Safe Sleep

By Megan Richardson, FNP-C

The American Academy of Pediatrics (AAP) recently updated their sleep recommendations for newborns and infants in order to reduce the rate of Sudden Infant Death Syndrome (SIDS).

In short, the recommendations are the same as they have been in recent years, with a few new ones added.

What is new:

  • Skin-to-skin contact between mother and baby for up to the first hour after birth: Recommended for mothers and newborns, regardless of feeding or delivery method, immediately following birth (as soon as the mother is medically stable, awake, and able to respond to her newborn), and to continue for at least an hour. When the mother needs to sleep, the newborn should be placed in a bassinet on his/her back.
  • Room sharing (but not bed sharing) for 6-12 months: Infants should sleep in the parents’ room, close to the parents’ bed but on a separate surface designed for infants.
  • Bedside sleepers (i.e. attached to the side of the parental bed) are OK if approved by the Consumer Product Safety Commission: The CPSC has published safety standards for these products,and they may be considered by some parents as an option.
  • In-bed sleepers are not recommended: There are no safety standards for in-bed sleepers so they cannot be safely recommended.
  • Sleeping on couches or armchairs is extremely dangerous for infants, with or without a parent/caregiver present: Sleeping on couches and armchairs places infants at extraordinarily high risk of infant death, including SIDS,suffocation through entrapment or wedging between seat cushions, or overlay if another person is also sharing this surface. Therefore, parents and other caregivers should be especially vigilant as to their wakefulness when feeding infants or lying with infants on these surfaces. Infants should never be placed on a couch or armchair for sleep.
  • Keep soft objects and loose bedding out of the infant’s sleep area even after infants can roll over independently: The only bedding that is safe in an infant’s sleep area is a fitted crib sheet. All other soft items and bedding (e.g. pillows, blankets, quilts, stuffed animals, crib bumpers) pose a SIDS and suffocation risk.

What is not new:

  • Put babies to sleep on their backs until they are 1 year old.
  • Use a firm sleep surface.
  • Avoid bed-sharing (allowing infants to sleep in bed with parents). It increases SIDS risk by 50%, especially in the first 6 months.
  • There is no evidence to recommend swaddling to reduce the risk of SIDS.
  • Consider offering a pacifier at naptime and bedtime.
  • Breastfeeding is recommended.
  • Avoid smoke exposure, alcohol and illicit drug use during pregnancy and after birth
  • Pregnant women should seek and obtain regular prenatal care.
  • Infants should be immunized in accordance with AAP and CDC recommendations.

For the full recommendations, see