Updated AAP Guidelines on Safe Sleep for Prevention of SIDS

Children should sleep in the same room, but not in the same bed, as their parents, for at least the first 6 months after birth.

Federal health agencies have announced their support of the American Academy of Pediatrics (AAP) updated guidelines on safe sleep in infants.

The agencies, including the Eunice Kennedy Shriver National Institute of Child Health and Human Development, part of the National Institutes of Health (NIH), the Centers for Disease Control and Prevention (CDC), the Maternal and Child Health Bureau of the Health Resources and Services Administration, and the US Food and Drug Administration (FDA), are all urging anyone who takes care of infants and children under age 1 to learn the new AAP recommendations.

One of the most notable changes is the recommendation that children sleep in the same room, but not in the same bed, as their parents, for at least the first 6 months after birth but ideally until age 1, to prevent sudden infant death syndrome (SIDS) or sudden unexpected infant death syndrome (SUIDs).

See all 19 updated guidelines below.

1. Always place infants on their back to sleep. This should be done until age 1 to reduce the risk of SIDS. Side sleeping is not safe,3,4 and putting an infant to sleep on its belly should only be considered in infants with certain upper airway disorders, such as gastroesophageal reflux disease (GERD) or anatomic abnormalities such as type 3 or 4 laryngeal clefts, that present a greater risk than SIDS.

Infants receiving nasogastric or orogastric feeds should be placed on their backs to sleep, and should not have their heads elevated.

Infants in the hospital, including preterm infants, should also be placed on their backs to sleep.

When babies are old enough that they can roll onto their stomachs themselves, they can be left asleep on their stomachs if they fall asleep that way.

2. Babies should sleep on a firm surface. The mattress should maintain its shape, and should not conform to the shape of the infant’s head. Soft mattresses or soft items in the bed, such as pillows or blankets, can increase the risk of suffocation. Cribs should be approved by the US Consumer Product Safety Commission (CPSC).

3. Breastfeeding is recommended to reduce the risk of SIDS.5-7

4. It is recommended that infants sleep in the same room as their parents but in their own crib, rather than in a separate room, for the first 6 months after birth, but ideally for a year. This is to increase the chance that if the infant requires attention, or if something is wrong, parents will be more likely to notice and provide the appropriate attention.

Couches and armchairs are especially dangerous places for infants to fall asleep, due to the risk of getting wedged between seat cushions or under the caregiver’s body.4,8,9,10,11 Sleeping in the parents’ bed is also dangerous for this reason. Parents should be vigilant against falling asleep with their child in any of these places, and infants should always be returned back to their crib when the parent is ready to go back to sleep.

5. Keep soft objects out of the infant’s sleeping area to reduce the risk of suffocation. This includes pillows, soft toys, quilts, comforters, sheepskins, and loose bedding.

6. Pacifiers can be offered for naps and bedtime. Studies have shown that pacifiers may decrease the risk of SIDS.12,13 However, infants should not be forced to use the pacifier if they refuse it; pacifiers should also not have a string around the infant’s neck, nor should they have stuffed toys or other items hanging from them, to reduce the risk of strangulation or suffocation.

7. Children should not be exposed to smoke during pregnancy or after birth. In addition to other health risks, the risk of SIDS is significantly increased when infants share a bed with a smoker, even if they do not smoke in bed.4,9,14,15,16,17

8. Children should not be exposed to alcohol or illicit drugs during pregnancy or after birth. In combination with bed-sharing, both can increase the risk of SIDS.18,19

9. Be cautious of overheating in infants, and avoid covering their heads. Studies have shown an increased risk of SIDS when infants are overheated.20-23 Generally, infants should be dressed in no more than 1 layer more than adults are wearing to be comfortable in a room. Overheating can be checked by watching for sweating or feeling whether the infant’s chest is hot to the touch. Overbundling and covering infants’ faces should be avoided.

10. Pregnant women should regularly obtain prenatal care. There is substantial evidence linking regular prenatal care with a decreased risk of SIDS.31-34