Key takeaways: Alone, on the Back, in a Crib (or bassinet) with nothing else in it, for every sleep until age 1. Room-share without bed-sharing for at least 6 months. Avoid inclined and weighted products. Never fall asleep with your baby on a couch or armchair.
Sleep-related deaths, including sudden infant death syndrome (SIDS) and accidental suffocation, are the leading cause of death for babies between 1 month and 1 year old. About 3,500 U.S. babies die this way each year. Many of these deaths happen in unsafe sleep environments, which means many are preventable. Here’s what the American Academy of Pediatrics recommends.
The ABCs of Safe Sleep
A is for Alone. Your baby should sleep in their own sleep space, without pillows, blankets, bumpers, stuffed animals, positioners, or other people.
B is for Back. Place your baby on their back for every sleep, naps and nighttime, until their first birthday. Back sleeping is the single most important step for preventing SIDS. Side sleeping isn’t safe because babies can easily roll onto their tummies. Once your baby can roll both ways on their own, you don’t need to flip them back, but always start on the back.
C is for Crib. Use a crib, bassinet, portable crib, or play yard that meets current federal safety standards. It should have a firm, flat, level mattress with a tight-fitting sheet and nothing else.
Room-Share, Don’t Bed-Share
The AAP recommends that babies sleep in the parents’ room, close to the parents’ bed but on a separate surface designed for infants, ideally for at least the first 6 months. Room-sharing has been associated with a lower risk of SIDS.
Bed-sharing (sharing an adult bed with your baby) is not recommended. The risk is highest when:
- Your baby is younger than 4 months.
- Your baby was born preterm or with low birth weight.
- An adult in the bed smokes, or the birthing parent smoked during pregnancy.
- An adult has used alcohol, sedating medications, marijuana, or other drugs.
- There are soft bedding, pillows, or a soft mattress.
- Your baby is sleeping with someone other than a parent, or with other children or pets.
Couches, sofas, and armchairs are the most dangerous places to fall asleep with a baby.
From the author
From First Breath to First Birthday is my month-by-month guide to your baby’s first year, written as a NICU and postpartum nurse. My book covers sleep month by month, alongside feeding, growth and the warning signs that mean it’s time to call the doctor.
When You’re Exhausted
Every parent gets tired, and many fall asleep while feeding at some point. Plan ahead:
- If you think you might fall asleep while feeding, feed in your bed rather than on a couch or chair.
- Remove pillows, blankets, and anything soft from around your baby.
- As soon as you wake up, move your baby back to their own sleep space.
- Ask a partner or helper to take your baby to the bassinet after night feeds.
Products That Aren’t Safe for Sleep
- Inclined sleepers, rockers, and swings: sleep surfaces tilted more than 10 degrees are unsafe. If your baby falls asleep in a car seat, swing, or bouncer, move them to a flat surface as soon as you can.
- Loungers, nests, and pods: these aren’t designed for unsupervised sleep.
- Weighted sleep sacks, swaddles, and blankets: not safe for infants.
- Crib bumpers: banned from sale under the Safe Sleep for Babies Act and linked to suffocation and entrapment.
- Sleep positioners and wedges: can cause suffocation and don’t prevent reflux complications.
- Home monitors: heart rate and oxygen monitors and “smart” baby monitors haven’t been shown to prevent SIDS and shouldn’t replace safe sleep practices.
Other Ways to Lower the Risk
- Breastfeed or feed human milk if you can. Any amount is associated with lower SIDS risk.
- Offer a pacifier at nap time and bedtime. For breastfed babies, you can wait until breastfeeding is well established. You don’t need to put it back in if it falls out after your baby is asleep.
- Avoid smoke, nicotine, alcohol, and drugs during pregnancy and after birth.
- Don’t overheat your baby. Dress your baby in no more than one more layer than an adult would wear. A wearable blanket (sleep sack) is a safe alternative to loose blankets. Don’t cover your baby’s head.
- Keep up with well-baby visits and vaccines. Vaccines are associated with a lower SIDS risk.
- Give supervised tummy time while your baby is awake to build strength.
Swaddling
Swaddling can help calm young babies, but always place a swaddled baby on their back, keep the wrap loose at the hips, and stop swaddling as soon as your baby shows signs of trying to roll. Our separate post on swaddling covers this in detail.
Teach Every Caregiver
Grandparents, babysitters, and childcare providers may have learned different advice years ago. Share these recommendations with everyone who puts your baby down to sleep.
The Bottom Line
Alone, on the Back, in a bare Crib, for every sleep. These simple steps protect your baby every night. If you’re exhausted, plan ahead so you never fall asleep with your baby on a couch or chair.
For a complete, nurse-written guide to sleep and safety in the first year along with tons else, see my book, From First Breath to First Birthday.
Related Articles
- Room-Sharing Without Bed-Sharing: Setting Up a Safe Space
- Products That Aren’t Safe for Sleep: Loungers, Inclined Sleepers, and Weighted Sacks
- SIDS Myths and Facts
Sources
- Moon RY, Carlin RF, Hand I; Task Force on Sudden Infant Death Syndrome; Committee on Fetus and Newborn. Sleep-related infant deaths: updated 2022 recommendations for reducing infant deaths in the sleep environment. Pediatrics. 2022;150(1):e2022057990.
- Moon RY, Carlin RF, Hand I; Task Force on Sudden Infant Death Syndrome; Committee on Fetus and Newborn. Evidence base for 2022 updated recommendations for a safe infant sleeping environment to reduce the risk of sleep-related infant deaths. Pediatrics. 2022;150(1):e2022057991.
- Centers for Disease Control and Prevention. Sudden unexpected infant death and sudden infant death syndrome: data and statistics. https://www.cdc.gov/sudden-infant-death
- National Institute of Child Health and Human Development. Safe to Sleep campaign. https://safetosleep.nichd.nih.gov
- US Consumer Product Safety Commission. Safe Sleep for Babies Act; infant sleep products rule (16 CFR Part 1236). https://www.cpsc.gov
- Thompson JMD, Tanabe K, Moon RY, et al. Duration of breastfeeding and risk of SIDS: an individual participant data meta-analysis. Pediatrics. 2017;140(5):e20171324.
This article is for general education and is not a substitute for individualized medical advice. Always talk with your baby’s health care provider or your own provider about your specific situation. If you think your baby or you may have a medical emergency, call 911.
