Safe Sleep Guidelines: A Reference Guide for Parents

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You probably feel like you’re awake around the clock with your little one, but in actuality, babies sleep 12  to 17 hours a day. And with sudden infant death syndrome (SIDS) being one of the leading causes of death for children under one, safe sleep is a priority for all parents and caregivers. Use this guide to ensure nap time and bedtime are safe for your little one.

Understanding SIDS

SIDS doesn’t refer to a specific illness, but describes when baby dies suddenly in his sleep and a cause cannot be determined even after a full investigation. According to the National Institute of Health’s Safe Sleep public education campaign, approximately 2,000 babies die of SIDS each year — and HealthyChildren.org notes that 20 percent of SIDS deaths happen when a child is in the care of someone other than a parent. And while doctors can pinpoint factors that significantly increase the risk of SIDS, the cause is still unknown.

The good news is that research shows up to 90 percent of SIDS cases are preventable by ensuring that you, your partner and any sitters or caregivers who watch your child are following safe sleep guidelines during naps and bedtime.

Back to Sleep

The single most important thing you can do to ensure safe sleep is put your baby to sleep on her back. This change in the 1990s reduced the number of SIDS cases by more than half. Once your baby is old enough to roll over, she should be fine to sleep on her tummy.

Safe Sleep in a Crib

Many parents choose to have their babies sleep in a crib, either in their bedroom or in a nursery. Some parents opt to have an infant sleep in a bassinet or co-sleeper — the guidelines for safe crib sleeping are applicable to these sleeping arrangements as well.

To ensure safe sleep in a crib, follow these guidelines:

  • Ideally, your newborn will sleep in your bedroom with you — at least for a few months — but not in the same bed. If your baby sleeps in a separate nursery, invest in an audio or a video monitor so you can hear the baby from different areas of your home.
  • Position the crib away from windows, heaters, cords and drapes.
  • Ensure that the crib mattress fits properly — it should be snug inside the railing of the crib. You shouldn’t be able to fit more than two fingers between the crib railing and mattress.
  • Use a fitted crib sheet pulled taut with no loose fabric.
  • Remove all toys, stuffed animals, loose blankets, pillows and other soft bedding, including the crib bumper, from the crib. Your child should not sleep with a blanket until after his first birthday.
  • Mobiles should be hung at least 12” above a baby. You’ll want to remove a mobile once your child can pull herself up to stand because she’ll definitely grab for it, and strings and small pieces could present a choking or strangulation hazard.
  • Always place your baby on his back to sleep.
  • Wearable blankets and swaddling are generally regarded as safe, though make sure your baby isn’t overdressed — overheating has been shown to increase the risk of SIDS. You should stop swaddling once a baby is old enough to roll over to prevent her from becoming tangled in her blanket.

Safe Co-sleeping

Co-sleeping — also called bed-sharing or the family bed — is a controversial practice that refers to when parents share an adult bed with their child (or children). Some research has shown the practice to increase the risk of SIDS and suffocation. In addition to the threat of a parent rolling over onto a child, a baby can become trapped in an adult bed between the mattress and the headboard, bed frame or wall, or tangled in sheets and blankets. Many pediatricians recommend that families who want to bed-share use a separate co-sleeper that can be attached to the bed instead.

Other well-known parenting experts, like Dr. Sears, argue that co-sleeping has benefits for the baby and the mother and does not increase the risk of SIDS as long as parents are practicing safe co-sleeping. If you do choose to co-sleep with your child, follow these safe sleep guidelines:

  •  Never sleep with a baby on a couch, futon, waterbed or other soft surface. An adult bed should have a firm mattress and be large enough for co-sleeping — a queen or king size bed usually works best.
  • Take precautions to prevent the baby from rolling off the bed. Use a guardrail or a push the bed against the wall making sure there is no space where the baby could become trapped.
  • Remove excess bedding and pillows from your bed. Blankets and pillows should be kept away from the baby’s face.
  • It is safest for babies to co-sleep with mothers only. Mothers who co-sleep have an innate awareness of their babies and are able to respond to their needs instinctually throughout the night. Fathers do not have the same awareness and are more likely to roll over onto an infant. If both parents are in bed, avoid having a baby sleep between mom and dad. Instead, have the baby sleep between mom and the wall or a guardrail with dad on the opposite side.
  • Always place your baby on her back to sleep.
  • Do not co-sleep if you’ve had any amount of alcohol, taken medication that can cause drowsiness or have ingested other drugs. Likewise, parents who suffer from sleep apnea or have risk factors that could lead to sleep apnea (like obesity), should not bed-share.

While SIDS and other sleep-related deaths, like strangulation, suffocation and choking, are not common, you can significantly reduce any risks by following safe sleep practices. Share these guidelines with your partner and your child’s sitter or caregiver, and rest easy knowing that your baby is sleeping safely.