Safe sleep is a topic that is discussed often, especially in October, which is Infant Safe Sleep Awareness Month / SIDS Awareness Month. But with all the information out there, it’s hard to get a concise list of what exactly “safe sleep” means and all of the aspects to be aware of.
That’s why we are breaking it down for you, so you can feel confident that you are doing your best to keep your baby safe during sleep.
First of all, why is safe sleep important?
SIDS is the most common reason for death in babies between 1 month and 1 year old. While SIDS is not completely preventable, some deaths can be avoided when certain precautions are taken.
What is recommended to avoid SIDS?
SIDS is unlikely to occur after age 1 (and 90% is in the first 6 months), so all of the AAP (American Academy of Pediatrics) recommendations are for babies under 12 months.
Here are the recommendations for babies under 12 months:
1. Your baby should sleep on her back.
This applies to both bedtime and naps. As your baby gets older, she may roll on to her stomach during sleep, but if she is able to roll back over on her own, you don’t have to worry about trying to re-position her. Just continue placing her to sleep on her back, and whether she stays that way is her choice. To prevent your baby from getting flat head syndrome, make sure she gets plenty of tummy time during her awake times (some recommend at least 30 minutes total in a day, and some pediatricians say at least an hour total in the day).
2. Use a firm mattress with a tight fitted sheet.
The mattress should not indent when the baby is lying in it, and the sheets shouldn’t wrinkle too much. The idea is that both the mattress and the sheet stay flat. Also, make sure that you cannot fit more than two fingers between the mattress and the sides of the crib; the mattress should fit the crib perfectly. This also means that your baby should not sleep in a rocker or swing, such as a Rock ‘n Play or mamaRoo, or fall asleep on a couch. Dock-A-Tots are also not officially recommended for safe sleep. If your baby falls asleep in a car seat or stroller, you should transfer her to her crib/bassinet/playard when possible. Between 2004 and 2014, researchers found that almost 350 infant deaths occurred when babies were sleeping in car seats, strollers, bouncers, or swings (two-thirds of those sleeping deaths happened in car seats, which were, for the most part, not in a car at the time).
3. Don’t have anything else in their sleep area.
Although nurseries on Pinterest and in baby magazines look cute, your baby’s bed should not have anything in it except a tight fitted sheet. This means no stuffed animals, pillows, blankets, quilts, sheepskins, toys, wedges, positioners, or bumper pads. If you think your baby will get cold, use a wearable blanket or warm swaddle. Pillows are not recommended until after age 2, or even better, until your baby transitions to a toddler bed.
4. Share a room for at least 6 months.
The AAP recommends that you sleep in the same room as your baby for at least the first 6 months of their life, or ideally, the first year. Room sharing decreases the risk of SIDS by up to 50%. It also makes it easier to feed your baby in those first few months before sleep training occurs! In an international study of 745 SIDS cases, it was estimated that 36% of SIDS deaths could have been prevented if the babies had been in the same room as the parents. However, parents are more likely to experience sleep deprivation if their baby sleeps in the same room. This is something for you and your partner to weigh the pros and cons of. If your baby is sleeping in a safe sleep crib, is breastfed (more info on that later), is at least 4 or 5 months old, and no one in the family smokes (more info on this, as well), then the chances of SIDS are quite low.
5. Avoid bed sharing.
Room sharing, but not bed sharing, is recommended. You can bring your baby into your bed to feed or comfort her, but if you fall asleep with your baby in your bed, there’s a risk of suffocation from you, your partner, pillows, or blankets, as well as a risk of her overheating or even falling off the bed. Bed sharing is always a risk, but is it even MORE of a risk if:
-You baby is under 4 months old, was born premature, or had a low birth weight.
-You or your partner smoke, or smoked during pregnancy, even if you only do it outside the house.
-You drank alcohol or took medication that makes you sleepy.
-You are not the baby’s biological parent.
-The bed is soft, or there are pillows and blankets on it.
These precautions are sometimes called the ABCs of safe sleep: Your baby is Alone, on their Back, in a safe Crib.
–Swaddling can help your baby sleep better, but stop swaddling when your baby starts rolling over on her own. The swaddle shouldn’t be loose enough to get undone, but also shouldn’t be so tight that it makes it hard for the baby to breathe or move her hips. Of course, always lay your baby on her back – especially in a swaddle!
-Try giving your baby a pacifier when they are going to sleep. Even if it falls out after the baby is asleep, you don’t need to put it back in; just giving the pacifier at the beginning of sleep has been shown to reduce the risk of SIDS. Don’t worry, though, if your baby doesn’t take the pacifier – some babies never learn to use them or like them.
–Breastfed babies are also less likely to die of SIDS. If possible, breastfeed your baby for at least 12 months – longer, if desired.
-Recent evidence shows that immunizations lower the chance of SIDS.
-Make sure there are no strings or cords anywhere near the crib that your baby could be strangled with, such as a baby monitor cord, window blind cords, or a mobile that is low enough for your baby to pull down.
-One cause of SIDS is overheating due to blankets, clothing, or room temperature. Turning on a fan has been shown to lower the chance of SIDS by more than 70%! The ideal room temperature is 68-72 degrees Fahrenheit. Your baby only needs to be wearing one more layer than you have on, so make sure you are not dressing them too warmly or putting a wearable blanket on top of already-warm clothes. Hats during sleep can also cause overheating. Here are some ways to know if your baby is the right temperature.
For more information about newborn sleep, check out our newborn sleep course.
Rachel Gorton/Mitchell is a certified infant and toddler sleep specialist and the owner of My Sweet Sleeper. She has worked as a sleep consultant since 2013 and has helped hundreds of families get better sleep with her individual approach to sleep teaching. As a mother herself, she is passionate about helping families get the sleep they need! For more information and to view her online courses and e-books, visit mysweetsleeper.com
The Conversation: Preventing infant deaths – The ABCs of safe baby sleep
HealthyChildren.org: How to Keep Your Sleeping Baby Safe – AAP Policy Explained
HealthyChildren.org: Make Baby’s Room Safe: Parent Checklist
National Sleep Foundation: SIDS and Sleep