Safe sleep for babies

Sudden infant death syndrome (SIDS) and other sleep-related deaths are rare, and a few simple habits lower the risk further. This page sums up the current guidance of the American Academy of Pediatrics (AAP), updated in 2022, and of the UK's NHS. The two agree on almost everything; where they differ, we say so.

Every sleep, day and night

• On the back. Put your baby down on their back for every sleep, naps included. Back sleeping carries a far lower risk of sudden death than sleeping on the tummy or side. Once your baby can roll both ways on their own, you do not need to turn them back.
• On a firm, flat surface. Use a cot, crib or bassinet with a firm, flat mattress that does not dip when the baby lies on it, and a fitted sheet. Nothing that tilts: the AAP says any surface inclined more than 10 degrees is not safe for sleep.
• Nothing else in the cot. No pillows, quilts, duvets, blankets, bumpers, soft toys or mattress toppers. The NHS recommends placing the baby "feet to foot" — feet at the bottom end of the cot — so they cannot wriggle under any bedding.
• In your room, in their own bed. Keep the baby's cot in the room where you sleep for at least the first 6 months. Room-sharing lowers the risk; sharing the same sleep surface raises it.

Things that raise the risk

• Sofas and armchairs. Never fall asleep with your baby on a sofa or armchair. This is one of the highest-risk situations there is.
• Car seats, strollers, swings and slings. They are not for routine sleep. If your baby falls asleep in one, move them onto their back on a firm sleep surface as soon as you can, and do not leave them in a car seat for long periods.
• Weighted products. Do not use weighted sleep bags, swaddles, blankets or other weighted items on or near your baby.
• Overheating. Dress your baby in about one layer more than you would wear to be comfortable. No hats indoors. The NHS suggests a room temperature of about 16–20 °C.
• Smoke. Smoking in pregnancy and smoke around the baby after birth both raise the risk. Keep cigarettes and vapes away from your baby altogether, indoors and out.

Things that help

• Breastfeeding, if you can, lowers the risk.
• A dummy (pacifier) offered at naps and bedtime lowers the risk too — it still helps if it drops out after your baby falls asleep. If you breastfeed, wait until feeding is going well before offering one. Never hang a dummy on a cord around the neck or clip it to clothing during sleep.
• If you swaddle, always lay your baby on their back, and stop as soon as they show any sign of trying to roll — for some babies this is as early as 2 months.
• Home breathing monitors are not a way to prevent SIDS — the AAP advises against using them for that, and they do not replace these habits.

If you do share a bed

The AAP's advice is to avoid sharing a bed with your baby under any circumstances. The NHS also recommends a separate cot, but recognises that many parents do end up sleeping with their baby, and gives this advice to make it safer:

• the baby sleeps on their back on a firm, flat mattress;
• pillows, sheets and blankets are kept away from the baby;
• the baby is not swaddled — a baby sleeping bag is safer;
• no other babies, children or pets are in the bed;
• the baby is never left alone in an adult bed;
• the baby cannot fall out of the bed or get trapped between the mattress and the wall.

The NHS says never share a bed with your baby if:

• your baby was born premature (before 37 weeks) or with a low birth weight (under 2.5 kg);
• you or your partner smoke — wherever and whenever you smoke, even if never in bed;
• you or your partner have had 2 or more units of alcohol;
• you or your partner have taken recreational drugs, or medicine that makes you drowsy.

When to talk to a doctor

Talk to your doctor or health visitor soon if your child:

• snores often, seems to struggle to breathe at night, or is very sleepy during the day;
• is not gaining weight as expected, or has lost their appetite;
• has sleep problems you are finding hard to manage.

If you are worried and not sure what to do, it is always fine to ask. If you are unsure whether a sleep product is safe, or your baby has a medical condition that might change this advice, ask your doctor or health visitor.

If your baby is under 3 months old with a temperature of 38 °C (100.4 °F) or higher, or 3–6 months old with 39 °C (102.2 °F) or higher, call your doctor straight away. If you cannot reach a doctor, call your local emergency number.

Call your local emergency number now if your baby:

• stops breathing for more than 20 seconds;
• is breathing very fast or with great effort — grunting, or sucking their tummy in with each breath;
• has blue, grey, pale or blotchy skin, lips or tongue;
• is very hard to wake, or will not wake up;
• is floppy, or is not feeding;
• has a seizure (fit), or a rash that does not fade when you press a glass against it.

Sources

• American Academy of Pediatrics (2022) — AAP updates safe sleep recommendations
• American Academy of Pediatrics, HealthyChildren.org — A parent's guide to safe sleep
• American Academy of Pediatrics, HealthyChildren.org — Swaddling: is it safe?
• American Academy of Pediatrics, HealthyChildren.org — Sleep apnea: signs to watch for
• American Academy of Pediatrics, HealthyChildren.org — When to call the pediatrician: fever
• NHS — Reduce the risk of sudden infant death syndrome (SIDS)
• NHS — Is your baby or toddler seriously ill?
• KidsHealth (Nemours) — Failure to thrive: when to see a doctor