Questions about sleep will be on your mind a lot during the first few months of your little one’s life. Isn’t my sleeping baby beautiful? How much should my baby sleep during the day? When will my little one sleep through the night?

But one of the most important questions you need to know the answer to is: What can I do to make sure my baby is sleeping safely?

How your baby sleeps, particularly during the first 12 months of their life, is very important for their health and well-being. To put your mind at rest, we’ve assembled this guide to the ABCs of safe sleep.

Safe sleep matters: What is sudden infant death syndrome (SIDS)?

SIDS is the unexplained death of an infant who is younger than one year old. In the United States, SIDS takes the lives of about 3,400 babies each year. This number has been continuously decreasing over the past 25 years due to better sleep practices, but SIDS is still the leading cause of death in infants between one month and one year of age.

The exact cause of SIDS is unknown, but the best-supported theory is that it may be due to a combination of three key factors:

  • Age – Most SIDS cases involve infants that are under 6 months old, frequently between 2-4 months old.
  • Environment – Factors like where and how an infant sleeps that could pose a risk.
  • Vulnerability – An underlying health condition that could make an infant more vulnerable to factors in their environment.

Researchers have discovered a strong association between SIDS and low activity of the enzyme butyrylcholinesterase (BChE) in infants’ blood. This is the first known vulnerability to SIDS that can be detected before SIDS occurs. However, more research is needed to find out whether measuring BChE can be used to prevent SIDS.

Is SIDS the reason why babies shouldn’t sleep on their stomachs?

Yes. While the exact cause of SIDS is unknown, many researchers believe that when babies sleep on their stomach, it can block their airway, interrupt their breathing or cause them to rebreathe their air. Rebreathing air is dangerous because it causes the level of oxygen to drop and the level of carbon dioxide to increase.

Normally, a rise in carbon dioxide level will cause baby to wake and turn their head to get the oxygen they need. But some babies don’t respond when their oxygen level is low. If the baby is unable to get enough oxygen, SIDS can occur.

So, what’s the safest sleep setup? What are safe baby sleeping positions? Read on to learn the answers.

Safe sleep for infants means following the ABCs:

According to the American Academy of Pediatrics (AAP), caregivers can promote safer sleep for infants by following the ABCs of safe sleep.

A: Alone. Your baby should always sleep alone. This means no bed-sharing (or co-sleeping), and no stuffed animals or other toys.

B: Back. Your baby should always sleep on their back – not on their stomach or side.

C: Crib that’s bare. Your baby should sleep in a crib that’s free of bumper pads, pillows, blankets and toys. Baby should always sleep in a crib or bassinet – not on an adult bed, sofa, cushion or other soft surface.

When and where it’s safe for babies to sleep: Answers to FAQs

The great thing about the ABCs of sleep is that they’re simple and memorable. But, it’s likely you still have a few questions about your baby and sleep. Here, we’ll answer some of the most frequently asked questions.

Can baby sleep in a swing or car seat?

Baby shouldn’t snooze in a swing or a car seat for prolonged periods of time – and definitely not overnight. Car seats, swings and similar products prop babies up in a seated position. And because baby’s neck muscles might not be fully developed, they may not be able to support the weight of their head, causing them to slump over. Slumping can lead to suffocation.

But if baby catches some shut-eye in the swing or takes a trip to sleepy-land while you’re driving to a nearby appointment, it’s okay. Just make sure you’re keeping a close eye on them and that it’s only for a little bit.

Is it safe to use an infant sleep positioner or wedge?

No. It’s never safe to use a wedge or positioner to prop your baby into a specific sleep position.

The U.S. Food & Drug Administration (FDA) strongly warns against using infant sleep positioners because they increase the risk of suffocation. Even if you find a product that says that it reduces the chance of SIDS, you should still steer clear. The FDA has not approved any infant sleep positioners.

When is swaddling or the use of sleep sacks safe?

Swaddling – or wrapping an infant in a light blanket – is often used as a way to soothe or calm a baby, as well as encourage them to lay in a face-up position. The AAP says swaddling can be safe and helpful, if done correctly.

But once your little one starts trying to roll over, usually at around two months old, it’s time to stop swaddling. That’s because if your baby manages to roll over while swaddled, they don’t have their arms free to help them roll back over, which can increase the risk of suffocation.

Sleep sacks or wearable blankets are an excellent way to keep baby warm – and can be used from day one. If a sleep sack allows for full movement of your baby’s arms and legs, it can be used indefinitely. But, if you’re using a wearable blanket that holds your babe’s arms or legs tight against their body, it should be swapped out for a looser-fitting style when baby starts to turn over.

When swaddling or using wearable blankets, make sure your little one doesn’t get too hot. Even though your baby is tiny and sleeping without blankets, they don’t need to be bundled up for bed. When getting them set for sleep, add one more layer than an adult would need to be comfortable and skip all head coverings. If they are sweating or their skin is hot to the touch, it’s time to back off the bundling.

Can a newborn sleep with a pacifier?

Sleeping with a pacifier is safe for babies of all ages.

If baby doesn’t want the pacifier, don’t force it – just try again when they are older. And make sure to skip pacifiers that are attached to clothing, a stuffed animal or blankets when sending your babe off to dreamland. Pacifiers attached to anything increases the chance of strangulation and suffocation.

It’s also important to note that there’s a right time to introduce a pacifier. If you’re breastfeeding, a pacifier can be confusing to your baby’s mouth. So, before introducing a pacifier, make sure your baby is a breastfeeding pro who is getting enough breast milk. If you are bottle feeding, the pacifier may be introduced right away.

Do pacifiers prevent SIDS?

According to the AAP, studies show pacifiers can help reduce the chance of SIDS, even if the pacifier falls out of baby’s mouth. So put your baby to bed with the pacifier, but don’t worry about putting the pacifier back in if they spit it out in their sleep.

When is it safe for baby to sleep on their stomach or side?

The safest sleeping position for a baby is on their back. So, your baby should always be put to sleep on their back for the first year of their life.

Of course, at some point your baby will start rolling over in their sleep. If your baby rolls to their tummy consistently while sleeping, and is at least three to four months old, you don’t need to roll them over to their back while they are sleeping. But even if baby keeps turning over in their sleep, always start them out on their back during the first year.

When is it safe for a baby to sleep with a blanket or stuffed animal?

Keeping soft or loose bedding away from sleeping babies is recommended for at least the first full year. But once your child has hit the one-year mark, there are still some important guidelines to follow.

For starters, don’t load up the crib with blankets. Continue to keep baby’s sleep space as clear as possible. One blanket and a special stuffed animal are okay, but more aren’t necessary – and could be dangerous.

When choosing a bedtime blanket, look for one that’s small and lightweight. Avoid weighted blankets and blankies with loose strings or ribbons around the border.

If you’re wondering when to give baby a pillow, wait until they have moved from a crib to a bed, which typically happens between 18 months and four years old.

When is it safe for a baby to sleep on a couch or armchair?

The answer to this one is: Never. Because they’re soft and filled with cracks and crevices, couches and armchairs are extremely dangerous for babies.

When is it safe to put a baby in their own room?

While it’s not advised to share a bed with your baby, it’s a good idea to keep their crib or bassinet nearby. Sleeping in the same room with your infant is highly encouraged for at least the first 6-12 months of their life – and can reduce the risk of SIDS by as much as 50%, according to the AAP.

Other safe sleep tips for infants

Beyond the ABCs of safe sleep, there are other recommended ways to reduce the chance of SIDS. A few of them are:

Feed breast milk through six months

Studies show your baby’s diet can make a difference, too. The AAP says that babies who are fed exclusively breast milk for their first six months have a reduced risk of SIDS.

Of course, breastfeeding isn’t always easy, and it’s totally okay if you can’t or choose not to breastfeed. You know what’s best for you and your baby.

If you would like to breastfeed but aren’t having success, ask for breastfeeding support from your baby’s doctor or a lactation consultant. They’ll help make sure baby gets enough to eat and can provide guidance about latching, milk supply and more.

Keep immunizations up to date

Evidence suggests that immunizations may protect babies from SIDS. So, keep on top of the childhood immunization schedule.

Don’t rely on products that claim to reduce the risk of SIDS

There are no proven products that help reduce the risk of SIDS. It can be fine to use some of these products – once you make sure the product meets consumer safety standards. But continue the ABCs of safe sleep and other measures to keep your baby safe.

When does the risk of SIDS decrease?

Your baby is at risk for SIDS from birth until their first birthday, but the chance of SIDS is highest for younger babies. So, maybe you’re wondering, what’s the risk of SIDS at five months? What’s the risk of SIDS at six months? What’s the risk of SIDS at nine months? According to the AAP, here is when SIDS deaths occur:

  • Between one and four months: 72% of SIDS deaths
  • Between five and six months: 18% of SIDS deaths
  • Between seven and 12 months: 10% of SIDS deaths

Even though younger babies are at greatest risk for SIDS, it’s still important to follow the ABCs of safe sleep through your baby’s first year.

We’re here to support you though the ABCs of sleep

Do you have questions about the ABCs of sleep? Do you wonder if your baby is reaching developmental milestones? We’re here to support you every step of the way.

Whatever your questions are, don’t hesitate to call us. HealthPartners patients can call our CareLine at 800-551-0859. Park Nicollet patients can call their clinic directly during regular business hours, or 952-993-4665 if it’s after hours. For questions and advice on new baby care, you can also call our 24/7 BabyLine at 612-333-2229.

If you’d like to speak to a doctor or clinician about your baby’s sleep or any other topic, just make an appointment.