Back to Sleep: How to create a safe sleep environment

What is SIDS? As a parent of a newborn, just the thought of Sudden Infant Death Syndrome, or SIDS, is terrifying. SIDS is the sudden, unexpected death of an infant under age 1. Sadly, it’s the third-leading cause of infant mortality. At around 4 months of age, the incidence of SIDS begins to decline. Until then, there are evidence-based ways you can help prevent and reduce your baby’s SIDS risk.

The recently updated American Academy of Pediatrics Safe Sleep Recommendations provide parents with useful, practical information to reduce SIDS risk. Here’s what you need to know.

Reducing SIDS risk

Birth Health. If your baby is born full term, healthy, and you had no complicating factors during pregnancy, your baby’s SIDS risk is significantly reduced. SIDS risk is increased if your baby was born preterm or had a low birth weight.

Back to Sleep.  Putting your baby to sleep in a supine position (flat on one’s back, facing upward) notably reduces the chances of SIDS. After the American Academy of Pediatrics (AAP) made this recommendation in the early 1990s, the US SIDS rate declined from 120 deaths per 100,000 live births in 1992 to 33 deaths per 100,000 live births in 2019, representing a decrease of nearly 73% over 27 years1.

Same room, separate beds. Today, about 60% of parents admit to bed-sharing with their baby at some point2. The AAP recommends sharing a room, but not a bed, with your infant. Put your little one in a crib or bassinet beside your bed, where he or she will be safest.

Firm surface. Crib and bassinet mattresses should be firm, and free from excess ties, blankets, or toys. Drop-side cribs should not be used. For information on crib safety standards, visit the Consumer Product Safety Commission’s website at

Breastfeeding. Breastfeeding for four to six months, whether exclusively or coupled with formula feeding, reduces the risk of SIDS by about 60 percent. Evidence shows that breastfed babies wake up more easily than exclusively formula-fed babies, which may reduce SIDS risk. Additionally, breastfeeding passes along critical immunity benefits which may reduce viral infections, another contributing SIDS factor.

Smoke exposure. Tobacco use during pregnancy and exposure to smoke in infancy increases SIDS risk. To reduce risk, ask that all household members and caregivers not smoke near the baby. Ask that they wash their hands and change their clothing after smoking and before caring for your baby.

Alcohol use. Alcohol use during pregnancy and postpartum increases SIDS risk, as does parents or caregivers falling asleep with their babies after drinking. Parents or caregivers who drink any amount of alcohol before bed should not bed-share with their infant.

Overheating. Being too warm or over-bundled increases SIDS risk. Additionally, loose blankets and pillows create a suffocation hazard. Ensure baby’s pajamas fit snugly and remove extra blankets or wraps, pillows, and toys.

Remember the expression “back to sleep.” Your child should be face up and dressed comfortably, but not overdressed. Follow these simple yet important safety guidelines for the first year, and both you and your little one will sleep better at night.