A Pediatrician Explains AAP’s New Safe Sleep for Babies Practices

By Dr. Georgie Pechulis, pediatric hospitalist at CHOC

The American Academy of Pediatrics (AAP) recently released updated recommendations on safe sleep practices for infants under one year of age, which are outlined below. Safe sleep is a top priority for all parents to reduce the risk of Sudden Infant Death Syndrome (SIDS) and other sleep-related deaths that claim as many as 3,500 infant lives in the U.S. every year SIDS is the unexplained death of an infant, even after thorough investigation, autopsy, and review of medical history.

safe sleep for babies
Dr. Georgie Pechulis, a pediatric hospitalist at CHOC

What can be done to prevent SIDS and other sleep-related deaths?

We know there are a number of practices proven to lower an infant’s risk of SIDS and sleep-related deaths. Taking these actions can help to create a safer sleep environment for your baby. Here are a few of the key points from the AAP’s updated recommendations.

Back to sleep for every sleep

Research shows that putting your baby to sleep completely on their backs for the first year greatly reduces the risk of SIDS.

Once an infant can roll on their own, they can be allowed to remain in the sleep position that he or she assumes.

To help prevent flat head syndrome or positional plagiocephaly, supervised and awake tummy time is recommended.

Close but Not Too Close

It is recommended that infants sleep in the parents’ room, close to the parent’s bed, but on a separate surface designed for infants. This is recommended ideally for the first year of life, but at least for the first six months.

Evidence shows that sleeping in the parents’ room but on separate surfaces decreases the risk of SIDS by as much as 50 percent.

Separate designated sleeping arrangements can prevent entrapment, suffocation and strangulation that can occur when infants sleep in an adult bed.

Keep it Simple

Keep soft objects and loose bedding away from the infant’s sleep area to reduce the risk of SIDS, suffocation, entrapment and strangulation

Although they are widely available on the market, crib bumpers and pads, stuffed animals and toys, pillows, and blankets are not recommended in the crib as they can easily block your baby’s breathing. The crib should only contain your baby, the mattress, and a fitted crib sheet.

If appropriate for the climate, infant sleep clothing, such as a wearable sleep sack or blanket is preferable.

Consider offering a pacifier at nap time and bedtime

A pacifier has been shown to have a protective effect, even if it falls out of the infant’s mouth. It doesn’t need to be reinserted if the baby falls asleep. It is not recommended to use any attachments to the pacifiers. Ensure breastfeeding is well established prior to any use of pacifiers in breastfeeding babies.

Avoid overheating and head covering in infants

Avoid the use of commercial devices that are inconsistent with safe sleep recommendations

Ensure that products conform to safety standards of the Consumer Product Safety Commission

Car seats, strollers, swings and infant carriers are not recommended for routine sleep, per the AAP’s recommendations. If an infant falls asleep in any of the above devices, they should be moved to a safe sleep surface as soon as is safe and practical.

What else is new in the recommendations?

Do not use home cardiorespiratory monitors as a strategy to reduce the risk of SIDS.

The AAP’s SIDS Task Force also addressed infant feeding and comforting in bed. As always, it is recommended to have your infant sleep separately in a designated surface apart from the parent sleep area. However, the AAP does recognize that parents frequently fall asleep while feeding their infant and evidence suggests that is it less hazardous to fall asleep with the infant in the adult bed than on a sofa or armchair. No pillows, blankets, sheets, or any other objects should be in the bed. Many infants who die from SIDS and sleep-related deaths are found with their head covered in bedding.

Infants who are brought into bed for feeding or comforting should be returned to their own crib or bassinet when the parents are ready to return to sleep. If a parent does fall asleep, the infant should be returned to their separate sleep surface as soon as the parent awakens.

Among the above recommendations, parents should avoid smoke exposure, alcohol and illicit drug use during pregnancy and after birth, as these can also increase risk of SIDS.  Regular prenatal care and immunizations per the Centers for Disease Control and AAP guidelines are also encouraged. And as always, breastfeeding is recommended and is known to provide a protective effect. Any degree of breastfeeding has been shown to be protective, increasing with exclusivity.

Ensuring Safe Sleep for Babies

October is Sudden Infant Death Syndrome (SIDS) Awareness Month, but parents should remember two things year-round to keep babies safe during sleep: babies should sleep alone and on their backs, a CHOC community educator tells CHOC Radio.

In podcast No. 36, Amy Frias outlines tips for parents to ensure their child stays safe while sleeping:

  • How to create a safe sleeping environment
  • What to do if the baby rolls onto their tummy

Printable tip sheets with information to keep children safe while sleeping are also available on CHOC’s website.

CHOC Radio theme music by Pat Jacobs.

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Healthy, Safe Sleep for Baby

baby not sleepingAs new parents often find, no one in the house sleeps if the baby doesn’t sleep. It’s very common to have sleep troubles with a baby, especially as new habits and routines are being developed.

Newborns and babies should get the recommended amount of sleep based on their age. These recommendations are only guidelines and not every baby will follow them:

Birth to 6 months – 9-12 hours at night (waking through the night to feed) / 2-8 hours during the day

6 months to 12 months – 10-12 hours at night (usually sleeping through the night) / 2-5 hours during the day

What if my baby has trouble sleeping?

The following are some helpful tips for establishing good sleep habits for your baby:

  • Newborns do not have a set night or day schedule for the first several weeks of life. It is best for a newborn not to sleep longer than 5 hours at a time in the first 5 to 6 weeks as their small bodies need frequent feedings.
  • Older babies should have a nap time and bedtime schedule. Put your baby to bed at the same time each night.
  • Babies should not be put to bed with a bottle. It causes problems with tooth decay and ear infections.
  • At bedtime, include quiet activities your baby likes, such as a bath, a story and a last breastfeeding or bottle. Avoid playing with and stimulating the baby.
  • Answer your baby’s cries on a schedule. Wait a few minutes longer before each response on a single night, or before every response on succeeding nights. Your baby soon will learn to fall back asleep on his or her own.
  • Swaddle your baby. Swaddled babies often sleep more deeply, are startled less often and fall back to sleep more easily. Learn how to swaddle your baby.

Preventing SIDS

Sudden infant death syndrome (SIDS) is a very real sleep-related risk for babies under age 1. Here are recommendations from

Image courtesy of Safe to Sleep campaign by the National Institute of Child Health and Human Development
Image courtesy of Safe to Sleep campaign by the National Institute of Child Health and Human Development

the American Academy of Pediatrics (AAP) on how to reduce the risk for SIDS:

  • Make sure your baby is immunized. An infant who is fully immunized reduces his or her risk for SIDS.
  • Breastfeed your infant. The AAP recommends breastfeeding for at least 6 months.
  • Place your infant on his or her back for sleep or naps. This can decrease the risk for SIDS, aspiration and choking. Never place your baby on his or her side or stomach for sleep or naps. If your baby is awake, allow your child time on his or her tummy as long as you are supervising, to strengthen the neck and head muscles.
  • Always talk with your baby’s doctor before raising the head of their crib if he or she has been diagnosed with gastroesophageal reflux.
  • Offer your baby a pacifier for sleeping or naps, if he or she isn’t breastfed. If breastfeeding, delay introducing a pacifier until breastfeeding has been firmly established.
  • Use a firm mattress (covered by a tightly fitted sheet) to prevent gaps between the mattress and the sides of a crib, a play yard or a bassinet. This can decrease the risk for entrapment, suffocation and SIDS.
  • Share your room instead of your bed with your baby. Putting your baby in bed with you raises the risk for strangulation, suffocation, entrapment and SIDS. Co-sleeping is a culturally variable practice. It can be safe under some very strict conditions, such as eliminating blankets and pillows from the bed. Parents are at higher risk for rolling over a baby if they are overweight, smoke, do illicit drugs or drink alcohol. If you are considering co-sleeping, please be sure to discuss the guidelines with your doctor.

Although reported use of blankets and other bedding for infants continues to decline, about half of U.S. infants are still placed to sleep with potentially hazardous bedding, according to a study in the latest issue of Pediatrics, published by the AAP.


  • Avoid using infant seats, car seats, strollers, infant carriers and infant swings for routine sleep and daily naps. These may lead to obstruction of an infant’s airway or suffocation.
  • Avoid using illicit drugs and alcohol. Don’t smoke during pregnancy or after birth.
  • Avoid overbundling, overdressing or covering an infant’s face or head. This will prevent him or her from getting overheated, reducing the risks for SIDS.
  • Avoid using loose bedding or soft objects. Bumper pads, pillows, comforters and blankets should not be used in an infant’s crib or bassinet to help prevent suffocation, strangulation, entrapment or SIDS.
  • Avoid using cardiorespiratory monitors and commercial devices. Wedges, positioners and special mattresses should not be used.
  • Always place cribs, bassinets and play yards in hazard-free areas. Avoid dangling cords or wires to reduce the risk for strangulation.

Visit the Sleep Disorder Center on choc.org to learn more about healthy sleep for kids.

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