More than 3,500 babies in the U.S. and over 130 babies in North Carolina die suddenly and unexpectedly every year while sleeping from Sudden Infant Death Syndrome (SIDS) and other sleep-related causes. From 2013-2017, 641 North Carolina infants died in this manner and the overwhelming majority of these deaths (88%) were associated with unsafe sleep environments (for example, blankets in bed, sleeping on an adult bed, etc.).
In an effort to reduce the risk of all sleep-related infant deaths, the American Academy of Pediatrics (AAP) has recommendations for families on how to create a safe sleep environment. Please share these recommendations with the families you serve. Click HERE to read the full AAP journal article.
- Research shows that babies who sleep on their backs are much less likely to die of SIDS than babies who sleep on their stomachs or sides. The problem with the side position is that the baby can roll more easily onto the stomach. Some parents worry that babies will choke when on their backs, but the baby’s airway anatomy and the gag reflex will keep that from happening. Even babies with gastroesophageal reflux (GERD) should sleep on their backs.
- Newborns should be placed skin-to-skin with their mother as soon as possible after birth, at least for the first hour. After that, or when the mother needs to sleep or cannot do skin-to-skin, babies should be placed on their backs in the bassinet. While preemies may need to be on their stomachs temporarily while in the NICU due to breathing problems, they should be placed on their backs after their problems resolve, so that they can get used to being on their backs and before going home.
- Some babies will roll onto their stomachs. You should always place your baby to sleep on the back, but if your baby is comfortable rolling both ways (back to tummy, tummy to back), then you do not have to return your baby to the back. However, be sure that there are no blankets, pillows, stuffed toys, or bumper pads around your baby so that your baby does not roll into any of those items, which could cause blockage of airflow.
- If a baby falls asleep in a car seat, stroller, swing, infant carrier, or sling, you should move him or her to a firm sleep surface on his or her back as soon as possible.
A crib, bassinet, portable crib, or play yard that meets the safety standards of the Consumer Product Safety Commission (CPSC) is recommended along with a tight-fitting, firm mattress and fitted sheet designed for that particular product. Nothing else should be in the crib except for the baby. A firm surface is a hard surface; it should not indent when the baby is lying on it. Bedside sleepers that meet CPSC safety standards may be an option, but there are no published studies that have examined the safety of these products. In addition, some crib mattresses and sleep surfaces are advertised to reduce the risk of SIDS. There is no evidence that this is true, but parents can use these products if they meet CPSC safety standards.
Place your baby back in his or her own sleep space when you are ready to go to sleep. If there is any possibility that you might fall asleep, make sure there are no pillows, sheets, blankets, or any other items that could cover your baby’s face, head, and neck, or overheat your baby. As soon as you wake up, be sure to move the baby to his or her own bed.
Certain situations make bed sharing even more dangerous. Therefore, families are strongly encouraged to not bed share with baby if:
- Your baby is younger than 4 months old.
- Your baby was born prematurely or with low birth weight.
- You or any other person in the bed is a smoker (even if you do not smoke in bed).
- The mother of the baby smoked during pregnancy.
- You have taken any medicines or drugs that might make it harder for you to wake up.
- You drank any alcohol.
- You are not the baby’s parent.
- The surface is soft, such as a waterbed, old mattress, sofa, couch, or armchair.
- There is soft bedding like pillows or blankets on the bed.
These include pillows, quilts, comforters, sheepskins, blankets, toys, bumper pads or similar products that attach to crib slats or sides. If you are worried about your baby getting cold, you can use infant sleep clothing, such as a wearable blanket. In general, your baby should be dressed with only one layer more than you are wearing.
Dress your baby in sleep clothing. Try a onesie, pajamas, and use a sleep sack/wearable blanket if the room is cold. These are designed to keep baby warm without the need for blankets. Do not over bundle baby. Watch for signs of overheating, such as sweating or the baby’s chest feeling hot to the touch. Keep the baby’s face and head uncovered during sleep, so don’t have your baby wear a hoodie or hat while they sleep.
Make sure that the baby is always on his or her back when swaddled. The swaddle should not be too tight or make it hard for the baby to breathe or move his or her hips. When your baby looks like he or she is trying to roll over, you should stop swaddling.
This helps reduce the risk of SIDS, even if it falls out after the baby is asleep. If you are breastfeeding, wait until breastfeeding is going well before offering a pacifier. This usually takes around 3-4 weeks. If you are not breastfeeding your baby, you can start the pacifier whenever you like. It’s OK if your baby doesn’t want a pacifier. You can try offering again later, but some babies simply don’t like them. If the pacifier falls out after your baby falls asleep, you don’t have to put it back in.
There is substantial evidence linking a lower risk of SIDS for infants whose mothers obtain regular prenatal care. Pregnant women should follow guidelines for frequency of prenatal visits.
Keep your baby away from smokers and places where people smoke. If you are a smoker or you smoked during pregnancy, it is very important that you do not bed share with your baby. Also, keep your car and home smoke-free. Don’t smoke anywhere near your baby, even if you are outside.
Please note: The AAP only mentions avoiding smoke and smoking in their recommendations, but Safe Sleep NC would also recommend that this includes vape and vaping.
It is very important not to bed share with your baby if you have been drinking alcohol or taken any medicines or illicit drugs that can make it harder for you to wake up.
Breastfeed or feed your baby expressed breast milk. The AAP recommends breastfeeding as the sole source of nutrition for your baby for about 6 months. Even after you add solid foods to your baby’s diet, continue breastfeeding for at least 12 months, or longer if you and your baby desire.
Your baby will receive important immunizations at these doctor visits. Recent evidence suggests that immunizations may have a protective effect against SIDS.
Wedges, positioners, special mattresses and specialized sleep surfaces have not been shown to reduce the risk of SIDS, according to the AAP.
If you have questions about using these monitors for other health conditions, talk with your pediatrician.
The AAP can’t recommend for or against these products because there have been no studies that have looked at their effect on SIDS or if they increase the risk of injury and death from suffocation.
Please note: Mandatory U.S. federal safety standards for bedside sleepers went into effect in 2014. Some bedside sleepers have been recalled because they allowed a baby to fall in a gap between the two mattresses, or otherwise allowed entrapment or strangulation. Any bedside sleeper sold in the U.S. must now meet the appropriate safety standards.