SAFE SLEEP

FOR YOUR BABY

Reduce the Risk of Sudden Infant Death Syndrome (SIDS) 

and Other Sleep-Related Infant Deaths
This is what a safe sleep environment 

for baby looks like. 

The sleep surface is flat (like a table) and level (not angled 

or inclined), covered only by a fitted sheet. The sleep area is 

clear—no objects, toys, or other items. And the sleep space 

is in the same room where parents sleep, but separate from 

their bed.
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Every day, families around the world welcome a new baby 

into their lives. They face joys and challenges in helping 

baby stay safe and healthy.

Still, thousands of babies die suddenly and unexpectedly in 

the United States each year—often while they are sleeping. 

Different groups use different terms to describe the death 

of a baby during sleep, such as: 

y Sudden Unexpected Infant Death (SUID)—This broad 

term describes all sudden, unexpected infant deaths, 

including those from a known cause, like an injury, and 

those from unknown causes.

y Sudden Infant Death Syndrome (SIDS)—SIDS is a 

sudden, unexpected death of a baby younger than 

1 year of age that doesn’t have a known cause even after 

a full investigation. 

y Other sleep-related deaths—This term describes 

deaths from something in or related to the baby’s sleep 

environment, how or where the baby sleeps, or things that 

happen during sleep. Other sleep-related deaths occur 

when baby can’t breathe, such as from:

{ Entrapment or wedging: Baby’s body or head gets 

stuck between two objects, like a mattress and wall, 

bed frame, or furniture

{ Suffocation: Something, such as a pillow or adult’s 

arm, covers baby’s face or nose

{ Strangulation: Something presses on or wraps around 

baby’s neck

No matter what it is called, the death of a baby during sleep 

is a tragedy. The actions described here can help parents 

and caregivers reduce baby’s risk of SUID, SIDS, and other 

sleep-related deaths. 
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Parents and caregivers can help 

protect baby during sleep by creating 

a safe sleep environment. 

We have made great progress in saving infant lives. 

The number of U.S. babies who die during sleep is much 

lower today than it was during the 1990s, when education 

and awareness efforts started. 

But unsafe sleep environments remain a deadly problem 

for U.S. babies, and the risk of death during sleep remains 

higher in Black/African American and American Indian/

Alaska Native babies than in White, Hispanic, or Asian/

Pacific Islander babies. 
Parents and caregivers can use the following actions 

to help keep baby safe and reduce baby's risk of dying 

during sleep.

Place babies on their backs to 

sleep for naps and at night.

Use a sleep surface that is firm, 

flat, level, and covered only by 

a fitted sheet.

Share your room with baby, 

not your bed, for at least the 

first 6 months.

Feed baby human milk, like by 

direct breastfeeding.

Keep things out of baby’s sleep 

area—no objects, toys, or other 

items.

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What can I do to help keep 

my baby safe during sleep?

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Place babies on their backs to sleep 

for naps and at night.

y Place all babies—including those born preterm

and those with reflux—on their backs to sleep

until they are 1 year old.

y It is not safe to place babies on their sides or

stomachs to sleep, not even for a nap. The safest

sleep position is on the back.

y Babies who sleep on their backs are at lower risk

for SIDS than babies who sleep on their stomachs

or sides.

y If baby usually sleeps on their back, putting them

on the stomach or side to sleep, for a nap or at

night, increases the risk for SIDS by up to 45 times.

ROLLING 

OVER

Once babies can roll from 

back to stomach and from 

stomach to back on their own,

you can leave them in the position they 

choose after starting sleep on their 

back. 

If they can only roll one way on their 

own, you can reposition them to their 

back if they roll onto their stomach 

during sleep.
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Use a sleep surface for baby that is 

firm (returns to original shape quickly 

if pressed on), flat (like a table, not a 

hammock), level (not at an angle or 

incline), and covered only with a 

fitted sheet. 

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y Both the sleep surface (such as a mattress) and the sleep 

space (like a crib, bassinet, or portable play yard) should 

meet the safety standards of the Consumer Product 

Safety Commission (CPSC). The CPSC offers more 

information about mattress and crib safety at https://

bit.ly/CPSCSafeSleep.

y Soft surfaces—like couches, sofas, waterbeds, memory

foam, air and pillow-top mattresses, quilts, blankets, and 

sheepskins—are not safe for babies to sleep on. Sleeping 

on soft surfaces raises baby's risk of wedging or 

entrapment, suffocation, and strangulation.

y Inclined or tilted sleep surfaces, with one end higher

than the other, are not safe for babies to sleep on

because baby’s body can slide down, which could block 

their airway and breathing.
Ways Baby’s Airway 

Can Be Blocked

Wedging/

Entrapment

Soft Bedding

Overlay

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Illustrations courtesy of the Centers 

for Disease Control and Prevention

y Do not use sitting devices, 

such as car seats and strollers, 

or carrying devices, like 

carriers and slings, for baby’s 

regular sleep area or for 

naps. If baby falls asleep in 

one of these devices, move 

them to their regular sleep 

space as soon as possible 

once you are out of a vehicle. 

The American Academy 

of Pediatrics offers travel 

safety tips (https://bit.ly/

AAPTravelSafety), such as 

giving baby breaks from 

the sitting device every 

few hours.

y Avoid letting baby sit 

slumped over, like with their 

chin on their chest, because 

it could block their airway 

and breathing. Young babies 

and those unable to control 

their head and neck muscles 

risk suffocation and death 

from sitting this way. 

y Keep comforters, quilts, 

pillows, and blankets out 

of baby’s sleep area.
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Feed your baby human milk, like 

by breastfeeding.

y In most cases, pediatricians and other

health care providers recommend feeding

only human milk, with nothing added, if

possible, for at least baby’s first 6 months.

Babies born preterm or with certain health

conditions may need different care.

y Feeding babies

human milk by direct

breastfeeding, if

possible, or by pumping

from the breast,

reduces the risk of SIDS.

Feeding only human

milk, with no formula

or other things added,

for the first 6 months

provides the greatest

protection from SIDS.

y Feeding baby any human milk, even with

other foods added, is more protective than

not feeding them human milk at all.

y The longer a baby gets human milk, the

lower the SIDS risk.

y Feeding human milk also has other

benefits for babies, such as reduced risks

of diarrhea, asthma, and ear infections.
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Share a room with baby for at least 

the first 6 months. Give babies their 

own sleep space (crib, bassinet, or 

portable play yard) in your room, 

separate from your bed. 

y Babies in their own sleep space are at

lower risk for injury and death from

SIDS and from situations like an adult or

sibling accidentally rolling over them.

y Room sharing by putting baby’s sleep

space near, but not in, your bed is safer

than sharing your bed with baby.

Sharing your room with baby is also safer

than putting baby in their own room.

y Keeping baby’s sleep space close to your

bed makes it easy to check on, feed, and

comfort baby without having to get all

the way out of bed.

Continued on next page
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y If you are bringing baby into your bed for feeding or

comforting, before you start, remove or clear away all

soft items and bedding from your side of the bed. This

practice may help prevent suffocation in case you fall

asleep. When finished, put baby back in their own sleep

space close to your bed.

y If you fall asleep while feeding or comforting baby in

your bed, put them back in a separate sleep area as

soon as you wake up. Research shows that the longer an

adult shares a bed with baby, the higher baby’s risk for

suffocation and other sleep-related death.

y Couches and armchairs are never safe places for

babies to sleep. These surfaces are extremely dangerous

when an adult falls asleep while feeding, comforting,

or snuggling with baby. Do not let babies sleep on

these surfaces alone, with you, with someone else, or

with pets.

Share a room 

with baby for at 

least the first 

6 months. Give 

babies their 

own sleep space 

(crib, bassinet, or 

portable play yard) 

in your room, 

separate from 

your bed. 

(Continued from previous page)
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Sharing an adult bed, couch, or armchair with 

baby can be risky, especially in some situations: 

VERY 

HIGH

RISK

y Sleep surface is soft, such as a

waterbed, old adult mattress,

couch, or armchair

y Adult is very tired, taking medication

that makes them drowsy, using

substances like alcohol, or whose

ability to respond is affected in

some way

y Adult smokes cigarettes or uses

tobacco products (even if they do

not smoke in the bed)

Low High

HIGH

RISK

y Baby is younger than 4 months

old (regardless of adult smoking or

sleep surface)

y Adult is not the baby’s parent, but

is another caregiver, such as a

grandparent or sibling

Low High

HIGHER 

THAN 

AVERAGE

RISK 

y Baby was born preterm (before 37

weeks) or born at a low birth weight

y Sleep area includes unsafe items,

such as pillows or blankets

Low High
Keep things out of baby’s sleep area 

—no objects, toys, or other items. 

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y Remove everything from baby’s sleep area

except a fitted sheet covering the mattress.

y Things in the sleep area can pose dangers

for baby, especially if they are:

{ Soft or squishy (pillows, stuffed toys, crib

bumpers)

{ Under or over baby (comforters, quilts,

blankets, positioners)

{ Non-fitted, even if lightweight, small,

or “tucked in” (loveys/cloths, non-fitted

sheets, tucked-in blankets)

{ Weighted (weighted blankets, weighted

swaddles, weighted objects)

y Research links crib bumpers and bedding other

than a fitted sheet covering the baby’s mattress

to serious injuries and deaths from SIDS,

suffocation, entrapment, and strangulation.
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Offer baby a pacifier for naps and at 

night once they are feeding well. 

y If feeding baby human milk through direct breastfeeding,

wait until breastfeeding is well established, based on your 

pediatrician’s guidance, before trying a pacifier.

Breastfeeding is “well established” when the parent has

enough milk to feed and satisfy baby’s hunger, parent and

baby are comfortable during breastfeeding, and baby is

gaining enough weight to meet growth goals.

y If not breastfeeding, offer baby a pacifier as soon as you

like. Research shows that pacifiers are especially helpful

for reducing SIDS risk in formula-fed babies.

y To reduce the risk of strangulation, choking, and

suffocation, do not attach the pacifier to clothing, stuffed 

animals, blankets, or other items.

y Do not coat the pacifier with anything, such as a

sweetened liquid or honey.

y If the pacifier falls out of baby’s

mouth during sleep, you don’t

need to put it back in.

y It is OK if baby doesn’t

want the pacifier; don’t

force baby to take it.

yFinger or thumb

sucking does not 

reduce SIDS risk.
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Stay smoke- and vape-free 

during pregnancy, and keep 

baby’s surroundings smokeand vape-free. 

y Smoking during pregnancy greatly

increases baby’s risk of SIDS.

y Second-hand smoke in the home, car,

or other spaces where baby spends time

also increases the risk of SIDS and other

health problems.

Stay drug- and alcohol-free 

during pregnancy, and make 

sure anyone caring for baby is 

drug- and alcohol-free.

y Research shows that drug and alcohol

use—during pregnancy and by infant

caregivers—increases the risk of SIDS.

y Sharing an adult bed with baby when

using drugs or alcohol also increases

baby’s risk of injury and death.
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Avoid letting baby get too hot, and 

keep baby’s head and face uncovered 

during sleep.

y Baby can get hot or overheated if they

are wearing too many layers of clothes

and bedding for the room temperature

(sometimes called overbundling).

Overheated babies are at higher risk

for SIDS and heat-related death.

y Dress baby in clothes suitable for the

temperature of the room.

y Wearing hats while indoors can make baby

too hot, so take off hats when baby is

inside.

y Watch for signs that baby is too hot, such as

sweating, flushing/red or hot skin, or baby’s

chest feeling hot to the touch.

y Dressing baby in a wearable blanket or an

extra layer of clothing can keep them warm

without adding items to the sleep area.

y Do not leave baby alone in a vehicle,

no matter the temperature outside.
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Get regular 

medical care 

throughout 

pregnancy.

y Visiting a health care

provider as soon as you 

find out you are

pregnant, and then

regularly until birth, can 

help promote a healthy 

pregnancy.

y Research shows that, in 

certain communities,

regular prenatal care

can also reduce the risk 

of SIDS.

Follow health care provider advice on 

vaccines, checkups, and other health 

issues for baby.

y Pediatricians and other medical providers have

the most up-to-date information about safe sleep,

growth and development, and other health topics

for baby.

y Research shows that vaccinated babies are at lower

risk for SIDS.

y Vaccines also protect people, including babies, from

dangerous and deadly diseases.
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Avoid products and devices that go 

against safe sleep guidance, especially 

those that claim to “prevent” SIDS and 

sleep-related deaths.

y Many wedges, positioners, or other products that

claim to keep babies in one position or to reduce the

risk of SIDS, suffocation, or reflux do not meet federal

guidelines for sleep safety. These products, such

as inclined sleepers, are linked to injury and death,

especially when used in baby’s sleep area. You can

help prevent injuries and deaths by not using these

products and devices.

y No product can prevent SIDS.

y The CPSC has more information about safety standards

for baby products at https://bit.ly/CPSCSafeSleep.

Avoid using heart, breathing, motion, 

or other monitors to reduce the risk 

of SIDS.

y These types of monitors are not effective at

detecting or preventing SIDS.

y If you choose to use these devices for reasons

other than detecting SIDS, make sure to follow

safe sleep recommendations to reduce baby’s risk

of sleep-related deaths.

y If you have questions about using these devices

for health problems or concerns other than SIDS,

talk with your baby’s health care provider.
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Avoid swaddling once baby starts to 

roll over (usually around 3 months 

of age), and keep in mind that 

swaddling does not reduce SIDS risk. 

y Even though swaddling does not reduce the risk of SIDS,

some babies are calmer and sleep better when they are

swaddled.

y If you choose to swaddle your baby, make sure you

follow the American Academy of Pediatrics safe sleep

recommendations to reduce baby’s risk of sleep-related

deaths.

y Once baby starts to roll over on their own, swaddling

increases risk of suffocation and 

strangulation. Stop swaddling 

baby when they start rolling 

over, usually around 3 months 

of age. 

y Using the back sleep

position for swaddled

babies is especially

important. A swaddled

baby may have

trouble moving out

of the stomach or side

positions, which puts

them at greater risk for

SIDS and other sleeprelated deaths than the

back sleep position.
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Give babies plenty of “tummy time” 

when they are awake, and when 

someone is watching them.

y Supervised tummy time helps strengthen your

baby’s neck, shoulder, and arm muscles.

y Tummy time also helps prevent flat spots on the

back of your baby’s head.

y Tummy time is an important way to help improve

baby’s motor skills and movement.

y Tummy time sessions can start within a few days

of birth, for 3 to 5 minutes, two or three times a

day. As baby grows stronger, you can slowly make

tummy time longer and practice it more times a day.

y Pediatricians recommend that, by about 2 months

of age, babies should be getting at least 15 minutes

to 30 minutes of total tummy time daily.

y For more information on tummy time, visit

https://bit.ly/AAPTummyTime.
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Frequently Asked Questions (FAQs)

Q: What is the best way to protect baby from 

sleep-related death?

A: Always place babies on their backs to sleep, in their 

own sleep space designed for babies and in the parents’ 

room, on a surface that is firm, flat, and level (not inclined) 

covered only by a fitted sheet, and with no objects, toys, or 

other items in the sleep area.

Q: Will my baby choke if placed on their 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 

human anatomy. 

When on their back,

baby’s trachea or

windpipe (tube to the

lungs) lies on top of

the esophagus (tube to

the stomach). Anything

regurgitated, refluxed,

or spit up from the

stomach through the

esophagus has to go

against gravity to get to

the windpipe and cause

choking. When on the

stomach, such fluids

leave baby’s esophagus

and pool at the opening

for the windpipe, making 

choking more likely.
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Q: When I was a baby, I was put on my stomach 

to sleep. Was that wrong?

A: No. Your caregiver followed advice based on the 

evidence available at that time. Since then, research 

has shown that sleeping on the stomach increases the risk 

for SIDS, and that sleeping on the back carries the lowest 

risk of SIDS. That’s why the latest recommendation is: 

“back is best.”

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

baby is born?

A: Yes! Experts recommend immediate skin-to-skin contact

for all parents and newborns for at least 1 hour after birth, 

once a health care provider says the parent is stable and can 

respond to their baby. When the parent needs to sleep or 

handle other activities, baby should be placed on their back 

in their own sleep space, such as a safety-approved crib or 

bassinet. 

1

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

my bed?

A: If you fall asleep while feeding or comforting baby 

in your bed, put them back in a separate sleep area as soon 

as you wake up. Research shows that the longer an adult 

shares a bed with baby, the higher baby’s risk for 

suffocation and other sleep-related death.

Before you bring baby into your bed for feeding or 

comforting, remove or clear away all soft items and 

bedding from your side of the bed. When finished, put baby 

back in a sleep area made just for babies, like a portable 

crib, close to your bed.

1The CPSC has more information on crib safety at https://bit.ly/CPSCSafeSleep.
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Spread the word!

Make sure everyone who cares for your baby knows the

ways to reduce the baby’s risk for sleep-related death. 

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 who cares for your baby—

reduce your baby’s risk by sharing these safe sleep 

messages with them. 

For more information, contact Safe to Sleep®:

Phone: 

1-800-505-CRIB (2742)

Email:

SafetoSleep@mail.nih.gov

Web:

https://safetosleep.nichd.nih.gov

Fax: 

1-866-760-5947

Telecommunications Relay Service:

Dial 7-1-1
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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
SAFE TO

SLEEP®

NIH Pub No 22-HD-7040 I January 2023

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

and Human Services.