Safe sleeping standards for infants

By Leah Eagle

Whether you’ve just had a baby, or are expecting, one of the most important things to do is to create a safe sleep environment for them. Since babies spend much of their time sleeping in the first year of their lives, the nursery should be the safest room in the house.

In this blog, we’ll take a look at ways you can make sure your baby is safe while sleeping.

According to the Centers for Disease Control and Prevention (CDC), there are about 3,500 sleep related deaths among U.S. babies each year. They can be from SIDS (Sudden Infant Death Syndrome), accidental suffocation or strangulation, and other unknown causes.

In 2021, the American Academy of Pediatrics (AAP) updated its safe-sleep guidelines for infants for the first time in more than five years. It emphasized the importance for babies to sleep on their backs on flat, level surfaces to reduce their risk of SIDS.

Many of the deaths each year are preventable, and the authors of the new guidelines urge parents to take several simple steps to help keep their children safe.

The AAP has the following recommendations for a safe sleep environment for infants:

Lay your baby on their backs for all naps and at night

It’s recommended that infants be placed for sleep in the supine (back) position every time they sleep until they turn one. Studies show that babies who sleep on their backs are less likely to die suddenly and unexpectedly than babies who sleep on their stomachs or sides. Some parents may worry that babies will choke when they're on their backs, but their airway anatomy and their gag reflex will keep that from happening, including those with gastroesophageal reflux disease (GERD).

According to the Safe to Sleep Campaign, babies automatically cough up or swallow fluid that they spit up or vomit—it's a reflex to keep the airway clear. Studies show no increase in the number of deaths from choking among babies who sleep on their backs.

Provide a firm, flat sleep surface

Use a firm, flat, sleep surface with no incline covered by a fitted sheet with no other bedding or soft objects to reduce the risk of suffocation or wedging or entrapment.

A firm surface shouldn't indent when your baby is lying on it. Any surface that inclines more than 10 degrees isn't safe for your baby to sleep on. If your baby falls asleep in a car seat, stroller, swing or infant carrier, move them to a firm sleep surface on their back as soon as possible.

Place your baby in a crib, bassinet, portable crib or play yard that meets the safety standards of the Consumer Product Safety Commission (CPSC).

Never co-sleep with your baby 

Instead of bed sharing, room share with your baby. This means keeping your baby's sleep area in the same room where you sleep for at least the first 6 months, but in a crib, bassinet, or play yard close to your bed.

The AAP recommends room sharing because it can decrease the risk of SIDS by as much as 50% and it's much safer than bed sharing. Pillows and blankets could be dangerous for babies, along with the risk of the baby falling off the bed or someone accidentally rolling onto them during the night.

Room sharing will also make it easier for you to feed, comfort and watch your baby. If you do bring your baby into your bed to feed or comfort them, place them in their own sleep space when you're ready to go to sleep.

Once your baby is able to sit up on her own (sometime between 4 and 7 months) or pull themselves up to a standing position, it’s time to lower the mattress so they can’t climb out.

Keep soft objects and loose bedding out of your baby's sleep area

This can include items like bumper pads, pillows, blankets, comforters, mattress toppers, non-fitted sheets and stuffed animals. Keep these out of your baby’s sleep area to reduce the risk of entrapment, suffocation or strangulation.

Don't let your baby get overheated

Overheating can increase the risk of SIDS. Babies only need one more layer than you would wear in the same environment to be comfortable.

All of the above recommendations are based on studies that include infants up to 1 year.

The Safe Sleep for Babies Act was passed in 2021. It makes it unlawful to manufacture, sell, or distribute crib bumpers or inclined sleepers for infants. Specifically, inclined sleepers for infants are those designed for an infant up to one year old and have an inclined sleep surface of greater than 10 degrees.

In its new guidance, the AAP also warns against the use of commercial devices that claim to reduce the risk of SIDS or other sleep-related issues, including wearable monitors. 

To stay on top of current recommendations and for more information regarding safe sleeping, be sure to keep up-to-date on the guidance provided by the American Academy of Pediatrics and talk with your baby's pediatrician should you have any questions.