Every year in the United States, approximately 3,500 babies die during sleep due to unsafe sleep environments, according to the American Academy of Pediatrics. The good news: following evidence-based safe sleep guidelines significantly reduces that risk. Here is what every parent needs to know.

What Are the AAP Safe Sleep Guidelines?

The American Academy of Pediatrics released its most recent comprehensive update to infant safe sleep recommendations in 2022. These guidelines apply to all healthy babies from birth through 12 months of age and are based on a review of 159 scientific studies.

The ABCs of Safe Sleep

The foundation of AAP safe sleep guidance is summarized as the ABCs: Alone, Back, and Crib.

A — Alone

Babies should sleep in their own separate sleep space. Bed-sharing — sharing a sleep surface with parents, siblings, or other children — significantly increases the risk of sleep-related infant death. The AAP recommends against bed-sharing under all circumstances. Room-sharing, where the baby's crib or bassinet is in the parents' bedroom, is specifically recommended and has been shown to decrease the risk of SIDS by as much as 50 percent. The AAP recommends room-sharing for at least the first six months and ideally for the first year.

B — Back

Babies should be placed on their backs to sleep for every sleep — both naps and nighttime — until they are 12 months old. Back sleeping is the single most effective action parents can take to reduce the risk of SIDS. A common concern is that babies on their backs will choke if they spit up. The AAP states that research shows a baby's airway is actually better protected when lying on their back than on their stomach, and that choking may be more likely in the prone position. Once a baby can roll from back to front and front to back independently, it is safe to leave them in whatever position they roll to — but always start them on their back.

C — Crib

Babies should sleep on a firm, flat, non-inclined surface in a crib, bassinet, portable crib, or play yard that meets current Consumer Product Safety Commission (CPSC) safety standards. The sleep surface should be covered with only a tight-fitting sheet — nothing else.

What Should Never Be in a Baby's Sleep Space

According to the AAP, the following items should never be placed in or near a baby's sleep area:

• Pillows or soft bedding of any kind
• Crib bumpers, including mesh bumpers
• Stuffed animals or toys
• Loose blankets
• Positioners or wedges
• Weighted blankets, weighted swaddles, or weighted sleep sacks

The AAP's 2022 update specifically added weighted sleep products to the list of items to avoid, noting that they can restrict chest expansion and breathing in infants.

Sleep Sacks: The Safe Alternative to Blankets

The AAP recommends using wearable blankets — called sleep sacks — instead of loose blankets to keep babies warm during sleep. Sleep sacks that do not compress the arms, chest, or body, and that allow the baby to move freely, are considered safe for use throughout infancy. Swaddle-style sleep sacks that restrict arm movement should be discontinued once a baby shows any signs of rolling.

Other Key AAP Recommendations

• Pacifier use: The AAP recommends offering a pacifier at naptime and bedtime. Multiple studies show pacifier use can reduce the risk of SIDS by 50 to 90 percent. If breastfeeding, wait until breastfeeding is well established before introducing a pacifier.
• Breastfeeding: Breastfeeding is associated with a reduced risk of SIDS. The AAP recommends exclusive breastfeeding for approximately six months, with continuation for one year or longer.
• Avoid overheating: Dress your baby lightly for sleep and keep the room between 68–72°F. Signs of overheating include sweating, flushed cheeks, damp hair, and rapid breathing.
• Immunizations: Routine immunizations should be kept up to date. Evidence suggests immunizations may have a protective effect against SIDS.
• Avoid inclined sleepers: Car seats, strollers, swings, and inclined sleepers are not recommended for routine sleep. If a baby falls asleep in one, move them to a firm, flat surface as soon as possible.
• Avoid smoke exposure: Keep babies away from tobacco smoke both during pregnancy and after birth.

What About Swaddling?

The AAP states that swaddling, when done correctly, can be an effective technique to help calm infants. However, swaddling must be discontinued as soon as a baby shows any signs of attempting to roll — typically around 3 to 4 months, though it can happen earlier. Proper swaddling should also leave adequate room for the hips and legs to move freely. Swaddling too tightly around the hips has been associated with developmental hip dysplasia.