Safe Sleep Practices :: Nationwide Children's Hospital, Columbus, Ohio

Safe Sleep Practices

Sleep-related deaths are the leading cause of infant death between 1 month and 1 year of age. In Ohio, more than three infant deaths each week are sleep-related.1 Many of these deaths are preventable.

Practice the ABC’s of safe sleep: Babies should always sleep Alone, on their Backs, in a Crib.

1. Ohio Child Fatality Review, 2006-2010 Deaths.

Sleep Position

  • Place your baby on his back for every sleep, night time and nap time.
  • Do not put your baby to sleep on his side or tummy.
  • Once your baby can roll from his back to tummy and tummy to back, your baby can stay in the sleep position that he assumes. But always place your baby to sleep on his back.
  • Your baby will not choke if they spit up.

When your baby sleeps on his back, the “air pipe” (trachea) lies on top of the “food pipe” (esophagus) (Picture 1).  If your baby spits up, it is harder for the spit up to go into the “air pipe” when your baby is on his back. However, when your baby sleeps on his stomach and spits up, it is easier for him to choke because the spit up can go right into the “air pipe” (Picture 2).

Safe Sleep Practices, Back Image
Picture 1

Safe Sleep Practices, Stomach Image
Picture 2

Make a Safe Place to Sleep

  • In 2011, new safety guidelines were established to make sure that cribs were safer for babies. Under these guidelines, traditional drop-side cribs can no longer be made or sold. Please check the Consumer Product Safety Commission for a list of recalled cribs.
  • Always place your baby to sleep in a safety-approved crib or Pack ‘n Play® with a firm mattress and a tight-fitting sheet.
  • Crib slats should be no more than 2-3/8 inches apart, this is about as wide as a dollar bill, from top to bottom. Your baby’s head could get trapped in more widely spaced slats.  
  • Make sure there are no gaps larger than two fingers between the sides of the crib and the mattress.
  • Never use soft bedding, comforters, pillows, loose sheets, blankets, sheep skins, toys or bumper pads in the crib or Pack ‘n Play®. These items could cause your baby to suffocate .
  • Put your baby’s crib away from windows and keep cords from window blinds, shades and baby monitors out of reach.

Always put your baby to sleep in a separate but close-by safe place to sleep.

  • Bed-sharing (sleeping in your bed with your baby) increases your baby’s chance of a sleep-related death, because adult beds and bedding are soft and can cause the baby to suffocate.
  • Room-sharing (your baby sleeps in your room in a separate space, such as a bassinet, Pack ‘n Play® or other safe sleep place) is a way to help prevent sleep-related deaths.
  • You may breastfeed your baby in bed with you. Always remember to put your baby back in his own separate safe place to sleep when you are finished nursing.

Make a Safe Home Environment

  • Never allow anyone to smoke around your baby.  SIeep-related infant deaths occur more often in babies who are exposed to smoke than in babies who have a smoke-free environment.

Keep sleeping rooms a comfortable temperature.

If you are comfortable in the room, then your baby will be too.

  • Do not overheat your baby. Overheating may cause problems with the control the baby’s brain has over breathing and waking up. Do not over-bundle your baby. Your baby should not feel hot to the touch.
  • Babies usually need one more layer of clothing than adults. You can put a Onesies® under the pajamas, or dress your baby in warmer pajamas than you would wear.
  • Use a SleepSack® instead of blankets to keep your baby warm.

Pacifier use can help prevent sleep-related deaths.

  • Offer your baby a clean, dry pacifier that is not attached to a string or stuffed animal at sleep times.
  • Pacifiers should only be used in breast-feeding infants after 3-4 weeks of age, once breastfeeding has been established.
  • Do not force your baby to use a pacifier.
  • You do not need to put the pacifier back in the baby’s mouth once your baby has fallen asleep and the pacifier has fallen out.

Ask your baby’s health-care providers about over-the-counter products.

  • Do not use products that claim to reduce the risk of Sudden Infant Death Sydrome (SIDS), such as wedges or baby positioners. These products have not been tested to see if they work or if they are safe.
  • Do not use home monitors for your baby that your baby’s doctor has not recommended or written a prescription for to reduce the risk of SIDS.
  • If your baby has a medical reason for a monitor, your baby’s doctor will prescribe a medical home monitor.
  • Learn more about reducing the risk of SIDS.

Tummy Time

Provide supervised awake tummy time for your baby.
This reduces the chance that the baby will get flat spots and bald spots on his head, which is called “positional plagiocephaly” (flattened head).

Learn more about Tummy Time.

Swaddling

  • Swaddling should only be used on babies up to 2 months of age.
  • Check for tightness. You should be able to slide your hand between the blanket and your baby’s chest. You should still be able to bend your baby’s hips easily with room for the baby to move his/her hips or legs.
  • If your baby is swaddled too loosely, the blanket can come undone and can cause your baby to suffocate.

Additional Resources

Safe to Sleep Public Education Campaign: Get educated and discover valuable information about Sudden Infant Death Syndrome (SIDS) and safe infant sleep. Learn about safe sleeping guidelines and ways to prevent SIDS, watch videos, and read about myths and facts regarding SIDS.

Consumer Product Safety Commission’s (CPSC): Explore the CPSC website to uncover useful information regarding safe sleep for infants. This site provides safety guidelines, sleeping recommendations, education materials, videos, product recalls, an OnSafety blog, and more.

Ohio Department of Health: Learn why it is safest to follow the ABCs of safe sleep.

Columbus Public Health: Learn the “A B C’s” of Safe Sleep!

Healthy Children: Get facts about SIDS. What it is, who is at risk, and how to protect your baby.  Learn about how you and your child’s caregiver can make your baby’s sleep environment as safe as possible.

First Candle: First Candle is a site dedicated to educating families and healthcare professionals about pregnancy and newborn care, stillborn births, Sudden Infant Death Syndrome (SIDS)/ Sudden Unexpected Infant Death Syndrome (SUIDS), grief support, and links to resources in the community.

SIDS Network of Ohio: The site provides information and education for families and healthcare professionals about infant safety, SIDS/SUIDS, and safe sleep guidelines. The SIDS Network of Ohio offers supportive services to those who have been affected by the sudden loss of an infant less than 2 years of age.

Safe Sleep for Babies: This learn how video from Consumer Product Safety Commission (CPSC) reviews safety concerns and what to look for when evaluating the safety of products used for infants, including information on crib parts and setup. Also available in Spanish

Sleep Positioners: A Suffocation Risk: A video from the U.S. Consumer Product Safety Commission outlining the dangers of using sleep positioners.

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