The safest place for a baby to sleep
As adults, we get to enjoy many privileges that babies do not have. We have developed our muscles and our brains to work together to make all of the movements we need to survive in our sometimes dangerous world. Newborn babies are not born with all of these necessary skills and rely on us to keep them safe. When most adults go to sleep at night, we have to worry very little about spontaneously dying in our sleep. For babies, they need special precautions to make sure they do not suffer with Sudden Infant Death Syndrome (SIDS). Prior to 1990 there were hundreds of babies each year that would lie down and never wake up again and major risk factors for those deaths were related to their sleeping environments. The rates of these deaths since the 90’s has decreased to about 5-8 per 10,000 live births due to the back to sleep campaign.
I often hear families tell me that “in the old days” babies would sleep on their bellies with blankets and toys or in the bed with parents and they “turned out just fine”. My response is usually the same that understanding risks of things does not give us a crystal ball of what will happen in the future, but there is a simple way to incorporate safe sleeping habits that could save your child’s life. Similar to how you could drive without wearing a seatbelt and still be just fine but it’s not the safest way to do it. If you were in a car crash, you would be happy that the seat belt was worn properly and it helped you survive.
It is a true tragedy to see an infant die with all of those years of life potential lost in a preventable circumstance.The following are the environmental sleep conditions that have contributed to this problem:
Putting babies down to sleep on their backs
The first and largest factor is the importance of sleeping on their backs vs sleeping on the sides or their bellies. Babies who sleep on their backs have 2-13x reduced chances of SIDS.
Sleeping on a firm baby mattress
Having soft bedding when combined with poor face down positioning in sleep can increase the odds of SIDS by 21 times.
Babies sleeping in their own crib alone
No blankets, toys or loose items of any sort in the crib with the baby. Although it is customary in many countries to have the mother and baby sleep in the same bed, the potential risks of SIDS outweigh the benefits of closeness and bonding that this arrangement offers. Bed sharing infants can have 3x increased risk of death. Bedding for adults is very soft and that is a known risk factor for SIDS. Attachment sleepers may be an alternative although there is no clear evidence of its safety or harms. For the families that do elect to share a bed with their babies, certain safety measures need to be taken. The dangers can be mitigated (still not as safe as sleeping in crib alone) by only having mom in bed with the baby, no alcohol consumption prior to sleep, baby is exclusively breastfed, no smokers at home, baby is older than 4 months old, not a premature baby, not a low birth weight baby, no smoking during pregnancy, no parent taking sleeping medications, no soft bedding.
No smoking in the home
Second-hand smoke exposure is linked to an increase in SIDS2. For help with quitting smoking please contact the national quit smoking hotline. 1-800-QUIT-NOW
No crib bumpers5
No inclined sleepers and no sleeping in car seats for long periods of time5
No more swaddling once a baby begins to roll over between 2-3 months of age5
May consider the use of a pacifier to lower risk of SIDS once breastfeeding is established
Baby sleep apnea monitors are not useful in reducing SIDS5
 Getahun D, Amre D, Rhoads GG, Demissie K. Maternal and obstetric risk factors for sudden infant death syndrome in the United States. Obstet Gynecol. 2004 Apr;103(4):646-52. doi: 10.1097/01.AOG.0000117081.50852.04. PMID: 15051553.
 Corwin, et al. Sudden infant death syndrome: Risk factors and risk reduction strategies. Uptodate.com. Available at : https://bit.ly/3rXDdG7
 Hauck, Fern R., et al. “Sleep environment and the risk of sudden infant death syndrome in an urban population: the Chicago Infant Mortality Study.” Pediatrics 111.Supplement 1 (2003): 1207-1214.
 Vennemann, Mechtild M., et al. “Bed sharing and the risk of sudden infant death syndrome: can we resolve the debate?.” The Journal of pediatrics 160.1 (2012): 44-48.
 Task Force on Sudden Infant Death Syndrome. “SIDS and other sleep-related infant deaths: updated 2016 recommendations for a safe infant sleeping environment.” Pediatrics 138.5 (2016).