ABCs of Safe Sleep for Babies

By Kathryn Sibley Horton
Read Time: 8 Minutes

If you have a new baby, or are expecting one soon, one of the most important issues you'll be dealing with is sleep. Babies sleep a lot, but not always when you wish they would. Feedings, diaper changes, and needing comfort can happen anytime, day or night, and whether it's your first little one or your fourth, every child is different. So, make the best of those blissful times when your baby is sleeping. Get rest for yourself when you can, and always give your baby room to breathe for safe sleep at bedtime and naptime.

The ABCs of safe sleep for babies are easy to learn and easy to do.

When you put your baby to bed with the ABCs, everyone gets more peaceful zzzs.

Risks to Babies While Sleeping

You may wonder why there is so much concern about safe sleep practices for babies. After all, babies have been sleeping in cribs for decades. What's changed is that we know a lot more about safe sleep and crib safety for the baby's first year. We'll get to that later in this article, but let's review what you should know about current risks for sleep-related infant death.

There are many things that can increase the risk of sleep-related infant death. Here are a few of the big ones:

• Mom smokes or uses drugs or alcohol before, during, or after pregnancy. 
• Parents share their bed with their baby.
• The baby sleeps on his (or her) tummy rather than his back.
• The baby sleeps with soft bedding, blankets, or stuffed animals in the sleep area.
• The baby sleeps on an unsafe surface, such as an adult bed or a sofa, where he can be trapped between a mattress and the wall, or in pillows or sofa cushions.
• The baby's crib is near strangulation hazards such as window blind cords and mobiles.
• A baby older than newborn (birth to 8 weeks) is swaddled for sleep.
• The temperature of the room where the baby sleeps is warm.
• The baby is overdressed for sleep.

Parents who are in-the-know can reduce the risk of babies dying unexpectedly in their sleep by following the ABCs for safe sleep until their baby's first birthday. It's also important to take your baby to get regular medical checkups.

About 3,600 babies die suddenly and unexpectedly in their sleep each year in the United States. We can help change that by using safe sleep practices for babies.

A Few Words About "The Way We've Always Done It"

Family traditions - "the way we've always done it" - may be one reason parents resist making changes. Grandpa loves to see his little sweetheart tucked in with his favorite sports team blanket. Auntie might be upset to see you remove the hand-knit hat she made. Traditions are often a wonderful thing, but some of them may put your baby at risk. As a parent, you can educate yourself and help any of your baby's caregivers understand and follow the ABCs of safe sleep. You can take charge of your baby's safe sleep and crib safety by remembering these guidelines.

• Bed sharing with thick blankets may have been common when Grandma had infants, but you have current information that room sharing, not bed sharing, is the best safe sleep practice.
• Babies won't choke while sleeping on their back, because their airway anatomy and the gag reflex prevent that from happening. Back sleeping actually helps protect your baby.

Improving Crib Safety

Let's discuss the nuts and bolts of a safe sleep surface for your baby. The recommendation for a safe sleep surface from the American Academy of Pediatrics (AAP) is a crib, bassinet, portable crib, or play yard that conforms to the safety standards of the Consumer Product Safety Commission (CPSC). 

Position the safe sleep bed in your bedroom, away from windows with drapery or blind cords and baby monitor cords.

Ensuring crib safety doesn't cost a lot. CPSC guidelines say "bare is best" when it comes to a safe sleep bed for your baby, reinforcing the ABCs. This means no bumper pad, bedding, pillows, or toys in bed with your baby. If your baby leaves an impression on the mattress, the surface is too soft. Do not use broken cribs, modified cribs, and cribs older than 10 years.

Here are other CPSC guidelines for safe sleep surfaces for babies:

• Properly assemble the crib by following the provided instructions.
• Make sure every part of the crib is installed correctly. If you are not sure, call the manufacturer for assistance.
• Ensure the mattress fits the crib, with no gaps larger than two fingers between the mattress and sides of the crib.
• Set up play yards properly, according to manufacturer directions.
• Use only the mattress pad provided with the play yard; do not add extra padding.

Be sure the crib, bassinet, portable crib, or play yard has not been recalled by checking the CPSC recall list.

Cribs for Kids provides free or reduced-cost cribs to low-income families, along with a fitted crib sheet embossed with the safe sleep message plus a wearable blanket, a pacifier, and safe sleep education materials, including the Safe Sleep for Your Baby DVD.

Share your room, not your bed.

Your baby sleeps a lot - approximately 16 hours a day, in intervals of 3 to 4 hours. Your baby will wake for feedings often. That schedule keeps you busy, so try to sleep when your baby sleeps, if you can.

Want to cuddle with baby and drift off to dreamland together? It's a natural desire, but one to resist when practicing safe sleep.

It may feel natural to sleep with your baby, and you may feel you are protecting your baby when you sleep together, but the AAP says that creates a greater risk for your baby.

• Bed sharing with your baby, also called co-sleeping, creates the dangers of entrapment, overheating, and suffocation.
• The soft and fluffy nature of modern beds and bedding does not align with safe sleep practices for babies.
• A sleepy adult may roll onto a baby.
• While you sleep, you cannot protect your baby from the risks introduced by co-sleeping.

Studies show that babies are safest when sleeping alone, on their back, in a crib in a cool and smoke-free room.

Room sharing is the safest way to be close to your baby while you both sleep.

This way you are close to each other but separated for safety, giving your baby room to breathe. Room sharing with your baby for at least six months, and preferably for one year, allows you to be close to your baby for easy monitoring and breastfeeding.

Position your baby's separate safe sleep surface next to yours, and you'll both sleep safe and sound.

Bringing baby to bed: is it ever okay?

Sometimes the night is long and the baby is crying. Feeding in the wee hours can seem easier in bed.

The AAP says to bring baby to bed only to feed or to comfort but not as a routine. Have safeguards in place, such as a buddy system or a timer, so you stay alert and return your baby to a safe sleep surface before falling back to sleep yourself.

AAP recommends the following for breastfeeding moms:

• Stay alert while breastfeeding and return your baby to the safe sleep bed after feeding.
• If you accidentally fall asleep while breastfeeding in bed, return your baby to the safe sleep bed as soon as you wake up.
• Avoid feeding your baby in an armchair or on a couch when you might fall asleep with him. Soft surfaces can make it hard for babies to breathe because their neck muscles are not strong enough to turn their head away from anything that may block their nose and mouth.

What about tummy time while baby is awake?

During your baby's calm and wakeful moments, supervised tummy time can help strengthen his neck, shoulder, and arm muscles. Tummy time is good for babies' motor development, hips, and skull by helping to prevent flat spots that babies may get from sleeping on their back. Tummy time is a fun, interactive time for you and your baby.

Do pacifiers help with safe sleep?

The use of pacifiers can help protect against sudden unexpected infant death. Moms who are breastfeeding their babies should make sure their babies are successfully breastfeeding before introducing a pacifier. This usually happens when a baby is around 3 to 4 weeks old. Use only simple pacifiers, with no attachments or toys. If the pacifier falls from your sleeping baby's mouth, don't put it back in.

Creating Sleep Routines for Babies

Sleep is a necessary rest time for everyone. To help transition to naptime and bedtime, create predictable routines for your baby that start with habits like this:

• Speak softly and dim the lights.
• Sing a lullaby or play soft music.
• Read a bedtime story.
• Give your baby a pacifier.
• Rock your baby to sleep.
• Lay your baby alone on his back on a firm surface for sleep.

Safe Sleep Reminders for Every Nap and Every Night

The ABCs of safe sleep for babies are easy to learn and easy to do. Babies should sleep alone, on their back, in a crib in a cool smoke-free room.

Room sharing with your baby - but never bed sharing - is recommended for the first 6 months of your baby's life and up to 1 year.

And use your ABCs, plus these reminders:

• Never place your baby to nap or sleep on chairs, couches, waterbeds, cushions, or blow-up mattresses.
• Never fall asleep with your baby on the same sleep surface.
• Reconsider family traditions that don't align with safe sleep practices for babies.
• Move babies who fall asleep in car safety seats, strollers, swings, infant carriers, and infant slings to a firm, safe sleep surface as soon as possible.

By following these tips, you can help keep your baby safe while sleeping, and you can get a good night's sleep too.