Your Guide to Safe Sleep for Baby

When it comes to baby sleep, many first-time parents have a rough idea of what’s safe and what’s not. Spend even a few minutes with Google or looking over paperwork from your pediatrician’s office, and the basics on safe sleep start to become pretty clear: babies should sleep alone, on their backs and in a crib or a bassinet with a firm sleep surface.

And once your baby arrives and you start life as a new parent, it’s time to put to the test all those rules you think you know:

My baby loves the swing, but can they sleep there?

What do I do if my baby falls asleep in their car seat?

My Instagram feed is filled with cute babies asleep in infant loungers—is that safe?

It’s one thing to know the rules of safe sleep in theory, but once you’re in the thick of these real-life situations, it can be really helpful to have some extra guidance.

We turned to two experts—Dr. Nkeiruka Orajiaka, pediatrician in Emergency Medicine at Children’s Hospital in Columbus, Ohio, and Dr. Kelly Fradin, a pediatrician who also shares parenting and pediatric health tips on social media—to help you interpret the guidelines around safe sleep for your baby, and to answer all the burning sleep questions you’re likely to have as an anxious new parent.

The Basics of Safe Sleep for Babies

The American Academy of Pediatrics (AAP) is the first place you should start when learning about safe sleep for your baby. How to Keep Your Sleeping Baby Safe provides a detailed guide for babies up to one year old and is your go-to source for all things involving sleep safety.

Many safe sleep practices are put into place in order to prevent Sudden Infant Death Syndrome (SIDS). SIDS refers to the unexplained sudden death of a baby under one year old who otherwise appeared healthy. SIDS deaths most often happen during sleep, and many sleep-related deaths can be prevented with the following safe sleep practices.

The most important thing to learn about safe sleep for babies under one year old is to always follow the ABCs:

• Babies should sleep Alone. That means no bed-sharing.

• Babies should be placed down to sleep on their Back.

• Babies should only sleep in a Crib or bassinet (playards count) with no loose bedding or soft objects—that means no pillows, blankets, bumpers, stuffed animals or toys. The sleep surface should have a firm, shallow, baby-safe mattress with only a fitted sheet (no other bedding).

But those ABCs are just the basics. To make sure your baby stays as safe as possible as they sleep, the AAP also recommends room sharing for the first six months. That way, if your baby needs help, you’re close by (without having them physically in bed with you). “Room sharing means keeping the baby's sleep area in the same area where you sleep. This is recommended for at least the first six to 12 months because it is safer than bed sharing. It also makes it easier for feeding, comforting and watching your baby,” Dr. Orajiaka says.

Another thing the AAP says to keep in mind: don’t let your baby get overheated, since that can put them at greater risk of SIDS. Experts recommend that you dress your baby in just one extra layer compared to adults. But don’t give your baby a hat to sleep, Dr. Orajiaka says, since there’s a risk of overheating (babies’ heads release a lot of extra heat) and suffocation if the hat slips off or down.

Swaddling is totally fine, and can act as that one extra layer to keep your baby at a comfortable temperature. Be sure the swaddle isn’t too tight or too loose, and stop using swaddles as soon as your baby shows signs of rolling over. But steer clear of anything that’s weighted; the AAP strongly advises against weighted sleep sacks due to a lack of evidence that they’re safe.

Where can my baby sleep safely?

Understanding the guidelines around safe sleep for your baby is very empowering. Baby sleep is one of the most anxiety-inducing parts of new parenthood for many families, and knowing the rules around what’s safe and what’s not can help you feel more confident as you navigate those early months with your newborn.

But what does safe baby sleep look like in different locations? We asked Dr. Orajiaka and Dr. Fradin about some of the sleep situations you might find yourself in just trying to get through the day as a new parent. Here’s what they had to say.

Can my baby sleep in their car seat?

The short answer: No, unless you’re in a moving vehicle and aren’t able to stop to take your baby out of their car seat.

“Car seats are really important for safety,” explains Dr. Orajiaka. “But if an infant falls asleep in a car seat, they should be removed and placed in a crib or a bassinet (or other safe sleep space) as soon as possible. The AAP recommends against the use of car seats for sleep outside of a car.” But don't panic or feel like you have to pull over the second your baby falls asleep in the car—just make sure you move them as soon as you get to your destination or are able to make a realistic pit stop. The AAP recommends that babies take a break from their car seat about every 90 minutes, anyway, so if you’re taking a longer road trip, be sure to schedule pit stops every hour and a half to take baby out and let them stretch.

Even if your baby is still asleep in their car seat once you’ve reached your destination, you need to transfer them to a safe sleep space. It’s totally understandable if you hesitate to move your sleeping baby from their comfortable position—we’ve all been there—but it’s really important for their safety to get them moved to a safe sleep space as soon as you get out of the car.

What if the car seat is attached to a stroller? “If babies are in an approved stroller with the car seat properly restrained, I think of it the same as being in a vehicle,” Dr. Fradin says. “Keep them cool and supervised.” And also just like with being in a vehicle, as soon as you’re able to take a break or when you’ve reached your destination, it’s important to take your baby out of the car seat and stroller as soon as possible.

Can my baby sleep in an infant lounger?

No, “DockATots and other ‘pods’ are NOT safe for sleep,” Dr. Orajiaka says. Infant loungers like the DockATot and Snuggle Me are safe spots for your baby to chill and relax, especially when you need to get other things done—but only if they’re awake.

Can my baby sleep in a baby swing?

No, since the incline of a swing will prevent baby from lying flat on their back. Dr. Fradin also points out that swings “are not intended for sleep,” and aren’t ever considered a safe sleep space. AAP guidelines say that if your baby happens to doze off in an infant swing, take them out immediately and transfer them to a safe sleep spot. Remember to always keep an eye on your baby when they’re in a swing to make sure they don’t fall asleep for too long. 

Can my baby sleep in a Moses basket?

Some pediatric experts don’t recommend Moses baskets as a safe sleep space. “Moses baskets are not properly regulated by the Consumer Product Safety Commission,” Dr. Orajiaka says. “Even though some may be considered bassinets, some others are unstable, have small parts or are structurally insufficient to hold an infant safely. There have also been a few recalls in the past. Choose a recommended bassinet instead.”

If you do choose to put your baby in a Moses basket, Dr. Fradin recommends making sure the base is flat and firm.

In a baby carrier?

Yes, but only for a short time, and baby should be taken out of the carrier and placed in a safe sleep spot as soon as possible. 

In accordance with the AAP’s guidelines, Dr. Orajiaka says that “wraps and carriers can be used when helping a baby fall asleep, but as with every sleep, baby should be placed alone, on their backs and in their crib for sleep.”

If you’re out and about, Dr. Fradin says carrier naps are okay, but with a few safety considerations in mind. “Baby carriers are great ways for baby to nap on the go; just be sure that the infant is high on your chest, at "kissing height" without fabric covering their face,” she says. “There is a helpful mnemonic device called TICKS to keep in mind: the carrier should be Tight, the child's face In view, Chin off the chest, Kissing height and Supported back.” 

Dr. Fradin also reminds parents to be aware of the possibility of baby overheating in a carrier, since that can put them at greater risk of SIDS.

Sudden Infant Death Syndrome: What You Need to Know

While SIDS is extremely scary, it’s important to remember that it’s very rare, and there are many things you can do as a new parent to help prevent it by creating a safer sleeping environment for your baby.

According to the AAP, approximately 3,500 infants die each year from sleep-related infant deaths. “The actual cause of SIDS is unknown,” explains Dr. Orajiaka. While many researchers believe SIDS may be associated with defects in the part of an infant’s brain that controls breathing and arousal from sleep, no definitive answers have been reached yet.

What are the risk factors of SIDS?

According to Dr. Orajiaka, there are many predisposing risk factors for SIDS. These are usually considered in two parts: maternal (parent) and infant/environmental factors.

Maternal risk factors for SIDS include:

• Young maternal age (under 20 years old)

• Maternal smoking during pregnancy

• Drug and alcohol use

• Late or no prenatal care

Infant and environmental factors include:

• Premature birth

• Low birth weight

• History of sibling dying of SIDS

• Non-recommended sleeping positions, including sleeping on belly, sleeping with bedding accessories or loose blankets and bed sharing

How can you prevent SIDS?

Research shows that creating a safe sleeping area for your baby by following all safe sleep guidelines can help reduce the risk of SIDS.

In addition to following the ABCs of safe sleep mentioned before, pediatric experts say there are a few additional research-backed prevention methods for SIDS:

• Breastfeed your baby, either exclusively or in combination with bottle feeding, for at least two months.

• Keep up with baby’s regular pediatrician checkups to monitor for any underlying health conditions.

• Offer a pacifier at nap time and bedtime. Research has shown that putting baby to sleep with a pacifier can reduce the risk of SIDS, Dr. Orajiaka says. She also says to avoid using pacifier clips or ropes while baby is sleeping, since they can pose a strangulation hazard.

• Don't rely on home cardiorespiratory monitors, also known as smart monitors or movement monitors (ones that track your baby's breathing, pulse, oxygen rate, etc.) as a way to reduce the risk of SIDS. While there's no harm in using these types of monitors, remember that they aren't medical devices, so you shouldn’t rely on them as a substitute for following safe sleep practices.