Frequently Asked Questions

Babies should be placed on their back every time they are laid down to sleep until one year of age, because: 

• Babies sleeping on their stomach 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.
• 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 can increase baby's risk of sleep-related infant death.

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 one.

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.
• Breastfeed.

Rolling over is an important part of a baby's growth. Most babies start rolling over around four to six 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. 

If baby is being swaddled, swaddling should be stopped as soon as baby shows any signs of attempting to roll.

If you have twins, triplets, or other multiples, each baby should sleep in their own crib, bassinet, or pack and play. There is a suffocation risk when multiples share a sleep surface.

Babies do not need to be swaddled, but it can help soothe them and reduce their startle reflex. 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. Overheating can increase baby's risk of sleep-related infant death. 
• 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 if baby shows any signs of attempting to roll. To learn more, review Swaddling & Safe Sleep.

Please note, there is no evidence that swaddling reduces the risk of sleep-related infant death.

Babies are safest when they sleep in their own crib, bassinet or pack and play. Babies are at risk of suffocation when they sleep in an inclined seat. An incline could 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 could put baby at risk of suffocation. 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. 

Breastfeeding provides the best nutrition for baby, builds their immune system and promotes bonding, as well as many other health benefits for mom and baby. Feeding your baby human milk has been shown to reduce the risk of sleep-related infant death.

Before breastfeeding baby, a parent should think about how tired they are. If there's even a slight chance they may fall asleep while feeding, they should avoid couches and armchairs. These surfaces can be very dangerous places for babies, especially when adults fall asleep with infants while on them. If there is a chance of falling asleep when feeding or comforting baby, take steps to reduce risks. Learn how to plan ahead. You can also watch this video from the Safe to Sleep® campaign to learn more.

The American Academy of Pediatrics does not recommend that you sleep with your baby as there is always some risk of suffocation. If you are thinking about sleeping with your baby, you should know that certain situations/factors make this more dangerous and increase the risk of sleep-related infant death. Some of these factors are not modifiable after baby is born. Review the Sleeping with Your Baby resource to learn more about the situations/factors that increase the risk of sleep-related infant death. 

Babies should have nothing in their sleep area until they are at least one year of age.

Note: Research has not shown 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 one year of age.

Babies are actually safer on their back. When baby is on their back, the air tube (trachea) is on top of the food tube (esophagus). When baby spits up while on their back, the food and liquid run back into their stomach and not to the lungs. When a baby is on their stomach, the food tube is on top of the trachea and any food or liquid that is spit up can more easily pool at the opening of the air tube, may cause choking. 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

Many products may seem safe to use with your baby during naps or sleep times. However, some of these products, such as bumper pads, positioners, docks, loungers, and inclined seats, can be dangerous for sleep. The Product Safety resource gives you questions to ask to determine if a product is safe for infant sleep. You can also review Safe Sleep Spaces to learn more about safe and unsafe sleep spaces and how to tell if a product is safe for infant sleep. 

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 their 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 their 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.  Learn more about Planning Ahead for Safe Sleep. You can also watch this video from the Safe to Sleep® campaign to learn more.

A firm, flat sleep area is safest for infants. A crib, bassinet, portable crib, or pack and play 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.

Your baby should be dressed for the space they are in. If you think your baby is cold, dress them in a footed sleeper with a sleep sack right for their size and age. Keep the room at a temperature that is comfortable for an adult. Learn more about Overheating & Safe Sleep. 

After hospital discharge, your baby does not need to wear a hat when indoors. Hats can cause baby to get too warm because baby is unable to release heat through their head. Hats can also slip off and become a suffocation hazard.