We've all heard that getting good sleep is a vital part of our health. It affects our growth, how we regulate stress, our immune system, and even our cardiovascular health. For children, and especially newborn babies, safe sleep can literally be the difference between life and death.
According to the Centers for Disease Control and Prevention, there are around 3,400 sleep-related deaths among U.S. babies each year. Sudden unexpected infant death (SUID) often occurs during sleep or in the baby's sleep area. SUIDs include sudden infant death syndrome (SIDS), accidental suffocation in a sleep environment, and other deaths from unknown causes. While there is no known cause of SIDS, there are steps you can take to reduce a baby's risk.
The American Academy of Pediatrics (AAP) updated its recommendations for safe sleep in 2022 to help reduce the risk of sleep-related deaths for babies and infants. Their technical report is also a great resource for safe sleep guidelines.
There is no guaranteed way to prevent SIDS, but you can reduce your baby's risk.
Research tells us that a safe sleep environment aids in reducing your baby's risk of SIDS. Unintentional suffocation and strangulation in bed are some of the main causes of sleep-related deaths in infants. The AAP's guidance helps parents take steps to ensure their baby is protected while they sleep.
Here are ways you can create a safer sleep environment for your baby.
Put your baby on their back every time you put them to sleep, even for naps. Babies who sleep on their backs are much less likely to die suddenly and unexpectedly than babies who sleep on their stomachs or sides. Babies who sleep on their sides can roll over more easily onto their stomachs, which can cause breathing problems for the baby.
The American Academy of Pediatrics (AAP) updated its recommendations in 2016 to help reduce the risk of sleep-related deaths. Their recommendations include:
- While you may worry that your baby will choke if they're on their back, your baby's airway anatomy and gag reflex will keep them from choking.
- A newborn baby should make skin-to-skin contact with their parent as soon after birth as possible, for at least an hour. After that, or when the mother needs to sleep or take care of herself, the baby should be placed back in a bassinet with no incline.
- Premature babies may need to be placed on their stomachs temporarily while they're in the NICU, but as soon as they're medically stable, place them back on their backs so that they can adjust to sleeping on their backs before going home.
- Some babies have a tendency to roll onto their stomachs. That's okay! You should always place your baby on their back to sleep, but if they are comfortable rolling both ways, you don't have to keep turning them onto their back.
Use a firm, flat, non-inclined sleep surface. A firm sleep surface means that it shouldn't indent when your baby is lying on it. The AAP states that any surface that inclines more than 10 degrees is not safe for your baby to sleep on, as it could cause entrapment.
- Ensure the sleep surface fits snugly with no gaps or spaces between the mattress and crib frame.
- Place your baby in a crib that meets Consumer Product Safety Commission (CPSP) safety standards. Check the CPSC website to be sure the crib has not been recalled.
- Don't use a crib or sleeping surface that is missing instructions, parts, or is broken.
- Any alternative sleep surfaces must comply with existing federal safety standards. If a sleep surface doesn't meet the standards, don't use it!
- If your baby falls asleep in a car seat, stroller, swing, or infant carrier, move them to a firm sleep surface on their back as soon as possible.
Do not sleep with your baby. Research shows that bed-sharing is dangerous for your baby. The risk of sleep-related infant death is more than 10 times higher for babies who bed share with someone who is fatigued or has taken sleep medications, alcohol, or other drugs that make it hard to stay awake. Room-sharing, rather than bed-sharing, decreases the risk of SIDS by as much as 50%.
- If you bring your baby into your bed to comfort them, lay them back in their crib on their back when you're ready to go to sleep.
- The risk of sleep-related infant death is 5 to 10 times higher when your baby is younger than 4 months old. If your baby is premature or has a low birth weight, it is especially important that you do not share a bed with them. The risk of sleep-related death is 2 to 5 times higher when your baby is born preterm or with low birth weight.
- Avoid falling asleep with your baby in other spots, too. The risk of sleep-related infant death is up to 67 times higher when infants sleep with someone on a couch, armchair, or cushion.
Keep the baby's sleep area free of soft objects and loose bedding. These objects can cause entrapment, suffocation, or strangulation. If you aren't sure whether an item causes harm to your baby if it is in their bed area, remove it.
- If you're worried about your baby getting cold, dress them in layers of clothing or use a wearable blanket. As a good rule of thumb, you should dress your baby in only one layer more than you are wearing.
- Don't use weighted blankets, sleepers, swaddles, sleep sacks, or other weighted objects on or near your baby.
Don't let your baby get overheated. Do not cover your baby's head. Be sure that sleepwear does not overheat your baby. Regulate the room's temperature and add another layer of clothing if warmth is needed.
- Check for signs of overheating, such as sweating, a hot chest, or flushed skin.
- Do not put a hat on your baby while indoors once you're home from the hospital.
Follow the ABCs of infant safe sleep and save a life:
- Alone
- Back sleeping only
- Crib
Follow these tips to lower SIDS risk.
- Feed your baby human milk because of its association with reduced SIDS risk.
- Breastfeeding your baby for at least the first year of life has been proven to decrease their risk of SIDS and provide other key benefits to your child's development.
- The Arkansas Milk Bank is an institution that accepts milk from healthy mothers across the state who have extra milk to give to babies who are hospitalized in NICUs across the state. Learn more about the Arkansas Milk Bank in one of our latest episodes of AFMC TV.
- Offer a pacifier at naptime and bedtime to reduce the risk of SIDS. Don't worry if the pacifier falls out on its own.
- Avoid alcohol, marijuana, opioids, and illicit drug use during pregnancy and after birth.
- Supervised, awake tummy time is recommended to facilitate development. Parents are encouraged to place the infant in tummy time while awake and supervised for short periods of time after hospital discharge. Parents should increase the amount of tummy time incrementally to at least 15 to 30 minutes daily by 7 weeks old.
- Get regular access to prenatal care during and after pregnancy.
- Schedule and attend all your well-child visits.
- Talk to your pediatrician if you have questions about the safety of your baby's sleep environment.
Don’t expect your baby to have a regular sleep-wake cycle until about six months of age. Typically, newborns sleep 16 hours a day, but they may only sleep one or two hours at a time.
Some parents use swaddling to calm their baby. The parent wraps a blanket or cloth snuggly around the baby, including the arms, so that only the head is uncovered. You may swaddle your baby if you'd like, but there is no evidence that shows swaddling your baby decreases their risk of SIDS.
Parents may worry about their baby developing a flat spot on the back of the head from back sleeping. Even if a flat spot develops, it will round out as the baby grows and sits up more. Follow these tips to reduce the chances of your baby developing a flat spot:
- Alternate which end of the crib you place your baby's head.
- Alternate the side your baby feeds on during breastfeeding or bottle feeding.
- Be sure your baby has some supervised tummy time while awake to strengthen their muscles.
- Limit the time spent on swings, bouncy chairs, and car seats, as these can put added pressure on the back of the head.
Arkansas ranked 50th among the 50 states in maternal mortality from 2018-2020 and 48th in infant mortality rate in 2021. Discover more about maternal mortality and post-delivery warning signs. Learn how to make a difference and decrease the number of families tragically impacted by maternal and infant mortality.
Other ways to reduce the chances of a flat head include alternating which end of the crib you place baby’s head, alternating the side she feeds on during feeding (breast or bottle fed). Be sure baby has some tummy time when awake and being watched to strengthen his muscles. This prepares him for crawling. Limit the time spent in swings, bouncy chairs and car seats because they put added pressure on the back of the head.
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