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Frequently Asked Questions

1. How should I place my baby in his/her crib for sleep?

Always place your baby on the back to sleep at nighttime and naptime. This is the safest sleep position for a healthy baby to reduce the risk of Sudden Infant Death Syndrome (SIDS). Since 1992, when the American Academy of Pediatrics (AAP) first stated that infants should be placed on their backs to sleep, the occurrence of SIDS has fallen by half.

Remember to talk with your baby’s child care providers, grandparents, other family members, babysitters and all caregivers about the importance of placing your baby on their back to sleep every time even for naps. About one in five sudden infant death syndrome deaths occur while an infant is in the care of someone other than a parent. Many of these deaths occur when babies who are used to sleeping on their backs at home are then put to sleep on their tummies by another caregiver. We sometimes call this “unaccustomed tummy sleeping.” Unaccustomed tummy sleeping increases the risk of SIDS. Babies who are used to sleeping on their backs and are put to sleep on their tummies are 6-9 times more likely to die from SIDS. 

Resources: American Academy of Pediatrics (AAP), the National Institute of Child Health and Human Development (NICHD) at the National Institutes of Health (NIH)

2. How will I know if my baby’s crib is safe for sleep?

Place your baby in a safety-approved crib with a firm mattress and a well-fitting sheet. The mattress is too loose if you can fit more than two finger widths between the edge of the mattress and the crib side. (Cradles and bassinets may be used, but choose those that are JPMA (Juvenile Products Manufacturers Association) certified for safety). There should be no loose, missing, or broken screws, hinges or slats. There should be no more than 2 3/8” between the slats (about the width of a soda can). There should be no corner posts over 1/16”high. 

Reference: American Academy of Pediatrics.

3. How should I dress my baby for sleep?

Don’t cover the heads of babies with a blanket or over wrap them in clothing and blankets. Consider using a sleeper or other sleep clothing instead of blankets. Avoid letting the baby get too hot. The baby could be too hot if you notice sweating, damp hair, flushed cheeks, heat rash, and rapid breathing. Dress the baby lightly for sleep. Set the room temperature in a range that is comfortable for a lightly clothed adult. 

Reference: American Academy of Pediatrics. Healthy Child Care America.

4. Can I let my baby sleep with a special stuffed animal or blanket?

Toys and other soft bedding, including fluffy blankets, comforters, pillows, stuffed animals, bumper pads, and wedges should not be placed in the crib with the baby. These items can lessen the baby’s ability to breathe if they cover his or her face. 

Reference: American Academy of Pediatrics.

5. Should my baby use a pacifier for sleep?

Consider giving a pacifier at nap time and bedtime. It has been shown that the risk of SIDS is lower when a pacifier is used during sleep. Using a pacifier does not affect breastfeeding (if breastfeeding is already well established), and does not cause later dental problems. Use the pacifier when placing the baby down for sleep, and do not insert the pacifier again once he/she falls asleep. If the baby refuses the pacifier, he/she should not be forced to take it. Pacifiers should not be coated in any sweet mixture. Pacifiers should be cleaned often and replaced regularly. 

For breastfed infants, do not start using the pacifier until 1 month of age to make sure that breastfeeding is well established. 

Reference: American Academy of Pediatrics (AAP), the National Institute of Child Health and Human Development (NICHD) at the National Institutes of Health (NIH), and the Consumer Product Safety Commission (CPSC)

6. When is it safe to place my baby on his/her tummy?

Have supervised “tummy time” for babies who are awake. This will help babies strengthen their muscles and develop normally. 

Reference: American Academy of Pediatrics.

Why is “Tummy Time” important? Infants now miss out on the 12 hours of tummy time that they used to get when sleeping on their tummies. Many infants also spend long hours in swings, car and infant seats when awake. Because of these practices, some infants are developing motor delays. 

Tummy time is important because it helps infants:

• Stretch and strengthen the head, neck, shoulder and back muscles they will need to learn important motor skills (for instance, how to push up, roll over, sit up, crawl, and pull to a stand).

• Develop their sensory-perceptual, social emotional, problem solving, balance, visual, and hearing abilities.

• Develop normally shaped heads (infants who spend most of their time on their backs when asleep and in infant seats when awake are at risk for developing flat spots on the backs of their heads).

National Institute of Child Health and Human Development, Tummy Time.  

Majnemer A and Barr RG. (2006) Association between sleep position and early motor development. Journal of Pediatrics 149,623-9 

American Physical Therapy Association (2008), Lack of time on tummy shown to hinder achievement of developmental milestones, say physical therapists.  

California Childcare Health Program
1950 Addison Street, Suite 107
Berkeley, CA 94704-1182 
(510) 204-0930 
Healthline (800) 333-3212

7. Is sleeping with my baby safe?

Remember, adult beds, sofas and chairs are not safe for sleeping babies and can greatly increase the risk of SIDS, suffocation and accidental infant deaths. There have been reports of infants being suffocated by an adult, brother, sister, other family member, or pet, that rolled on top of the infant while sharing a bed or other sleep area such as as couch or chair. Bring baby into your bed to breastfeed and bond, but when its time for sleep, place your baby in his or her own separate, safe sleep area in the same room. If you have been drinking alcohol, or taking drugs/medicines that may make you sleepy, or are very tired, or are very overweight, do not bring your baby into bed with you. 

Reference: First Candle and the National SIDS/Infant Death Resource Center (NSIDRC).

8. Is it ok for my baby to sleep on the couch or recliner?

Remember, adult beds, sofas and chairs are not safe for sleeping babies and can greatly increase the risk of SIDS, suffocation and accidental infant deaths. When it is time for sleep, place your baby in his or her own separate, safe sleep area or in a crib that meets current safety standards in the same room. 

Reference: First Candle.

There is an increased risk that baby may get stuck between the back of the couch or baby’s head may become buried in cushion gaps or soft cushions. 

Reference: SIDS: A Parent’s Guide to Understanding and Preventing Sudden Infant Death Syndrome, by William Sears, M.D.

9. Does smoking affect my baby’s ability to sleep safely?

Mothers who smoke cigarettes during pregnancy increase the risk of SIDS  three times, despite the birth weight of the baby. The risk increases with the number of cigarettes smoked per day. Some studies have shown that cigarette smoke in the baby’s environment after birth also increases SIDS risk. The risk has been shown to increase with either the number of cigarettes smoked by the parents or the number of hours the infant spends in the presence of smokers.  

Reference: The National Institute of Child Health and Human Development (NICHD)

10. Will special baby monitors keep my baby safe from sleep related death or injuries?

These breathing/heart monitors have not been proven to protect a baby from sleep related death.

“Home cardiorespiratory monitoring should not be prescribed to prevent SIDS. Parents should be advised that home cardiorespiratory monitoring has not been proven to prevent sudden unexpected deaths in infants. Pediatricians should continue to promote proven practices that decrease the risk of SIDS—back sleep position, safe sleeping environments, and elimination of prenatal and postnatal exposure to tobacco smoke.” 

Reference: Policy Statement: Apnea, Sudden Infant Death Syndrome, and Home Monitoring. Pediatrics. 2003;111:914-917


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