For nine long months, you went to all your checkups, took your prenatal vitamins (even though they made you sick), slaved through maternity workouts, and made sure to eat the rainbow of healthy foods.
Your tiny bundle of joy has finally arrived, and your heart feels like it’s grown at least two sizes bigger. If you’re like most new parents, you suddenly find yourself Googling everything from how many diapers a day are normal to how to keep your sleeping baby safe.
While we can’t help you with the diaper situation (okay, it’s 8-12), keep reading for some guidelines on infant sleep safety that may help.
Main Causes of Sleep-Related Infant Deaths
Sleep-related infant deaths include sudden infant death syndrome (SIDS), accidental suffocation, and deaths from unknown causes and many can be attributed to these common practices:
Not Placing Infant on Back to Sleep
The likelihood of SIDS is much higher in newborns who are placed on their sides or stomachs for sleep. While choking is a concern for some parents, the airway anatomy and gag reflex prevent this from happening. According to the American Academy of Pediatrics (AAP), even babies with reflux should be placed on their backs for sleeping.
Using Bedding that is Soft
Using soft bedding like blankets, bumper pads, pillows, and toys is not recommended because infants can roll into them or accidentally cover their faces, blocking the airway. While it may seem harsh, only your baby and a firm mattress with a tightly fitted sheet should be in the crib.
It may be tempting to bring your baby to bed to get some extra rest. Unfortunately, bed-sharing may increase the risk of SIDS and isn’t recommended. This practice is especially unsafe for babies who were born prematurely, mothers who smoked during pregnancy, and parents who are obese.
What is Safe Sleep?
While it may feel daunting at first, keeping your little one safe while sleeping is possible if you follow certain guidelines. The AAP has created the ABC’s of sleep to make it easier for parents to remember—Alone, on their Back, and in a Crib free of extra items.
Guidelines that Could Help Your Infant Sleep Safely
Beyond the ABC’s, there are some additional guidelines that are important to follow to reduce risks while your little one is sleeping.
Clear the Crib of Potential Hazards
One of the joys of pregnancy is setting up the nursery. Many parents go to great lengths to outfit their newborn’s first resting place with elaborate decor and accessories. While many stores sell these matching bundles that include bumper pads, window coverings, comforters, and more, many of these items are hazardous for babies.
Soft bedding like blankets, pillows, bumper pads, and toys aren’t recommended for infants because of the risk of suffocation. Luckily, many cribs convert to toddler beds, and at that point, you can safely use all of that adorable bedding. Until then, less is more.
Ask Your Doctor for Safe Sleep Guidelines
While major health authorities like the AAP and CDC make general infant safety recommendations, every situation is different. Some newborns are born prematurely, some have special needs, and some have medical conditions that require extra precautions.
If you have concerns about your particular situation, the best person to speak with is your child’s doctor or pediatrician. They’ll have the latest, research-based info and can give you individualized guidance on how to keep your little one safe. They can also help to answer any questions you have about sleep safety guidelines.
Use Firm Bedding and Tight Sheets
There’s nothing like sinking into the comforting cradle of memory foam—except if you’re a baby. Unfortunately, soft mattresses are a hazard for babies since they can increase the risk of suffocation. The same goes for top sheets, blankets, and comforters.
The safest set-up is a firm mattress that fits snugly in the crib (with no gaps or spaces between the mattress and frame) covered with a tightly fitted sheet. A firm mattress should feel hard and not indent under your baby. You can dress your sweet cherub in layers or use a swaddle or sleep sack for warmth.
Place Baby on Back to Sleep
Back in the day, doctors promoted stomach sleeping for newborns because they thought it prevented choking. Now, we know the opposite is true. In the 90s, the “back-to-sleep” campaign was launched following mounting evidence that stomach sleeping was linked to an increased risk of death.
According to the National Institutes of Health, “compared with back sleeping, stomach sleeping increases the risk of SIDS by 1.7 – 12.9.” It is believed that the stomach position increases the rebreathing of carbon dioxide (decreasing oxygen levels), leads to upper airway obstruction, and causes overheating. Being placed on the back is considered the most effective intervention for safety.
Don't Allow Your Infant to Nap in a Swing
After nine months of being rocked in the womb, it’s no surprise that babies love motion. Many parents have been known to drive around for hours as a last resort to get a colicky infant to settle. Unfortunately, in a semi-upright position, the weight of the head can put pressure on the neck and block the airway.
A 10-year study of infant sleep-related deaths found that 3% occurred in sitting devices. It’s natural for little ones to conk out in the car seat or a swing, but according to the AAP, they should be moved to their crib as soon as possible to decrease the risk of SIDS.
Share a Room Not a Bed
Advice from the AAP is to keep your bundle of joy close but not too close. They recommend room-sharing for the first year (or at least the first 6 months) for SIDS protection; however, bedsharing is not advised. According to a 4-year study on SIDS, bed-sharing occurred in 47.1% of deaths.
If you’d like to have your babe within arms reach, you can consider a side-car arrangement or a bassinet placed close by. And if you do decide to co-sleep, it’s important to know the risks and do so as safely as possible.
Try Using a Pacifier
According to new research, breastfeeding for at least two months reduces the risk of SIDS by nearly 50%. Even if you can’t breastfeed, using a pacifier can also offer protection during sleep. Although the AAP has said in the past to avoid pacifiers until breastfeeding is established, more recent research suggests that pacifiers have no correlation with breastfeeding troubles.
It’s not fully understood how pacifiers contribute to safety, but their use decreased SIDS risk by 90% during last sleep according to one study. Try offering a pacifier at every nap and at bedtime, but you don’t need to worry about replacing it if it falls out while your little one is asleep.
Learn to Swaddle Safely
If you delivered in a hospital, you probably watched the nurses wrap your precious newborn into a cocoon. Swaddling can help your little one sleep because it resembles the tight confines of the womb. While you can buy swaddles that make the process easy, if you plan to swaddle using a blanket, it’s important to do so safely.
The AAP says that swaddling does come with a slight risk because it decreases arousal, making it harder for infants to wake up. If you swaddle, always place your baby on her back, watch for signs of overheating, and stop swaddling once your little one shows signs of trying to roll over.
Keep Room at a Comfortable Temperature
Another risk factor is overheating. Most parents pile on layers, worrying that their babies will be too cold. In reality, being too hot is more of a risk. Most experts recommend temperatures between 65 and 72 degrees Fahrenheit, or the equivalent of 18 to 21 degrees Celsius.
If you’re worried that this is too cool, you can add a swaddle or a sleep sack on top of infant pajamas. In general, most little ones are comfortable at the same temperature as adults (although some could benefit from one additional layer). Signs of overheating include sweating, flushed cheeks, rashes, damp hair, and rapid breathing.
Learn more: What is The Ideal Temperature a Baby's Room Should Be?
Invest in a Reliable Baby Sleep Monitor
At some point, every parent needs a break. Maybe you want to sneak in a shower, make a phone call, or just eat a meal in peace. When you can’t be next to your baby, a monitor is the next best thing.
A monitor can help to keep an eye (and ear) on your babe when you’re not around, but remember to also physically check on your tiny bundle in person too.
Remove Hanging Blinds or Cords Near Baby's Crib
Keeping the room as dark as possible can help your little one to rest, but many parents overlook a common hazard—hanging blinds and cords. Any hanging or loose items near the crib can lead to strangulation. Try to choose a location in the room that’s far away from tiny hands.
Mobiles that are securely attached can be safely used until your little one can get up on hands and knees (or by the time they are five months old). It’s also essential to avoid placing necklaces or strings around your baby’s neck or attaching a pacifier or toys to the crib or your baby.
How to Choose Safe Sleep Products
When you’re shopping for infant products, there are some important recommendations to keep in mind that may help to increase safety.
Check for Recalls
It’s astonishing how many child products are recalled every year, and yet many parents fail to register products so they aren’t even aware of the potential danger. As a parent or caregiver, it’s wise to periodically check for recalls on the items you use.
Recalls are generally issued by the Consumer Product Safety Commission, the Food and Drug Administration, and the National Highway Traffic Safety Administration, although you can also check with individual manufacturers.
Know the Expiration Date
Food isn’t the only thing with an expiration date. Most infant products have a short shelf life in order to keep little ones safe. The exact lifetime varies from product to product, but generally, items like car seats last for six years, while cribs last around ten years. To be sure, look for the expiration date on your item or check with the manufacturer.
Don't Buy Used Safety Items
There’s no doubt that kids are expensive. Gently used children’s clothing and accessory stores are popping up everywhere, but when it comes to certain items, it’s better to opt for new. This is especially true for things like car seats and cribs.
In addition to shorter shelf lives, older items may not meet current safety standards. For example, cribs manufactured before June 2011 may have drop-side rails which have now been banned. Used car seats may have been in an accident or recalled, so it’s best to buy these new.
Use Caution in Products that Allow Newborn to Sleep in Bed with You
Items that are marketed as making it safer for your baby to co-sleep should be used with caution. None of these products are endorsed or recommended by the major regulating bodies like the CDC or AAP because of a lack of research on their safety.
The AAP does recommend room sharing, and many parents find that a side-by-side arrangement is easiest during the early newborn phase. This can include having the crib or bassinet right up to the side of the bed or using a specially designed side-car that attaches directly to the side of the bed.
Be Wary of Home Infant Apnea Monitoring
Infant apnea is a medical condition that involves dangerous pauses in breathing and/or episodes of the heart rate dropping. This is more common in newborns who were born prematurely but occasionally can occur in healthy babies too.
Unless you’ve been advised to use a home apnea monitoring system by your pediatrician, these devices are best avoided. The AAP advises against relying on at-home heart or breathing monitors as a way to prevent SIDS since these items aren’t regulated and could actually increase risk in some situations.
Check to Ensure Products Meet Safety Standards
Safety standards for children’s items are constantly being updated based on the latest research and data. Organizations like the Consumer Product Safety Commission (CPSC) and the CDC continuously update the public on things like recalls, guidelines, and regulations for manufacturers.
Before buying items for your little one, check with the CPSC to see if the product that you’re considering is safe. While it may take an extra few minutes of time, it’s worth it when it comes to your baby’s well-being. Your pediatrician may also be able to provide you with guidance on the latest standards.
Recommendations to Reduce Risk of SIDS
Well-child check-ups are when your pediatrician will weigh and measure your baby to monitor growth and development. It’s also when your tiny tot will receive vaccinations that prevent harmful illnesses like meningitis and whooping cough. According to the AAP, recent evidence suggests that getting vaccinations may also help to protect against SIDS.
Don't Smoke Near Your Baby's Room
Smoking during pregnancy or around your little one increases the risk of SIDS. If you smoke, it’s extremely important not to share a bed with your infant. It’s also best to avoid smoking in the car, home, or anywhere your baby will be.
According to research, breastfeeding or giving expressed breastmilk is protective against SIDS. The longer a babe is exclusively breastfed (without giving any formula), the better. For families that are unable to breastfeed, offering a pacifier can also help to protect little ones while sleeping.
Practice Tummy Time When Baby Is Old Enough
While babies should never be placed on their stomachs for sleep, tummy time while awake is important for motor development and to prevent flat head syndrome. Tummy time should always be supervised by an adult and should be practiced daily.
At first, your newborn may fuss and cry during tummy time because they aren’t used to being placed face down. Try laying face to face with your baby, using a mirror, or dangling toys to encourage your little one to lift up his head. This will encourage upper body strength and help your tot eventually learn to crawl.
Having a baby can be an emotional rollercoaster. Even before your little one was born, you probably worried about whether she’d be healthy and born full-term. Once your bundle of joy arrives, the worries only increase—especially when it comes to safe sleep.
The best thing you can do as a parent is to familiarize yourself with the risks (which you just did) and follow the recommended guidelines for keeping your little one safe. Before you know it, this stage will pass and you’ll be worrying about things like how to stop your child from licking the bottom of his shoe and how to sneak veggies in her pasta.
Jill Zwarensteyn is the editor for Sleep Advisor and a certified sleep science coach. She is enthusiastic about providing helpful and engaging information on all things sleep and wellness.
Based in Los Angeles, she is an experienced writer and journalist who enjoys spending her free time at the beach, hiking, reading, or exploring new places around town.
She’s also an avid traveler who has a personal goal of being able to successfully sleep on an airplane someday.