Usually, when parents are concerned about their baby’s sleep, it is about how to get them to sleep: better, sounder, longer. Parents are often quite desperate for some uninterrupted sleep. However, one of the greatest safety concerns in babies is where and how they sleep.
In recent years, remarkable progress has been made in reducing the risk of sleep-related deaths and SIDS in infants. Research has shown a number of factors related to the risk of death while sleeping, and effective changes that reduce the risk. The two greatest changes involve babies sleeping on their backs, and keeping things out of the crib or sleeping area that can cause suffocation.
Sleep position: On the back. Always.
It is now recommended that babies always sleep on their backs. This has been shown to drastically reduce the risk of sudden infant death syndrome (SIDS). After research suggested that this was effective in reducing SIDS, some countries that implemented it on a public health scale, and the SIDS rates dropped dramatically in these countries. In 1992, this became the recommendation in the United States, and in 1994 a national campaign was started. It has had the same effect in this country. The campaign was originally called Back to Sleep and is now called Safe to Sleep.
Some parents are concerned about spitting up and sleeping on the back, but it has been consistently shown that sleeping on the back is the safest for babies, and that babies do not choke from spitting up. You should always lie your baby down on her back to sleep. Once she is old enough to roll over, if she rolls over in her sleep you do not have to roll her back over onto her back. Some babies do seem many do to be happier sleeping on their stomachs, but most seem to adapt well, and there other ways to help settle and calm babies.
Babies should not sleep on their sides. Do not use wedges or props to put your baby on her side.
Sleeping on the back has increased the number of babies with flattening of the back of the head (positional plagiocephaly), but research shows that this usually goes away on its own with no problems. Giving babies tummy time for at least a total of 30-60 minutes per day helps prevent it, and it is good for their development as well. If your baby prefers one side of her head, position her so that she turns her head towards the right and left sides at different times.
Back sleeping has also caused a sight delay in the development of upper body strength and rolling over from front to back, but this is mild and resolves over time with no known problems. It simply occurs a few weeks later than we have traditionally seen it and should not be considered abnormal.
A new risk of SIDS has now appeared. Babies who normally sleep on their backs and are put on their tummies at daycare or by a babysitter or family member are at increased risk of SIDS. You must be sure that everyone who cares for your baby knows to put her on her back to sleep.
Sleep location
The safest place to sleep is in a crib or bassinet in your room or the baby’s room.
Never put your baby to sleep on a sofa, waterbed, chair, pillow or cushion.
Bedsharing increases the risk of sleep-related death and is not recommended by the American Academy of Pediatrics. Breastfeeding or other feeding at night can be made easier by having the baby sleep in a bassinet or crib near or attached to your bed.
This is a controversial recommendation. Many people recommend bedsharing for cultural reasons, and many breastfeeding advocates do as well, although among some advocates the reasons are related more to attachment parenting philosophy than breastfeeding per se. Research does show that the risks of bedsharing are much higher if parents smoke, drink alcohol, use drugs, or are obese. However, the risks are still there in families who do none of these things. The safest place for babies to sleep is in alone in a crib or bassinet.
Sleep environment
Babies should sleep on a firm surface with just a sheet over the mattress. There should be no extra padding, no padding around the rails of the crib, no stuffed animals, pillows, bumpers, or anything else in the bed with your baby.
You can wrap your baby in a blanket, but even better is a sleeper made for bundling babies. If necessary, you can lay a light blanket over your baby and tuck it into the sides of the crib, but it is better just to dress and wrap your baby warm enough and not use a blanket over her.
There should be no gap between the mattress and sides of the crib or sleep area. Drop-side cribs are no longer recommended or manufactured in the United States. See crib safety recommendations for more specific safety issues related to cribs.
Don’t let your baby get overheated. Be sure she is not dressed too warmly, and don’t put the crib or bassinet near a window or a vent. Dress your baby lightly, and keep the room temperature at a level comfortable for a lightly dressed adult. If your baby looks red or flushed, has damp hair or sheets, is sweating, or is getting heat rashes, then she is probably getting too warm while sleeping.
Do not allow any tobacco smoke in the house, definitely not in the baby’s sleeping area.
Other ways to reduce the risk of sleep-related death & SIDS
In addition to sleeping on the back, safe place to sleep in crib or bassinet, no soft materials, and avoiding overheating and tobacco smoke, there are other ways to decrease the risk of sleep-related death:
- Breastfeeding
- Using a pacifier
- Not smoking while pregnant
- Not using alcohol or drugs while pregnant or after the baby is born
Resources
References
Moon R, Task Force on Sudden Infant Death S. SIDS and Other Sleep-Related Infant Deaths: Expansion of Recommendations for a Safe Infant Sleeping Environment. Pediatrics. 2011;128(5):1030-1039. DOI: 10.1542/peds.2011-2284 PubMed: 22007004
Laughlin J, Luerssen TG, Dias MS, the Committee on Practice and Ambulatory Medicine SoNS. Prevention and Management of Positional Skull Deformities in Infants. Pediatrics. 2011;128(6):1236-1241. DOI: 10.1542/peds.2011-2220 PubMed: 22123884
The Academy of Breastfeeding Medicine Protocol Committee. ABM Clinical Protocol #6: Guideline on Co-Sleeping and Breastfeeding. Breastfeeding Medicine. March 2008, 3(1): 38-43. doi:10.1089/bfm.2007.9979.
November 5, 2014. Last revised March 3, 2016
