About 3,400 babies die from sleep-related causes in the US each year. That includes SIDS, accidental suffocation, and strangulation in the sleep environment. It's a terrifying number. But the research is clear on what reduces the risk.
The ABCs of Safe Sleep
The American Academy of Pediatrics keeps it simple:
That's the foundation. Everything else builds on those three points.
The Crib Setup
What goes IN the crib: A firm mattress with a fitted sheet. That's it.
What stays OUT of the crib: Blankets, pillows, bumper pads, stuffed animals, loose bedding, positioners, wedges, and anything else. All of it increases suffocation risk.
I know it looks bare. I know you want it to be cozy and cute. But bare is safe. Decorate the walls instead.
Choosing the Right Crib
- Look for:
- CPSC (Consumer Product Safety Commission) certification
- Slat spacing less than 2 3/8 inches
- No drop-side rails (banned since 2011 but still show up at garage sales)
- A firm mattress that fits snugly with no gaps
- No decorative cutouts that could trap a head or limb
Don't buy used cribs unless you can verify they meet current standards. Hand-me-down cribs from the 90s or earlier may not be safe.
Bassinet vs. Crib
Either works for the first few months. Bassinets are smaller and easier to keep in your room for nighttime feeds. Most have weight limits around 15-20 pounds, so you'll transition to a crib at some point.
The AAP recommends room-sharing (baby in your room but on their own sleep surface) for at least the first 6 months, ideally 12 months. Room-sharing reduces SIDS risk. Bed-sharing does not. There's a big difference.
Swaddling
Swaddling is fine for newborns. It helps them sleep and reduces the startle reflex. But stop swaddling as soon as your baby shows signs of rolling, usually around 2-3 months.
A swaddled baby who rolls onto their stomach can't use their arms to push up or reposition. That's a suffocation risk.
Sleep Sacks
Once you stop swaddling, sleep sacks are a great alternative to blankets. They keep baby warm without the risk of loose fabric covering the face. Use a weight-appropriate sleep sack for the room temperature.
Temperature
Overheating is a SIDS risk factor. Keep the room between 68-72°F. Dress your baby in one more layer than you'd wear. If their chest feels warm (not hot) and their hands are slightly cool, that's normal.
Pacifiers
Offering a pacifier at sleep time is associated with reduced SIDS risk. Researchers aren't entirely sure why. You don't need to force it, and don't reinsert it after the baby falls asleep. But if your baby takes a pacifier, use it at sleep time.
What About Inclined Sleepers?
Don't use them. Products like the Fisher-Price Rock 'n Play were recalled after being linked to over 30 infant deaths. Babies should sleep on a flat surface, not inclined. Car seats, swings, and bouncers are not safe sleep environments either.
The Hard Part
Safe sleep rules feel strict. And at 3 AM when nothing else is working, it's tempting to let the baby sleep on your chest on the couch or prop them in a bouncer. Those are some of the most dangerous sleep situations.
If you're struggling with sleep, talk to your pediatrician. Don't compromise on safe sleep out of desperation.