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There are three simple steps you can take to ensure your baby is sleeping safely and reduce his risk of Sudden Infant Death Syndrome (SIDS) and other sleep-related causes of infant death. Learning the ABCs of safe sleep is important for all caregivers -- including parents, grandparents, aunts, uncles, babysitters, childcare providers, and anyone else who might care for a baby.


The ABCs of Safe Sleep

A - Alone
B - Back

Baby should always sleep alone. Not with other people, pillows, blankets, or stuffed animals.

Baby should always sleep on his or her back. Always place your baby to sleep on his or her back. If he rolls over, it is safe to leave him.

C - Crib

Baby should sleep in a crib or sleep space (ie. bassinet or pack and play, see FAQ page) that meets safety standards. Never place a baby to sleep on an adult bed, sofa, chair, cushion, inclined sleeper, or other soft surface.

Recommendations for Safe Sleep

On June 21, 2022, the American Academy of Pediatrics released an updated policy statement, Sleep-Related Infant Deaths: Updated 2022 Recommendations for Reducing Infant Deaths in the Sleep Environment to provide recommendations for building safe sleep environments.

Recommendations include:

Back to sleep for every sleep.

Infants should be placed to sleep on their backs for every sleep by every caregiver until the child reaches 1 year of age. Side sleeping is not safe, nor advised.

Use a firm, flat, noninclined sleep surface to reduce the risk of suffocation or wedging/entrapment.

Infants should be placed on a firm, flat, noninclined sleep surface (ie. firm mattress in a crib) covered by a fitted sheet with no other bedding or soft objects to reduce the risk of SIDS and suffocation. Sleep surfaces with inclines of more than 10 degrees are unsafe for infant sleep. A firm surface maintains its shape and does not indent or conform to the shape of the infant's head when the infant is placed on the surface. Infants should never be left to sleep on sofas, chairs, or in sitting devices (ie. rock and play, inclined sleepers, mamaroos, swings, nap nannies, etc.). Soft bedding remains a risk for infants older than 4 months. Sitting devices (car seats, strollers, swings, infant carriers, and infant slings, are not recommended for routine sleep in the hospital or at home, particularly for infants aged less than 4 months. If an infant falls asleep in a sitting device, they should be removed as soon as is safe and practical.

Breastfeeding is recommended.

Breastfeeding is associated with a reduced risk of SIDS. Unless contraindicated, it is recommended that mothers breastfeed exclusively or feed with expressed milk for six months, in alignment with recommendations from the AAP.

Roomshare without bedsharing.

Infants should sleep in their parents' room, close to the parents' bed but on a separate surface for at least six months, preferably a year.

Offer a pacifier at nap time and bedtime.

It's okay if your infant doesn't want to use the pacifier and you do not have to put the pacifier back in if it falls out. Remember to not use pacifiers that attach to infant clothing or attached to objects, such as stuffed toys or other items that may be a suffocation or choking risk.

Avoid smoke and nicotine exposure, as well as alcohol, marijuana, opioids, and illicit drug use during pregnancy and after birth.

Smoking is a major risk factor for SIDS. There is also an increased risk of SIDS with prenatal and postnatal exposure to alcohol and drugs. The risk of SIDS is significantly higher with concomitant smoking and alcohol use.

Avoid overheating and head covering in infants.

Studies have demonstrated an increased risk of SIDS with overheating. However, it is difficult to provide specific room temperature guidelines. Evaluate the infant for signs of overheating, such as sweating, flushed skin, or the infant's chest feeling hot to the touch.

Swaddling should not be used as a strategy to reduce the risk of SIDS.

Swaddling can be used as a strategy to calm an infant. However, there is a high risk for death if a swaddled infant is placed in or rolls to their tummy. If an infant is swaddled, always place them on their back and discontinue swaddling when the infant shows signs of rolling over (usually at age 3 to 4 months, but this could be earlier). Swaddling should be snug around the chest, but allow for ample room at the hips and knees to avoid exacerbation of hip dysplasia. Weighted swaddle clothing or weighted objects within swaddles are NOT safe and therefore NOT recommended. There is no evidence with regard to risk of SIDS related to the arms being swaddled in or out. Parents can decide on an individual basis whether to swaddle and whether the arms are swaddled in or out, depending on the behavioral and developmental needs of the infant.

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