Most parents understand the necessary steps for reducing the risk of sleep-related infant death, but too many disregard them. Here’s how to ensure safe sleep for babies during naps and bedtime.

By Shaun Dreisbach

Back in 2014, we worked with American Baby to poll 4,547 moms in partnership with Safe Kids Worldwide, an organization devoted to preventing childhood injuries. These moms, all of whom had babies age 1 and younger, recognized the rules—96 percent know a baby should sleep alone, on his back, in a crib. But yet they still veered off course when caring for their own infant.

This is a risky move, since about 3,500 infants die each year from Sudden Unexpected Infant Death Syndrome (SUID). Even if parents follow all the rules for safety, some incidences of SUID, including cases of sudden infant death syndrome (SIDS), would still occur. Not all cases can be explained, says Kate Carr, president and CEO of Safe Kids Worldwide. "But the number would be much lower" if parents followed proper safety protocols. 

We're not interested in finger-wagging: "Moms who ignore sleep rules aren't bad parents!" Carr says. "Their baby is crying and they make a decision that seems okay at 3 a.m." 

Find out if you're making any of the missteps our survey uncovered, and learn the best ways to ensure safe sleep for babies.

Babies should sleep in a bare crib.

An astounding 73 percent of moms in our survey say they have placed at least one item inside the crib with their baby. A blanket was most common (59 percent), followed by bumpers (35 percent), stuffed animals (23 percent), and pillows (8 percent). All are suffocation hazards for babies 1 and younger, and can increase the risk of SIDS up to five times, regardless of Baby's sleep position, reports the American Academy of Pediatrics (AAP). 

To be fair, moms sometimes get a mixed message. "When women walk through a baby store or flip through a catalog or magazine, they see bumpers, blankets, and stuffed animals, and they think they need to buy them to be good parents," says Rachel Moon, M.D., director of academic development at Children's National Health System, in Washington, D.C., and chair of the AAP's task force on SIDS. 

When setting up your little one’s crib, always remember that bare is best. The only thing you should have in the crib is a fitted sheet, Carr says. No pillows, no stuffed animals, no sleep positioners or sleep wedges (they pose the same suffocation hazards as pillows), and no crib bumpers, which have been linked to suffocation and strangling of infants.

Always put your baby down to sleep on her back.

Twenty-eight percent of moms say they have put their baby to sleep on his stomach, a practice that leaves babies at increased risk for SIDS. And of those who take this risk, 47 percent do it before their baby turns 3 months old. "That's when the risk of SIDS is highest, in the first four months," says Jodi Mindell, Ph.D., associate director of the Sleep Center at the Children's Hospital of Philadelphia and author of Sleeping Through the Night.

Many of these parents are what we'd call "conscientious objectors," Carr says. "They think that what they're doing is somehow better or safer than what their pediatrician is telling them." Parents who are desperate not to hear their baby cry, for example, may find ways to rationalize stomach-sleeping. Dr. Moon notes: "It's true, babies do wake up more easily when they're on their back. But that may actually protect them from SIDS. Infants who sleep on their stomach don't arouse as well, which means they can get in trouble with their oxygen levels and never wake up."

Another common justification for stomach-sleeping (for 10 percent of the rule-breakers) was worry that Baby would choke from reflux. No evidence supports this. In fact, stomach-sleeping is riskier than back-sleeping when it comes to choking concerns, Dr. Moon says.

To ensure safe sleep for babies, make back-sleeping non-negotiable. "The only way you're going to teach your baby to sleep on his back is to teach your baby to sleep on his back," Dr. Moon says. "It's the same thing as an infant who hates to be in his car seat. He just has to be in his car seat." 

Be careful with co-sleeping.

Co-sleeping, defined as sleeping on the same surface with Baby, is common, Dr. Mindell says. Sixty-five percent of the moms we polled have slept in bed with their infant, and of those, 38 percent do so regularly. The majority of these bedsharing moms worry about their baby's risk of accidental suffocation, but they do it anyway. Why? To help their child sleep, to make nursing easier, to bond with Baby, and because Baby won't sleep anywhere else, they say.

But bed-sharing is perilous. Studies show that about half of all suffocation deaths among infants happen in an adult bed. Compared with sleeping in a crib, the overall death rate is more than 40 times higher for babies who sleep with a parent. "There are multiple dangers in an adult bed that can suffocate Baby, from a less-firm mattress and big pillows to fluffy comforters and extra blankets," Carr says. "Parents also mistakenly believe they're light sleepers and would wake up if they rolled over on their baby, but that's not the case in so many tragic instances."

The safest option is putting Baby to sleep in a portable crib in your room. Then, when she's used to that, move her to a crib in her own room. Not only will be she be safe, she'll snooze more deeply. "In one study I conducted, we found that babies who sleep with Mom and Dad wake up twice as often than when they sleep alone," Dr. Mindell says. "They don't learn to soothe themselves, and that's what keeps them up."

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Never sleep on the couch with your baby.

A staggering 53 percent of moms in our poll report they share the couch with their infant, a number that astonished our experts. It's by far the most dangerous choice because couches can be softer and more plush than an adult bed, and Mom or Dad could accidentally roll over and suffocate Baby, Dr. Moon says. Ironically, some parents think couch-sharing is relatively safe because if they put Baby between their body and the back of the couch, she can't fall off like she could in a bed. In reality, the child can become trapped between the parent's body and the couch, and that can be much more dangerous, Dr. Moon says.

As a safety upgrade, bond with your baby before bed, and then put her in her crib, Carr says. When you're wiped out or if it's nighttime, avoid nursing or feeding your baby on the couch. You're more apt to doze off there than in a less comfy spot, Dr. Mindell says. If your sweetie falls asleep and you're tempted to snuggle her while you browse your Netflix queue, think twice. 

Finally, never place a sleeping baby on a couch. About 18 percent of moms say their baby has slept on a couch alone, but even if you're awake, it's never safe. It takes only a minute for suffocation to occur.

Follow these sleep guidelines for naps, too.

As we pored through the comments in our study, one thread stood out: Many moms who wouldn't dream of putting their baby on his stomach at nighttime do so at naptime. "Parents think that since they're up and about, they're watching their baby," says Dr. Mindell. "But the reality is, you're in the kitchen, you're on the computer, and if your baby is having a hard time breathing, it's silence."

Dr. Moon points out that research also shows that a baby who is used to sleeping on his back but is periodically put on his belly to snooze is 18 times more likely to die from SIDS. Experts aren't sure why, but one theory is that babies who nod off on their back most of the time develop motor skills differently and can't lift their head as easily when they're on their stomach, which puts them at risk for asphyxiation.

FAQs: Putting Baby to Sleep

Practicing safe sleep habits for your baby can be grueling during the first year. You're exhausted, up and down all night, and listening to your baby wail on her back in her bare crib. In these moments, sticking to what you know is right may feel insurmountable. But this stage won't last forever. Your baby will drift off. Soon enough, she'll outgrow these risks (and you'll graduate to big-kid concerns). In the meantime, you'll rest better knowing that you've done the safe thing.

Here are some common questions and answers about safe sleep for babies.

When can baby sleep with a blanket, and when can a baby sleep with a pillow?

A baby's crib should be completely empty, with the exception of a fitted sheet, until he turns one year old. Having anything else in the crib—including blankets and pillows—increases the risk of SIDS.

What about baby sleep positioners and baby sleep wedges?

For babies under 1 year old, sleep positioners or sleep wedges are just as dangerous as blankets and pillows, says Carr. Leave them out of the crib until your little one's first birthday.

Can baby sleep on his side?

Side-sleeping also isn't safe for an infant. It's easy for a side-sleeping a baby to roll onto his back, which increases the risk for SIDS.

When can babies sleep on their stomach?

If your baby is able to flip himself onto his stomach while sleeping, it's okay to leave him that way. By the time he can do this, his risk for SIDS is much lower. But you should still continue to put him down to sleep on his back until he reaches age 1.

Can you put Baby to sleep in a swing?

According to a 2016 policy statement from the American Academy of Pediatrics, sitting devices like swings aren't recommended for sleep. Your little one could get in a compromising position that causes suffocation, and he won't be able to get out of it.

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