Safe sleep for babies

Each year, thousands of babies in the United States die while sleeping, often due to sudden infant death syndrome, suffocation or strangulation. 

What is SIDS?

SIDS, or Sudden Infant Death Syndrome is the sudden death of an infant from unknown causes before the age of 12 months.  Most SIDS deaths occur in babies between one and 4 months of age.  SIDS is the leading cause of death of infants between the ages of 1 month and 12 months.  It accounts for about 2500 deaths every year in the United States.

SIDS is diagnosed only after all other causes of death have been ruled out.  Although we do not know what causes SIDS, several risk factors have been identified including:

• Stomach sleeping
• Sleeping in a crib with loose bedding, bumpers, stuffed animals
• Becoming overheated while sleeping
• Tobacco smoke exposure (second hand smoke exposure)
• Poor prenatal care

How can I reduce the risk of SIDS?

SIDS is preventable with safe sleep habits.  Follow these guidelines to reduce the risk of sleep-related infant death:

Back to sleep:  In 1992 the American Academy of Pediatrics (AAP) launched its “Back to Sleep” campaign.  Since then, the incidence of SIDS has decreased by about 50%.  Infants should always be put on their backs to sleep.  This includes nap time and at bed time. 

Firm mattress: Babies should always sleep in a firm mattress in a crib, portable crib, or bassinet.  Make sure that there have been no recalls on your baby’s crib. 

Nothing in bed with baby: A baby does not have the strength to move its head away if something such as a stuffed animal or blanket gets in his face.

There should be no pillows, loose blankets, bedding, crib bumpers or plush toys in bed with your baby.  Infants can be put to sleep in a wearable blanket or sleep sack.  Swaddling is acceptable for the first 2-3 months of life as long as the swaddle is tight and the baby cannot get out of it. Once your baby starts to roll over, do not keep his arms in swaddle. You can help your baby transition to not being swaddled by keeping one arm out initially and then letting both arms out.

Avoid overheating: The optimal temperature for your sleeping baby is 65-70 degrees F.

Share this info with all of your baby’s caregivers: Be sure to talk to anyone caring for your baby, such as childcare providers, friends, sitters or grandparents about safe sleep practices.  When a baby is used to sleeping on its back, and then is put tummy-down to sleep, their risk of SIDS is even greater.

Frequently asked questions about infant sleep safety

Is tummy time safe?

There are some times when it is good for your baby to be on his or her stomach. Tummy time is good for your baby’s neck strength and helps prevent flattening of the back of your baby’s head (plagiocephaly).  Pediatricians encourage frequent tummy time when babies are awake and supervised.

What if my baby rolls onto his or her tummy when sleeping?

If your baby is able to comfortably roll both ways (from tummy to back and back to tummy), you do not have to reposition baby to sleep on her back if she rolls over.

Is a pacifier okay?

Pacifiers have been shown to decrease risk of SIDS.

Can my baby sleep in his car seat?

Car seats should not be used for sleeping outside of the car. The concern is that your baby’s head will fall forward and he will not be able to breathe as well. If your baby falls asleep in the car, move baby to his crib once you reach your destination. If you are going on long car drives, try to have someone sit in the backseat with your baby.

Additional resources:

• How to keep your sleeping baby safe: AAP policy explained (AAP)
• Additional information about SIDS (American SIDS Institute)
• More information about safe sleep and SIDS (First Candle Foundation)
• Guidelines for choosing a safe crib (CPSC.gov)

Reviewed by Sara Laule, MD
Updated by Sydney Ryckman, MD, February 2022