What are 5 things parents can do to lower the risk of SIDS?

Recommendations from the American Academy of Pediatrics (AAP) for Reducing the Risk of Sudden Infant Death Syndrome (SIDS)

What are 5 things parents can do to lower the risk of SIDS?
Advanced Practice Nurse Leilani Feliciano and Chief of Pediatrics and Newborn Medicine Dr. Elizabeth Carlin

Sudden infant death syndrome (SIDS) is the leading cause of death in infants from ages one month to one year. October is SIDS Awareness Month, a time to raise awareness about this tragic cause of death.

“It is critical for new parents to have open communication and trust with their pediatrician,” says Elizabeth Berk Carlin, MD, chief, Department of Pediatrics and Newborn Medicine. “Pediatricians play a critical role in discussing and stressing ‘safe sleep’ in a supportive and nonjudgmental environment.”

Here are 15 recommendations from the American Academy of Pediatrics on reducing the risk of SIDS.


Whether it’s a short nap during the day, or putting your baby down for the night, infants should always be placed to sleep on their backs.


Cover the mattress with a fitted sheet and nothing else! No soft, fluffy bedding, toys, or pillows in the baby’s sleep area.


Unless medically contraindicated, mothers should breastfeed exclusively or feed with expressed milk (i.e., not offer any formula or other non-human milk-based supplements) for at least six months.


It is recommended that infants sleep in the parents’ room, but in his/her own crib or basinet, ideally for the first year of life, but at least for the first six months. Evidence exists that infants who sleep in their parents’ room, in their own cribs, have a decreased risk of SIDS of as much as 50%.


Soft objects, such as pillows and pillow-like toys, quilts, comforters, sheepskins, and loose bedding, such as blankets and non-fitted sheets, can obstruct an infant’s nose and mouth. An obstructed airway can pose a risk of suffocation, entrapment, or SIDS.


Although the mechanism is yet unclear, a protective effect of pacifiers on the incidence of SIDS has been reported. The protective effect of the pacifier is observed even if the pacifier falls out of the infant’s mouth. It does not need to be reinserted once the infant falls asleep.


Both maternal smoking during pregnancy and smoke in the infant’s environment after birth are major risk factors for SIDS. Mothers should not smoke during pregnancy or after the infant’s birth. The risk of SIDS is particularly high when the infant shares a bed with an adult smoker, even when the adult does not smoke in bed.


There is an increased risk of SIDS with prenatal and postnatal exposure to alcohol or illicit drug use. Parental alcohol and/or illicit drug use in combination with bed-sharing places the infant at particularly high risk of SIDS.


In general, infants should be dressed appropriately for the environment, with no greater than one layer more than an adult would wear to be comfortable in that environment. Parents and caregivers should evaluate the infant for signs of overheating, such as sweating or the infant’s chest feeling hot to the touch. Overbundling and covering of the face and head should be avoided.


There is a substantial linking of a lower risk of SIDS for infants whose mothers obtain regular prenatal care. Pregnant women should follow guidelines for frequency of prenatal visits.


Evidence suggests that vaccination may have a protective effect against SIDS.


Be particularly wary of devices that claim to reduce the risk of SIDS. Examples include, but are not limited to, wedges and positioners and other devices placed in the adult bed for the purpose of positioning or separating the infant from others in the bed.


The use of cardiorespiratory monitors has not been documented to decrease the incidence of SIDS.


The SIDS taskforce and the AAP Committee on Practice and Ambulatory Medicine and Section on Neurologic Surgery agree that “a certain amount of prone positioning, or ‘tummy time,’ while the infant is awake and being observed is recommended to help facilitate the infant’s development and strength necessary for timely attainment of certain motor milestones.”


Swaddling, or wrapping the infant in a light blanket, is often used as a strategy to calm the infant while he/she is lying on their back. There is a high risk of death if a swaddled infant is placed in the crib/basinet lying on their stomach, or if a swaddled infant rolls to that position. If infants are swaddled, they should always be placed on the back. Swaddling should be snug around the chest but allow for ample room at the hips and knees. When an infant exhibits signs of attempting to roll, swaddling should no longer be used.

All parents of babies born at Englewood Hospital and Medical Center are provided information and education on ‘safe sleep’ and reducing the risk of SIDS. “Expectant and new parents are educated during the Mom 101 seminars held by the Childbirth Education Department,” says Leilani Feliciano, MSN, MA, RNC-OB, APN-C, WHNP-BC, an advanced practice nurse in Englewood Hospital’s Family Birth Place. “After delivery, education on safe sleep and SIDS prevention continues during the parent’s hospital stay, before they are discharged home with their newborn.”

For additional information, please see “SIDS and Other Sleep-Related Infant Deaths: Updated 2016 Recommendations for a Safe Infant Sleeping Environment” from the AAP.

Posted on October 28, 2016

Reviewed by Amita Shroff, MD on April 07, 2021

Parents who know about SIDS may think of it as their worst nightmare. Sudden infant death syndrome is known as SIDS or crib death. It’s when a baby 12 months or younger dies during sleep with no warning signs or a clear reason.

Although there is no 100% way to prevent SIDS, there is a lot you can do to lower your baby’s risk. Since the American Academy of Pediatrics issued its safe sleep recommendations in 1992 and launched its "Back to Sleep" campaign in 1994, the SIDS rate has dropped dramatically. That year, the SIDS death rate was 103 per 100,000 live births, compared to 35 per 100,000 live births in 2018. 

Put a Sleeping Baby on Their Back

Your baby’s risk of SIDS is much higher any time they sleep on their side or stomach. (A baby placed on their side can roll over on their stomach.) These positions put your baby’s face in the mattress or sleeping area, which can smother them.

So, every time you put your baby in their bed to sleep -- for naps, at night, or any time -- lay them down on their back. Don’t let them sleep in a stroller, car seat, baby seat or swing for a prolonged period of time. Get them out and lay them on a firm, flat surface or bed.

Tell anyone who takes care of your baby how essential it is to lay your sleeping baby on their back each time. That includes grandparents, babysitters and childcare providers, older siblings, and others. They may think one time won’t matter, but it can. When a baby who usually sleeps on their back is suddenly laid on their stomach to sleep, the risk of SIDS is much higher.

If you’re worried your baby might choke while sleeping on their back, don't be. Choking is very rare, and healthy babies tend to swallow or cough up fluids automatically. If you’re concerned, ask your pediatrician about elevating the head of your baby's bed.

Once your baby can roll over both ways, which usually happens around 6 months, they may not stay on their back. That’s OK. It’s fine to let them choose their own sleep position once they know how to roll over.

Firm Bed, No Soft Toys or Bedding

To prevent smothering or suffocation, always lay your baby down to sleep on either a firm mattress or surface in a crib or bassinet. All your baby’s crib needs is the fitted sheet -- don't put blankets, quilts, pillows, sheepskin, stuffed toys, or crib bumpers in your baby's crib.

To confirm the safety of your baby's mattress or crib, contact the Consumer Product Safety Commission at 800-638-2772 or www.cpsc.gov.

Don't Smoke Around Your Baby

If you smoke, here's a huge reason to stop before you get pregnant: Babies born to women who smoked during pregnancy die from SIDS three times more often than babies born to nonsmokers. Smoking when you're pregnant is a major risk factor for SIDS, and secondhand smoke around your infant also increases the chances of SIDS. Don't let anyone smoke around your baby.

Keep Your Sleeping Baby Close, but Not in Your Bed

When a baby sleeps in the same room as mom, studies show it lowers the risk of SIDS. But it's dangerous for a baby to sleep with another child or an adult in the same bed, in an armchair, and on a couch.

If you bring your baby into your bed for comforting or breastfeeding, be sure to put the baby back in their own cradle, bassinet, or crib when you're ready to sleep. If you are tired, don’t breastfeed while sitting in a chair or on a couch in case you fall asleep.

Never bring the baby to bed with you when you're very tired or using medicines that affect your sleep.

Breastfeed as Long as You Can

Breastfeeding your baby can lower the risk of SIDS by as much as 50%, though experts aren't sure why. Some think breast milk may protect babies from infections that raise their SIDS risk. Do not drink alcohol if you breastfeed, because that raises your baby’s risk of SIDS. In addition, the simple touch is helpful. Skin-to-skin contact is important for your baby’s development.

Immunize Your Baby

Evidence shows babies who’ve been immunized in accordance with recommendations from the American Academy of Pediatrics and the CDC have a 50% reduced risk of SIDS compared with babies who aren’t fully immunized.

Consider Using a Pacifier to Put Baby to Sleep 

Putting your baby to sleep with a pacifier may also help prevent SIDS, though researchers aren't sure why. There are a few tips to follow when using a pacifier:

  1. If you're breastfeeding, wait until your baby is breastfeeding regularly (at least 1 month old) before starting to use a pacifier. Introducing a pacifier too soon can lead to nipple confusion and cause your baby to prefer the pacifier's nipple over your own.
  2. Don't force your baby to take the pacifier if they don't want it.
  3. Put the pacifier in your baby's mouth when you put them down to sleep, but don't put it back in their mouth after they fall asleep.
  4. Keep the pacifier clean, and buy a new one if the nipple is damaged.
  5. Don't coat the pacifier with honey, alcohol, or any other substance.

Keep Your Baby From Overheating

Because overheating may raise a baby's risk of SIDS, dress your infant in light, comfortable clothes for sleeping, and keep the room temperature at a level that's comfortable for an adult.

If you're worried about your baby staying warm, dress them in a "onesie," pajamas that cover arms, legs, hands, and feet, or place them in a "sleep sack" (a wearable blanket). However, don't use a regular blanket -- your baby can get tangled in it or pull the blanket over their face.

Steer Clear of Products That Claim to Reduce the Risk of SIDS

It's best to avoid any product that says it can lower your baby's risk of SIDS, because they haven't been proven safe or effective. Cardiac monitors and electronic respirators also haven't been proven to reduce SIDS risk, so avoid these, too.

Don't Give Honey to an Infant Under 1 Year Old

Because honey can lead to botulism in very young children, never give honey to a child under 1 year old. Botulism and the bacteria that cause it may be linked to SIDS.

Remember, your baby's health care provider is always available to answer any questions you have about SIDS, SIDS prevention, and keeping your baby warm, happy, and safe.

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