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Frequently Asked Questions
If you have a question related to infant safe sleep, go to the Contact Us page. The frequently asked questions are updated as we receive new questions. The answers to these questions are based on the American Academy of Pediatrics Policy Statement Sleep-Related Infant Deaths: Updated 2022 Recommendations for Reducing Infant Deaths in the Sleep Environment.
Why is it recommended that babies sleep on their back?
Babies should be placed on their backs every time they are laid down to sleep until 1 year of age, because:
- Babies sleeping on their stomachs have a greater risk of sleep-related death.
- Babies sleeping on their stomachs can sleep too deeply and may not wake up to take a breath.
- Stomach sleeping increases the risk of rebreathing the same air that is near baby’s face. When this happens, a baby who does not rouse and move their head can end up with too much exhaled carbon dioxide and not enough oxygen in their blood. This can be fatal.
- Sleeping on the stomach increases a baby’s risk of becoming overheated, because not as much heat is given off in the stomach-sleeping position. Overheating has been associated with greater risk for unexpected infant death.
Should a baby still be placed on his back to sleep if he spits up often or has reflux or GERD?
Some babies have GER (also known as reflux) or GERD. GER (gastroesophageal reflux) is normal spit up. GERD (gastroesophageal reflux disease) is when reflux causes other symptoms such as poor weight gain. GERD requires a medical diagnosis and is very rare in babies under age 1.
The American Academy of Pediatrics and the North American Society for Pediatric Gastroenterology and Nutrition recommend back sleeping, even for infants with reflux. Elevating the head of the crib or having baby sleep in a car seat or swing are not recommended. Elevating the head of the crib may cause baby to slide down into a position that may compromise breathing. Sleeping in a swing or other inclined seat can be dangerous for many reasons.
Parents can do the following to help reduce how much a baby spits up:
- Hold baby upright after feedings.
- Limiting the baby’s activity after feedings.
- Burp baby frequently during and after feedings.
- Provide more frequent, smaller feedings.
- Reduce a baby’s exposure to smoke in the home.
What should parents do when their baby begins to roll over?
Rolling over is an important part of a baby's growth. Most babies start rolling over around 4 to 6 months of age, but some start earlier. Once baby can roll from their back to their stomach and from their stomach to their back, they can be allowed to remain in the sleep position they move to on their own. To reduce the risk of sleep-related infant death, it is important that baby starts every sleep time on the back and that there are no soft objects, toys, crib bumpers, or loose bedding in baby's sleep area.
Are there risks associated with swaddling? When should swaddling be discontinued?
Yes. There are risks associated with swaddling. They include:
- Swaddling too tightly at baby's hips can cause problems. Keep the swaddle loose at baby's hips. The hips and legs need to have room to move.
- Swaddling can cause baby to overheat.
- If baby is swaddled with a blanket, it could come loose and become a suffocation hazard.
- Tight swaddling can make it hard for baby to breathe. There should be enough room to fit two fingers between baby’s chest and the swaddle.
- Accidental deaths have occurred when swaddled babies are placed on their stomach or when they roll to their stomach. (Baby may roll onto their stomach even if not regularly rolling.)
If caregivers swaddle baby, they should always place baby fully on their back to sleep. Swaddling should be stopped by 6 to 8 weeks of age or earlier if baby shows any signs of attempting to roll. To learn more, review the Swaddling resource.
Please note, there is no evidence that swaddling reduces the risk of sleep-related infant death.
Can babies sleep in swings, bouncy seats, or other sitting devices?
Babies are safest when they sleep in a crib, bassinet or pack and play. Babies can suffocate while sleeping in a swing or any seat that puts them on an incline. An incline can cause baby's head to slump down and their airway could be pinched. A baby's airway is only about the size of drinking straw! Also, a baby can more easily roll over when sleeping on an incline even if they haven't done so before. Rolling over in an inclined seat can cause baby to suffocate. If baby falls asleep in a swing, bouncy seat, car seat, or other sitting device, they should be moved to a crib, bassinet or pack and play as soon as it is possible.
How can you breastfeed and practice safe sleep?
Breastfeeding does provide the best nutrition for baby, builds the immune system and promotes bonding, as well as many other health benefits. Breastfeeding also reduces the risk of sleep-related infant death.
Before a mother starts breastfeeding her baby, she should think about how tired she is. If there's even a slight chance she may fall asleep while feeding, she should avoid couches and armchairs. These surfaces can be very dangerous places for babies, especially when adults fall asleep with infants while on them. Mothers who bring the baby into an adult bed for feeding or comforting should remove all soft items and bedding from the area, especially if there’s any chance that she may fall asleep. If she accidentally falls asleep while feeding or comforting baby in the adult bed, the mother should put the baby back into his or her separate sleep space as soon as she wakes up. Mothers could set an alarm to wake her up or have a support person available in case she accidentally falls asleep. Watch this video from the Safe to Sleep® campaign to learn more.
When can you give babies blankets/stuffed animals to sleep with?
Babies should have nothing in their sleep area until they are at least one year of age.
Note: Research has not shown us when it's 100% safe to have these objects in the crib; however, most experts agree that these objects pose little risk to healthy babies after 12 months of age.
Why don't babies choke when they are on their back?
Babies are actually safer on their backs. When a baby is on his back, the air tube (trachea) is on top of the esophagus (the tube that carries food). If a baby spits up while on his back, the food and fluid run back into the stomach and not to the lungs. When a baby is on his stomach, the esophagus (or food tube) is on top of the trachea and any food or fluid that is regurgitated or refluxed can more easily pool at the opening of the trachea, making it possible for the baby to aspirate or choke. The following images and video help illustrate this.
Image from National Institute of Child Health and Human Development Safe to Sleep® Campaign, available at: www.nichd.nih.gov/sts/news/downloadable/Pages/default.aspx
How do I know if a product is safe for sleep?
We get a lot of questions about whether a product is safe for sleep for your baby. Go to Safe Sleep Spaces to learn more about safe and unsafe sleep spaces and how to tell if a product is safe for infant sleep.
What should providers tell caregivers about falling asleep while feeding their baby?
Parents may accidentally fall asleep while the baby is still in bed with them. This situation can be dangerous, as there is often loose or soft bedding (such as blankets or pillows) in the bed. Babies can also fall into and become wedged in the space between the adult mattress and the wall or nearby furniture. Parents who bring the baby into an adult bed for feeding or comforting should remove all soft items and bedding from the area, especially if there’s any chance that the caregiver may fall asleep. Parents should put their baby back into his or her separate sleep space when the baby or parent is ready to go to sleep. If the parent accidentally falls asleep while feeding or comforting baby in the adult bed, the parent should put the baby back into his or her separate sleep space as soon as the parent wakes up. Parents could set an alarm to wake them up or have a support person available in case they accidentally fall asleep. Watch this video from the Safe to Sleep® campaign to learn more.
What is a safe sleep space?
A firm, flat sleep area is safest for infants. A crib, bassinet, portable crib, or play yard that follows the safety standards of the Consumer Product Safety Commission (CPSC) is recommended. The mattress should be covered by a tightly-fitted sheet with no other bedding or soft items in the sleep area. Review the Safe Sleep Steps for more information on what a safe sleep environment looks like.
Are weighted sleep sacks and weighted swaddles safe?Weighted sleep sacks, weighted swaddles, and other weighted items are not recommended for babies. Adding weight could make it harder for baby to expand their chest and breathe properly. There are no studies showing that it is safe to put any weight on baby’s chest. In addition, suggested benefits of weighted blankets and swaddles for babies are unproven.
What should baby wear to sleep?
Dress baby appropriately for the environment, with no greater than one layer of clothing more than an adult would wear to be comfortable. Keep the room at a temperature that is comfortable for an adult. Babies should not wear hats while sleeping.