Safe Sleep Best Practices and Guidelines for Babies

Infants spend most of their day sleeping, so it is crucial that new parents and caregivers learn about and practice safe sleep for babies. Safe sleep practices can reduce the risk of choking, suffocation, or breathing accidents during sleep.

How Much Do Babies Sleep?

Infants, especially newborns, sleep at least 16 hours a day, usually three to four hours at a time. They wake up every few hours around the clock because they get hungry. As the baby grows, they will get into a regular sleep pattern.

Once they are six to eight weeks old, babies will begin sleeping through one or two nighttime feedings. Eventually, they will sleep through the night, giving you six to eight hours of rest.

Some infants begin to wake up again at night around five to six months old. If this happens, check with your pediatrician to see if you should start feeding your baby solid foods.

Why is Safe Sleep for Infants Important?

Safe sleep practices can save lives. You can do many important things to keep your baby safe.

Following safe sleep guidelines can help prevent sudden unexpected infant death (SUID) and reduce other sleep-related risks and injuries. SUID is the leading cause of death once babies leave the newborn nursery.

Talk about these safety steps with your family, friends, and anyone else who helps take care of your baby. Explain in detail what you expect them to do. Do not assume that people who care for your baby know these guidelines.  

How Should a Newborn Sleep? It is as simple as ABCD:  

Alone

• Do not sleep in the same bed (or on any other sleep surface, like a couch) with your baby.
• Babies should sleep in a crib, bassinet, or pack-and-play alone and next to your bed until 12 months of age if possible.
• Bed sharing is never recommended.
• Nothing else should be in your baby’s sleep space except for your baby.
• Pacifiers can decrease the likelihood of SUID. After breastfeeding has been established, offer a pacifier at nap time and bedtime. Pacifiers should not be attached to a string, cord, stuffed animal, or anything else.

Back

• Put your baby to sleep on their back, not the side or tummy. This placement reduces the risk of SUID and choking.
• Once your baby learns to roll from the back to the belly, you do not need to keep shifting them. Keep putting your baby down to sleep on their back even if they have reflux or spit a lot. It is always safest to lay your baby down on their back to sleep.

Clean, clear crib

• Use a firm, flat, non-inclined sleep surface (crib, cradle, pack-and-play, or bassinet) with a fitted sheet for naps and at night.
• Never put your baby to sleep on a pillow, quilt, sheepskin, or other soft surface, and never put soft items like bumper pads, pillows, and stuffed animals in the crib. These things can block your baby’s mouth.
• The crib, bassinet, or pack-and-play should meet current safety standards. Do not use a crib that is broken, has missing parts, or has been recalled. Using a crib built before 2011 is unsafe because of dropping side rails.
• Dress your baby in a sleep sack or sleeper onesie instead of using blankets. Make sure that your baby doesn’t get too warm. Your baby is likely too warm if he or she sweats or tosses and turns a lot. If you worry that your baby is too cold, put them to bed in a sleeper with long sleeves and long legs or a sleep sack. Do not use blankets until the age of 1.
• If your baby falls asleep in a car seat, stroller, swing, infant carrier, or infant sling, move them to a firm, flat sleep surface as soon as possible. Note: If the device has a buckle, it is not a safe sleep space.

Danger

• Be aware, not impaired. Being sleepy, exhausted, or under the influence of alcohol or drugs (including some prescription medicines) impairs your ability to take care of your baby, making bed-sharing even more dangerous.
• Secondhand smoke is bad for everyone, including babies. Smoking in the house can increase the risk of SUID. Vaping near a baby is also dangerous because of the chemicals released. Never allow others to smoke around your baby.

If your bassinet, crib, or play yard is not new, check with the CPSC to ensure it hasn't been recalled. Make sure they meet the Consumer Product Safety Commission (CPSC) safety standards.

If you do not have a crib, bassinet, or pack-and-play for your baby and cannot afford one, contact Cribs for Kids, talk with your doctor, or call toll-free at 1-888-721-CRIB.

Other Things You Should Know

Experts also recommend these tips to reduce sleep-related deaths:

• Remove all items from the feeding area, as they are a suffocation risk, and set an alarm at the start of each feed.
• Weighted blankets/sleepers/swaddles or other weighted objects should not be used
• Use of home cardiac respiratory monitors is not recommended and may lead to safe sleep guidelines not being followed.
• You may put a hat on your baby if you are outdoors in cold weather, but take it off once inside.
• No matter how frustrated you get, never shake a baby. Your baby may not stop crying no matter what you try. If you need to take a break or time to calm yourself, place your baby in a safe sleep space (Alone, on their Back, and in their Crib) and check on them every 10 to 15 minutes.

Although your baby shouldn't sleep on their stomach, tummy time is important when they're awake and someone watches them. By two months old, infants should get 15 to 30 minutes of tummy time each day.

Spending time on their stomach helps:

• Develop your baby's motor (muscle and movement) skills.
• Prevent flat spots on the back of their head.
• Strengthen your baby's back and neck muscles.

Why is it important to know about SUID?

SUID is the sudden death of an infant under 1 year of age. Every year, there are about 3,500 SUID deaths in the United States.  SUID can happen to any infant.

In addition to following the ABCDs, breastfeeding your baby and using a pacifier may help prevent SUID.

You should be suspicious of products that are advertised as helping prevent SUID. Talk to your doctor before buying any product that claims to reduce SUID risk.

Known risk factors for SUID include:

• Infants who are born premature (less than 37 weeks gestation).
• Infants with a low birth weight (less than 5 lb 8 oz).
• Black/African American, American Indian/Alaskan Native infants.
• Babies who have been sick with a high fever within the past two to three weeks.

With so much to learn, caring for an infant sometimes feels overwhelming. If you have questions or concerns or need support, UPMC is here for you. We encourage all new parents to reach out anytime and take advantage of parenting classes and support groups.

By UPMC Editorial Staff. Last reviewed on 2024-09-05.