SAFE SLEEP

FOR YOUR BABY

Reduce the Risk of Sudden Infant Death Syndrome 

(SIDS) and Other Sleep-Related Causes of Infant Death
This is what a safe sleep environment 

looks like. The infant’s sleep area has 

no bumpers, pillows, blankets, or 

toys and is in the same room where 

the parents sleep.

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Each year in the United States, thousands of babies die suddenly 

and unexpectedly. Some of these deaths result from unknown 

causes, such as Sudden Infant Death Syndrome (SIDS), while others 

are from known causes, including other sleep-related causes of 

infant death.

What is SIDS?

SIDS is the sudden, unexpected death—that doesn’t have a known 

cause even after a full investigation—of a baby between 1 month 

and 1 year of age. 

About one half of the sudden, unexpected infant deaths that occur 

in the United States each year are from SIDS.

What are other sleep-related 

causes of infant death?

Other sleep-related causes of infant death are those related 

to how or where a baby slept. These can include accidental: 

l Suffocation: when something, such as a pillow, or someone

covers the baby’s face and nose, blocking the ability to breathe

l Entrapment: when the baby gets trapped between two objects,

such as a mattress and a wall, and can’t breathe

l Strangulation: when something presses on or wraps around

the baby’s neck, blocking baby’s airway

Fast facts about SIDS

l SIDS is the leading cause of death among babies

1 month to 1 year of age.

l Most SIDS deaths happen when babies are between

1 month and 4 months of age.

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What should parents and 

caregivers know about SIDS 

and other sleep-related

causes of infant death?

We have made great progress

in reducing SIDS.

Since the 1990s, when the U.S. back-sleeping recommendations were 

first released and public awareness efforts began, the overall U.S. SIDS 

rate has dropped by about 50 percent. This lower rate equals 

thousands of babies’ lives. Since then, the number of babies placed on 

their backs to sleep has tripled. Among African American babies, the 

number of SIDS deaths went from 1,235 in 1994 to 490 deaths in 2016.

But, as SIDS rates have declined, deaths from other sleeprelated causes, such as suffocation, have increased, and 

certain groups remain at higher risk for SIDS than others. 

For example, African American and American Indian/Alaska Native 

babies are at higher risk for SIDS than are white, Hispanic, or Asian/

Pacific Islander babies. So there is still work to do to save infant lives.

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Babies sleep safest on their backs. 

Babies who sleep on their backs are much less 

likely to die of SIDS than babies who sleep on their 

stomachs or sides.

Every sleep time counts. 

Babies should sleep on their backs for naps and 

at night. Babies who are used to sleeping on their 

backs but who are then placed on their stomachs, 

like for a nap, are at very high risk for SIDS. 

Sleep surface and sleep 

environment matter. 

Babies who sleep on a soft surface, such as an adult 

mattress, or under a soft covering, such as a soft 

blanket or quilt, are more likely to die of SIDS or 

suffocation. These deaths also are more likely when 

soft objects, toys, and blankets are in the baby’s 

sleep area.
What can I do to lower my 

baby’s risk of SIDS and other 

sleep-related causes of death?

There is no sure way to prevent SIDS, but parents and caregivers 

can take steps to reduce the risk of SIDS and other sleep-related 

causes of infant death:

Always place baby on his or her 

back to sleep, for naps and at night, 

to reduce the risk of SIDS.

The back sleep position is the safest position for all babies until they 

are 1 year old. Preemies (infants born preterm) should be placed on 

their backs to sleep as soon as possible after birth. 

Babies who are used to sleeping on their backs, 

but who are then placed to sleep on their 

stomachs, like for a nap, are at 

very high risk for SIDS.

If baby rolls over on his or her own during sleep 

from back to stomach or stomach to back, there is 

no need to reposition the baby. Starting sleep on 

the back is most important for reducing SIDS risk.

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Use a firm and flat sleep surface, such 

as a mattress in a safety-approved crib*, 

covered by a fitted sheet with no other 

bedding or soft items in the sleep area. 

* A crib, bassinet, portable crib, or play yard that follows the safety standards

of the Consumer Product Safety Commission (CPSC) is recommended.

For information on crib safety, contact the CPSC at 1-800-638-2772 or

http://www.cpsc.gov.

Never place baby to sleep on soft surfaces, such as on a couch, 

sofa, waterbed, pillow, quilt, sheepskin, or blanket. These surfaces 

can be very dangerous for babies. Do not use a car seat, stroller, 

swing, infant carrier, infant sling, or similar products as baby’s 

regular sleep area. Following these recommendations reduces the 

risk of SIDS and death or injury from suffocation, entrapment, 

and strangulation.

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Breastfeed your baby to 

reduce the risk of SIDS.

Breastfeeding has many health 

benefits for mother and baby. Babies 

who breastfeed, or are fed breastmilk, 

are at lower risk for SIDS than babies 

who were never fed breastmilk. The 

longer a baby is exclusively breastfed 

or fed breastmilk, the lower the risk.

If you bring baby into your bed for 

feeding, put him or her back in a 

separate sleep area when finished. This 

sleep area should be made for infants, 

like a crib or bassinet, and close to your 

bed. If you fall asleep while feeding or 

comforting baby in an adult bed, place 

him or her back in a separate sleep 

area as soon as you wake up. Evidence 

shows that the longer a parent and an 

infant bed-share, the higher the risk for 

sleep-related causes of infant death, 

such as suffocation. Breastfeeding 

information is available at http://www.

cdc.gov/breastfeeding/faq/index.htm.
Room sharing reduces the risk for SIDS.

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Share your room with baby. Keep baby 

in your room close to your bed, but on 

a separate surface designed for infants, 

ideally for baby’s first year, but at least 

for the first 6 months.

Room sharing reduces the risk of SIDS. Baby should not sleep in an 

adult bed, on a couch, or on a chair alone, with you, or with anyone 

else, including siblings or pets. Having a separate safe sleep surface 

for the baby reduces the risk of SIDS and the chance of suffocation, 

strangulation, and entrapment. 

If you bring your baby into your bed for feeding or comforting, 

remove all soft items and bedding from the area. When finished, put 

baby back in a separate sleep area made for infants, like a crib or 

bassinet, and close to your bed. 

Couches and armchairs can also be very dangerous for babies, if 

adults fall asleep as they feed, comfort, or bond with baby while on 

these surfaces. Parents and other caregivers should be mindful of 

how tired they are during these times. There is no evidence for or 

against devices or products that claim to make bed sharing “safer.”
Do not put soft objects, toys, 

crib bumpers, or loose bedding 

under baby, over baby, or anywhere 

in baby’s sleep area.

Keeping these items out of baby’s sleep area reduces the risk of 

SIDS and suffocation, entrapment, and strangulation. Because 

evidence does not support using them to prevent injury, crib 

bumpers are not recommended. Crib bumpers are linked to 

serious injuries and deaths from suffocation, entrapment, and 

strangulation. Keeping these and other soft objects out of baby’s 

sleep area is the best way to avoid these dangers.

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Do not smoke during 

pregnancy, and do not 

smoke or allow smoking 

around your baby or in 

your baby’s environment.

To reduce the risk of SIDS,

women should:

Get regular prenatal care 

during pregnancy.

Avoid smoking, drinking 

alcohol, and using 

marijuana and illegal drugs 

during pregnancy and after 

the baby is born.

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Think about giving your baby 

a pacifier for naps and nighttime 

sleep to reduce the risk of SIDS.

Do not attach the pacifier to anything—like a string, clothing,

stuffed toy, or blanket—that carries a risk for suffocation, choking,

or strangulation. 

Wait until breastfeeding is well established (often by 3 to 4 weeks) 

before offering a pacifier. Or, if you are not breastfeeding, offer 

the pacifier as soon as you want. Don’t force the baby to use it. 

If the pacifier falls out of baby’s mouth during sleep, there is no 

need to put the pacifier back in. Pacifiers reduce the risk of SIDS 

for all babies, including breastfed babies.

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Do not let your baby get too hot 

during sleep.

Dress your baby in sleep clothing, such as a wearable blanket, 

designed to keep him or her warm without the need for loose 

blankets in the sleep area. Dress baby appropriately for the 

environment, and do not overbundle. Parents and caregivers 

should watch for signs of overheating, such as sweating or the 

baby’s chest feeling hot to the touch. Keep the baby’s face and 

head uncovered during sleep.

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Research links increased SIDS risk with 

too many layers of clothing or blankets, 

and with higher room temperature.
Follow guidance from your health 

care provider on your baby’s vaccines 

and regular health checkups. 

Vaccines not only protect baby’s health, but research shows 

that vaccinated babies are at lower risk for SIDS.

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Avoid products that go against safe 

sleep recommendations, especially 

those that claim to prevent or reduce 

the risk for SIDS. 

Evidence does not support the safety or effectiveness of wedges, 

positioners, or other products that claim to keep infants in a specific 

position or to reduce the risk of SIDS, suffocation, or reflux. In 

fact, many of these products are associated with injury and death, 

especially when used in baby’s sleep area.

Do not use heart or breathing 

monitors in the home to reduce 

the risk of SIDS. 

Some health care providers recommend these monitors for 

conditions not related to SIDS or SIDS risk. If you have questions 

about using these monitors for other health conditions, talk with 

your baby’s health care provider, and always follow safe 

sleep recommendations.

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Give your baby plenty of tummy 

time when he or she is awake and 

someone is watching.

Supervised tummy time helps strengthen your baby’s neck, 

shoulder, and arm muscles. It also helps to prevent flat spots on the 

back of your baby’s head. Limiting the time spent in car seats, once 

the baby is out of the car, and changing the direction the infant lays 

in the sleep area from week to week also can help to prevent these 

flat spots.

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Answers to common 

questions about SIDS 

and other sleep-related 

causes of infant death

Q: What is the best way

to reduce baby’s risk 

for SIDS?

A: The best way to reduce

the risk for SIDS is to always 

place baby on his or her 

back to sleep in a separate 

sleep area, designed for a 

baby, with no soft objects, 

toys, or loose bedding.

Q: Will my baby choke

if placed on the back 

to sleep? 

A: No. Healthy babies

naturally swallow or cough 

up fluids—it’s a reflex all 

people have. Babies may 

actually clear such fluids 

better when sleeping on 

their backs because of the 

location of the opening to

the lungs in relation to the 

opening to the stomach. 

There has been no increase 

in choking or similar 

problems for babies who 

sleep on their backs.

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Q:When I was a baby, I was put on my stomach to sleep. Was

that wrong?

A: No. Caregivers were following advice based on the evidence

available at that time. Since then, research has shown that 

sleeping on the stomach increases the risk for SIDS. This 

research also shows that sleeping on the back carries the lowest 

risk of SIDS, and that’s why the recommendation is “back is best.”

Q: Can I swaddle my baby to reduce the risk of SIDS?

A: There is no evidence that swaddling reduces SIDS risk. In fact,

swaddling can increase the risk of SIDS and other sleep-related 

causes of infant death if swaddled babies are placed on their 

stomachs for sleep or roll onto their stomachs during sleep. If 

you decide to swaddle your baby, always place baby fully on his 

or her back to sleep. Stop swaddling baby once he or she starts 

trying to roll over. 

Q:Can I practice skin-to-skin care as soon as my baby

is born?

A: Experts recommend skin-to-skin care for all moms and

newborns for at least an hour after birth, once the mom is 

stable, awake, and able to respond to her baby. When mom 

needs to sleep or handle other things, babies should be placed 

on their backs in a bassinet. 

Q:What if I fall asleep while feeding my baby?

A: Any time you fall asleep while holding or feeding your baby, he

or she is at risk for SIDS, suffocation, or sleep-related causes of 

death or injury. Couches and armchairs can be very dangerous 

for babies when shared with an adult who then falls asleep. 

Research shows that adult beds are also dangerous in these 

situations but are less risky than a couch or armchair. Before 

you start feeding your baby, think about how tired you are. If 

there’s even a slight chance you might fall asleep, avoid couches 

or armchairs and remove all soft items and bedding from an 

adult bed before you start the feeding to reduce the risk of SIDS, 

suffocation, or other sleep-related causes of death. If you fall 

asleep while feeding or comforting your baby on any surface, 

place him or her in a separate sleep area as soon as you wake.

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Spread the word!

Make sure everyone who cares for your baby knows 

the ways to reduce the risk of SIDS and sleep-related 

infant deaths.

Talk with your health care provider about any questions 

or challenges related to safe sleep practices for your baby.

Help family members, siblings, grandparents, babysitters, 

day care workers—EVERYONE—reduce your baby’s risk. 

Share these safe sleep messages with those who care for 

your baby or for any baby younger than 1 year of age.

Remember:

Babies sleep safest on their backs for naps and at night!

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For more information, contact

the Safe to Sleep® campaign:

Phone: 1-800-505-CRIB (2742)

Email: SafetoSleep@mail.nih.gov

Fax: 1-866-760-5947

Web: http://safetosleep.nichd.nih.gov

Safe to Sleep® campaign collaborators include:

Eunice Kennedy Shriver National Institute of Child Health and

Human Development, National Institutes of Health

Maternal and Child Health Bureau of the Health Resources

and Services Administration

Centers for Disease Control and Prevention, Division of

Reproductive Health

Consumer Product Safety Commission

American Academy of Pediatrics

American College of Obstetricians and Gynecologists

First Candle

NIH Pub No 17-HD-5355

January 2019

Safe to Sleep® is a registered trademark of the U.S. Department of Health and Human Services.