Safe Sleep for Infants

Key takeaways

• Position: place babies on their backs for every sleep, naps and night
• Surface: a firm, flat, level surface in a crib, bassinet or play yard that meets safety standards
• Most useful single change: Dress the baby in no more than one layer more than an adult would wear, to avoid overheating.
• Commonest mistake: Falling asleep with a baby on a couch or armchair.
• See a doctor if any of the signs under "When to get help" below apply to you.

Why it matters

Sleep-related deaths are a leading cause of death in babies after the first month, and simple steps lower the risk.

The numbers, in one place

Published figures for Safe Sleep for Infants

Measure	Figure
Position	place babies on their backs for every sleep, naps and night
Surface	a firm, flat, level surface in a crib, bassinet or play yard that meets safety standards
Room-sharing	share a room, not a bed, ideally for at least the first 6 months
Bedding	no pillows, blankets, bumpers or soft toys in the sleep area
Other protective factors	breastfeeding, offering a pacifier at sleep time and avoiding smoke exposure

What helps

• Dress the baby in no more than one layer more than an adult would wear, to avoid overheating
• Use a wearable blanket instead of loose bedding
• Move a baby who falls asleep in a car seat, swing or stroller to a flat sleep surface
• Make sure every caregiver knows the safe sleep rules

What to avoid

• Falling asleep with a baby on a couch or armchair
• Using inclined sleepers, nursing pillows or positioners for sleep
• Smoking, vaping, alcohol or drugs around the baby
• Weighted sleep sacks or weighted blankets

In depth

Sudden unexpected infant death includes sudden infant death syndrome, or SIDS, as well as deaths from accidental suffocation and strangulation in bed. These deaths usually happen during sleep, often with no warning. Researchers believe SIDS may happen when a baby with an underlying vulnerability, such as a problem with how the brain controls breathing or waking, meets a stressor in the sleep environment, such as sleeping on the stomach or overheating, during a critical period of development.

Back sleeping is the single most effective step. When babies sleep on their backs, they are less likely to rebreathe exhaled air or to overheat, and their airways are better protected. Since back sleeping was widely promoted in the US, SIDS rates have dropped substantially. Babies who usually sleep on their backs but are placed on their stomachs for a nap are at particularly high risk, which is why every caregiver needs to follow the same rules.

Soft surfaces and loose items are dangerous because babies cannot reliably move their heads away from something covering their face. Pillows, blankets, bumpers and soft toys can block airflow. Adult beds, couches and armchairs carry additional risks, including an adult or another child rolling onto the baby or the baby becoming trapped between cushions or against the wall.

Signs and symptoms

• A baby found on the stomach or side after being placed on the back
• Soft bedding, pillows or toys in the crib
• A baby sleeping in a car seat, swing or stroller for long periods outside the car
• A baby who feels hot, sweaty or flushed during sleep
• Breathing pauses, color changes or limpness, which need urgent medical attention
• A baby showing signs of rolling while still swaddled

Causes and risk factors

• Stomach or side sleeping
• Soft sleep surfaces such as adult beds, couches or armchairs
• Bed-sharing, especially with an adult who smokes, drinks or is very tired
• Loose bedding, pillows and soft toys in the sleep area
• Overheating from too many layers or a warm room
• Smoking during pregnancy or around the baby
• Preterm birth and low birth weight

How it is checked

There is no test to predict which babies will die of SIDS. Instead, your baby's doctor will talk with you about safe sleep at well-baby visits and answer questions about your baby's sleep environment. They can also advise on situations such as reflux, prematurity or other medical needs.

If a baby has a brief episode of breathing pauses, color change, limpness or unresponsiveness, they should be evaluated by a doctor right away. These episodes are sometimes called brief resolved unexplained events. The doctor will take a history, examine the baby and decide whether further tests or monitoring are needed.

Related topics

• RSV (Respiratory Syncytial Virus): Sorting the Evidence From the Noise (Infectious Diseases)
• The Evidence on Breastfeeding Basics, Without the Hype (Pregnancy and Postpartum)
• The Sleep Environment: What Published Guidance Supports (Sleep)
• The Evidence on Safe Disposal of Medicines, Without the Hype (Substance Use and Recovery)

Where to go next

• A Q and A on Safe Sleep for Infants
• Safe Sleep for Infants at a Glance
• Injury Prevention: The Complete Guide
• Car Seats and Seat Belts: Sorting the Evidence From the Noise
• The Evidence on Drowning Prevention, Without the Hype

When to get help

Call 911 right away if a baby is not breathing, is limp or unresponsive, or has blue or gray lips, and start infant CPR if you know how. Call your baby's doctor for any breathing pauses, fever under 3 months or concerns about sleep.

Where this comes from

• American Academy of Pediatrics — How to Keep Your Sleeping Baby Safe: AAP Policy Explained
• Eunice Kennedy Shriver National Institute of Child Health and Human Development — Safe to Sleep
• CDC — Helping Babies Sleep Safely

How this page was put together

Every figure, recommendation and warning above is taken from the guidance named in Where this comes from. Nothing on this page is inferred, summarized or generalized beyond what those bodies publish: where they give a number, it is their number, and where they are silent, so are we. Pages are rebuilt whenever the underlying record changes. Sign-off by a named clinician, where it has happened, is shown at the top of the page along with the date.

Medical disclaimer

This article is general information, not medical advice. It cannot account for your own history, medication or circumstances. Always speak to your doctor, pharmacist or another qualified health professional before making changes that affect your treatment, and never delay seeking medical advice because of something you have read here. In an emergency, call 911.