Practice Safe Infant Sleep

We’re taking time this month to review an important recommendation for safe infant sleep: always placing baby to sleep on his or her back, for naps and at night. The back sleep position is the safest for all babies, including those born preterm.

It is especially important to note that babies who are used to sleeping on their backs, but who are then placed to sleep on their stomachs, like for a nap, are at a much higher risk for Sudden Infant Death Syndrome (SIDS). Parents should make sure all baby’s caregivers—babysitters, grandparents, childcare workers, and others—know this key safe sleep recommendation and use it all the time to reduce the risk of SIDS.

It can be easier to remember the safe infant sleep recommendations if you incorporate them into a routine. Healthcare providers can work with parents and caregivers to reinforce the importance of back sleeping and help them to develop naptime and nighttime routines for baby. A simple nighttime routine could include these steps:

1. Breastfeeding: Babies who are breastfed or fed expressed breast milk are at a lower risk for SIDS than babies who were never fed breast milk. If you bring baby into your bed to feed, and there is a chance you might fall asleep, remove all soft items and bedding from the area.
2. Cuddle time: If you bring baby into bed for bonding time, and there’s a chance you might fall asleep, make sure to remove soft items and bedding from the area.
3. Back Sleeping: Place baby to sleep on his or her back for every sleep time, including naps and at night.?

Experts recommend that babies be placed on their backs for every nap and at bedtime until 1 year of age. This recommendation was made because of the evidence:

• • Babies who sleep on their stomachs (called prone sleeping) have a 230% to 1,300% greater risk of sleep-related death. In addition, if a baby is placed on the side to sleep but ends up on his or her stomach, the risk of sleep-related death is 8.7 times greater than that for babies placed on their backs to sleep.

• • Prone sleeping increases the risk of rebreathing in the same air that baby breathed out, under the baby’s face, because babies may not rouse or move their heads. When this happens, babies can end up with increasing levels of carbon dioxide in their blood—carbon dioxide is what we breathe out—and not enough oxygen. This can be fatal.

• • Prone sleeping also increases the risk of the baby’s getting overheated. When prone, the baby gives off less heat to control temperature. Overheating has been linked to greater risk for unexpected death.

• • In young babies (2 to 3 months of age), prone sleeping changes how the nervous system controls the cardiovascular system (how hearts function) during sleep. This can result in the brain receiving less oxygen.  A baby who usually sleeps on the back but is then placed on the stomach for sleep—by a different caregiver, for example—has a higher risk for SIDS the first and every time baby is put on the stomach to sleep. Studies have reported an 8.7 to 45.4 times greater risk of sleep-related death for babies in this situation. This finding highlights the importance of everyone putting baby to sleep on his or her back for all sleep times.

Once babies can roll over in both directions on their own, they should still be placed on their backs to sleep to start, but do not need to be returned to the back position if they roll over on their own.