Understanding Safe Sleep for Babies: A Comprehensive Guide

Disclaimer: This blog is for informational purposes only and is not intended as medical advice. Always consult your pediatrician or a qualified healthcare provider regarding your baby's specific sleep needs.

The ABCs of Safe Sleep

A: ALONE

B: on their BACK

C: in a CRIB

Does this sound overly simple? Maybe you just want more details, or maybe safe sleep sounds overwhelming. It can feel like a lot of information, but remember that creating a safe sleep environment is about taking practical steps, and you’re already on the right path by staying informed. In this guide, we’ll break down key terms and best practices for keeping your little ones safe while they sleep. So, let’s get into it. 

A FEW TERMS

SUID and SIDS: What’s the Difference

Sudden Unexpected Infant Death (SUID) is an umbrella term including SIDS, accidental suffocation or strangulation in infants under one, while Sudden Infant Death Syndrome (SIDS) has no obvious cause. While the cause remains unclear The Safe to Sleep campaign of 1994 has reduced SIDS by over 50%.

Co-Sleeping: This is a broad term to describe a baby sleeping in the same space as their parents or caregivers. This can include bed-sharing, which is never recommended, as well as room sharing where the baby sleeps in a separate bed like a crib or bassinet but is near the adults. Some may even include contact napping. Co-sleeping can be very beneficial, particularly in the first 3-6 months, as it allows for easier nighttime feeds, close monitoring, and promotes a sense of security for the baby. See the AAP recommendations for co-sleeping here.

Bed-Sharing: This is when a baby sleeps in the same bed as their parents or caregivers. While bed-sharing is sometimes done for convenience, it significantly increases the risk of SUIDS and is not recommended by the American Academy of Pediatrics (AAP). 

The distinction between co-sleeping and bed-sharing is critical because, although keeping your baby close at night has advantages, the safest way to do this is through room sharing with your baby sleeping in their own bed. Any reference to co-sleeping in this post will mean room-sharing, not bed-sharing.

Now that we’ve covered some basic terms, let’s dive into where your baby should sleep. Room sharing, as mentioned, is highly recommended. According to the AAP, babies should ideally sleep in the same room as their parents for the first 6 months, and room sharing is shown to reduce the risk of SIDS by as much as 50%. That may seem like a long time but it will go in a blink, therefore I recommend getting through at least the first 12 weeks together before the baby is in their own room.

Room-sharing may seem daunting, but it also allows for easier night-time feeds, better temperature control, and close monitoring of the baby. When your baby is close to you, they can hear your breathing, smell your scent, and feel the warmth of your presence. This can help regulate their breathing and heart rate, reducing the likelihood of breathing irregularities. Some may want their adult space to stay baby-free, so many parents will sleep on cots, couches, etc in the nursery over the adult's bedroom. While the separation is not for everyone, some find rotating nights in the nursery to help everyone get enough sleep in the long run. This is very dependent on each family's comfort levels and baby’s feeding needs.

Room Temperature Guidelines: Keep the room cool to prevent overheating (ideal temperature is 68–72°F).

Crib Placement: Position your crib or bassinet along an interior wall, rather than an exterior wall. Most manufacturers recommend placing the crib about one foot away from the wall and at least three feet away from windows, vents, or heaters. Be sure to check your product's specific guidelines for exact measurements, as they can vary. This arrangement helps with temperature regulation by keeping your baby away from drafts and direct heat sources. It's also important to keep the crib at arm's length from blinds, cords, or any other furniture. If the crib is in the adult bedroom, be mindful of any electronic devices or screens that may cast blue light onto the sleeping area. Some choose to have the bassinet near the adult’s bed, but be sure to still abide by the spacing guidelines. I also suggest keeping the changing supplies within an adult's reach of the feeding spacewhen arranging the room.

Crib Safety: The crib should be clear of any items that could pose a hazard. No crib bumpers, mobiles hanging over the bed, pillows, loveys, bottles, or toys. Use original parts and only fitted sheets designed for the crib or bassinet. A firm and flat surface is key. 

Portable Cribs and Play Yards: These options are great for smaller spaces or travel. The same safety guidelines apply – use the original mattress, stay within weight limits, and avoid adding any extra cushions or positional devices. Refer to the safety guidelines of each individual product.

Smart Bassinets: In recent years, "smart bassinets" have become more popular. These devices often include built-in swaddles and features like rocking, vibrating, or playing white noise, sometimes triggered by your baby’s cries. But are they safe? As long as you follow safe sleep guidelines and stick to the size limits, using a "smart bassinet" doesn’t seem to pose any extra risk. You can always check for safety recalls here. I’m not a fan of smart bassinets for two reasons, neither of which are about safety. First, the soothing features can be overused, creating sleep problems that are harder to fix later rather than creating positive habits to build on.  For many parents, these products can be a lifesaver during the newborn stage and when used short-term, with a smooth transition away from using the features, many babies do well once they're out of the bassinet. 2. This is a short-term product that costs A LOT.

Avoid Loungers or Positional Devices: Although marketed for comfort, loungers and positional devices can create a hazardous environment for your baby. Even for babies with reflux, a flat surface is recommended, always consult with your pediatrician to find safer sleep options if you have concerns.

Sleepwear: Pajamas should be snug-fitting. Natural fibers, like cotton, are most recommended. 

Swaddling: Swaddling is a common practice for newborns and can help them feel secure. Place the swaddle below the shoulders around the chest area, keeping the neck and airway clear of fabric. Your baby’s swaddle should be snug but not tight, especially around the hips. Swaddle blankets are often lightweight and made from natural fibers, never weighted. Using a thick blanket increases the chance of overheating. Velcro or Snap Swaddles are great options to ensure that the swaddle stays secure. Always make sure your baby is within the weight limits for the swaddle product and monitor for signs of rolling.

Transitioning Out of the Swaddle: Around the time your baby starts to show signs of rolling over (typically around 2-3 months), it’s important to stop swaddling. Many parents opt for a one-arm-out swaddle technique during the transition period, but once that baby rolls it’s time to switch.

Sleepsacks: Sleep sacks are wearable blankets designed to keep babies cozy and safe without the need for loose blankets in the crib. They are often used after the swaddling stage to provide a secure, cozy feel while allowing freedom of movement, and they can be worn into toddlerhood. Weighted or other products that may restrict movement are NOT recommended. 

Pacifiers: Using a pacifier during naps and bedtime can help reduce the risk of SIDS, although it’s not necessary for all babies. If you’re planning to breastfeed, pacifier use should be introduced after breastfeeding is well established, usually around 3-4 weeks. I find many bottle-fed babies don’t take to a pacifier until that time frame as well. I can only recommend orthodontic safe pacifiers, not only for the benefits of the soft palate and sinus development, but their shape helps them stay in the mouth. Whereas pinky-shaped pacifiers often require babies to actively hold them in. If your baby uses a pacifier, it’s fine if they spit it out after falling asleep. Make sure there are no pacifier attachments or clips in the crib with them.

Now back to The ABCs of Safe Sleep, but let’s expand.

Alone in Their Sleep Space, means alone.

It’s tempting to place your baby with cozy blankets, stuffed animals, or a lovey, but these items can increase the risk of suffocation or strangulation. The sleep space should be completely bare, except for a fitted sheet. As your baby gets older, you may introduce comfort items when it’s developmentally appropriate (around 12 months). In my experience introducing these items too early can cause the baby to stir or awaken rather than use them to soothe as intended. 

On Their Back

Placing babies on their backs to sleep is one of the most critical recommendations for reducing the risk of SIDS. Babies should sleep on their backs every time they’re put down for sleep, whether it's nap time or nighttime. Once your baby can roll over on their own, they may roll onto their tummy during sleep, and that’s okay. However, you should always start them on their back.

In a Crib (or Bassinet, Portable Crib, or Play Yard)

A crib or similar sleep space must be flat and firm, free of soft surfaces like Boppy pillows, DockATots, or other positional devices. Use original parts, mattresses, and fitted sheets intended for the crib/bassinet. No bumpers, mobiles, or “tents”. 

You may be thinking a crib or bassinet makes sense at night, but what about the rest of the day? Well simply put any products that are not firm or don't allow for a baby to be flat on their back are not for sleep. We've already discussed things like adult beds, boppys, dock-a-tots, etc but this also includes bouncers, swings, and other positional products often marketed for soothing or comfort. While these products can be helpful for short periods of awake soothing or play, they are not designed for prolonged use. To ensure the baby is positioned with a clear airway, the use of any device should be actively monitored by an adult. When they start to fall asleep it's important to always move your baby back to a safe, flat sleep surface, like a crib or bassinet.

Car Seats and Strollers: While it’s ok if your baby falls asleep in the car, car seats out of the car and detached from a stroller are no longer at a level resting position and therefore are not for sleep. Remove your sleeping baby from the car seat once inside. Not all strollers are made alike and whether or not they are at a level resting position comes down to each individual product. Even at a level position car seats and/or strollers should not be used for prolonged sleep.

Contact Napping: Another common practice, especially in the early months, is contact napping. This is when your baby naps while being held or worn in a baby carrier or fabric wrap. Contact naps are a great way to bond and promote co-regulation and unlike bed-sharing, contact napping is safer as long as certain precautions are followed. The baby's airway must be clear and the face uncovered. No chin to chest or other positions that may restrict movement or airway. If using a carrier be sure your baby is in a proper position, within weight recommendations, and be aware of overheating. The adult should always be awake, alert, and actively monitoring the baby.

Allergens and Cleanliness: Creating a clean, allergen-free environment is important to a healthy sleep environment for your baby for everyone but especially for those with pets, particularly those that shed, as they can introduce allergens and dirt into the home. Regular cleaning is key—vacuum and wipe down your baby’s sleep area frequently, wash crib bedding often, and consider using an air purifier in the baby’s room to improve the overall environment by reducing allergens, dust, and dander. It’s crucial to maintain a smoke-free home at all times, as secondhand smoke is a leading risk factor for SUID.

Pets: If you have pets at home, it’s essential to take extra precautions to ensure your baby’s sleep environment is safe. Pets, especially cats and dogs, can be curious about the new baby, and while they may not mean any harm, they could accidentally disrupt the baby’s safe sleep setup. Keep your baby’s crib or bassinet off-limits to pets. While it may seem cute for a dog or cat to cuddle with the baby, it’s a safety risk. Before the baby arrives, start preparing your pet for the changes by gradually introducing them to new baby items like cribs, bassinets, swings, etc. Consider using barriers like a baby gate or closed doors to keep them out of the room where your baby is or is going to sleep to get them used to new routines. Provide baby-free spaces for your pets to access if they are feeling stressed by the new family member. Always supervise interactions between your pet and baby. Even when room sharing with an adult, pets should not have access to the baby’s sleep space.

Let’s wrap up. Safe sleep is about taking practical steps with the right devices. You can check for product safety recalls here and look at the AAP safe sleep guidelines here. By following safe sleep guidelines, you are already taking significant steps to protect your baby. Stay informed and consistent with safe sleep practices to ensure an environment where your baby can thrive while you have peace of mind.

Speak to your pediatrician for any health concerns related but not limited to sleep. All being said don't let the fear of SUID's cause unnecessary stress, it's important to remember that while SIDS and other sleep-related risks can be concerning, they are rare. Trust yourself and take it one day at a time. 

For a quick cheat sheet, you can download my Safe Sleep Checklist below.

Safe Sleep Checklist.pdf

Download PDF • 1.30MB