Sudden infant death syndrome (SIDS) is the sudden, unexplained death of an infant younger than one year old. Some people call SIDS "crib death" because many babies who die of SIDS are found in their cribs.

SIDS is the leading cause of death in children between one month and one year old. Most SIDS deaths occur when babies are between one month and four months old. Premature babies, boys, African Americans, and American Indian/Alaska Native infants have a higher risk of SIDS.

Although health care professionals don't know what causes SIDS, they do know ways to reduce the risk. These include

• Placing your baby on his or her back to sleep, even for short naps. "Tummy time" is for when babies are awake and someone is watching
• Having your baby sleep in your room for at least the first six months. Your baby should sleep close to you, but on a separate surface designed for infants, such as a crib or bassinet.
• Using a firm sleep surface, such as a crib mattress covered with a fitted sheet
• Keeping soft objects and loose bedding away from your baby's sleep area
• Breastfeeding your baby
• Making sure that your baby doesn't get too hot. Keep the room at a comfortable temperature for an adult.
• Not smoking during pregnancy or allowing anyone to smoke near your baby

SIDS is the sudden, unexplained death of an infant younger than 1 year of age that remains unexplained after a complete investigation. This investigation can include an autopsy, a review of the death scene, and complete family and medical histories.

A diagnosis of SIDS is made by collecting information, conducting scientific or forensic tests, and talking with parents, other caregivers, and health care providers. If, after this process is complete, there is still no identifiable cause of death, the infant's death might be labeled as SIDS.

SIDS is not the cause of every sudden infant death.

Each year in the United States, thousands of babies die suddenly and unexpectedly. These deaths are called SUID (pronounced Soo-id), which stands for “Sudden Unexpected Infant Death.”

SUID includes all unexpected deaths: those without a clear cause, such as SIDS, and those from a known cause, such as suffocation. One-half of all SUID cases are SIDS. Many unexpected infant deaths are accidents, but a disease or something done on purpose can also cause a baby to die suddenly and unexpectedly.

“Sleep-related causes of infant death” are those linked to how or where a baby sleeps or slept. These deaths are due to accidental causes, such as suffocation, entrapment, or strangulation. Entrapment is when the baby gets trapped between two objects, such as a mattress and a wall, and can’t breathe. Strangulation is when something presses on or wraps around the baby’s neck, blocking the baby’s airway. These deaths are not SIDS.

Other things that SIDS is not:

• SIDS is not the same as suffocation and is not caused by suffocation.
• SIDS is not caused by vaccines, immunizations, or shots.
• SIDS is not contagious.
• SIDS is not the result of neglect or child abuse.
• SIDS is not caused by cribs.
• SIDS is not caused by vomiting or choking.
• SIDS is not completely preventable, but there are ways to reduce the risk.

• SIDS is a sudden and silent medical disorder that can happen to an infant who seems healthy.
• SIDS is sometimes called "crib death" or "cot death" because it is associated with the time when the baby is sleeping. Cribs themselves don't cause SIDS, but the baby's sleep environment can influence sleep-related causes of death.
• SIDS is the leading cause of death among babies between 1 month and 1 year of age.
• About 1,360 babies died of SIDS in 2017, the last year for which such statistics are available.
• Most SIDS deaths happen in babies between 1 month and 4 months of age, and the majority (90%) of SIDS deaths happen before a baby reaches 6 months of age. However, SIDS deaths can happen anytime during a baby's first year.
• Slightly more boys die of SIDS than girls.
• In the past, the number of SIDS deaths seemed to increase during the colder months of the year. But today, the numbers are more evenly spread throughout the year.
• SIDS rates for the United States have dropped steadily since 1994 in all racial and ethnic groups. Thousands of infant lives have been saved, but some ethnic groups are still at higher risk for SIDS.

Talk with your health care provider about any questions or challenges related to safe sleep practices for your baby.

What is the best way to reduce baby's risk for SIDS?

The best way to reduce the risk for SIDS is to always placebaby on his or her back for all sleep times in a separate sleep area, designed for a baby, with no soft objects, toys, or loose bedding.

Why should I place my baby on his or her back to sleep?

Research shows that the back sleep position carries the lowest risk of SIDS.

Research also shows that babies who sleep on their backs are less likely to get fevers, stuffy noses, and ear infections. The back sleep position makes it easier for babies to look around the room and to move their arms and legs.

Remember: Babies sleep safest on their backs, and every sleep time counts!

Is a baby-sized cardboard box a safe alternative infant sleep surface?

Currently, the American Academy of Pediatrics (AAP) Task Force on SIDS indicates that there is not yet enough evidence to say anything about the potential benefit or dangers of using cardboard boxes, wahakuras, or pepi-pods.

A firm and flat sleep area that is made for infants, like a safety-approved* crib or bassinet, and is covered by a fitted sheet with no other bedding or soft items in the sleep area is recommended by the AAP to reduce the risk of SIDS and other sleep-related causes of infant death. Keeping baby in your room and close to your bed, ideally for baby's first year, but at least for the first 6 months is also recommended by the AAP. Room sharing reduces the risk of SIDS. Having a separate safe sleep surface for baby reduces the likelihood of suffocation, entrapment, and strangulation.

You may want to consider these questions before making a decision:

• Will all caregivers properly use the surface with no soft bedding or toys?
• Will all caregivers practice other safe infant sleep recommendations?

*A crib, bassinet, portable crib, or play yard that meets the safety standards of the Consumer Product Safety Commission (CPSC) is recommended by the AAP Task Force on SIDS.

Are baby-sized cardboard boxes subject to mandatory safety standards like other infant sleep areas?

Cardboard boxes for babies are currently not subject to any Consumer Product Safety Commission (CPSC) mandatory safety standards. These products do not meet CPSC's definition of a bassinet, crib, or handheld carrier. It is important to note that CPSC does not have the authority to pre-approve or pre-test products for safety before they are sold.

Tell the CPSC if you have any safety concerns or issues with a baby-sized cardboard box or other product.

What if I fall asleep while feeding my baby?

Research shows that it is less dangerous to fall asleep with an infant in an adult bed than on a sofa 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 while feeding, avoid couches and armchairs. These surfaces can be very dangerous places for babies, especially when adults fall asleep with infants while on them. If you think you might fall asleep while feeding your baby in an adult bed, remove all soft items and bedding from the bed before you start feeding to reduce the risk of SIDS, suffocation, and other sleep-related causes of death.

Will my baby choke if placed on the back to sleep?

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.

When the baby is in the back sleep position, the trachea (tube to the lungs) lies on top of the esophagus (tube to the stomach). Anything regurgitated or refluxed from the stomach through the esophagus has to work against gravity to enter the trachea and cause choking. When the baby is sleeping on its stomach, such fluids will exit the esophagus and pool at the opening for the trachea, making choking much more likely.

Cases of fatal choking are very rare except when related to a medical condition. The number of fatal choking deaths has not increased since back sleeping recommendations began. In most of the few reported cases of fatal choking, an infant was sleeping on his or her stomach.

When I was a baby, I was put on my stomach to sleep. Was that wrong?

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."

Can I swaddle my baby to reduce the risk of SIDS

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 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.

What if my baby can't get used to sleeping on his or her back?

The baby's comfort is important, but safety is more important. Parents and caregivers should place babies on their backs to sleep even if they seem less comfortable or sleep more lightly than when on their stomachs.

A baby who wakes frequently during the night is actually normal and should not be viewed as a "poor sleeper."

Some babies don't like sleeping on their backs at first, but most get used to it quickly. The earlier you start placing your baby on his or her back to sleep, the more quickly your baby will adjust to the position.

Is it okay if my baby sleeps on his or her side?

No. Babies placed to sleep on their sides are at increased risk for SIDS. For this reason, babies should sleep fully on their backs for naps and at night to reduce the risk of SIDS.

Can I practice skin-to-skin care as soon as my baby is born?

Experts recommend skin-to-skin care for all moms and newborns for at least 1 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.

I saw a product that said it could prevent SIDS and keep my baby in the right position during sleep. Can I use it to prevent SIDS?

There is currently no known way to prevent SIDS, nor are there any products that can prevent 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.

The U.S. Food and Drug Administration, the Consumer Product Safety Commission, the American Academy of Pediatrics, and other organizations warn against using these products because of the dangers they pose to babies. Avoid products that go against safe sleep recommendations, especially those that claim to prevent or reduce the risk of SIDS.

If my baby rolls onto his or her stomach during sleep, do I need to put my baby in the back sleep position again?

No. Rolling over is an important and natural part of your baby's growth. Most babies start rolling over on their own around 4 to 6 months of age. If your baby rolls over on his or her own during sleep, you do not need to turn the baby back over onto his or her back. The important thing is that your baby start every sleep time on his or her back to reduce the risk of SIDS, and that there is no soft objects, toys, crib bumpers, or loose bedding under baby, over baby, or anywhere in baby's sleep area.

What if my baby's grandparents or another caregiver wants to place my baby to sleep on his or her stomach for naptime?

Babies who usually sleep on their backs, but who are then placed to sleep on their stomachs, like for a nap, are at very high risk for SIDS. So it is important for everyone who cares for babies to always place them on their backs to sleep, for naps and at night, to reduce the risk of SIDS.

Why shouldn't I use crib bumpers in my baby's sleep area?

Bumper pads and similar products that attach to crib slats or sides are often used with the intent of protecting infants from injury. However, evidence does not support using crib bumpers to prevent injury. In fact, crib bumpers can cause serious injuries or death. Keeping them out of your baby's sleep area is the best way to avoid these dangers.

Before crib safety was regulated, the spacing between the slats of the crib sides could be any width, which posed a danger to infants if they were too wide. Parents and caregivers used padded crib bumpers to protect infants. Now that cribs must meet safety standards, the slats don't pose the same dangers. As a result, the bumpers are no longer needed.

Are there times when my baby should be on his or her stomach?

Yes, your baby should have plenty of Tummy Time when he or she is awake and when someone is watching. Supervised Tummy Time helps strengthen your baby's neck and shoulder muscles, build motor skills, and prevent flat spots on the back of the head.

Will my baby get flat spots on the back of the head from sleeping on his or her back?

Pressure on the same part of the baby's head can cause flat spots if babies are laid down in the same position too often or for too long a time. Such flat spots are usually not dangerous and typically go away on their own once the baby starts sitting up. The flat spots also are not linked to long-term problems with head shape. Making sure your baby gets enough Tummy Time is one way to help prevent these flat spots. 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. Check out the other things parents and caregivers can do to prevent flat spots on the back of the head.

How old are babies who die from SIDS?

The majority (90%) of SIDS deaths occur before a baby reaches 6 months of age, and the number of SIDS deaths peaks between 1 month and 4 months of age. However SIDS deaths can occur anytime during a baby's first year, so parents should still follow safe sleep recommendations to reduce the risk of SIDS until their baby's first birthday.

What is SUID?

SUID stands for "Sudden Unexpected Infant Death." SUID is defined as deaths in infants younger than 1 year of age that occur suddenly and unexpectedly, and whose cause of death is not immediately obvious prior to investigation.

SUID includes all unexpected deaths: those from a known cause, and those from unknown causes. SIDS and suffocation are both types of SUID. About one-half of all SUID cases are SIDS. Many unexpected infant deaths are accidents, but a disease or something done on purpose can also cause a baby to die suddenly or unexpectedly. For some SUID, a cause is never found.

What is SIDS?

SIDS stands for "Sudden Infant Death Syndrome," and is the sudden, unexplained death of a baby younger than 1 year of age that doesn't have a known cause even after a complete investigation. This investigation includes performing a complete autopsy, examining the death scene, and reviewing the clinical history.

When a baby dies, health care providers, law enforcement personnel, and communities try to find out why. They ask questions, examine the baby, gather information, and run tests. If they can't find a cause for the death, and if the baby was younger than 1 year old, the medical examiner or coroner may call the death SIDS.

What are other sleep-related causes of infant death?

Other sleep-related causes of infant death are those that occur in the sleep environment or during sleep time. They include accidental suffocation by bedding, entrapment (when a baby gets trapped between two objects, such as a mattress and wall, and can't breathe), or strangulation (when something presses on or wraps around a baby's neck, blocking the baby's airway). These deaths are not SIDS, but they are SUID.

Myth: Babies can “catch” SIDS.

Fact:
A baby cannot catch SIDS. SIDS is not caused by an infection, so it can’t be caught or spread.

Myth: Cribs cause “crib death” or SIDS.

Fact:
Cribs themselves do not cause SIDS. But features of the sleep environment—such as a soft sleep surface—can increase the risk of SIDS and other sleep-related causes of infant death. Find out more about what is a safe sleep environment for your baby.

Myth: Babies who sleep on their backs will choke if they spit up or vomit during sleep.

Fact: Babies automatically cough up or swallow fluid that they spit up or vomit—it’s a reflex to keep the airway clear. Studies show no increase in the number of deaths from choking among babies who sleep on their backs. In fact, babies who sleep on their backs might clear these fluids better because of the way the body is built.

Myth: SIDS can be prevented.

Fact:
There is no known way to prevent SIDS, but there are effective ways to reduce the risk of SIDS.

Myth: Shots, vaccines, immunizations, and medicines cause SIDS.

Fact:
Recent evidence suggests that shots for vaccines may have a protective effect against SIDS. All babies should see their health care providers regularly for well-baby checkups and should get their shots on time as recommended by their health care provider.

Myth: SIDS can occur in babies at any age.

Fact:
Babies are at risk of SIDS only until they are 1 year old. Most SIDS deaths occur when babies are between 1 month and 4 months of age. SIDS is not a health concern for babies older than 1 year of age.

Myth: If parents sleep with their babies in the same bed, they will hear any problems and be able to prevent them from happening.

Fact:
Because SIDS occurs with no warning or symptoms, it is unlikely that any adult will hear a problem and prevent SIDS from occurring. Sleeping with a baby in an adult bed increases the risk of suffocation and other sleep-related causes of infant death.

Sleeping with a baby in an adult bed is even more dangerous when:

• The adult smokes cigarettes or has consumed alcohol or medication that causes drowsiness.
• The baby shares a bed with other children.
• The sleep surface is a couch, sofa, waterbed, or armchair.
• There are pillows or blankets in the bed
• The baby is younger than 11 weeks to 14 weeks of age.
• The baby shares a bed with more than one person, especially if sleeping between two adults.

Instead of bed sharing, health care providers recommend room sharing—keeping baby’s sleep area separate from your sleep area in the same room where you sleep. Room sharing is known to reduce the risk of SIDS and other sleep-related causes of infant death.

Data from the Centers for Disease Control and Prevention (CDC) show that 1,545 infants died from sudden infant death syndrome (SIDS) in 2014 (the most recent year for which data are available).

SIDS was the leading cause of death in children between 1 month and 1 year of age in 2013.

The majority (90%) of SIDS deaths occur before a child is 6 months old, with most happening between 1 month and 4 months of age.

What factors increase the risk of SIDS?

Currently, there is no known way to prevent SIDS, but there are ways to reduce the risk. Several factors present during pregnancy, at birth, and throughout the first year after birth can impact SIDS risk. Many of these factors can be controlled or changed to reduce the risk, but some cannot be controlled or changed.

One of the most effective actions that parents and caregivers can take to lower SIDS risk is to place their baby to sleep on his or her back for all sleep times.

Research shows that:

• Back sleeping carries the lowest risk for SIDS and is recommended.
• Stomach sleeping carries the highest risk for SIDS—between 1.7 and 12.9 times the risk of back sleeping. It is not recommended.
• The side-lying position also increases the risk. It is unstable and babies can easily roll to their stomach. It is not recommended.

Other known risk factors for SIDS include the following:

• Preterm birth. Infants born before 37 weeks in the womb are at higher risk for SIDS than are infants born at full term.
• Smoking. Maternal smoking during pregnancy and smoke in the infant's environment increase the risk of SIDS.
• Race/ethnic origin. African American and American Indian/Alaska Native infants are at higher risk for SIDS than are white, Hispanic American, or Asian/Pacific Islander American infants.

Research shows that several factors put babies at higher risk for SIDS and other sleep-related causes of infant death.

Babies are at higher risk for SIDS if they:

• Sleep on their stomachs
• Sleep on soft surfaces, such as an adult mattress, couch, or chair or under soft coverings
• Sleep on or under soft or loose bedding
• Get too hot during sleep
• Are exposed to cigarette smoke in the womb or in their environment, such as at home, in the car, in the bedroom, or other areas
• Sleep in an adult bed with parents, other children, or pets; this situation is especially dangerous if:
  • The adult smokes, has recently had alcohol, or is tired.
  • The baby is covered by a blanket or quilt.
  • The baby sleeps with more than one bed-sharer.
  • The baby is younger than 11 to 14 weeks of age.

Health care providers and researchers don't know the exact cause, but there are many theories.

More and more research evidence suggests that infants who die from sudden infant death syndrome (SIDS) are born with brain abnormalities or defects. These defects are typically found within a network of nerve cells that rely on a chemical called serotonin that allows one nerve cell to send a signal to another nerve cell. The cells are located in the part of the brain that probably controls breathing, heart rate, blood pressure, temperature, and waking from sleep.

But scientists believe that brain defects alone may not be enough to cause a SIDS death. Evidence suggests that other events must also occur for an infant to die from SIDS. Researchers use the Triple-Risk Model to explain this concept. In this model, all three factors have to occur for an infant to die from SIDS. Having only one of these factors may not be enough to cause death from SIDS, but when all three combine, the chances of SIDS are high.

These factors are:

• At-risk infant. An infant has an unknown problem—such as a genetic change or a brain defect—that puts him or her at risk for SIDS. Health care providers, parents, and caregivers don't know about these problems, so they don't know the infant is at risk.
• Important time in infant's development. During the first 6 months after birth, infants go through many quick phases of growth that can change how well the body controls or regulates itself. Also, infant's bodies are learning how to respond to their environment.
• Stressors in the environment. All infants have stressors in their environments—sometimes called external stressors because they are outside the body. Being placed to sleep on the stomach, overheating during sleep, and exposure to cigarette smoke are all examples of external stressors. Infants who have no problems like those explained above can usually correct or overcome external stressors to survive and thrive. But an infant who has an unknown problem and whose body systems are immature and unstable might not be able to overcome these stressors.

According to the Triple-Risk Model, all three things have to be present for SIDS to occur.

Removing one of these factors—such as external stressors—may tip the balance in favor of the infant's survival. Because the first two situations can't be seen or pinpointed, the most effective way to reduce the risk of SIDS is to remove or reduce environmental stressors. Strategies to remove these stressors form the basis of the Safe to Sleep campaign messages.

Research shows that there are several ways to reduce the risk of SIDS and other sleep-related causes of infant death.

The actions listed here and in Safe to Sleep® materials and publications are based on recommendations from the American Academy of Pediatrics (AAP) Task Force on SIDS.

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 . 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 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.

Preemies (infants born preterm) should be placed on their backs to sleep as soon as possible after birth.

Can my baby choke if placed on the back to sleep?

The short answer is no—babies are not more likely to choke when sleeping on their backs.

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

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.

*A crib, bassinet, portable crib, or play yard that follows the safety standards of the Consumer Product Safety Commission (CPSC) is recommended.

Why shouldn't I use crib bumpers in my baby's sleep area?

Evidence does not support using crib bumpers to prevent injury. In fact, crib bumpers can cause serious injuries and even death. Learn more about why keeping crib bumpers out of baby's sleep area is the best way to avoid these dangers.

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 are babies who were never fed breastmilk. Longer duration of exclusive breastfeeding leads to lower 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.

What if I fall asleep while feeding my baby?

It is less dangerous to fall asleep with an infant in an adult bed than on a sofa or armchair. The latest safe sleep recommendations include precautions in case you fall asleep while feeding your baby.

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."

Can I practice skin-to-skin care as soon as my baby is born?

Yes, when mom is stable, awake, and able to respond to her baby.

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.

To Reduce the Risk of SIDS, Women Should:

• Get regular prenatal care during pregnancy
• Avoid smoking , drinking alcohol, and using marijuana or illegal drugs during pregnancy or after the baby is born.

More information about smoking and SIDS risk is provided below.

To Reduce the Risk of SIDS, Do Not Smoke During Pregnancy, and Do Not Smoke or Allow Smoking Around Your Baby

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.

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.

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

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. Learn more about why swaddling is not recommended as a way to reduce SIDS risk and how you can swaddle safely.

Follow Health Care Provider Guidance on Your Baby's Vaccines and Regular Health Checkups

Vaccines not onlyprotect baby's health, but research shows that vaccinated babies are at lower risk for SIDS.

Avoid Products That Go Against Safe Sleep Recommendations, Especially Those That Claim To Prevent or Reduce the Risk For SIDS

There is currently no known way to prevent 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

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.

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 prevent flat spots on the back of your baby's head.

You can also help prevent flat spots by limiting the baby’s 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.

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

Research shows that there are several ways 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. 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. Preemies (infants born preterm) should be placed on their backs to sleep as soon as possible after birth.
• 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. 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.
• 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 are babies who were never fed breastmilk. Longer duration of exclusive breastfeeding leads to lower 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.
• 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.
• To Reduce the Risk of SIDS, Women Should:
  • Get regular prenatal care during pregnancy
  • Avoid smoking, drinking alcohol, and using marijuana or illegal drugs during pregnancy or after the baby is born.
• To Reduce the Risk of SIDS, Do Not Smoke During Pregnancy, and Do Not Smoke or Allow Smoking Around Your Baby.
• 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.
• 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.
• 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.
• Avoid Products That Go Against Safe Sleep Recommendations, Especially Those That Claim To Prevent or Reduce the Risk For SIDS. There is currently no known way to prevent 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. 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.
• 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.

Make sure everyone who cares for your baby knows the ways to reduce the risk of SIDS and other sleep-related causes of infant death.

Did you know that babies should sleep on their back rather than their belly? Research has revealed many risk factors for sudden infant death, and sleep position is the most important one.

Each year in the U.S., about 3,500 infants die suddenly and unexpectedly in their sleep. In about half of these deaths, doctors can’t find a medical reason to explain why, even after a complete review. When the doctor doesn’t have answers, the death is called sudden infant death syndrome (SIDS).

“All babies are at risk, especially those under 1 year of age,” explains Dr. Marion W. Koso-Thomas, a child health expert at NIH. Babies are most vulnerable to SIDS up to 4 months old.

“One of the critical pieces to SIDS risk reduction is how the baby sleeps,” she says. “Babies who are sleeping should be on their back.”

Limit a baby’s belly time to when they’re awake. A baby shouldn’t sleep on their belly or side.

Why does sleep position matter? Sleeping on the belly lowers an infant’s blood pressure and reduces their ability to get oxygen to the brain. Between 2 and 4 months old, especially, the reflex to breathe to get more oxygen is repressed when an infant sleeps on their belly.

Researchers also suspect that a brain condition may be a cause of SIDS. They have been studying the part of the brain that controls breathing and heart rate during sleep. They think these babies may not have the reflex to awaken when breathing becomes impaired.

“More research needs to be done to understand what’s going on in those babies and hopefully identify a screening tool to help save their life,” Koso-Thomas says.

What causes SIDS may not be known, but several things raise the risk. In addition to sleep position, research shows that soft bedding above or below your infant is a danger.

“There is no need to have a blanket,” Koso-Thomas says. Instead, dress your baby in sleep clothing, such as a onesie, that’s designed to keep them warm. This keeps them safer.

Make sure they’re dressed appropriately for the environment. But don’t overbundle. Check for signs that they’re too hot, like sweating or if their chest is hot to the touch.

It’s important to prevent your baby’s nose and mouth from becoming covered. “The area around them should not have any clutter—no toys, no bumpers,” Koso-Thomas emphasizes.

Experts also advise that you keep your baby in the same room, but not in your bed with you. When you’re done feeding, place your baby in their safe area, such as a cradle next to your bed.

“The safe sleep environment is the biggest factor that’s going to reduce or eliminate the SIDS risk for a baby that’s less than a year old,” Koso-Thomas says. See the Wise Choices box to learn other tips for providing a safe sleep environment.

Help Protect Your Baby From SIDS

• Always place babies on their back to sleep, for naps and at night.
• Use a firm and flat sleep surface, such as a mattress in a crib. Cover the surface with a fitted sheet.
• Do not use any blankets, bumpers, toys, or other soft items in the sleep area.
• Breastfeed your baby if you can.
• Share your room with your baby. Keep your baby close to your bed in a crib or other surface made for infants for the first year, or at least the first 6 months.
• Don’t smoke or let others smoke around your baby or in your baby’s environment.
• Get regular health checkups and recommended vaccinations for your baby.

Expecting or caring for a baby? Take these steps to help baby sleep safely and reduce the risk of sleep-related infant deaths, including sudden infant death syndrome (SIDS).

There are about 3,400 sleep-related deaths among US babies each year. CDC supports the recommendations issued by the American Academy of Pediatrics (AAP) to reduce the risk of all sleep-related infant deaths, including SIDS.

Parents and caregivers can help create a safe sleep area for babies by taking the following steps:

• Place your baby on his or her back for all sleep times—naps and at night. Even if a baby spits up during sleep, babies’ anatomy and gag reflex help prevent them from choking while sleeping on their backs. Babies who sleep on their backs are much less likely to die of SIDS than babies who sleep on their sides or stomachs.
• Use a firm, flat (not at an angle or inclined) sleep surface, such as a mattress in a safety-approved crib covered only by a fitted sheet. Some parents and caretakers might feel they should place their baby on a soft surface to help the be more comfortable while sleeping. However, soft surfaces can increase the risk of sleep-related death. A firm sleep surface helps reduce the risk of SIDS and suffocation.
• Keep your baby’s sleep area (for example, a crib or bassinet) in the same room where you sleep, ideally until your baby is at least 6 months old. Accidental suffocation or strangulation can happen when a baby is sleeping in an adult bed or other unsafe sleep surfaces. Sharing a room with your baby is much safer than bed sharing and may decrease the risk of SIDS by as much as 50%. Also, placing the crib close to your bed so that the baby is within view and reach can also help make it easier to feed, comfort, and monitor your baby.
• Keep soft bedding such as blankets, pillows, bumper pads, and soft toys out of your baby’s sleep area. Additionally, do not cover your baby’s head or allow your baby to get too hot. Some parents may feel they should add sheets or blankets to their baby’s crib to help keep their baby warm and comfortable while sleeping. However, sheets, comforters, and blankets can increase the risk of suffocation or overheat your baby. If you’re worried about your baby getting cold during sleep, you can dress them in sleep clothing, like a wearable blanket. In a Pediatrics report, CDC scientists and colleagues found that infant suffocation deaths during sleep were most frequently due to soft bedding, such as blankets and pillows.

What is SIDS?

• "SIDS" stands for Sudden Infant Death Syndrome.
• Sudden, unexplained death of an infant less than 1 year old.

What should I know about SIDS?

• Babies sleep safer on their backs.
• Babies should be placed on a firm sleep surface.

What can I do to lower my baby's risk of SIDS?

• Babies should be put on their backs to sleep for nap and at night.
• Keep toys, objects, and loose bedding out of your baby's sleep area.
• Do not allow smoking around your baby.
• Do not allow your baby to overheat during sleeping.

What about "tummy time"?

• Daily tummy time is necessary for normal development.
• Make sure your baby spends several hours on their tummy when they are awake and someone is watching.

Tummy time is not only an important way to prevent flat spots on your baby's head, it is also an important part of your baby's normal growth.

What Is Tummy Time?

Tummy time describes the times when you place your baby on his or her stomach while your baby is awake and someone is watching.

Tummy time is important because it:

• Helps prevent flat spots on the back of your baby's head
• Makes neck and shoulder muscles stronger so your baby can start to sit up, crawl, and walk
• Improves your baby's motor skills (using muscles to move and complete an action)

From the day they come home, babies benefit from 2 to 3 tummy time sessions each day for a short period of time (3 to 5 minutes). As the baby grows and shows enjoyment of tummy time, you can lengthen the sessions. As babies grow older, more tummy time helps build strength for sitting up, rolling over, crawling, and walking.

Tummy Time Tips

These suggestions can help you and your baby enjoy tummy time:

• Spread out a blanket in a clear area of the floor for tummy time.
• Try short tummy time sessions after a diaper change or after your baby wakes from a nap.
• Put a toy or toys within your baby's reach during tummy time to help your baby learn to play and interact with his or her surroundings.
• Ask someone you trust to sit in front of your baby during tummy time to encourage interaction and bonding.
• As your baby gets older, your tummy time sessions can last longer, and you can have them more often throughout the day.

Other Ways to Help Prevent Flat Spots on Your Baby's Head

In addition to tummy time, parents and caregivers can try these other ways to help prevent flat spots from forming on the back of baby's head:

• Hold your baby upright when he or she is not sleeping. This is sometimes called "cuddle time."
• Limit the amount of time your baby spends in car seats, bouncers, swings, and carriers.
• Change the direction your baby lies in the crib from one week to the next—for example, have your baby's feet point toward one end of the crib one week, and then have the feet point toward the other end of the crib the next week.

Vaccines have not been shown to cause sudden infant death syndrome (SIDS).

Babies receive multiple vaccines when they are between 2 to 4 months old. This age range is also the peak age for sudden infant death syndrome (SIDS). The timing of the 2 month and 4 month shots and SIDS has led some people to question whether they might be related. However, studies have found that vaccines do not cause and are not linked to SIDS.

Multiple research studies and safety reviews have looked at possible links between vaccines and SIDS. The evidence accumulated over many years do not show any links between childhood immunization and SIDS.

Placing healthy babies on their backs to sleep reduces the risk of SIDS.

SIDS is the sudden, unexpected death of a baby younger than 1 year of age that doesn’t have a known cause even after a complete investigation. These deaths often happen during sleep or in the baby’s sleep area.

In 1992, the American Academy of Pediatrics recommended that healthy babies be placed on their backs to sleep. That recommendation, along with the National Institute of Child Health and Human Development’s 1994 “Back-to-Sleep” campaign (now known as the Safe to Sleep® campaign), encouraged caregivers to place infants on their backs to sleep, and coincided with a dramatic reduction in the SIDS rate in the United States.

Also, research has found the rate of SIDS declined dramatically following the 1994 “Back-to-Sleep” campaign, and then stabilized in the 2000s at a time when the number of infant immunizations was increasing. The findings provide strong evidence that immunization is not linked to SIDS. See the published article on SIDS rates.

CDC and FDA closely monitor the safety of all vaccines.

CDC and the Food and Drug Administration (FDA) are committed to ensuring that vaccines provided to the public are safe and effective. Once vaccines are licensed in the United States, CDC and FDA continuously monitor them through several safety systems.

The FDA cautions parents and caregivers against purchasing baby products with claims to prevent or reduce the chance of Sudden Infant Death Syndrome (SIDS) (sometimes called Sudden Unexpected Infant Death or SUID). These baby products can pose a risk of serious injury to a baby, including the risk of suffocation.

Common baby products with these claims include:

• Infant sleep positioners - these products should not be used due to the risk of serious harm (see below)
• baby monitors
• mattresses
• crib tents
• pillows
• crib bedding, including bumpers and blankets

What Should Parents/Caregivers Know About These Baby Products?

• Do not use infant positioners --- they could harm your baby. These free-standing devices are placed in the crib or bassinet and are intended to hold an infant on their side or back while sleeping. The most common types of sleep positioners feature bolsters attached to each side of a thin mat and wedges to elevate the baby’s head.
  • The FDA is aware of infant deaths from these products over the years. Infants may suffocate after rolling from a side to stomach position or after being placed on their sides in the positioning product. Even if placed properly on their backs, infants may scoot up or downward on the positioning device, and may become entrapped in the product or between the positioning device and the crib, play yard, sleep mat or bassinet.
  • Infant positioning products pose a risk of suffocation, whether or not they make medical claims.
• The FDA is not aware of any clinical or scientific evidence that shows that currently available baby products prevent or reduce the chance of SIDS.
• Be aware that any product that claims to prevent or reduce the chance of SIDS has never been cleared or approved for that use by the FDA.
• The FDA discourages consumers from purchasing any product claiming to reduce a baby’s SIDS risk. These products are not proven to prevent SIDS.
• Always check with your health care professional before using any new medical product for your baby.

Health care providers and others may use some of the following terms when discussing infant deaths.

• Sudden Unexpected Infant Death (SUID): The death of an infant younger than 1 year of age that occurs suddenly and unexpectedly. After a full investigation, these deaths may be diagnosed as:
  • Suffocation: When no air reaches a baby's lungs, usually caused by a block in the airway
  • Entrapment: When a baby gets trapped between two objects, such as a mattress and wall, and can't breathe
  • Infection: When a baby has a cold or other infection caused by a virus or bacteria that makes breathing difficult
  • Ingestion: When a baby takes something into the mouth that blocks the airway or causes choking
  • Metabolic diseases: Conditions related to how the body functions that can lead to problems with breathing
  • Cardiac arrhythmias: When a baby's heart beats too fast or too slow and affects breathing
  • Trauma (accidental or non-accidental): When a baby experiences an injury
  • SIDS

In some cases, the evidence is not clear or not enough information is available, so the death is considered to be of undetermined cause.

• Sudden Infant Death Syndrome (SIDS): One type of SUID, SIDS is the sudden death of an infant younger than 1 year of age that cannot be explained even after a full investigation that includes a complete autopsy, examination of the death scene, and review of the clinical history.
• Accidental Suffocation and Strangulation in Bed (ASSB): One type of SUID, ASSB is a cause-of-death code used for vital statistics purposes. This code is used to identify infant deaths caused by suffocation or asphyxia (blockage of the infant's airway) in a sleeping environment. For example:
  • Suffocation by soft bedding: When soft bedding, a pillow, or a waterbed mattress blocks the infant's airway.
  • Overlay: When another person shares the sleep surface with the infant and lays on or rolls on top of or against the infant while sleeping, blocking the infant's airway.
  • Wedging or entrapment: When an infant gets trapped between two objects, such as a mattress and wall, bed frame, or furniture, blocking the infant's airway.
  • Strangulation: When something presses on or wraps around the infant's head and neck blocking the airway.
• Co-Sleeping: A sleep arrangement in which the parent (or another person) and infant sleep in close proximity (on the same surface or different surfaces) so as to be able to see, hear, and/or touch each other. Co-sleeping arrangements can include room sharing or bed sharing. The terms "bed sharing" and "co-sleeping" are often used interchangeably, but they have different meanings.
• Room Sharing: A sleep arrangement in which an infant sleeps in the same room as parents or other adults, but on a separate sleep surface, such as a crib, bassinet, or play yard. The American Academy of Pediatrics (AAP) recommends that the infant's sleep surface be close to the parents' bed to aid in feeding, comforting, and monitoring of the infant. Room sharing is known to reduce the risk of SIDS and other sleep-related causes of infant death.
• Bed Sharing: A sleep arrangement in which an infant sleeps on the same surface, such as a bed, couch, or chair, with another person. Sleeping with a baby in an adult bed increases the risk of suffocation and other sleep-related causes of infant death.