Safe Sleep Guide
Informational guide for 1 year old and younger
Table of Contents:
- Sleep Products
- Sleep Locations
- Cribs, Bassinets, Pack n’ Plays
- Co-Sleeping, Bed/Surface-Sharing
- Room Sharing vs. Independent Room Sleeping
- Overheating – Swaddles & Pajamas
- Breastfeeding vs. Bottle Feeding for Sleep
- Other Factors
- Quick Link Reference Guide
I know it’s not fun and it can be a bit uncomfortable or even scary, but let’s talk about sleep safety. Of course, whenever I work with a family one-on-one, we would discuss infant sleep safety in detail and we’d review their specific sleep environment, but what about you?! I know the internet is teeming with information, but if you’ve made it here then, I want to provide you with all the newest and updated information around safe sleep practices in all sleep situations.
I work with families around the world and that means reviewing the safe sleep guidelines from a global standpoint, not only the American Academy of Pediatrics, which is a fantastic resource and wealth of important education (info is linked to below). However, there are other countries and cultures that take a different view on what safe sleep looks like. So, my focus for all the families I support is to provide parents with the knowledge they need to make informed decisions that are best for their family. This means we will discuss –
— Sleep Products & Recalls
— Co-sleeping or surface sharing
– sleeping in or on the same space or surface with your baby
— Room sharing
– sleeping in the same room as your baby but separate sleep surfaces
— Independent room sleeping
– babies who sleep in their own room without a caregiver
— Other Factors
– Swaddles/pajamas, pacifiers, feedings, etc.
No matter where your baby sleeps at any given time, the most important factor is safety! There are reliable resources and support for all the sleep options listed above, so there is no excuse for not creating the safest sleep environment possible for your unique baby. Now to that end, let’s get to the important stuff!
Before we get to the sleep location or safety protocols, there have been a lot of updates around safety with infant products recently; specifically, around those products used for sleep, including, cribs, pack n’ plays, bassinets, swings, rockers, bouncers, incline sleepers, bumpers/padding, swaddles/pajamas, etc.
Since the recall list is ever growing and changing, it’s important to review the latest version of product recall list and always evaluate your products to ensure none are on the list.
You can view the list here – Consumer Product Safety Commission – Sleep Products and Recalls
You’ll also want to ensure that all the products for your child meet the federal safety standards by having a Children’s Product Certificate (CPC).
Let us start with the discussion of sleeping surfaces or sleep locations. A sleep surface is any surface you would place your baby on to sleep. Now guidelines states, when placing an infant down for sleep they always need to be placed on their backs. However, once a baby learns to rolls from their back to their tummy, (generally 4-6 months of age) if they were to roll onto their tummy within their sleep space, you DO NOT need to flip them back onto their backs. It’s our job as their caregiver to place them on their backs, but if they want to sleep on their stomach (which most do) then they can stay in that position if they’re strong enough to get there.
Cribs, Bassinets, Pack n’ Plays
If your baby sleeps generally in one of these locations, be sure you have confirmed that it is not on the recall list and meets the federal safety standards. You will want to ensure that there are no toys, bumpers, blankets, pillows or padding of any kind within the sleep space or attached to the sleep space. If your sleep space is up to federal standards, then the infant cannot hurt themselves within the sleep space. This means they cannot hurt their head if they roll/bump into the sides or injury their arms or legs if they get stuck in the slats.
Bassinets – Please note that bassinets are designed for non-rolling infants. Once your baby begins to roll on to their side or flips over completely, they need to transition out of the bassinet.
Reflux/GERD infants – It is also worth noting that the AAP and the CPSC have not approved any incline devices safe for sleep.
This is a controversial topic, but I am here for the facts and to keep all babies safe! While the AAP has a very strict no co-sleeping under any circumstance rule, the studies have found that almost all parents have either tried co-sleeping or ended up co-sleeping on accident. Accidents can be dangerous, so I feel it is best to create the safest sleep space as you can to be prepared.
On the other side, the International La Leche League promotes co-sleeping as an effective sleep option for breastfeeding mothers (link below for their specific information).
If you’re just preparing to avoid accidental co-sleeping or you are choosing to co-sleep, you need to ensure a safe sleep space for your child. Similarly, to the information above, there should be no pillows, blankets, sheets, mattress toppers, padding, bumpers or toys around the area where your child will be sleeping. The goal is to avoid and limit your baby’s risk of entrapment, suffocation or strangulation from soft object and loose bedding.
In general, you want to ensure you stay close to your baby and do not put the baby between you and anyone else (spouse, partner, sibling or animal). Floor beds are often recommended for co-sleeping, as there is minimal risk of if the baby falls off the bed.
While some studies have pointed to co-sleeping be a safe and healthy options for some families, it is important to follow the co-sleeping guidelines. This means to never co-sleep with your child on a couch, sofa, armchair or recliner. If you are feeling tired, be sure to create a safe place for you and your child to lay down together to reduce high risk accidents on these plush seating options!
Higher risks – The risk of a SIDS event is higher if you are a smoker (of any kind) or when you under the influence of any drugs or alcohol, as well as, if your baby was born premature or underweight. Be sure to read more about the pros, cons, risks and statistics in the links below.
Room Sharing vs. Independent Room Sleeping
Studies have shown that sharing a room with your baby in the first 6 months can help a baby sleep better and is a safer option than leaving an infant in their own room to sleep.
For newborns (0-3 months old), it is important for them to have as much skin-to-skin contact and possible and keep close to caregivers. Newborns are still learning to regulate their breathing and heartbeat, so being close to caregivers can help them stabilize, making sleep safer.
After 6 months of age, it is generally a parent preference as to whether they want to keep the baby close by in their room or if the baby’s noises are interfering with a parent’s sleep and the parent would like to add some distance for a better night’s sleep.
Some parents start with the baby in a bassinet right next to their bed and once a baby transitions to a crib or pack n’ play, they add some space between the parent’s bed and the baby’s sleep space but stay in the same room.
Developmentally speaking, I find infants transition to independent room sleeping best between 5-7 months. As babies get older, they can become attached/familiar with their sleep environment, which makes changing their environment a learning curve once they are beyond 7-8 months of age.
Overheating – Swaddles & Pajamas
Overheating is a large risk factor when discussing sleep safety. Many mothers worry about their baby being too cold and can over dress the baby, which can be very dangerous. You never want to use a blanket, quilt, sheet, or other loose items to keep your baby. Not only is it a safety risk but it also will come off of them overnight which will lead to more sleep interruptions.
The ideal sleep temperature is 68 to 72 degrees Fahrenheit or 19 to 22 degrees Celsius. Within these temperature ranges it would appropriate to have two breathable layers, i.e.- a onesie and a swaddle or sleep bag/sack – or simply footie pajamas. Yes, your baby’s hands will feel cold, but this is not a reliable source of their core body temperature. You can put your hand on their chest or the back of their neck to best determine if they are sweaty or cool to the touch.
Avoid mittens, socks or head covering of any kind. These are a choking hazard and will end up falling off as well. If your baby keeps scratching themselves, you can look for fold over hand covering that are an extension of the long sleeves. Using a wearable blanket, sleep sack or bag is a great alternative to socks.
It’s important to note, whatever you dress your child in, they need to easily (without stretching the fabric) be able to bring their knees to their chest. This is important for long term hip development. To learn more about swaddles, sleep bags and hip development you can see my resource page on the subject here – Sleep Products Resource
Breastfeeding vs. Bottle Feeding for Sleep
All the latest research indicates that breastfeeding is the preferred feeding option for all babies. However, this is a complicated matter, so I am not here to discuss feedings with you, although, I am a firm believer that a responsively fed baby and a happy mommy is the best option!
Directly sleep related, breastfeeding can lower the SIDS risks in general and co-sleeping specifically is considered to be safer when breastfeeding.
Myth busting – There is no direct relation to formula fed babies sleeping better or longer. Whether you feed formula or breastmilk, it will not directly affect their ability to sleep better or longer. Some bottle-fed babies may drink more during the day, which could help them need less feedings overnight, but that is not guaranteed. Also, adding oatmeal or rice powder to bottle fed babies will not help them sleep longer. Filling babies up right before falling asleep could cause more harm than good and adding solids like oatmeal or rice before 6 months of age can negatively affect the baby’s GI track. A baby’s feedings should be considered in a 24-hour period, not just the hour before they go to bed. If you’re worried about your baby’s calorie intake, see an infant feeding specialist to discuss in more detail!
Pacifier have been shown to lessen the risk of SIDS when used for sleep and naps. You can try 1 pacifier for 4-6 days offering at different times throughout the day and at sleep times until you find one they like. You may go through several brands, which means this process could take some time but if the pacifier is important then you may find it worth the time. However, not all babies will accept a pacifier and that is okay!
Important fact – Pacifier can interfere with a newborn developing a breastfeeding relationship. Be sure to talk with your lactation consultation when breastfeeding to discuss introducing a pacifier to your breastfeeding baby.
There are many factors that go into determining your own baby’s SIDS risks, including their medical history and your family’s history. Be sure to also review these additional factors – the use of alcohol, marijuana, opioids, nicotine, smoking or vaping (in the house or car). Using any one of these during pregnancy or around your baby can significantly increase your child’s risk of SIDS.
Take your time and do your homework to ensure the best and safest sleep environment for you and your baby.
Got more questions? I am happy to help!
Quick Link Reference Guide
American Academy of Pediatrics (AAP) safe sleep guidelines and recommendations:
- AAP Patient Care – Safe Sleep
- AAP – Guide to Safe Sleep
- Reducing Infant Death in the Sleep Environment – Updated 2022
AAP Quick Reference –
- Place infants on their backs for sleep in their own sleep space with no other people.
- Use a crib, bassinet, or portable play yard with a firm, flat mattress and a fitted sheet. Avoid sleep on a couch or armchair or in a seating device, like a swing or car safety seat (except while riding in the car).
- Keep loose blankets, pillows, stuffed toys, bumpers, and other soft items out of the sleep space.
- Breastfeed if possible and avoid smoking.
International Co -Sleeping/Bed Sharing Guidelines and Recommendations:
The Safe Sleep Seven
- A non-smoker
- Sober and unimpaired
- A breastfeeding mother and their baby should be:
- Healthy and full-term
- On their back
- Lightly dressed and you both are:
- On a safe surface