The SIDS Center of New Jersey

The American Academy of Pediatrics (AAP) informs us that in the U.S. about 3,500 infants die each year from what are called sleep-related infant deaths.  One of the most common of these sudden unexpected infant deaths is Sudden Infant Death Syndrome or SIDS.  It is a diagnosis given when a death cannot be explained even after a thorough evaluation.  But even though the causes may not be identified, we have learned what to do to reduce the risk of these deaths.  And, there is an added benefit: These same recommendations also reduce the risk of other sleep-related infant deaths, such as those from ill-defined and unknown causes and accidental suffocation. By following these guidelines, everyone who takes care of a baby has the power to reduce the risk of these deaths. Share them with everyone who takes care of your baby!  

Ninety percent of these deaths occur by six months of age, and the peak period is from two to four months. Safe sleep recommendations are intended for the first 12 months of a baby's life. 

First, babies should be put to sleep on their backs.  The use of the back to sleep position has resulted in a major decline in sleep-related infant deaths.  Neither the side position nor the belly down position is recommended for placing an infant to sleep.  Grandparents may remember that they were advised to do the opposite, to put the baby to sleep on the tummy.  However, we know better now, so we do better.  Back is best. Check with baby's pediatrician or other health care provider for additional confirmation. 

There has been no increase in choking or similar problems for babies who sleep on their backs. The AAP states that, "The supine sleep position on a flat, non-inclined surface does not increase the risk of choking and aspiration in infants and is recommended for every sleep, even for infants with...reflux.” For any questions, check with baby's health care provider.  

The AAP recommends that you place your baby on his or her back at the start of all sleep periods in the first year of life. As they develop, a baby may turn over to another position during sleep.  Once babies reach the age where they are well able to roll from back to belly and from belly to back on their own, usually by around six months, they can remain in the position they assumed.  

No.  The AAP does not recommend the use of any product that restricts the movement of an infant.  These products can and have had unintended consequences resulting in deaths, and some have even been recalled because of that.  

To protect a baby from the risk of a flat spot, the AAP recommends offering lots of tummy time for your baby when he is awake and being watched by you.  Tummy time can begin once baby comes home from the hospital of birth.  An early goal is to increase the time so that baby receives at least 15 to 30 minutes of tummy time by 7 weeks of age. Also, make sure that your baby isn't spending all his or her time in a crib, or a car seat or an infant carrier.  Pick your baby up, spend time holding your baby, and enjoy lots of cuddle time.  

1. The AAP recommends placing infants to sleep in a crib, portable crib, bassinet or play yard that meets current safety standards of the Consumer Product Safety Commission. (https://cpsc.gov/SafeSleep)
2. It should contain a flat, firm mattress. An inclined mattress is considered unsafe. There have been recent recalls of inclined sleepers.
3. The mattress should be type intended for the crib or other recommended sleep product you are using.
4. There should be no gaps between the mattress and the sides of the crib or other recommended sleep product.
5. The mattress should be covered just by a tightly fitted sheet. The corners of a firm mattress should not curl up when a properly sized sheet is fitted onto on a firm mattress.
6. Don't place any pillows or quilts over or under the sheet.
7. In fact, and this is very important, there should be no loose bedding in the crib.  No pillows, no quilts, no blankets, no stuffed animals or other soft or fluffy items, and no bumpers either.  Although these things are pretty, they are associated with an increased risk of sleep-related infant deaths.  And, there should be no one else in the baby's sleep space, not even a twin.
8. The AAP recommends that babies are safest sleeping near the parent's bed but not in the parent's bed.  When the baby is close by the parent's bed, the parent can still see, touch, hear and respond to the baby. Room sharing instead of bed-sharing is best.  Parents are urged to share their room with their infant for the first year of life or for at least the first six months.
9. Parents may choose to bring the baby into bed to play, comfort, cuddle and feed!  But, when parents are ready to fall asleep, it is safest to place the baby back in his or her own near-by safe sleep space. The longer an adult shares a bed with baby, the higher baby’s risk for suffocation and other sleep-related death.  
10. Sometimes a tired parent who is breastfeeding at night may fall asleep with the baby in the adult bed.  To ensure that the baby is safe until the parent wakes up and puts the baby back into his own nearby sleep space, parents should make sure that their own soft bedding, such as pillows or blankets, are out of reach of the baby so that there is no risk that they will cover the baby's face and cause harm.  
11. Sleeping in an adult bed with baby (bed sharing) is especially dangerous if the parent has used sedatives or alcohol, is very fatigued, smoked in pregnancy or is a smoker now even if they do not smoke in bed, or if a very soft surface is used, such as a waterbed, old mattress, a mattress with memory foam, a sofa, a couch, or any other situations that add to the risk of bed sharing with a baby less than four months of age, sleeping with someone who is not the infant's parent, a premature or low birth weight baby, or a bed with soft bedding accessories such as pillows or blankets. 
12. Sofas and chairs are not designed for babies to sleep on whether alone or with someone and are very dangerous. Babies should not be put to sleep on these. Also, sitting devices such as car seats, strollers, swings, and infant carriers and infant slings are not recommended for routine sleep, particularly when the infant is less than four months of age.  When an infant falls asleep in a sitting device, move them to a crib or other appropriate flat surface as soon as it is safe and practical to do so. Car seats and similar items are not stable on a crib mattress or other elevated surface.  Therefore, do not leave infants unattended in car seats and similar items.  Also, when using a car seat or similar item, remember to buckle the straps.

Infants should be dressed appropriately for the environment, with no more than one layer more than an adult would wear to be comfortable in that environment. If parents feel that more warmth is necessary, infant sleep clothing, such as a wearable blanket, should be used instead of a blanket.  It should be the right size for the baby.  Parents should avoid overheating the baby because overheating is a risk factor for SIDS.  You can tell if a baby is overheated by checking if they are sweating or if the chest feels hot to the touch.  Over-bundling and covering the face and head should be avoided. When indoors, infants should not be wearing a hat. Wearable blankets should not contain weighted material, The AAP advises against any baby clothing that contains weighted material. 

Smoking contains nicotine which has been found to be a major risk factor. Therefore, smoking or the use of any device that delivers nicotine should be avoided in pregnancy and after. Smoking by a pregnant mother or by people in her presence can cause harm to the developing baby.  Exposing the baby to smoke after he or she is born also is a major risk factor.  If a mother has stopped smoking during pregnancy in order to protect her baby, she should stay smoke-free even after! Household smokers matters too.  Homes and even cars that contain a baby should be smoke-free zones.  In addition to avoiding nicotine, the AAP advises that alcohol, marijuana and opioids also should be avoided during pregnancy and after birth. 

Yes! Breastfeeding or pumped human milk is associated with a lower risk of SIDS! Therefore, for that reason and many others, providing human milk is highly encouraged.  Pediatricians and other healthcare providers recommend that, if at all possible, infants should be fed human milk exclusively (ie, not offered any formula or other nonhuman milk-based supplements) for at least the first six months. The longer a baby receives breast milk, the lower the risk of SIDS. However, feeding babies human milk some of the time is more protective than not feeding them human milk at all. 

Pacifiers help reduce risk. If the baby is breastfeeding. parents should wait until breastfeeding is well established before introducing the pacifier. The pacifier should not be attached to a string, to clothing, or to a stuffed animal due to the risk of strangulation or suffocation.  It should be clean, with nothing coating it, and in good condition. It should be offered but not forced.  If it falls out during the night, there is no need to put it back.