American Academy of Pediatrics (AAP) Recommendations
Back to Sleep for Every Sleep
Infants should be placed in the supine position for every sleep until the child reaches 1 year of age. Side sleeping is not safe and is not advised. Preterm infants are at an increased risk of SIDS, so they must be placed in the supine position as soon as possible. Prone or lateral sleep positions are acceptable if the infant is observed and awake, particularly in the postprandial period.
Use a firm sleep
Infants should be placed on a firm sleep surface (e.g., mattress in a safety-approved crib) covered by a fitted sheet with no other bedding or soft objects to reduce the risk of SIDS and suffocation. A firm surface maintains its shape and will not indent or conform to the shape of the infant’s head when the infant is placed on the surface. Soft mattresses, including those made from memory foam, could create a pocket (or indentation) and increase the chance of rebreathing or suffocation if the infant is placed in or rolls over to the prone position. A crib, bassinet, portable crib, or play yard that conforms to the safety standards of the Consumer Product Safety Commission (CPSC), including those for slat spacing less than 2-3/8 inches, snugly fitting and firm mattresses, and no drop sides, is recommended. Additionally, the sleeping environment should be free of hazards, such as dangling cords, electric wires, toys, or other cushions and bedding to avoid the risk of strangulation or suffocation.
Breastfeeding is recommended
Breastfeeding is associated with a reduced risk of SIDS. Unless contraindicated, mothers should breastfeed exclusively or feed with expressed milk (i.e., not offer any formula or other nonhuman milk-based supplements) for six months, in alignment with recommendations of the AAP. The protective effect of breastfeeding increases with exclusivity. However, any breastfeeding has been shown to be more protective against SIDS than no breastfeeding.
Room-sharing without bed-sharing
It is recommended that infants sleep in the parents’ room, close to the parents’ bed, but on a separate surface designed for infants, ideally for the first year of life, but at least for the first six months. There is evidence that sleeping in the parents’ room but on a separate surface decreases the risk of SIDS by as much as 50 percent. In addition, this arrangement is most likely to prevent suffocation, strangulation and entrapment that may occur when the infant is sleeping in the adult bed. The infant’s crib, portable crib, play yard, or bassinet should be placed in the parents’ bedroom until the child’s first birthday. Although there is no specific evidence for moving an infant to his or her own room before 1 year of age, the first six months are particularly critical, because the rates of SIDS and other sleep related deaths, particularly those occurring in bed-sharing situations, are highest in the first six months. Placing the crib close to the parents’ bed so that the infant is within view and reach can facilitate feeding, comforting, and monitoring of the infant.
Avoid soft, loose bedding
Keep soft objects, such as pillows, pillow-like toys, comforters, quilts, sheepskins and loose bedding such as blankets and unfitted sheets, away from the infant’s sleep area to reduce the risk of SIDS, suffocation, entrapment and strangulation. Infant sleep clothing, such as a wearable blanket, is preferable to blankets and other coverings to keep the infant warm while reducing the chance of head covering or entrapment that could result from blanket use. Learn more here.