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Safe Sleep: How to Keep Baby Safe While Sleeping

Jan 16, 2022 | 7 minutes Read

“So, you’re saying I shouldn’t sleep with my baby,” the new mom asked. As a labor and delivery nurse, I get this question all of the time. When I explain the risks and dangers of sharing your bed with your newborn, I am very firm. The risks of harm for your newborn baby are just too great.

Sudden Infant Death Syndrome (SIDS)

Sudden infant death syndrome, otherwise known as SIDS, sounds scary but perhaps these are just rare deaths that can’t be prevented—or at least that’s what a lot of new parents believe.

While there is some truth to this, experts including the nurses who care for you in the hospital during labor and birth, know that for the most part these deaths can be prevented with safe sleep practices.

SIDS is the tradition term used by the Centers for Disease Control and Prevention (CDC) for all sleep-related infant deaths. SIDS deaths are part of a broader category of infant loss in the first year called sudden unexpected infant death, or SUID instead of SIDS.

Every year, approximately 3,400 babies die of SUID each year, say experts at the CDC.

How Parents Can Reduce SIDS Risk:
  • Putting baby on its back to sleep for every nap or sleep in an infant-safe sleep situation (crib or bassinet)
  • Never let baby sleep or nap on a soft surface, like a couch or chair, or on a fluffy blanket or mattress
  • Never share your bed with your baby; your infant’s SIDS risk is actually lower if baby sleeps in its own safe sleep situation in your room—just not in your bed
  • Put baby to sleep with one more layer than you’re comfortably wearing; overheating increases SIDS risk
Researchers have identified the following factors that may put a baby at increased risk for SIDS:
  • Being born premature
  • Breathing in secondhand smoke; babies who live with smokers have increased SIDS risks
  • Being BIPOC (Black, Indigenous or a Person of Color)
  • Family history of SIDS incidents
  • Being male—boys are slightly more likely to die of SIDS
  • Being 4-6 months old—this is when all infants are more vulnerable to SIDS
It’s so important for parents to follow the advice that experts have observed that reduces their baby’s risk for SIDS and take the preventative steps known to reduce SIDS risk, especially when they put their baby in its crib or bassinet for sleep.

Most babies who die from SIDS are typically put to sleep in an unsafe sleep situation, and the typical cause of death is suffocation.

One of the best ways to prevent a newborn’s death in the first year of life is to use the ABCs of safe sleep, as recommended by the CDC and the American Academy of Pediatricians.

ABCs of Safe Sleep

While all the safe sleep recommendations are important, the ABCs of safe sleep touch on the most critical:

A is for Alone
B is for Back
C is for a safe and empty Crib.

A is for Alone

The A of the ABCs means baby sleeps alone in their own crib or bassinet. Soft and squishy surfaces including beds, couches or recliners are not safe sleep spaces for newborns.

Bedsharing, while fun and cozy when everyone is awake, is dangerous if you both fall asleep. The danger occurs if baby becomes wedged next to you, is rolled onto or leaned into by you, gets covered by heavy blankets or becomes overheated between parents.

And nothing says lullaby more than a baby dozing on the chest of a sleepy parent, which is a dangerous opportunity for you both to fall soundly asleep.

We know it’s HARD to remain alert after nursing, especially when you’re not getting a lot of sleep otherwise, but please do your best to always put baby back to sleep in a safe sleep space.

Know that infants ages 4 months and younger, or who were born small or prematurely, are the most vulnerable to SUIDs.

If you are breastfeeding at night and fall asleep in bed during the feeding, put the baby back into his own bed as soon as you awaken. Consider setting an alarm for 15 minutes to prevent long periods of sleeping together.

Consider Room Sharing & Breastfeeding

What we can get excited about is room sharing. This means baby sleeps in a safe crib or bassinet in your room—not in your bed. In fact, room sharing helps protect against SUIDs and makes breastfeeding easier when baby is close by.

While we’re discussing breastfeeding, please know that experts at the CDC report that breastfeeding has been found in research to help protect against SIDS. Any amount of nursing is good, and more is better. Aim to nurse your baby at least 6 months—a year is even better.

Finally, begin with baby sleeping in their crib or bassinet from the very first night they come home from the hospital or birthing center.

We know it’s inviting to snuggle and fall asleep with your little one—resist that temptation and keep baby safe during their earliest months.

B is for Back

This means baby is put to sleep in their safe infant crib or bassinet on their back, starting from birth, and for every single sleep—including naps.

Side positioning is not safe, and commercial positioning devices meant to keep baby mostly on their back while leaning on their side, or sidelying, have been deemed unsafe by the Consumer Products Safety Division.

These devices (typically soft and pillow-like) are dangerous once the baby can wiggle around and roll over—which is sooner than you might expect!

Once baby can roll over on their own, there’s no need to guide baby onto their back should they roll during sleep. Just ensure that there is nothing unsafe under them, such as a soft toy or fluffy blanket.

Put baby to sleep on their back from birth. Babies love the counterpressure on their bellies that would come from sleeping on their tummy—but the SIDS risks are simply too high. Stomach-sleeping is a strong risk factor identified in research for SIDS.

That’s why it’s even more important from the day of baby’s birth, and for every sleep thereafter until baby can roll on their own, to put your little one to sleep on their back.

Swaddling your baby with a swaddle blanket or wrap can help some babies settle into sleep. The gentle restraint of their arms (like when they were inside of you) calms and soothes babies and helps them fall asleep more easily.

Whether you use a blanket to create a swaddle or buy a swaddle blanket, it’s important to swaddle correctly, and to stop swaddling when baby begins to look like they are trying to roll over—this can be as early as 2 months post-birth for some babies.

Pacifiers can calm and help baby self-soothe, and research has shown that pacifier use decreases the risk of SIDS by at least 50%! Experts at the National Institutes of Health publishing in the journal, Pediatrics, found that one SIDS death could be prevented for every 2,733 infants if babies were placed for sleep with a pacifier.

It’s unique that the protection seems to come while baby is falling asleep because the research also indicates that once baby releases the pacifier during sleep, there’s no additional benefit in replacing it. So go ahead and give your baby a pacifier every time they nap or take a snooze. After baby’s 1st birthday, SIDS risk plummets and pacifier use is no longer recommended.

If you are breastfeeding, wait until breastfeeding is going well before introducing baby to a pacifier. Some babies get confused between mom’s warm breast and nipple, and the pacifier—something experts call “nipple confusion.” As long as baby is nursing well, there’s no need for further concern.

C is for a CRIB

So, when we say crib, what we really mean is an infant bed that is safe and empty, except of course for the baby!

The top two choices from the American Academy of Pediatrics and the U.S. Consumer Product Safety Commission (CPSC) include:

--CPSC-approved infant crib
--CPSC-approved infant bassinet

Check the CPSC site for approved infant beds and sign up for recall notices on infant products, including infant beds.

Be warned: There are also a lot of sleep products out there that claim to help your baby sleep, or to prevent SIDS. These claims are typically unproven, provide a false sense of security, and some of these products are dangerous!

Make sure the crib mattress is designed for an infant crib, not a child’s bed, and that the fit is snug and tight in baby’s sleep surface. Adult mattresses, memory foam, and any pillow-like surfaces are generally too soft and create the risk that an infant’s face may become buried in the bedding, especially once they can roll over.

In-bed sleepers and infant loungers can be found in online and in stores, but these haven’t proven to be safe and aren’t recommended.

Finally, any item that is not intended for sleep (such as car seats, swings, or strollers) shouldn’t be used for routine sleep.

Baby’s bed should be entirely empty, with just baby resting on their back on a tight-fitting sheet, on a mattress fitted for baby’s crib or bassinet.

This means no bumper pads, stuffed animals, pillows, blankets, or other objects of any type except perhaps a stray pacifier around 3-4 months after birth are allowed.

Traditionally, cribs have been decorated inside and out in anticipation of baby—but this creates increased SUIDs risks.

This recommendation is hard for some parents who love a highly decorated and cozy crib. Newborns sleep still for only a short while, and not long after birth, most babies will begin to move around in their sleep.

This creates risk when an infant can wiggle around and get their face covered by a blanket or roll over into a stuffed animal or pillow. Many SUID babies are found rolled into or covered by these soft items. Even blankets are not recommended. Use swaddle sleepers, sleep sacks or footed pajamas instead.

One last recommendation that is worth its own shout-out: Make sure all your family, friends, and caregivers know your safe sleep “rules” and the importance of following them while caring for the baby.

Many grandparents placed their babies on their tummies as this was the practice at the time, or they may have bed-shared, and many popular infant sleep ideas that can be found on social media are not evidence-based or safe.

With the research we now have, parents can feel confident knowing they are doing everything they can to prevent a sleep related death. You may be tempted to skip putting baby in their crib or bassinet after a sleepy nursing session, but the reward is knowing that you’re putting your baby back to sleep every time in the safest possible way.

Safe Sleep Recommendations from the American Academy of Pediatrics

1. Keep all prenatal visits when you are pregnant
2. Don’t sleep with your baby (bedsharing)—share your room with baby in their own crib or bassinet instead (room-sharing)
3. Put baby on their back for every sleep; side positions are not safe until baby can roll over on their own
4. Use a safety-approved crib, bassinet, or pack-n-play with a firm mattress and tight sheet
5. Keep all soft stuff out of the crib or basinet, including blankets, pillows, bumper pads, and stuffed toys
6. Breastfeed! It’s protective against SIDS and the more the breastmilk baby gets the better
7. Offer your baby a pacifier—it helps protect against SUIDs
8. Keep baby away from tobacco smoke during pregnancy and after birth
9. Avoid alcohol, marijuana, or illicit drugs during pregnancy and after baby’s birth
10. Keep baby cool but comfortable—wearing one more layer than you are and make sure baby’s not getting warm or hot
11. Provide all recommended immunizations for the baby—this protects their health
12. Avoid monitors or devices marketed to reduce the risk of SIDS—they’re not proven safe or effective
13. Don’t let baby sleep in their car seat, swing, stroller or carrier
14.Provide “tummy time” when the baby is awake and you can supervise
15. Teach everyone who cares for your baby about these safe sleep rules, including grandparents, relatives, babysitters, siblings, and friends

Sharon C. Hitchcock, DNP, RNC-MNN, has been a nurse for more than 35 years, and an educator for 10 years. She currently teaches obstetrics at the University of Arizona College of Nursing and is passionate about infant sleep, infant sleep safety, and all things obstetrics. She is a mom and grandma of two and has much lived experience in the struggles and challenges new parents face. In her spare time, she enjoys writing for AWHONN’s parenting website, Healthy Mom&Baby.

The ABCs of safe sleep are simple and a sure-fire way to ensure baby snoozes safely for every nod-off and nap.

The information contained on this article should not be used as a substitute for the medical care and advice of your health care professional.