Safe Sleep Recommendations


​Safe Sleep: Recommendations

Approximately 3500 infants die each year in the United Started from sleep related infant deaths. The AAP policy statement, SIDS and Other Sleep-Related Infant Deaths: Updated 2016 Recommendations for a Safe Infant Sleeping Environment provides recommendations for building safe sleep environments. Explore these recommendations and relevant resources below to help families create a safer sleep environments for their children. 

AAP Safe Sleep Environment Recommendations 

Back to Sleep for every sleep.

  • Infants should be placed for sleep in a supine position (wholly on the back) for every sleep by every caregiver until the child reaches 1 year of age.  
  • Side sleeping is not safe and is not advised. 
  • Skin-to-Skin is care is recommended for all mothers and newborns, regardless of feeding or delivery method, immediately following birth (as soon as the mother is medically stable and awake) for at least an hour. Thereafter, or when the mother needs to sleep or take care of other needs, infants should be placed supine in a bassinet. 

Use a firm sleep surface. 

  • Infants should be placed on a firm sleep surface (eg, mattress in a safety-approved crib) covered by a fitted sheet with no other bedding or soft objects to reduce the risk of SIDS and suffocation. 
  • Infants should never be left to sleep on sofas, armchairs or in sitting devices. 
  • Soft bedding remains a risk for infants older than 4 months 

Breastfeeding is recommended. 

Breastfeeding is associated with a reduced risk of SIDS. Unless contraindicated, mothers should breastfeed exclusively or feed with expressed milk (ie, not offer any formula or other nonhuman milk-based supplements) for 6 months, in alignment with recommendations of the AAP.  

Explore the AAP Breastfeeding resources for more information or this online module from the National Action Partnership to Promote Safe Sleep, An Individualized Approach to Helping Families Embrace Safe Sleep and Breastfeeding.  

Room share without bed sharing. 

  • Infants should sleep in the parents’ room, close to the parents’ bed but on a separate surface (room sharing). The infant’s crib, portable crib, play yard or bassinet should be placed in the parent’s bedroom for at least 6 months but preferably a year. 
  • Even though it is not recommended that infants sleep on the same surface as the parents, there are times when parents may fall asleep while feeding their infant. Evidence suggests that it is less hazardous to fall asleep with the infant in the adult bed than on a sofa or armchair, should the parent fall asleep.  
  • Because there is evidence that the risk of bedsharing is higher with longer duration, if the parent falls asleep while feeding the infant in bed, the infant should be placed back on a separate sleep surface as soon as the parent awakens. 

Find this resource from the National Institute of Child Health and Human Development (NICHD)Breastfeeding your Baby to Reduce the Risk of SIDS.   

Keep soft objects and loose bedding away from the infant’s sleep area to reduce the risk of SIDS, suffocation, entrapment, and strangulation.  

  • Soft objects such as pillows and pillow-like toys, quilts, comforters, sheepskins, and loose bedding can obstruct an infant’s nose and mouth.  
  • Infant sleep clothing is preferable to blankets and other coverings to keep the infant warm 
  • Bumper pads are similar products that attach to crib slates or sides are not recommended for infants. 
  • A large percentage of infants who die of SIDS are found with their head covered by bedding. Therefore, no pillows, sheets, blankets, or any other items that could obstruct infant breathing or cause overheating should be in the bed. 

Consider offering a pacifier at nap time and bedtime once breastfeeding has been firmly established. 

  • Studies have reported a protective effect of pacifiers on the incidence of SIDS, even if the pacifier falls out of the infant’s mouth.  
  • The pacifier should be used when placing the infant for sleep. It does not need to be reinserted once the infant falls asleep. 
  • Pacifiers that attach to infant clothing, stuffed toys, or other objects should not be used with sleeping infants.  

Avoid smoke exposure during pregnancy and after birth. Encourage families to set strict rules for smoke-free homes and cars and eliminate exposure to secondhand smoke.  

Avoid alcohol and illicit drug use during pregnancy and after birth. 

  • Prenatal alcohol and/or illicit drug use in combination with bed-sharing places the infant at particularly high risk.  

Avoid overheating and head covering in infants. 

  • In general, infants should be dressed appropriately for the environment, with no greater than 1 layer more than an adult would wear to be comfortable in that environment.  
  • There is currently insufficient evidence to recommend the use of a fan as a SIDS risk-reduction strategy.  

Pregnant women should obtain regular prenatal care. 

Infants should be immunized in accordance with recommendations of the AAP and Centers for Disease Control and Prevention (CDC). 

Avoid the use of commercial devices that are inconsistent with safe sleep recommendations. 

  • The Consumer Product Safety Commission (CPSC) offers safety standards for bedside sleepers. There are no safety standards for in-bed sleepers. In addition, there are no published data examining the association of the use of bedside or in-bed sleepers with SIDS or unintentional injury of death, including suffocation. Therefore, a recommendation for or against the sleepers cannot be provided.  

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