Best Safe Sleep Practices

Sudden Unexpected Infant Death (SUID)

The loss of a baby may be the most devastating event that a family can endure. SUID is the sudden death of an infant under one year of age from any cause, including unknown causes such as Sudden Infant Death Syndrome (SIDS).
SUID rates in African-American, Asian, and Native American babies are twice to nearly three times higher than the rates of white babies. To reduce the risk of SUID and help ensure that your baby sleeps safely, the AAP recommends that:

Babies Should Sleep on their Back

box The risk of SUIDS is up to 19 times higher for babies when they are used to sleeping on their backs, but wind up on their stomachs for some reason. Having babies sleep on their backs drastically reduces infant death. Most pediatricians know that when babies are placed on their stomachs they tend to sleep better, they are less apt to startle, and they often sleep through the night sooner; however, infants who sleep on their stomachs face the greatest risk of SUID. Unfortunately, this critical information is not being passed along by many pediatricians and hospital staff. These can also be cultural behaviors, for example, African-American mothers are significantly more likely to place their infants on their tummies and have adults and children sleeping in the same bed.

Supervised "tummy time" is important to help older infants strengthen those back and arm muscles so when they do turn over in the middle of the night they have the strength to push themselves up and turn their head.

Babies Should Sleep Alone and on an Appropriate Sleep Surface

boxBabies and caretakers are biologically wired to want to sleep next to each other. Human infants are by nature contact-seekers, and particularly within that first few months, when babies are so vulnerable and fragile. But according to the American Journal of Public Health (APR2012), a recent study of more than 3,100 U.S. infants who died of SIDS found that 70 percent were sleeping on a bed or other surface "not intended for infants" - and most often (64 percent) with an adult or another child.And yet the number of families that bed share has stayed stable over the last decade.

Advocates of bed-sharing (sometimes referred to as co-sleeping and sleep-sharing) say that the soothing and bonding benefits of this age-old practice can be made safe for babies if measures such as eliminating soft, loose bedding from the adult bed are taken. But new research challenges that argument, says Jeffrey Colvin, a pediatrician at Children's Mercy Hospitals and Clinics in Kansas City, Mo. "So many of the deaths that we saw in this study were in the context of bed sharing, yet, at least according to the (state review teams that provided the data) there were no other objects in the bed that would have made an additional risk," he says. "What we're learning is that not only is it unsafe and a big risk factor for SIDS and other sleep-related deaths, but it's impossible to make bed sharing safe."

Never Use Pillows, Quilts or Loose Blankets Under a Baby or in a Crib

box Infants typically begin rolling from the back to the stomach position around 4 months of age. Older infants (ages 4 months to 12 months) were more likely than younger infants to have objects in their sleep area,such as pillows, blankets, bumper pads and stuffed animals at the time of death. They were also more likely to have been found face-down even though they were placed to sleep on their back or side.

According to the American Academy of Pediatrics (AAP), infants' cribs should be free of these soft objects; and parents should avoid products that are marketed for preventing head injuries and keeping babies' limbs from getting trapped. The AAP says bumper pads may raise the risk of suffocation or strangulation. They are dangerous and unnecessary.

Do Not Use Sleep Positioners

box This picture of a doll shows why few sleep specialists advise using "sleep positioners" and pads on the sides of the crib. There are times when parents think they are doing the right thing by using commercial products promoted to keep babies safe, when they could actually be placing their babies at risk. The federal government has warned that the soft fabric sleep positioners that parents put in the crib to keep babies safely sleeping on their backs could be dangerous, and even deadly. Babies have suffocated after rolling from a side to a stomach position or becoming trapped between a sleep positioner and the frame of a crib or bassinet. Furthermore, the AAP does not support the use of any sleep positioner to prevent SUIDS.

Do Not Over-Heat or Over-Dress Your Baby

box This is one of the confusing and conflicting recommendations as the use of swaddling blankets has been heavily promoted. Dress baby with a onesie or a swaddling bag. Swaddling is alright as long as the baby's head is uncovered. Covering the head drastically increases the risk of sudden death. When babies start to roll, swaddling is no longer safe since swaddled babies rolled onto their stomachs cannot use their hands and arms to help roll out of this dangerous position. Babies overdressed or covered in blankets are also at risk. The rate of SUIDS death shows a pronounced peak during the colder months of the year and may be related to this risk factor.

Dress Baby Warm, Comfy, and Loose

boxMany babies are swaddled too "tight." Older infants especially, like to sleep "loose," and may sleep longer stretches with coverings that allow more freedom of movement. Oftentimes, dressing a baby loosely during the day and swaddling at night conditions baby to associate sleep with swaddling. A baby who gets too hot or too cold may become restless.

Consider Using a Pacifier

box Using a pacifier every time you place your baby down to sleep can greatly reduce the risk of SIDS. If you are breastfeeding, wait until nursing is going well (usually 3-4 weeks) before offering a pacifier. Limit pacifier use to the first year of life. This includes the peak ages for SIDS risk and the 1 to 5 month period when the baby's need for sucking is the highest. Do not use a string or other device to attach pacifiers around your baby's neck or to clothing. Infants who refuse a pacifier should not be forced to take one.


box Co-sleeping is not bed-sharing! Keep baby close AND safe by keeping the bassinet at arms-reach and bed-level.




box Exposure to smoke during pregnancy and after birth increases the risk of death for babies. The more exposure - the higher the risk. If you or your family can't quit, always smoke outside the house in clothing that you can remove, such as a smoking jacket, before handling your baby. It is also advised that you wash your hands after smoking and before you handle your baby.

Breastfeeding May reduce the Risk of SUIDS

box There is evidence that SUIDS is less common in breast-fed babies. This association is not fully understood, but the fact that breast-fed babies have fewer infections is possibly a contributing factor.

wendy brockman of jefferson county insights: safe sleep