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Providing a baby with a safe sleeping environment is vital, but what exactly does this involve?
Many new parents and caregivers wonder which sleeping position is safest for a baby, which type of bed is best, and whether the crib should have padding called bumpers.
Below, we answer these and other questions about sleep during the first year of life.
For safety, all infants should sleep on their backs for the first year of life, the American Academy of Pediatrics (AAP) and the Department of Health and Human Services recommend. They give the same guidance for babies born preterm.
Infants who sleep on their backs appear to have a lower risk of sudden infant death syndrome (SIDS).
Since the AAP made these recommendations in 1992, there have been significantly fewer cases of SIDS. However, the syndrome caused the deaths of an estimated 1,400 infants in the United States in 2017 — and the figure may actually be higher, as SIDS may have contributed to deaths from unknown causes.
The risk of SIDS appears to be higher within the first 6 months of life, and most cases occur between the ages of 1 and 4 months. For this reason, sleeping on the back is most important in the first 6 months.
SIDS is unlikely to occur after 12 months of life.
Some preterm infants with respiratory diseases may need to sleep on their stomachs. This should only take place in a medically supervised environment, such as a hospital.
Some people worry that sleeping on the back flattens the baby’s head, but if this happens, it is usually temporary. Encouraging the baby to lie and play on their tummy during waking hours can also help prevent this.
Another concern is that the infant may choke on vomit or saliva while sleeping on their back. However, the National Institutes of Health (NIH) report that there is no evidence of this. In fact, they say, babies who sleep on their backs may clear fluids more effectively.
Providing a safe sleep environment is just as important as making sure that the infant is in the right position.
It is crucial to ensure that the baby’s sleeping area has nothing that could cause suffocation or entrapment. In 2017, 900 infants in the U.S. died of accidental strangulation or suffocation in bed.
A person can take the following precautions to make sure that a baby’s sleep is safe.
- Place the baby on their back for sleep.
- Ensure that the sleeping surface is flat and firm.
- Use a crib, bassinet, or portable crib.
- Encourage supervised tummy time when the baby is awake.
- Offer the infant a clean, dry pacifier, but do not insist if they do not want it.
- Ensure that there are no cords or other hanging items nearby.
- Cover the mattress with a fitted sheet.
- Use sleep clothing, such as a sleep sack or another one-piece outfit.
- Make sure the crib is safety-approved.
- Maintain a comfortable room temperature, avoiding drafts and overheating.
- Establish a bedtime routine when the infant is 4–6 months old.
- Share a room with the baby if being this close feels important.
- Have bumper pads, loose bedding, pillows, stuffed animals, comforters, wedges, positioners, or bean bags on the bed.
- Let the baby sleep on a soft mattress, sofa, or waterbed.
- Cover the baby’s head.
- Expose the baby to secondhand smoke.
- Share a bed with the baby, due to the risk of suffocation.
- Use blankets or loose coverings.
- Place the baby too close to air conditioning or heating vents.
- Use heart rate or breathing monitors, as they do not appear to reduce health risks in healthy infants.
- Dress the baby in too many clothes.
The following may also help reduce the risk of SIDS:
- Get the recommended shots, as these may help protect the baby from SIDS.
- Attend all health visits.
- Breastfeed, if possible, for at least 6 months.
- Avoid drinking alcohol, smoking, and using recreational drugs during pregnancy.
Bringing home a new baby can feel overwhelming, but following clear guidance can reduce caregivers’ anxiety and risks to the infant.
Anyone who feels concerned or has questions about safe sleep can ask a healthcare provider, such as a pediatrician, for more information.
It is important to ensure that everyone who cares for a baby is following safe sleep guidance and has access to a healthcare provider if questions arise.
Baby monitors can help a person listen to — and even watch — a baby in another room. They are available for purchase online.