A Guide to Safe Baby Sleep

This blog post was written by Brooke Boruff, OTR/L and Abby Sharpe, the Infant Insights sleep consultant.

One of the main things discussed with parents prior to leaving the hospital, if they have had a hospital birth, is safe sleep for their infant. As a parent, one of our top priorities is ensuring our baby sleeps safely from birth and beyond. Those tiny snoozes add up to crucial rest for your little one’s development—and ensuring your baby is safe when sleeping gives you such a peace of mind. But with so much conflicting advice, it’s easy to feel overwhelmed as a parent. What is safe sleep? Can we co-sleep? What sleep sacks are most safe?

So, let’s break down the essentials of safe sleep practices, supported by the American Academy of Pediatrics (AAP) so you can rest easier knowing your baby is snoozing soundly and securely in their baby bed.

Why Safe Sleep Practices Matter

In the late 1990s organizations around the world focused on reducing infant death created a recommendation that babies should be put on their back to sleep and “back is best”. This recommendation was put in place due to the high risk of Sudden Infant Death Syndrome (SIDS) and this initiative has been largely successful, lowering the SIDS occurrence by 60 percent. SIDS and other sleep-related accidents are leading concerns for parents of young babies. While these risks can feel daunting, following evidence-based safe sleep guidelines can dramatically reduce the chances of harm. Creating a safe sleep environment not only protects your baby but also establishes healthy sleep habits that will last into toddlerhood and beyond. A secure and well-designed baby bed, or sleeping area, is at the heart of this environment.

Maybe you’ve heard of the “ABCs” of safe sleep. So what are they?

The simplest way to remember safe sleep basics is through the acronym ABC:

• Alone: Your baby should sleep in their own baby bed, such as a crib or bassinet.
• Back: Always place your baby on their back for every sleep—naps and nighttime.
• Crib: Use a firm, flat mattress in a baby bed that is free from any loose bedding, toys, or bumpers. 

These three rules form the foundation of safe sleep practices recommended by pediatric experts, including myself, a licensed OT, and the Infant Insights sleep consultant.

Now that we know the ABC, how should we set up the safest sleeping space for our baby?

First, we should choose a safe baby bed, 

A crib, bassinet, or play yard with a firm, flat mattress is ideal. Make sure your chosen baby bed meets current safety standards by reading the labels and information given by the manufacturer. Avoid inclined sleepers, wedges, pillows, or other products marketed for convenience that don’t align with safe sleep recommendations.

Next, keep your baby’s bed bare

Less is more when it comes to your baby’s bed setup. A fitted sheet is all you need. Do not use blankets, pillows, bumpers, and stuffed animals, as these can pose suffocation risks. A stuffed animal or blanket is not recommended to be used in your infant’s baby bed until 12 months old, and safe sleep recommendations are provided by the AAP from birth to 12 months here. A pillow is not recommended until age 2.

Lastly, avoid bedsharing if possible.

The American Academy of Pediatrics (AAP) recommends room-sharing for at least the first six months, however some parents choose to move the baby to their own space before this age. The AAP also recommends that parents avoid bed sharing, but if you are going to bed share it is very important to complete this safely. A few key tips for co-sleeping as safely as possible, although this is not encouraged are: 

• Avoid soft surfaces.

• Firm, flat surfaces are best.

• Remove loose or soft items around your baby (pillows, blankets, etc)

• Place baby on their back

• Keep pets and other children out of the bed while the infant is sleeping

• Dress infant in proper sleeping attire and a wearable blanket to avoid overheating
• Offer a pacifier during naps and bedtime to reduce the risk of SIDS (recommendations by sleepfoundation.org)

Although some choose to bed share, or co-sleep, it is always best and most safe for your baby to sleep in their own baby bed, or bassinet, nearby, rather than in your bed. Placing the baby bed within arm’s reach helps with nighttime feeding and monitoring while keeping your baby safe because they are in their own space. Need sleep help? Chat with Abby, the Infant Insights sleep consultant inside Bloom by Infant Insights.

What about Swaddles and Sleep Sacks? Which ones are safe?

Swaddling can be a soothing tool for newborns, as their reflexes integration and they transition from womb to world, but it must be done safely:

• Ensure the swaddle is snug around the arms but loose around the hips to prevent hip dysplasia.
• Stop swaddling as soon as your baby shows signs of rolling over, typically between 2-4 months. These signs are grasping feet, bringing the arm across the chest, and rolling to their sides, among others.
• Ensure the swaddle is not loose around the baby’s neck and face area. A tight swaddled pattern on the upper body is always best.

Sleep sacks that are non-weighted are a safer alternative for older babies that are rolling and moving more. Sleep sacks provide warmth without the risks of loose blankets and are perfect for keeping your baby comfortable in their baby bed. They also provide sensory stimulation through deep pressure if the sleep sack has a torse band, which is soothing and supports your baby’s independent sleep.

In addition to sleep sacks and swaddles, your baby’s clothing should be appropriate for the room temperature, typically a lightweight onesie or sleeper under a swaddle or sleep sack. Overheating increases the risk of SIDS, so avoid heavy blankets, high TOG sleep sacks in warm climates, or overdressing your baby for sleep. Whether swaddled or in a sleep sack, ensure your baby’s body temperature stays regular by dressing them appropriately for sleeping in their baby bed.

Pacifiers actually reduce the risk of SIDS and increase safe sleep

This may surprise you, but offering a pacifier during naps and bedtime has been shown to reduce the risk of SIDS, even if it falls out after your baby is asleep. A study in 2005 found that 1 in every 2733 SIDS fatalities can be prevented with paci usage. Additionally, breastfeeding has also been found to refuse to reduce the risk of SIDS. When used properly, pacifiers are a great addition to your baby bed routine. Don’t worry if your baby does not use a pacifier! You can still achieve safe sleep standards without using a pacifier or breastfeeding your infant. 

When is my child safe to sleep anyway they please?

Once your baby reaches their first birthday, the rules for safe sleep begin to loosen slightly. By this age, the risk of SIDS drops dramatically because your baby is mobile and moving a ton. At this age babies can sleep with a lightweight blanket or lovey in their baby bed according to the AAP.  However, it’s still a good idea to maintain a safe, uncluttered sleep space to reduce other risks, such as entrapment or suffocation.

As a parent, you know what’s best! Follow your instincts and brush up on the recommendations.

Parenting is a mix of instinct and informed decision-making. While you know your baby better than anyone, leaning on research-backed guidelines like discussed in this post ensures you’re providing the safest environment for your baby. Whether it’s the perfect baby bed setup or understanding what accessories are safe, being informed is key.

Questions will arise and here are some common FAQ around safe baby sleep:

1. Can my baby sleep in a car seat or swing?

These should only be used for travel or short periods under supervision. Transfer your baby to a safe baby bed as soon as possible and avoid sleeping in a car seat or swing unless otherwise directed by a healthcare professional.

2. What about co-sleeping?

While cultural practices vary, sharing a bed increases risks. Room-sharing is a safer alternative that still keeps your baby close in their own baby bed. See recommendations for safe co-sleeping here if you choose to complete this with your baby.

3. When can my baby sleep on their stomach?

Once your baby can consistently roll from back to stomach and vice versa, usually around 6-8 months, you can let them find their preferred sleep position. There is no need to go in and roll your baby over if they are able to put themselves on their tummy, and return to their back independently. Until your baby is completing this on their own, it is recommended to complete back sleeping when your baby is in a crib or bassinet. 

4. What about contact napping positions?

Of course there will be times when your baby sleeps in a carrier, or on your chest. When completing sleeping positioning in a belly down position, be sure the airway is free and you can see the baby’s face. It’s also best to stay awake while your baby sleeps in belly down positions, and if not, place your baby in a crib or bassinet for safest sleep practices.

In conclusion, your baby’s sleep safety is a priority for you and me too. In a perfect world, all of these things would be completed to ensure the safest sleeping environment possible. Of course this may not always be the case, but always consult a healthcare professional if you have any questions or concerns. In the event that your baby is in an unsafe sleeping environment, it’s always best to supervise or transfer them to a safe sleeping environment. 

Trust your instinct and know the experts at Infant Insights are here to help if you need us!