Safe sleep, the AAP way

Work it out for your family: Baby sleep schedule by age. Today's wake windows, naps and bedtime for your baby's age, and what changes next.

The short answer

For every sleep, day and night, until the first birthday: on the back, alone, on a firm, flat surface with only a fitted sheet, in your room but not in your bed [1][2]. That’s the American Academy of Pediatrics (AAP) 2022 policy in one line. Everything below fills in the details.

These rules aren’t a parenting style. They’re the steps with evidence behind them for lowering the risk of SIDS and accidental suffocation [1].

The core rules

Back to sleep, every sleep. Naps count. Once your baby rolls both ways on their own, still put them down on their back. You don’t need to turn them back over [3].
Firm, flat and level. Use a crib, bassinet or portable play yard with a firm, flat mattress and a fitted sheet [2]. The AAP says to use only products made for infant sleep that meet federal safety standards [1].
Nothing else in the space. No pillows, blankets, quilts, bumpers, stuffed toys or other soft things [2].
Share a room, not a bed. Keep your baby’s crib or bassinet in your room, preferably for at least the first 6 months [1].
Not in seats. Car seats, strollers, swings, carriers and slings aren’t for routine sleep, especially under 4 months [1]. If your baby falls asleep in one, move them to a firm, flat sleep surface on their back as soon as you can [3]. A car seat is fine while you’re driving [2].

The AAP’s position is plain: it “cannot support bed-sharing under any circumstances” [1].

Some situations make bed-sharing far more dangerous. They aren’t a checklist: avoiding them doesn’t make bed-sharing safe. The AAP says the risk of a sleep-related death is [1][3]:

Up to 67 times higher when sleeping with someone on a couch, a soft armchair or a cushion.
10 times higher or more when sleeping with an adult who is impaired by tiredness, sedating medicine, alcohol or drugs, or who smokes.
5 to 10 times higher when the baby is under 4 months old, even if nothing else applies.
Higher again when the baby was born early or at a low birth weight, or shares the surface with someone other than a parent. The AAP’s parent guide puts the risk for a baby born early or small at 2 to 5 times higher [3].

The AAP’s parent guide adds smoking or vaping during pregnancy to the higher-risk list [3].

If you might fall asleep while feeding

Night feeds and exhaustion go together. The AAP’s advice for those hours [3][4]:

Don’t feed on a couch or armchair. That’s the most dangerous place to doze off with a baby.
If you’re feeding in your bed and might fall asleep, first move pillows, blankets, sheets and anything else that could cover your baby’s face.
As soon as you wake, put your baby back in their own sleep space, on their back.

This is about cutting the danger of an accident. It isn’t a plan to bed-share. If you’re so tired you worry about falling asleep holding your baby, tell your doctor. The National Maternal Mental Health Hotline is free, confidential and open 24/7: call or text 1-833-TLC-MAMA (1-833-852-6262) [5]. In a crisis, call or text 988 [5].

Swaddling

Swaddling is optional. There’s no evidence that it lowers the risk of SIDS [1].

A swaddled baby always goes on their back [1].
Stop swaddling once your baby shows signs of trying to roll. That’s usually at 3 to 4 months, but it can be earlier [1].
No weighted swaddles, weighted sleep sacks, weighted clothing or weighted blankets on or near your baby [1].

Pacifiers

Pacifier use is linked to a lower risk of SIDS [1].

Offer one at naps and bedtime. If you breastfeed or chestfeed, wait until feeding is going well first [3].
It’s fine if your baby doesn’t want one. If it falls out after they’re asleep, you don’t have to put it back [3].
Don’t hang a pacifier around your baby’s neck or clip it to their clothes during sleep [3].

Room temperature and overheating

Overheating raises the risk of SIDS [3]. The AAP doesn’t give a set room temperature. It gives these rules instead [3]:

Dress your baby in only one layer more than you’re wearing.
If you’re worried your baby is cold, use layers of clothing or a wearable blanket, not a loose blanket.
Check for sweating, a hot chest or flushed skin.
No hat indoors once you’re home from the hospital.

A smoke-free, substance-free home

Smoking during pregnancy and smoke around your baby after birth are major risk factors for SIDS [3]. That includes vaping. Don’t smoke anywhere near your baby, even outside [3]. The AAP also says to avoid exposure to nicotine, alcohol, marijuana, opioids and illicit drugs, during pregnancy and after [1].

What else lowers the risk

Breast milk. Any human milk is more protective than none. Two months of at least partial human milk feeding significantly lowers the risk [1]. If you formula-feed, every other rule here still protects your baby.
Prenatal care. The AAP recommends regular prenatal care during pregnancy [6].
Routine vaccines [1].
Supervised tummy time while awake. Start soon after you come home, building to at least 15 to 30 minutes a day by 7 weeks [1].

What doesn’t help

Products that claim to prevent SIDS. There’s no evidence any of them work, and they can give a false sense of security [1].
Home heart-and-breathing monitors. Don’t use them to lower the risk of SIDS [1]. There’s no evidence that consumer heart-rate or oxygen monitors lower it either, and none replaces the rules above [3].

The federal rules

US law backs up the AAP:

Infant sleep products. Products sold for sleep for babies up to 5 months that aren’t covered by the crib, bassinet, play yard or bedside sleeper standards must have a sleep surface tilted 10 degrees or less. Think in-bed sleepers, baby boxes, travel bassinets and baby nests. This covers products made after June 23, 2022 [7].
The Safe Sleep for Babies Act. Since November 12, 2022, inclined sleepers (more than 10 degrees) and crib bumpers are banned in the US, no matter when they were made [8]. The ban covers padded bumpers, vinyl bumper guards and slat covers. Non-padded mesh liners aren’t covered by the ban [8]. The AAP’s rule is still a firm mattress, a fitted sheet and nothing else [2].

Don’t use a banned product, even a hand-me-down.

Sources

American Academy of Pediatrics, “American Academy of Pediatrics Updates Safe Sleep Recommendations: Back is Best” (June 21, 2022), summarizing Moon RY, et al., “Sleep-Related Infant Deaths: Updated 2022 Recommendations for Reducing Infant Deaths in the Sleep Environment,” Pediatrics 2022;150(1):e2022057990. aap.org, doi.org
American Academy of Pediatrics, “Safe Sleep.” aap.org
HealthyChildren.org (AAP), “How to Keep Your Sleeping Baby Safe: AAP Policy Explained.” healthychildren.org
HealthyChildren.org (AAP), “Safe Sleep Tips for Sleep-Deprived New Parents.” healthychildren.org
Health Resources and Services Administration (HRSA), “National Maternal Mental Health Hotline.” mchb.hrsa.gov, and 988 Suicide & Crisis Lifeline. 988lifeline.org
Guideline Central, “AAP Sleep-Related Infant Deaths: Updated 2022 Recommendations for Reducing Infant Deaths in the Sleep Environment” (summary of the AAP policy, Moon RY, Carlin RF, Hand I, 2022). guidelinecentral.com
US Consumer Product Safety Commission, “Infant Sleep Products Business Guidance.” cpsc.gov
US Consumer Product Safety Commission, “Safe Sleep for Babies Act Business Guidance.” cpsc.gov

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