Welcome to Safe Sleep 101

This post is a beginner-friendly introduction to safe sleep. Links to evidence and more in-depth discussions are provided underneath each section.

Why this matters

Sudden Infant Death Syndrome (SIDS) is the #1 cause of death in healthy, full-term babies.

The good news is that the vast majority of SIDS cases are preventable. This post covers how to do just that.

Guiding principles

Let’s quickly cover three principles to wrap your head around:

1 – Your perception of the risk of SIDS is inherently biased.

Do not dismiss the risk of SIDS just because you don’t personally know people who have lost babies.

2 – Many of the strategies to make babies sleep “better” are dangerous for that very reason.

An infant’s ability to wake easily is what protects them against SIDS.

3 – You can’t always tell ‘just by looking’ that certain behaviors are risky.

Much of what we consider “obvious” today about preventing SIDS was only discovered by painstakingly collecting and analyzing large amounts of data on incidences of SIDS.

When it comes to infant sleep, just because something appears to be safe, doesn’t mean that it is.

Now let’s dive in…

Safe Sleep Basics

Follow the ABC’s of safe sleep:

Infants should sleep…

A – alone
B – on their back
C – in a regulated crib, bassinet or play yard, with nothing but a fitted sheet and a pacifier

Remember that “sleep” doesn’t just mean at night… it refers to supervised naps too.

If a baby falls asleep in his swing, seat, lounger, etc., it is not enough to just watch him — you must move him to a safe sleep space.

Why can’t you just supervise — why do you have to move him?

Because asphyxia can look just like sleeping. There isn’t a fight for life or a choking sound to alert you that something is wrong.

Safe sleep spaces are federally regulated. There are only 3 types of products that have undergone mandatory safety testing for infant sleep:

• CRIB
• BASSINET
• PLAY YARD (often called Pack N Play)

If a product is not explicitly called one of these names (in the user manual; not just the sales description), it is not safe for sleep.

Surprisingly common and surprisingly risky…

Never share a bed with an infant. Bedsharing increases the risk of SIDS.

Never place a sleeping baby on a couch, chair, or adult bed due to the high risk of entrapment and suffocation.

Never add additional mattresses, blankets, or anything to make a baby’s sleep space more “comfortable.”

Never leave a baby alone with pets. Make sure animals are in a different room if you are unable to supervise.

Click here to email yourself the aforementioned list of guides to come back to later.

Swaddling

It’s no longer safe to swaddle when your baby starts showing signs of rolling. The risk of death is high if a swaddled infant rolls onto his stomach.

Many safe sleep experts instruct caregivers to stop swaddling at 8 weeks or first signs of rolling, whichever comes first.

Make sure the swaddle is tight enough so that it doesn’t ride up near the baby’s face. (Swaddling should not restrict the lower body for healthy hip development).

You can switch to a sleep sack (a wearable blanket) when it is no longer safe to swaddle.

Nursery Decor

Hard items like frames, mirrors, and name signs should not be hung over a crib.

Mobiles attached to the crib are safe until 5 months or when baby begins to push up, whichever happens first.

Bumpers and rail covers are unsafe.

Window treatments and window cords should not be within 3 feet of a crib.

This is NOT an exhaustive list of nursery safety.

Baby Wearing

It’s fine if your baby falls asleep while you’re baby wearing, but it’s best to transfer him to a safe sleep space when one is available.

Follow the “TICKS” guidelines: Tight, In view at all times, Close enough to kiss, Keep chin off the chest, Supported back.

Travel Systems

It’s fine if your baby falls asleep in his car seat or stroller while you’re out and about, as long as he is properly buckled. Transfer him to a safe sleep space when one is available.

Car seats and strollers should not be used for routine sleep. They should only be used to transport your baby from one location to another.

Never leave the straps unbuckled or partially buckled due to strangulation risk.

Dressing for Sleep

Dress your baby based on the temperature of the room, not the temperature outside.

Baby should be wearing no greater than 1 layer more than you. (Use the graphic below as a guide).

Hats and mittens are unsafe for sleep.

Pacifiers

Offering a pacifier at the start of every sleep period reduces the risk of SIDS by up to 90%.

The protective effect persists even if the baby drops the pacifier (so there is no need to replace it).

Pacifiers are safe to leave in the sleep space, but pacifier CLIPS are not.

Breastfeeding

Breastfeeding reduces the risk of SIDS by up to 50%.

Moms should be careful not to fall asleep while breastfeeding.

Roomsharing

Roomsharing decreases the risk of SIDS by up to 50%.

The AAP recommends that infants sleep in the same room as a parent ideally for the first year after birth, but at least for the first 6 months.

Note: Room-sharing and bed-sharing are not the same thing.

Products that are unsafe for sleep

MOST products are unsafe for sleep, even if they are marketed for sleep.

Keep in mind that there is no proactive agency that checks all of these products before they go on the market.

Do NOT assume that something is safe just because it’s carried by a major retailer.

There is a long list of examples below.

Safe Products for Sleep

Only safe if used as intended by the manufacturer and if you’re following all of the other safety guidelines we’ve discussed here.

CRIBS & BASSINETS

The product should be called a “crib” or “bassinet” in the user manual.
Use a crib or bassinet manufactured after June 2011. There is a good chance that an older crib no longer meets all the current safety standards, especially if it has a drop side. DO NOT USE a vintage or heirloom crib.

Homemade or “DIY” cribs are unsafe as they have not been safety tested.

Purchasing a used crib is a risk, particularly if it’s not from someone you know and trust. You do not know whether the crib was previously broken and has been repaired or altered. (There have been many infant deaths associated with cribs that are broken and missing parts — including those that have been fixed.)

Do not use a memory foam crib mattress. Your baby’s mattress should be firm.

Make sure the mattress fits snugly against the inside of the crib.

Some crib mattresses have infant and toddler sides. Make sure the infant side is facing up for the first 12 months.

PLAYARDS

The product should be called a “playard” in the user manual.

Use a play yard manufactured after February 2013 (when new federal safety standards were implemented).

Read more about Pack ‘n Play safety here.

Wrapping up your introduction to safe sleep…

Congratulations, if you read this entire post, you are now a graduate of Safe Sleep 101!

Here are a few articles to read next:

• 3 Things I Can’t Believe I Didn’t Know About Safe Sleep
• What Not to Put on a Baby Registry: UNSAFE Stuff to Skip
• When and How to Stop Swaddling: The Ultimate Guide

Intro to Safe Sleep + Preventing SIDS