A checklist for what is and isn't safe for baby

Published: July 16, 2018 | Updated: July 30, 2020

About 3,500 babies in the United States die each year from sudden unexpected infant death (SUID), which is death that occurs suddenly and unexpectedly in children under age 1.

The cause of death is not always immediately clear, but half of these deaths are attributed to sudden infant death syndrome (SIDS). Others often are related to the sleep environment, such as suffocation from bed sharing or a baby being placed to sleep on his or her stomach.

One of the biggest sleep-related risk factors is an adult sharing a bed with an infant, according to Erika Janes, R.N., injury prevention coordinator for Norton Children’s Prevention & Wellness and Safe Kids Louisville. Every five days, an infant in Kentucky dies in an unsafe sleep environment, according to Safe Sleep Kentucky.

To keep children safe, parents, grandparents and caregivers need to follow the ABCDs of sleep: Babies should sleep Alone, on their Backs, in a safe Crib, and only be held and cared for when caregivers are awake and alert to prevent Drops.

“It’s very tempting to let a crying infant fall asleep in your bed or on your chest on the couch, but it can be deadly,” Janes said. “If you fall asleep with the child next to you or on you, you could roll over onto your baby or your baby could slide off of your chest and be stuck next to you, causing suffocation. I cannot stress how important it is for babies to sleep alone, on their backs, in a crib.”

“This does not mean that a baby should never be placed on his or her stomach,” said Richard A. Boada, M.D., pediatrician with Norton Children’s Hospital Medical Group – Jeffersonville. “Spending time on the stomach, often called tummy time, helps with shoulder development.”

Parents should make sure the baby spends time on the stomach, but only while he or she is awake and supervised.

In 1992, the American Academy of Pediatrics (AAP) first recommended that babies be placed to sleep on their backs to prevent SIDS, as studies have reinforced the fact that babies who sleep on their backs are less likely to die from SIDS than those who sleep on their stomachs.

“Putting your baby on their back to sleep — for naps and at night — is the single most important thing you can do to prevent SIDS,” Janes said. “Babies who sleep on their backs can clear their airway easier than if they are on their stomach.”

In 2011 and again in 2016, the AAP expanded its recommendations to include a safe environment, adding that babies should sleep on a firm surface by themselves without soft bedding or stuffed animals. The crib can also be a play yard, bassinet or portable crib, ideally in the parent or guardian’s room. The AAP recommends the baby sleep in the parent or guardian’s room for at least the first six months and up to a year.

Other steps to reduce the risk of SIDS:

• Room-share, but don’t bed-share. Not only is the mattress surface and bedding hazardous, but an infant can be suffocated by a sleeping adult.
• Avoid smoking during pregnancy, and never smoke in the house, car or near a baby or child.
• Do not place quilts and other fluffy material under or around a sleeping baby. Also, do not let a baby sleep on a soft surface, such as a sofa or soft mattress. These items can obstruct breathing and can create “pockets” where expired air accumulates and new air cannot reach the infant.
• Keep pillows, stuffed animals and other soft materials, including bumper pads, out of the crib. These can obstruct the baby’s breathing.
• Keep the room temperature comfortable to a lightly clothed adult. Do not use a blanket to cover your baby. Instead, use footed pajamas or a sleep sack. Also avoid using a hat.

For information on infant sleeping position, talk to your pediatrician.