About 3,500 babies die suddenly and unexpectedly every year in the U.S. in unsafe sleep environments. These include deaths from sudden infant death syndrome (SIDS) and accidental suffocation deaths that occur while babies are sleeping and are the most common cause of death for infants from 1 month to 1 year of age. The good news is that by following the safe sleep recommendations, most of these deaths can be prevented!

The American Academy of Pediatrics (AAP) is the leading organization of pediatricians (baby and children doctors) in the U.S. The AAP develops guidelines for parents and others who care for babies every 5 years, based on the latest research. Many other organizations have adopted these guidelines, including state and federal agencies that provide advice on mother and infant health. There are many recommendations to help keep babies safe during sleep. The main ones that we are focusing on in TodaysBaby are:

• Always place your baby on the back for sleep.
• Have your baby sleep in your room but not in your bed. Babies sleep safest in their own sleep space, such as a bassinet, crib or portable crib that is in your room, close to your bed.
• Avoid soft bedding in the sleep space. This includes fluffy blankets, bumper pads, pillows, and stuffed toys.
• Offer a pacifier to your baby for every sleep. For babies who are breastfeeding, you should wait until breastfeeding is going well, usually when your baby is 2 to 3 weeks old.

Research from all around the world has shown that babies who sleep on their back are at the lowest risk for SIDS and suffocation deaths. This allows baby to have a clear, open air passage and avoid situations which may cause harm, such as a face down position where air cannot get to the baby freely. It is important to put your baby on the back every time, even for naps.

It is not safe to sleep on the side, because babies often roll over and cannot change their position to a safe one when they are young. So a baby placed on the side may end up on the stomach, and this causes the same problem as sleeping on the stomach to begin with. So, always place your baby on the back for sleep.

Actually, babies choke LESS when on their backs. This is demonstrated in the photos below. So don’t worry, your baby is much safer on the back.

On the Back:

Here the airway is above the esophagus (food pipe).

Anything that is spit up will be pushed  back down

by gravity to the lowest point.  The trachea (airway) is protected.

On the stomach, the airway is below the

esophagus. Anything that is spit up will be

pushed back down by gravity to the lowest

point. On the stomach it is easier to breathe food,

or aspirate, into the lungs

It is true that many babies sleep more soundly on their stomachs. This is a problem however, because they may not wake up when they are in an unsafe situation, such as their nose pressed against the mattress. We want them to be able to wake up quickly and get themselves out of these situations. That is why we say, back is best.

But there are things you can do to help your baby sleep better and more comfortably on their back.

• Rocking your baby or putting your baby in a swing can help them fall asleep. However, you should also transfer babies onto a flat surface, like a crib, once they fall asleep.
• Soft background noise is soothing. You can try a fan, soft music, a white noise machine, or something similar.
• Pacifiers can help babies fall asleep and also help protect them from SIDS. Offer a pacifier at sleep time once breastfeeding has been established
• Swaddling can help comfort babies.

You can use a lightweight blanket to swaddle your baby, or a sleep sack on the market with a swaddle feature. Here is a picture of a baby in a swaddle sleep sack.

Stop swaddling when the baby is 3-4 months old, or once the baby tries to roll over (swaddled or unswaddled), whichever comes first.

Always place your baby on the back to sleep. A swaddled baby on the stomach has a much higher risk of suffocating.

Once your baby is rolling from front to back and back to front easily, you do not have to fix their position. But still always place your baby on the back. If your baby rolls onto the stomach and you are not sure if they can roll onto the back by themself, it is best for you to place them on the back again. Be sure to keep the sleep area free from loose blankets, pillows or other things that they might roll onto and cause a suffocation risk.

Babies spend a lot of time on their back since they sleep a lot, so it is important that they spend as much time as possible off of their backs when they are awake. They should be held upright or in a front baby carrier, and also have “tummy time” a few times a day. For tummy time, you can work up to 2-3 times a day. By 2 months of age, babies should spend about 20 minutes total every day in tummy time. Place the baby on the stomach on a firm surface. A blanket on the floor works great. The baby needs to be supervised by an attentive adult. Babies who fall asleep during tummy time should be moved to a crib, on the back. If you or the adult watching the baby needs to leave the room again, place the baby in a secure location on the back.

You can make tummy time more fun for your baby:

• Prop them up on their arms.
• Place yourself or a toy just out of reach and encourage them to reach for you or the toy.
• Place them on your chest while lying on your back. They will lift their head in order to see you better.

Babies who sleep in a bed with their mother or parents are at higher risk of dying from SIDS and suffocation. This also applies to breastfeeding babies. Adult beds are not designed with infant safety in mind. Mattresses can be thick and soft. Bedding is usually loose and soft (think comforters and pillows). Babies can also fall out of beds.

Research has found that babies who sleep in the same room as their parents but in their own bassinet or crib are at lower risk of SIDS than babies who sleep in a different room. So, if possible, we recommend that you place your baby in a crib or bassinet close to your bed for at least the first 6 months. You can keep an eye on your baby and rest assured that they are safe when they are  sleeping. When you feed and cuddle, bring your baby into bed. But just be sure to return them to the crib or bassinet when you are ready to sleep.

No! Moms frequently fall asleep when nursing and the worst place to fall asleep with a baby is on a couch or easy chair. The baby can easily slip down into a cushion and suffocation is a big risk. So, during the night, go ahead and take your baby into your bed to nurse. Make sure there is room around your baby-no pillows or loose blankets. If you do fall asleep, as soon as you wake up, move your baby to the crib or bassinet. If you have a partner, it is helpful to enlist your partner’s help. If you are sleepy, your partner can look after the baby and make sure they are placed back in the crib to sleep.

During the day or at times when you are not feeling sleepy, it is fine to nurse on the couch or chair. If you do start to feel drowsy, it is a good idea to place your baby back in the crib, bassinet, or play yard.

Our recommendations are based on studies that show that sleeping with a baby, even when mother breastfeeds, places the baby at higher risk for SIDS. Sadly, we know of many babies who died in bed with the most caring and loving mothers. Even though we understand the emotional pull of sleeping with your baby, we have to keep to our bottom line: no bedsharing.

It is true that bedsharing does make breastfeeding easier.  Research has shown that breastfeeding is generally continued for longer when babies sleep with their mothers. So, it is important to know this and make it as easy to breastfeed as possible while also keeping your baby’s safety in mind. That is why we recommend having your baby sleep right near you—in a crib or bassinet. The most important factor in successful and longer breastfeeding is the mother’s desire to breastfeed. So, be prepared and you will be successful!

You are right, it does look kind of empty. But your baby will get used to whatever environment you place them in. It may bother us, but it won’t bother your baby. Soft or loose blankets, pillows, plush toys, and bumper pads all pose a suffocation or strangulation risk. So they need to be out of the crib while the baby sleeps. Also, do not use inclined sleepers, positioners, or sleep wedges. Your baby should sleep on a firm, flat mattress (inclined no more than 10 degrees).

To decorate the room and make things look more colorful, hang quilts on the wall, or drape one over a chair. Without bumper pads, you will be able to see your baby more easily and they will be able to see you.

We don’t recommend mesh bumpers. We are afraid that they can still cause harm. A baby could get tangled in the cloth and strangulation could result. There is no need for these bumpers.

Some parents worry about the legs of their babies getting caught between the slats of the crib. A good solution is for parents to use a sleep sack or wearable blanket – it eliminates the need for loose bedding, and it prevents the  legs from getting stuck in the slats.

Many studies have shown that babies who use a pacifier at bedtime are less likely to die from SIDS compared with babies who did not use a pacifier. We don’t know why this is so. There are some theories that these babies may sleep a little lighter which is a good thing since babies who sleep too soundly are at higher risk for SIDS. The pacifier may also help open the breathing passages. But however it works, the pacifier does seem to be protective.

Since SIDS occurs in the first year of life, we recommend that you stop the pacifier when your baby is about a year old. It is easier to take it away then rather than waiting until your baby is older. Your baby may cry at first, but generally, babies get used to being without the pacifier pretty quickly. 

There is a slightly higher chance of getting ear, stomach and other minor infections in babies who use pacifiers. But because the benefits are so great in terms of reducing the risk of SIDS, it is still better to use the pacifier. Try offering it just when your baby goes to sleep (at night and for naps). Wash the pacifiers often and throw them away when they start to crack or wear out.

As far as dental problems go, pacifiers do NOT cause crooked teeth or abnormal bite as long as the pacifier is stopped by the age of 3 years. We suggest that you take the pacifier away when your baby is about a year old.

Some babies don’t take a pacifier at first. You can wait a few days to a week and offer it again. Try a few times. If your baby still won’t take it, that’s fine. You don’t need to keep offering it and you don’t need to worry. By doing all the other safe sleep steps, your baby’s risk of SIDS and suffocation will be very low.

No, there is no need to insert the pacifier once your baby is sleeping. We know that the pacifier is going to fall out within 15 minutes or so of falling asleep. That’s normal. If you baby wakes up and cries, then go ahead and reinsert it. Most babies will sleep right through.