Safe Sleep for Babies: How to Lower the Risk of SIDS

Sleep is when many parents worry most. The American Academy of Pediatrics (AAP), through its HealthyChildren.org site, says about 3,500 babies in the United States die suddenly and unexpectedly during sleep each year, mostly from sudden infant death syndrome (SIDS) or accidental suffocation. No method guarantees that SIDS will not happen, but a safe sleep setup lowers the risk.

Always place babies on their backs

The AAP advises placing babies on their backs for every nap and every night. Side sleeping is described as just as risky as stomach sleeping, because a baby can roll onto the stomach. Babies with reflux should still sleep flat on their backs. Once a baby can roll both ways comfortably, you do not need to keep turning them back, but always start them on their back.

A firm, flat surface

• The surface should be firm and should not dip under your baby's weight. Any incline above 10 degrees is unsafe.
• Use a crib, bassinet, portable crib or play yard that meets safety standards, and check recall lists, especially for older cribs.
• The mattress should fit tightly, with only a fitted sheet on it.
• Car seats, strollers, swings and carriers are not for routine sleep. Move a baby who falls asleep in one to a firm, flat bed as soon as possible.
• Products not made for infant sleep, such as nursing pillows, should not be used for sleeping.

Room sharing, not bed sharing

The AAP recommends keeping your baby's sleep space in your room, close to your bed but not in it, for at least the first 6 months. It says this can lower SIDS risk by up to 50 percent and makes night feeds easier.

The AAP advises against bed sharing in all circumstances. If you bring your baby into your bed to feed or comfort them, put them back in their own space before you fall asleep. The AAP also warns against falling asleep with a baby on a sofa or soft armchair, where the risk can be up to 67 times higher. Bed sharing is especially dangerous if a parent has had alcohol or drowsiness-causing medicines or drugs, if anyone smokes or vapes, or if the baby is under 4 months or was born early or small.

Keep soft objects and loose bedding out

Leave pillows, quilts, comforters, blankets, toys and bumper pads out of the sleep space. If your baby seems cold, use layers or a wearable blanket rather than loose covers. The AAP says not to use weighted blankets, sleepers or swaddles.

Avoid overheating

Overheating raises SIDS risk. The AAP suggests dressing your baby in no more than one layer more than an adult would wear in the same room. Sweating, a hot chest or flushed skin are warning signs, and babies should not wear hats indoors after the first days at home.

Other things that help

• Breast milk: The AAP says breastfeeding or expressed milk protects against SIDS, and more protection comes the longer it continues.
• Pacifiers: Offer one at naps and bedtime. For breastfed babies, wait until feeding is well established. If it falls out during sleep, you do not need to put it back.
• Smoke-free air: Do not smoke, vape or use nicotine during pregnancy or after birth, and keep the home and car smoke-free.
• Checkups and vaccines: The AAP says regular visits and vaccines may help protect against SIDS.
• Tummy time while awake: It supports motor development and helps prevent flat spots on the head.
• Swaddling: It does not lower SIDS risk. If you swaddle, always place the baby on their back, keep it snug but not tight, and stop when the baby starts trying to roll, usually around 3 to 4 months.

Be careful with gadgets

The AAP says there is no evidence that products claiming to reduce SIDS work, and home heart or oxygen monitors do not reduce risk. They should never replace safe sleep habits.

When to see a doctor

Ask your baby's pediatrician about any worry over sleep or the sleep space. Seek urgent care if your baby is hard to wake, stops breathing, turns blue or looks unwell. In an emergency, call your local emergency number (112 in India, 911 in the United States).