safe Sleep for Baby
Nora Hedgecock, OTR/L - February 5, 2021
Now that we've covered how newborns sleep, let's talk about sleep safety. The conversation about sleep safety is intimately related to something that it's often hard to even talk about - SIDS. SUID (Sudden Unexpected Infant Death) refers to all unexpected infant deaths, which includes SIDS and accidental suffocation. It’s important to remember that the incidence rate of SUID is extremely low (less than 0.001% of infants according to the CDC's 2018 data), and that there are simple steps you can take to reduce the risk and keep your little one safe while they sleep.
Tips for safe sleep
The following checklist is based on the 2016 recommendations from the American Academy of Pediatrics (AAP) for a safe sleeping environment to reduce the risk of SIDS:
- Always place baby to sleep on their back.
- Use a firm sleep surface with a tight-fitting sheet.
- Baby should never be placed to sleep on a couch, chair, pillow, or other soft surface where they may become wedged or trapped.
- There should be no loose fabric, blankets, pillows, or stuffed animals in baby’s sleep area (e.g. crib/bassinet).
- Share your room with baby. The American Academy of Pediatrics recommends having baby sleep in your room in a bassinet/small crib for the first six months, and ideally first year.
- It is safe to swaddle. If you’re using a swaddle, make sure there isn’t any loose fabric. The swaddle should be taut, but still allow baby to breathe comfortably and move their hips freely.
- Prevent baby from overheating. Don’t overdress them and watch for signs of overheating (e.g. chest hot to the touch, sweating)
A note on pacifiers
Pacifiers, while not necessary, can help reduce the risk of SIDS. If you are breastfeeding, hold off on offering baby a pacifier until they are 2-3 weeks old to support your milk production. If you are formula-feeding, the pacifier can be introduced at any time. If the pacifier falls out of your baby’s mouth after they fall asleep, you don’t need to put it back in.
Swaddling and rolling
Swaddling should stop as soon as baby starts to roll.
You should always place your baby to sleep on their backs. Once they’ve started to roll and you’ve transitioned out of the swaddle, if your baby rolls to their stomach during sleep you don’t need to turn them back over onto their back. It is still very important that there should be no blankets, pillows, bumpers, or stuffed animals in baby’s bed - just a firm mattress, tight sheet, and baby!
Car seat and stroller sleep
Car seats, strollers, or swings are not recommended for routine, unsupervised sleep as the baby might move into a position while asleep where straps or buckles block airflow. For this same reason, it is especially important to make sure that all straps and harnesses are properly buckled and tightened to prevent baby from slipping down into an unsafe position. If your baby falls asleep in the car or on your walk, transfer them to a safe sleep surface once you get home.
Room-sharing vs. Bed-sharing
The AAP recommends room-sharing, where parents place baby to sleep in a bassinet or small crib near their bedside, bringing baby into the parent bed only to feed or comfort while the parent is awake.
Bed-sharing refers to anytime a baby and parent sleep in a bed together. The AAP advises parents against bed-sharing. However, in a 2016 update of their safe sleep guidelines, the AAP recognized that parents often fall asleep while feeding their infant in bed even if they’ve never intended to bed-share, and acknowledged there are measures parents can take to reduce the risk of SIDS in these instances.
Over half (61%) of parents report they have bed-shared with their infant at some point. Knowing this, we feel it’s important to provide information on safe bed-sharing for families who choose to bed-share with any frequency. For more information about guidelines for safer bedsharing, check out Dr. James McKenna and La Leche League.
Every baby and every family is different. There is no one-size-fits-all recommendation or magic formula to completely eliminate SIUD, but there are many ways to make your baby’s sleep environment safe. We encourage you to use this information, explore these resources, and talk to your healthcare providers to make a decision that feels right for you and your family so that you and your baby can sleep sweetly, soundly, and safely.
As always, we are here for you. Join us for our office hours where you can ask about all things baby, sleep and beyond - no question is off limits!
“Data and Statistics for SIDS and SUID.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 10 Nov. 2020, www.cdc.gov/sids/data.htm.
“Helping Babies Sleep Safely.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 30 Sept. 2020, www.cdc.gov/reproductivehealth/features/baby-safe-sleep/index.html.
“How to Keep Your Sleeping Baby Safe: AAP Policy Explained.” HealthyChildren.org, American Academy of Pediatrics, www.healthychildren.org/English/ages-stages/baby/sleep/Pages/A-Parents-Guide-to-Safe-Sleep.aspx.
McKenna, James J. “Safe Cosleeping Guidelines.” Mother-Baby Behavioral Sleep Laboratory, University of Notre Dame, cosleeping.nd.edu/safe-co-sleeping-guidelines/.
“Safe Sleep for Babies.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 9 Jan. 2018, www.cdc.gov/vitalsigns/safesleep/.
“Safe Sleep for Your Baby: Reduce the Risk of Sudden Infant Death Syndrome (SIDS) and Other Sleep-Related Causes of Infant Death.” National Institute of Child Health and Human Development, National Institutes of Health, Jan. 2019, www.nichd.nih.gov/sites/default/files/2019-04/Safe_to_Sleep_brochure.pdf.
“The Safe Sleep Seven.” La Leche League International, 29 July 2020, www.llli.org/the-safe-sleep-seven/.
Task Force On Sudden Infant Death Syndrome. “SIDS and Other Sleep-Related Infant Deaths: Updated 2016 Recommendations for a Safe Infant Sleeping Environment.” American Academy of Pediatrics, American Academy of Pediatrics, 1 Nov. 2016, pediatrics.aappublications.org/content/138/5/e20162938.