Skip to content

ABCs of Safe Sleep Arrangements for Your Baby

Today, ten babies will die as the result of preventable sleep related deaths that might have been prevented if their parents had known the risk. Parents who aren’t told about the most recent recommendations have the same risk of losing a child as those who ignore the recommendations. We want to be sure every parent knows the safest way for their baby to sleep. We encourage all parents to follow the guidelines.

In this article, we share the latest information on the safest sleeping arrangements for your baby from published research. We also debunk some myths that may encourage parents to ignore the guidelines.

The loss of a child is a tragedy. When that loss was preventable, many parents never fully recover from the psychological pain.

Differences Between What Feels Safe and What is Safe

It’s natural to assume that your baby is safest in your arms or next to you, but that is not what experience shows. Researchers discourage co-sleeping arrangements. It is too easy to accidentally suffocate your baby.

Your body can block your baby’s little mouth and nose, causing suffocation. In the exhausted sleep that is common when caring for a baby who wakes you up during the night, you can be too tired to wake up.

If you place your arm across your baby’s body and fall asleep, the weight of your arm becomes dead weight that may be too much weight for your baby’s body.

Your blankets and sheets also pose a risk to your baby. If a blanket, sheet, or pillow blocks your baby’s air passages, your baby can suffocate. Babies can’t roll over to remove the blockage that makes it impossible for them to breathe the way older children and adults can.

The safest location for your baby to sleep is in your room in a bassinet or crib located near your bed. Your baby should be alone in his or her own sleeping area.

Alone in their crib or bassinet is the safest place for your baby. This does not mean they have to be alone in the room—just in their sleeping space.

Sleeping Arrangements to Avoid

Unfortunately, some of the sleeping arrangements that pose a danger feel safe and some of them make for adorable pictures. Arrangements that are cute can be dangerous to your baby.

These sleeping arrangements pose risks to your baby’s life:

  • Co-sleeping in your bed
  • Sleeping while the baby is laying on your body
  • Allowing the baby to sleep laying on you even if you are awake
  • Sleeping with you in a chair or on a sofa
  • Sleeping in a different room than you

Safest Sleeping Position for Babies

Before your baby becomes strong enough to roll over, they will sleep in the position you lay them down in. Babies should always be placed on their back to sleep.

Myths Related to Babies Sleeping on Their Back

Until around 1990, mothers were advised to place their babies in bed on their tummy. They were told this was important because a baby who spit up or threw up during sleep could drown from the fluids because they couldn’t turn their head or roll on their side. Because women were given this advice by individuals in positions of authority such as pediatricians and nurses, they believed it was good advice.

This has led to a persistent myth that babies should be placed on their stomach to sleep. The facts show that babies are better able to clear their airways when they are on their back because of the internal position of the airway in their body.

The advice given to new parents is based on the best information available at the time. In this case, more research led to better advice for today’s new parents than the advice given to their parents or siblings whose children were born earlier.

The safest sleeping position for your baby is on his or her back.

Another myth about putting your baby to bed on their back is that their head will flatten on the back. While they may experience some flattening, the effect usually disappears when they begin turning over on their own.

As a parent, you can reduce the impact by placing your baby in other positions when they are awake. Your baby should have time on their tummy when they are awake and you are closely supervising them.

The third myth is that the baby will develop a bald spot. Many babies lose their hair during the first year. They lose it in the areas that receive the most friction first but that doesn’t mean they wouldn’t lose it if they slept in a different position.

Sleeping Arrangements to Avoid

Your baby’s back is the safest sleeping position. Don’t:

  • Place your baby on his or her tummy to sleep
  • Lay your baby on his or her side to sleep

Dr. Lori Feldman-Winter, a member of a group tasked with updating the recommendations to prevent SIDS, suggests feeding your baby in bed if there is any possibility you will fall asleep while they nurse because sofas and cushioned chairs pose a much greater risk to your baby. It is better to stay awake but the realities of parenting a newborn may make that impossible.

Cribs are the Safest Place for Baby to Sleep

Cribs in the parent’s bedroom fitted with a firm sheet are the safest place for your baby to sleep. Bassinettes are safe for very young babies. Once your baby become mobile, which includes being able to move themselves into a sitting position, crawl, or raise themselves up by holding onto something, bassinettes pose a risk that your baby’s first time standing will result in a tumble over the side of the bassinette. Move your baby to a crib as soon as they show signs of being able to raise themselves up.

Use a crib for your baby’s bed.

Later, we’ll share some alternatives to a crib if the cost of a crib or space limitations won’t allow you to place a crib in your bedroom as well as options for naps when you won’t be in your bedroom with your baby.

Sleeping Arrangements to Avoid

  • Sleeping on your bed with or without you
  • Falling asleep with baby on a sofa
  • Sleeping on a chair

Preventing the Death of Babies

Many of the deaths of infants that occur are preventable. I don’t say this to blame the parents. Parents who lose a child don’t do it on purpose. Often it is a communication problem. Even if they were told to lay their baby on its back, they may not have been told why. Or, they may have been told by well meaning grandparents that sleeping on the back poses a suffocation risk.

The point of this article is not to cast blame on parents who have tragically lost a child. The goal is to prevent new deaths.

It is very clear in the chart from the CDC that deaths from Sudden Infant Death Syndrome (SIDS) dropped substantially after the guidance given to new parents changed from tummy sleeping to back sleeping. Sleeping on the back save’s babies’ lives!

You should also avoid attire that will cause your baby to overheat.

Can We Do Better?

Yes, we can do better. The guidance isn’t always followed. In 2017, 3,600 babies died in their beds from a combination of SIDS, unknown causes, and accidental suffocation or strangulation.

  • 100% of the suffocation and strangulation deaths were avoidable
  • Many of the SIDS deaths may have been avoidable

As mentioned previously, not all parents follow the guidelines. Co-sleeping increases the baby’s risk of dying but it has become increasingly common over the past twenty years.

Many babies are still placed on their stomachs.

Babies are also placed on the parent’s bed to sleep by themselves. This is especially common when traveling or visiting a home that does not have a crib or bassinette.

Protecting Your Baby Before and After Birth

You can begin protecting your baby before it is born. The following behaviors improve your baby’s chances of having a long, healthy life:

  • Regular pre-natal visits
  • Taking, but not exceeding, the recommended vitamin and micro-nutrient intake prior to and during pregnancy including recommendations for folic acid, B6, B12, D, and other vitamins.
  • Get healthy before you get pregnant (physically fit, old enough (adults), and develop good stress management skills).
  • Give your body time to recover between babies (wait 18 months to get pregnant again).
  • Get the vaccinations recommended by the American Academy of Pediatrics (AAP) and the Center for Disease Control (CDC).

The following behaviors should be avoided because they reduce your baby’s chances of enjoying a long, healthy life:

  • Taking any drugs, whether prescribed, over the counter, or illegal that are not recommended and approved by your OBGYN prior to use.
  • Smoking cigarettes
  • Smoking cannabis
  • Exposure to secondhand smoke during pregnancy and after birth
  • Avoid alcohol use during pregnancy and after birth
  • Avoid experiencing more stress than you have the skill to handle without emotional upset. Stress management skills can greatly reduce the effect stressors have on your and your baby’s current and future health.

Maternal exposure to alcohol and nicotine during pregnancy are significantly associated with a higher risk of SIDS. Younger parents have a greater risk of losing a child to SIDS.

Products to Avoid

Although baby products are tightly regulated, lawmakers usually act after babies have been harmed rather than proactively restricting products that are marketed to parents. Researchers usually arrive at conclusions about which products to avoid before law makers act. Researchers discourage the use of the following products for your baby:

  • Wedges, whether or not they are marketed as a way to prevent SIDS
  • Products designed to position your baby or restrict their movement
  • Products that are marketed as SIDS prevention devices without supporting research
  • Home monitors that monitor your baby’s respiration unless recommended by a physician for a specific medical problem
  • Crib bumpers
  • Pillows
  • Any product with strings, ribbons, or other items that could wrap around the baby’s throat including devices designed to keep pacifiers from becoming lost
  • Soft mattresses
  • Products with buttons, removable eyes, or other choking hazards

Products to Use

  • Firm mattress
  • Tight fitting sheet in the crib or bassinette
  • New crib that meets current safety recommendations. Depending on the age of a used crib, it could fail a variety of safety tests including lead paint on antique cribs to bars that are too far apart.
  • Pacifiers
  • Sleep bags and onesies that are appropriate for the temperature

You can ask the other parent or another adult in the home to wake up and monitor whether you fall asleep if you think you will fall asleep while breastfeeding. If it is during the daytime and there is an older child home, you can also ask them to quietly read or play while you nurse the baby and put the baby in their crib after they nurse if you do fall asleep.

Professionals That Interact with New Parents

Doctors, nurses, lactation consultants, Doulas, Midwives, and others who interact with new parents should make a point of having non-judgmental conversations with parents about sleep safety for newborns. Because new advice conflicts with advice their parents may have received when they had babies, understanding that the guidance has changed will help parents choose between what their parents tell them is the right way to keep their baby safe and more recent evidence based on research.

Age Specific Recommendations

These age specific recommendations are based on studying the behaviors and practices that led to the best outcomes for large numbers of babies. Although the risk of sudden infant death is highest during the first four months of life, there is a risk throughout the first year.

The risk of strangulation continues throughout childhood. For example, mini blinds with cords pose a danger to children. Newer models don’t have cords but if you have older varieties, look into making them safer for your child or replacing them.

At birth:

At least an hour of skin-to-skin contact with the mother, if possible. With father or adoptive parent if the mother is not available.

First Four Months of Life:

  • The American Academy of Pediatrics (AAP) reports that having the baby sleep in the parent’s room reduces the risk of death from SIDS by 50%
  • Breastfeed the baby

Four Months to One Year:

  • Continue breastfeeding
  • Continue keeping soft pillows, toys, blankets, crib bumpers, and stuffed animals out of the baby’s crib.

Safe Sleeping Arrangements While Traveling and Co-Sleeping Alternatives

Life goes on after your baby is born. You still visit friends and relatives. Packing up a full-sized crib isn’t practical. Additionally, although parents are encouraged to sleep when their baby sleeps, it is not always practical. You may have other children at home who need to be supervised or a job that requires your attention.

Portable travel sleep solutions can be used to keep your baby in the room with you when you are unable to sleep in your room while your baby sleeps. Since babies that co-sleep with their parents have a lower risk of death, it makes sense to keep the baby in the room with you when you are awake, and they are asleep.

You can use a portable bassinette that has mosquito netting outdoors as well as inside. They are small and allow you to keep your baby in the same room you’re in while they nap.

A small travel bassinet or Finnish-type baby box can be set on the parent’s mattress, between the parents, to provide a safe place for baby to sleep. A portable bed could be placed on top of the covers on your bed to keep your baby close to you as long as it is a long way from the edge of the bed.

Good communication is important. Avoid the panic you’ll feel if you return from having your parents watch your baby to learn that they laid the baby down on their bed “because she isn’t rolling over yet, so she’ll be fine.” The risk of soft mattresses, loose blankets, pillows, and other bedding materials commonly found on adult beds pose a risk to infants.

Make sure anyone you entrust with your child’s well-being understands the current recommendations to keep your child safe.

You can also buy a Pack and Play portable play yard and add mosquito netting for a solution that will last longer. The useful life of bassinettes is very brief and depends on how quickly your baby grows.

We hope you never experience the heart wrenching tragedy of losing a child for any reason but especially not to something that might have been prevented. Please help pass this evidence-based information on to other parents.

As mentioned above, intrinsic risk factors affect the vulnerability of the infant, increasing susceptibility to the influence of extrinsic risks. These factors include male sex, prematurity, low birth weight, genetic polymorphisms, and prenatal exposure to drugs, particularly nicotine (from cigarettes) and alcohol. Intrinsic risk factors are normally not modifiable, with the exception of exposure to maternal cigarette smoking or alcohol consumption during pregnancy. Although these could also be considered extrinsic risk factors (such as would occur via exposure to second-hand smoke after birth), as maternal exposure during pregnancy causes the highest risk for SIDS it will be presented in this section.