The following list was compiled from various sources, including the American Academy of Pediatrics (AAP) policy statement on SIDS risk, the AAP book Caring for Your Baby and Young Child: Birth to Age 5, and Safe Co-Sleeping - Notes from Sleep Expert, Dr. James McKenna. It represents a thorough range of currently recognized precautions aimed at maximizing infant safety in cribs and, for those parents who choose to bedshare, adult beds.
Recommendations That Apply to Infant Sleep in Both Cribs and Adult Beds
• Use a firm mattress. A soft mattress can result in infant
• There should be no gaps between the mattress and the
frame of the crib or bed. Infants and small children can become
wedged in gaps and asphyxiate.
• Bedding should fit tightly around the mattress. Fitted
sheets that become loose from a corner can cover and
smother a baby.
• Avoid strings or ties on all nightclothes (both baby’s and
parents’). These pose a strangulation risk.
• Avoid soft bedding and other items, including comforters,
pillows, featherbeds, stuffed animals, etc. Each of these
poses a risk of suffocation.
• Keep the baby’s face uncovered to allow ventilation.
• Put the baby on his or her back to sleep. Babies sleeping on their
backs are less likely to become victims of SIDS.
• Adults should avoid smoking. Exposure to tobacco, both pre-
and post-delivery is associated with a higher risk of SIDS.
• Avoid overheating the room in which the baby sleeps and
avoid overdressing the baby. Overheating is associated with
an increased risk of SIDS.
•Avoid placing a crib near window treatment cords or sashes.
These pose a strangulation risk.
Advice Specific to Cribs
• When a baby learns to sit, lower the mattress level so that
he or she cannot fall out or climb over the side rail.
• When a baby learns to stand, set the mattress level at its lowest point
and remove crib bumpers.
• When a baby reaches a height of 35 inches or the side rail is less than
three-quarters of his or her height, move the baby to another bed.
Babies can fall from their cribs if the side rails are not at the right
level in relationship to the mattress surface.
• Crib bumpers should have at least six ties, and these should be no
longer than 6 inches in length. Bumper ties that are too long can
pose a strangulation risk.
• Hang crib mobiles well out of reach and remove them when baby
starts to sit or reaches five months of age, whichever comes first.
Mobiles become strangulation or choking hazards if the baby can reach
• Remove crib gyms when the baby can get up on all fours. Babies can
become entangled in these and risk strangulation.
• Keep baby warm by dressing him or her in a blanket sleeper. If you
use a blanket, make sure your baby’s head remains uncovered during
Additional Recommendations for Bedsharing
• A parent’s very long hair (at or approaching waist length) should be
pulled back and fastened. The hair can become wound about the
baby’s neck, posing a strangulation risk.
• Adults using alcohol or other drugs, those taking over-the-counter or
prescription medications that may cause them to sleep too soundly,
and those suffering from extreme exhaustion should not bedshare.
Such adults may not be aware of the baby in the bed, creating a risk
of overlying and suffocation.
• Head/footboard railings should have spaces no wider than those
allowed in safety-approved cribs. As with cribs, these spaces can
become places for babies to become entrapped and suffocate.
• Refrain from using bed rails with infants under one year. Babies can
become wedged between the mattress and the side rail, resulting in
• Refrain from allowing siblings in bed with an infant less than one-year-old. Very young babies are at a greater risk of overlying and suffocation by older siblings.
• Do not bedshare in a waterbed. The surface of a waterbed can
prevent ventilation if a baby moves to a facedown position.
• Avoid placing an adult bed directly alongside furniture or a wall.
Babies and young children can become trapped between the bed
and other furniture or a wall and suffocate.
Safe Co-Sleeping - Notes from Sleep Expert, Dr. James McKenna:
● Breastfeeding significantly helps to protect infants from death including deaths from SIDS/SUDI and from secondary disease and/or congenital conditions.
● Infants should sleep on their backs, on firm surfaces, on clean surfaces, in the absence of smoke, under light (comfortable) blanketing, and their heads should never be covered.
● The bed should not have any stuffed animals or pillows around the infant and never should an infant be placed to sleep on top of a pillow.
● Sheepskins or other fluffy material and especially bean bag mattresses should never be used.
● No water beds.
● Infants should never sleep on couches or sofas - with or without adults.
● Bottle-feeding babies should always sleep alongside the mother on a separate surface rather than in the bed.
● Both parents should agree and feel comfortable with the decision. Each bed-sharer should agree that he or she is equally responsible for the infant and acknowledge that the infant is present.
● Both parents should think of themselves as primary caregivers.
● Infants a year or less should not sleep with other children's siblings.
● Persons on sedatives, medications or drugs, or who are intoxicated or excessively unable to arouse should not co-sleep on the same surface with the infant.
● Extremely obese persons, who may not feel exactly where or how close their infant is, may wish to have the infant sleep alongside but on a different surface.
General Advice Regarding Infant Sleep
• Do not sleep with the baby on sofas or overstuffed chairs.
• Do not put a baby to sleep alone in an adult bed.
(Both of these practices put a baby at risk for wedging, entrapment, and
Parents who choose to bedshare with their infants must be proactive. They must evaluate their sleep environment and make it as safe as possible for their baby. Both parents should feel comfortable with the decision to place baby in the environment that is chosen, whether crib or adult bed and should be committed to following that environment’s safety precautions, as noted above. No one sleep environment can guarantee that a baby will be risk-free, but there are ways of reducing risk in both cribs and adult beds.
FOR MORE INFORMATION
Back to Sleep Campaign: 800-505-CRIB; www.nichd.nih.gov/sids
The Danny Foundation: 800-83-DANNY; www.dannyfoundation.org
Kids In Danger: 312-595-0649; www.KidsInDanger.org
National Safe Kids Campaign: 202-662-0600; www.safekids.org
US Consumer Product Safety Commission: 800-638-2772; www.cpsc.gov
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1. American Academy of Pediatrics policy statement, “Changing Concepts of
Sudden Infant Death Syndrome: Implications for Infant Sleeping Environments
and Sleep Position (RE9946),” www.aap.org/policyrRe9946.html, March 2000.
2. American Academy of Pediatrics, Caring for Your Baby and Young Child, Birth to Age 5 (New York: Bantam Books, 1998), 16–17.
3. SIDS Alliance, “Safe Infant Bedding Practices,” www.sidsalliance.org/Healthcare/
4. Patricia Donohue-Carey: Solitary or shared sleep: What’s Safe?