The Safe to Sleep® campaign, formerly known as the Back to Sleep campaign, focuses on actions you and others can take to help your baby sleep safely and to reduce your baby's risk of Sudden Infant Death Syndrome (SIDS) and other sleep-related causes of infant death.

The term "SIDS" may sound scary, and the death of a baby is always heartbreaking. But there are a number of ways you can lower his or her risk while giving your baby the best care possible.

Learning about SIDS and safe sleep for babies is important for all caregivers, not just for parents. Grandparents, aunts, uncles, babysitters, childcare providers, and anyone else who might care for babies should learn more. Simple actions can make a big difference.

Sleep needs for babies change according to their age. Newborns sleep during most of the day, but they sleep in very short fragments of 1 to 2 hours at a time.

Also, the sleep cycles of babies are different than the sleep cycles of adults. The sleep cycles of babies are shorter, and they spend much less time in rapid eye movement (REM) sleep, which is the stage of sleep where dreams happen.

Sudden Infant Death Syndrome (SIDS) 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 will call the death SIDS.

If there is still some uncertainty as to the cause after it is determined to be fully unexplained, then the medical examiner or corner might leave the cause of death as “unknown”.

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.

We don’t know exactly what causes SIDS at this time.

Scientists and health care providers are working very hard to find the cause or causes of SIDS. If we know the cause or causes, someday we might be able to prevent SIDS from happening at all.

More and more research evidence suggests that infants who die from SIDS are born with brain abnormalities or defects. These defects are typically found within a network of nerve cells that send signals to other nerve cells. The cells are located in the part of the brain that probably controls breathing, heart rate, blood pressure, temperature, and waking from sleep. At the present time, there is no way to identify babies who have these abnormalities, but researchers are working to develop specific screening tests.

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 at the same time 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.

Even though the exact cause of SIDS is unknown, there are ways to reduce the risk of SIDS and other sleep-related causes of infant death.

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.

• 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.

Even though we don’t know the exact cause of SIDS, we do know that some things can increase a baby’s risk for SIDS and other sleep-related causes of infant death. The good news is that there are ways to reduce the risk.

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.

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.

The American Academy of Pediatrics (AAP) Task Force on SIDS reviews all the latest scientific and clinical evidence about SIDS and other sleep-related infant deaths and makes recommendations about the most effective ways to reduce baby’s risk of Sudden Infant Death Syndrome (SIDS), and sleep-related deaths, such as suffocation.

The actions listed here and in Safe to Sleep^® materials and publications are based on the AAP Task Force recommendations.

It’s important for all caregivers—parents, grandparents, aunts, uncles, babysitters, child care providers, and everyone who might care for baby—to learn about safe infant sleep to help reduce baby’s risk.

Place babies on their backs to sleep for naps and at night.

• Place all babies—including those born preterm and those with reflux—on their backs to sleep until they are 1 year old.
• 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.
• Babies who sleep on their backs are at lower risk for SIDS than babies who sleep on their stomachs or sides.
• 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.
• 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.

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.

• Both the sleep surface (such as a mattress) and the sleep space (like a crib, bassinette, 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.
• Soft surfaces, like couches, sofas, waterbeds, memory foam, air and pillow-top mattresses, quilts, thick blankets, and sheepskins, are not safe for babies to sleep on. Babies who sleep on soft surfaces may not be able to breathe from due to:
  • Entrapment or wedging. Baby’s body or head gets stuck between two objects, such as a mattress and wall, bed frame, or furniture
  • Suffocation. Something, such as a pillow or an adult’s arm, covers baby’s face and nose.
  • Strangulation: Something presses on or wraps around baby’s neck or head.
• 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 and their head can slump forward, which could block their airway and breathing.
• 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 a sitting or carrying device, 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, such as giving baby breaks from the sitting device every few hours.
• 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 are at high risk for suffocation and death from sitting this way.
• Keep comforters, quilts, pillows, and blankets out of baby’s sleep area.

Feed your baby human milk, like by breastfeeding.

• In most cases, pediatricians and other healthcare 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.
• 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.
• Feeding baby any human milk, even with other foods added, is more protective than not feeding them human milk at all.
• The longer a baby gets human milk, the lower the SIDS risk.
• Feeding human milk also has other benefits for babies, such as reduced risks of diarrhea, asthma, and ear infections.

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.

• Babies in their own sleep space are at lower risk for injury and death from SIDS and situations like an adult or sibling accidentally rolling over them.
• Room sharing, by putting baby’s sleep space near, but not in, your bed, is safer than sharing your bed with baby. It is also safer to share your room with your baby than putting baby in their own room.
• 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.
• 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. When finished, put baby back in their own sleep space close to your bed.
• Babies with their own sleep space are at lower risk for injury and death from situations like an adult accidentally rolling over them.
• 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.
• 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.
• Sharing an adult bed, couch, or armchair with baby can be risky, especially in some situations.
  • Very high risk:
    • Sleep surface is soft, such as a waterbed, old adult mattress, couch, or armchair
    • Adult is very tired, taking medication that makes them drowsy, using substances like alcohol, or whose ability to respond is is affected in some way
    • Adult smokes cigarettes or uses tobacco products (even if they do not smoke in the bed)
  • High risk:
    • Baby is younger than 4 months old (regardless of adult smoking or sleep surface)
    • Adult is not the baby’s parent, but is another caregiver, such as a grandparent or sibling
  • Higher-than-normal risk:
    • Baby was born preterm (before 37 weeks) or born at a low birth weight
    • Sleep area includes unsafe items, such as pillows or blankets

Keep things out of baby’s sleep area—no objects, toys, or other items.

• Remove everything from baby’s sleep area except a fitted sheet covering the mattress.
• 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)
  • Non-fitted, even if lightweight, small, or “tucked in”(loveys/cloths, non-fitted sheets, tucked-in blankets)
  • Weighted (weighted blankets, weighted swaddles, weighted objects)
• 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.

Offer baby a pacifier for naps and at night once they are feeding well.

• If feeding baby human milk through direct breastfeeding, wait until breastfeeding is well established, based on 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.
• 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.
• To reduce the risk of strangulation, choking, and suffocation, do not attach the pacifier to clothing, stuffed toys, blankets, or other items.
• Do not coat the pacifier with anything, such as a sweetened liquid or honey.
• If the pacifier falls out of baby’s mouth, you don’t need to put it back in. It is OK if baby doesn’t want the pacifier; don’t force baby to take it.
• Finger or thumb sucking does not reduce SIDS risk.

Stay smoke- and vape-free during pregnancy, and keep baby’s surroundings smoke- and vape-free.

• Smoking during pregnancy greatly increases baby’s risk of SIDS.
• Second-hand smoke in baby’s home, car, or other spaces where baby spends timealso 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.

• Research shows that drug and alcohol use—during pregnancy and by infant caregivers—increases the risk of SIDS.
• Sharing an adult bed with baby when using drugs or alcohol also increases baby’s risk of injury and death.

Avoid letting baby get too hot, and keep baby’s head and face uncovered during sleep.

• 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.
• Dress baby in clothes suitable for the temperature of the room.
• Wearing hats while indoors can make baby too hot, so take off hats when baby is inside.
• 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.
• Dressing baby in a wearable blanket or an extra layer of clothing can keep them warm without adding items in the sleep area.
• Do not leave babies should not sleep or be left alone in a vehicle, no matter the temperature outside.

Get regular medical care throughout pregnancy.

• Visiting a healthcare provider as soon as you find out you are pregnant, and then regularly until birth, can help promote a healthy pregnancy.
• 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.

• Pediatricians
• and other medical providers have the most up-to-date information about safe sleep, growth and development, and other health topics for baby.
• Research shows that vaccinated babies are at lower risk for SIDS.
• Vaccines also protext people, including babies, from dangerous and deadly diseases.

Avoid products and devices that go against safe sleep guidance, especially those that claim to “prevent” SIDS and sleep-related deaths.

• 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 death by not using these products and devices.
• No product can prevent SIDS. The Consumer Product Safety Commission has more information about safety standards for baby products at https://www.cpsc.gov.

Avoid using heart, and breathing , motion, or other monitors as your main way to reduce the risk of SIDS.

• These types of monitors are not effective at detecting or preventing SIDS.
• 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.
• If you have questions about using these devices for health problems or concerns other than SIDS, talk with your baby’s healthcare provider.

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.

• Even though swaddling does not reduce the risk of SIDS, some babies are calmer and sleep better when they are swaddled.
• 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.
• 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.
• Using the back sleep position for swaddled babies is especially important. A swaddled baby may have trouble moving out of because sleeping on the stomach or side positions, which puts them at greater risk when swaddled increases the risk for SIDS and other sleep-related infant death than the back sleep position.

Give babies plenty of “tummy time” when they are awake, and when someone is watching them.

• Supervised tummy time helps strengthen your baby's neck, shoulder, and arm muscles.
• Tummy time also helps prevent flat spots on the back of your baby's head.
• Tummy time is an important way to help improve baby’s motor skills and movement.
• Tummy time sessions can start within a few days of birth, for 3 to 5 minutes, 2 or 3 times a day. As baby grows stronger, you can slowly make tummy time longer and practice it more times a day.
• 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.
• Visit https://healthychildren.org for more information on tummy time.

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.

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.

The U.S. Food and Drug Administration is reminding parents and caregivers not to put babies in sleep positioners. These products—sometimes also called “nests” or “anti-roll” products—can cause suffocation (a struggle to breathe) that can lead to death.

The FDA regulates baby products as medical devices if, among other things, the manufacturer claims that the product is intended to cure, mitigate, treat, or prevent, or reduce a disease or condition in its labeling, packaging, or advertising. A number of sleep positioners are considered medical devices because of their intended use. (This intended use can be outlined by statements made on the labels, labeling, instructions for use, or promotional materials for the products.)

Sleep positioners that do not meet the definition of a medical device may be regulated by the Consumer Product Safety Commission.

Some types of sleep positioners can feature raised supports or pillows (called “bolsters”) that are attached to each side of a mat, or a wedge to raise a baby’s head. Products called “nests” can feature soft, wall-like structures that surround the base. The positioners claim to keep a baby in a specific position while sleeping and are often used for babies under 6 months old.

To reduce the risk of sleep-related infant deaths, including accidental suffocation and Sudden Infant Death Syndrome (SIDS), the American Academy of Pediatrics recommends that infants sleep on their backs, positioned on a firm, empty surface. This surface should not contain soft objects, toys, pillows, or loose bedding.

Safety Advice for Putting Babies to Sleep

• NEVER use infant sleep positioners. Using this type of product to hold an infant on his or her side or back is dangerous.
• NEVER put pillows, blankets, loose sheets, comforters, or quilts under a baby or in a crib. These products also can be dangerous. Babies don’t need pillows and adequate clothing—instead of blankets—can keep them warm.
• ALWAYS keep cribs and sleeping areas bare. That means you should also never put soft objects or toys in sleeping areas.
• ALWAYS place a baby on his or her back at night and during nap time. An easy way to remember this is to follow the ABCs of safe sleep: “Alone on the Back in a bare Crib."

About Infant Suffocation and Other Dangers

Each year, about 4,000 infants die unexpectedly during sleep time from accidental suffocation, SIDS, or unknown causes, according to the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD).

The federal government has received reports about babies who have died from suffocation associated with their sleep positioners. In most of these cases, the babies suffocated after rolling from their sides to their stomachs.

In addition to reports about deaths, the federal government also has received reports about babies who were placed on their backs or sides in positioners—but were later found in other, dangerous positions within or next to these products.

To avoid these dangers, remember:

• The safest crib is a bare crib.
• Always put babies on their backs to sleep.

Beware of Medical Claims About Sleep Positioners

Some manufacturers have advertised that their sleep positioners prevent SIDS; gastroesophageal reflux disease (GERD), in which stomach acids back up into the esophagus; or flat head syndrome (plagiocephaly), a deformation caused by pressure on one part of the skull.

Here are the facts:

• The FDA has never cleared an infant sleep positioner that claims to prevent or reduce the risk of SIDS.
• The FDA had previously cleared some infant positioners for GERD or flat head syndrome.
• In 2010, the FDA became aware of infant positioners being marketed with SIDS claims and notified manufacturers to stop marketing these devices and submit information to support FDA clearance.

The FDA intends to take action against device manufacturers who make unproven medical claims about their products. You can do your part to keep your baby safe by not using sleep positioners.

Finally, if you have questions about how to safely put a baby to sleep, or how to avoid or treat certain health issues, talk to your health care provider.

Many parents have questions about Sudden Infant Death Syndrome (SIDS), Sudden Unexpected Infant Death (SUID), and safe sleep for babies.

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

About SIDS and Other Sleep-Related Infant Deaths

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, healthcare 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 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 are other sleep-related infant deaths?

Other sleep-related infant deaths 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.

What is the best way to reduce baby’s risk?

The best way to reduce baby’s risk is to always place them on their backs to sleep for all sleep times in a separate sleep area, designed for a baby, with no soft objects, toys, or comforters, quilts, pillows, and blankets.

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.

When can I stop worrying about SIDS? 

The term “SIDS” applies to only infants younger than 1 year of age.

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

Research shows that swaddling does not decrease baby’s risk of SIDS. However, some babies are calmer and sleep better when they are swaddled. But, once baby starts to roll over on their own, swaddling increases risk of other sleep-related death by suffocation and strangulation.

Using the back sleep position for swaddled babies is especially important because sleeping on the stomach or side when swaddled increases the risk for SIDS and other sleep-related deaths.

The swaddle should not be too tight or make it hard for baby to breathe or move their hips. And caregivers should watch for signs of overheating, such as sweating or feeling hot to the touch, in a swaddled baby.

If you choose to swaddle your baby, make sure you follow other safe sleep recommendations to reduce baby’s risk of sleep-related deaths. And stop swaddling baby when they start rolling over, usually around 3 months of age.

About Back Sleeping

Why should I place my baby on their 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!

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 their 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."

What if my baby can’t get used to sleeping on their 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 their 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.

If my baby rolls over onto their stomach during sleep, do I need to reposition them onto their back again?

Once baby 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.

But, if they can only roll one way on their own, you should reposition them to their back if they roll onto their stomach during sleep.

What if my baby’s grandparent or another caregiver wants to place my baby to sleep on their stomach for naptime?

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.

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.

Will my baby get flat spots on the back of their head from sleeping on their 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.

Are there times when my baby should be on their stomach?

Yes. Your baby should have “tummy time” when they are awake, and when someone is watching them. 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.

About Baby’s Sleep Area

Is it safe share my bed with my baby?

Sharing an adult bed with baby, a practice known as bed sharing, increases the risk of SIDS, suffocation, and other sleep-related infant deaths.

Sharing an adult bed, couch or armchair with baby can be risky, especially in some situations.

• Very high risk:
  • Sleep surface is soft, such as a waterbed, old adult mattress, couch, or armchair.
  • Adult is very tired, taking medication that makes them drowsy, using substances like alcohol, or whose ability to respond is affected in some way
  • Adult smokes cigarettes or uses tobacco products (even if they do not smoke in the bed)
• High risk:
  • Baby is younger than 4 months old (regardless of adult smoking or sleep surface)
  • Adult is not the baby’s parent, but is another caregiver, such as a grandparent or sibling
• Higher-than-normal risk:
  • Baby was born preterm (before 37 weeks) or born at a low birth weight
  • Sleep area includes unsafe items, such as pillows or blankets

Instead, healthcare providers recommend sharing your room with baby for at least the first 6 months. Room sharing means baby has their own sleep space (crib, bassinet, or portable play yard) in your room, separate from your bed. Room sharing is safer than sharing your bed with baby. It is also safer than putting baby in their own room. Room sharing also lowers baby’s risk for injury and death from situations like an adult or sibling accidentally rolling over them. 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.

What if I fall asleep while feeling my baby in my bed?

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, before you start, remove or clear away all soft items and bedding from your side of the bed before you start. 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.

Are baby-sized cardboard boxes safe?

Currently, the American Academy of Pediatrics (AAP) Task Force on SIDS does not have enough evidence to recommend for or against using a cardboard box, a wahakura (a woven bassinet-like structure intended as a safe sleeping space for an infant), or a Pepi-Pod^® (a plastic version of a wahakura).

The use of any sleep area that is not safety-approved for infant sleep or that does not adhere to Consumer Product Safety Commission (CPSC) mandatory safety standards for infant sleep products is not recommended.

The AAP Task force recommends that parents and caregivers use a sleep surface for baby that is firm (returns to original shape quickly if pressed on), flat (like a table not a hammock in a safety-approved* crib), level (not at an angle or incline), and covered only with a fitted sheet..

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

Crib bumpers, bumper pads, and similar products that attach to crib sides, railings, or slats are often used with the intent of protecting babies from injury. However, evidence does not support using crib bumpers to prevent injury. In fact, crib bumpers can increase your baby’s risk of suffocation and wedging and can cause serious injuries or death. Keeping bumpers 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 the spaces were too wide. Parents and caregivers used padded crib bumpers to protect infants. Now that cribs must meet safety standards, the spaces between slats don’t pose the same dangers. As a result, bumpers are no longer needed.

In 2021, the President signed the Safe Sleep for Babies Act, which prohibits the manufacture and sale of crib bumpers and certain inclined sleepers.

What if I don’t have a safe sleep environment for my baby?

Contact your state health department if you need help finding a safe sleep environment for your baby. Your state health department has resources and can connect you with local initiatives and groups that may be able to help you and your baby.

Products Advertised to Reduce or Prevent SIDS

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 product that can prevent SIDS because there is no known way to prevent SIDS.

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.

The U.S. Food and Drug Administration, CPSC, AAP, and other organizations warn against using these products, because they are dangerous for babies.

Can certain monitors detect SIDS before it happens?

Home heart and breathing monitors are not recommended as a primary way to detect SIDS.

If you choose to use devices that measure baby’s heart rate and breathing for reasons other than detecting SIDS, make sure to follow safe sleep recommendations to reduce baby’s risk of sleep-related deaths.

The NICHD-led Collaborative Home Infant Monitoring Evaluation study looked at babies who were at high risk for SIDS. The monitors were not effective at identifying situations that might lead up to SIDS. Based on this and other research findings, AAP recommends that caregivers not use these monitors to prevent SIDS or identify babies at risk for SIDS.

Healthcare providers might prescribe these products to manage certain medical conditions. If you have questions about using these devices for health problems or concerns other than SIDS, talk with your baby’s healthcare provider.

Keep in mind that breathing, heart, and other home monitors are different from baby monitors that allow caregivers to hear and/or see the infant from another room.

CPSC and the Juvenile Products Manufacturers Association advises parents and caregivers to check all baby monitors and other products with electrical cords to make sure they are out of baby’s reach. Monitors should be placed at least 3 feet away from any crib, bassinet, play yard, or other safe sleep environment.

Other Questions

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

Experts recommend skin-to-skin contact for all parents and newborns for at least 1 hour after birth, once a healthcare provider says the parent is okay and able to respond to their baby. When the parent needs to sleep or handle other things, baby should be placed on their back in their own separate sleep area, such as a safety-approved crib* or bassinet.

Why are weighted swaddles or blankets not recommended for babies?

Weighted blankets and swaddles are not recommended because there is not enough evidence of their safety for use with infants, and because—based on what we know about infant health, SIDS, and sleep-related infant deaths--they could actually cause harm.

All parents and caregivers should consider the following:

• An infant’s ribcage is still developing and adding weight could make it difficult for baby to expand their chest to take in air, reducing their ability to breathe properly. There are no studies of what amount of weight, if any, is safe to place on baby’s chest.
• Weighted swaddles and blankets are a new product category, meaning there are currentlyno safety standards for them beyond the general rules for children’s products (for example, lead content, likelihood to catch on fire, etc.). There are also no studies regarding the use of these products and the risk of sleep-related death.
• If the infant rolls over during sleep, the additional weight could make it more difficult for them to roll onto their back again. Sleeping on the stomach carries the highest risk of SIDS. That risk is very high among infants who are used to sleeping on their back, but who are placed onto their stomachs for sleep, and among infants who are swaddled and who are placed or roll onto their stomachs.
• Because there are no safety regulations for these products, they could be made with heavy/thick materials that increase overheating risk. Overheating from excessive clothing or blankets and high room temperature are associated with an increased SIDS risk.
• Claims that these products are safe for infants during sleep are based on a single study of 16 infants in an intensive care unit with neonatal opioid withdrawal syndrome, in which the infants were constantly monitored and covered with a weighted blanket for only 30 minutes at a time. Because this tightly controlled situation is very different from using a weighted product on an infant for an hour or more at a time, without constant monitoring, the safety of product use in the home cannot be assumed.
• Suggested benefits of weighted blankets and swaddles for infants are unproven. Although there is some evidence suggesting that the products may be beneficial in certain groups of older children or adults, there are no studies that show any benefits specifically in infant groups.

What kind of support is available for parents who have lost a baby to SIDS?

One of the most important things to remember when a baby dies from SIDS is that the family are not to blame. The causes of SIDS remain unknown. Even though there are ways to help reduce the risk, there is no definitive way to keep SIDS from occurring.

A variety of resources are available to help families who have lost an infant to SIDS. Talking to other parents or caregivers who have lost an infant to SIDS may be helpful. A healthcare provider also may be able to recommend local resources and groups.

Parents can also find support at the community and state level through the National SUID/SIDS Resource Center and other organizations such as First Candle and Cribs for Kids^®.