infant sleeping

Sweet Dreams, Safe Sleep: The American Academy of Pediatrics Updates its Safe Sleep Recommendations

A recent policy statement by the American Academy of Pediatrics (AAP), Sleep-Related Infant Deaths: Updated 2022 Recommendations for Reducing Infant Deaths in the Sleep Environment, details consistent, but updated recommendations for reducing the risk of Sudden Infant Death Syndrome (SIDS) for infants. These recommendations include a continued emphasis on back position sleep, a recommendation for same room/separate sleep area practices, and breastfeeding. The policy statement advises against smoking, alcohol, and the use of potentially dangerous sleep products.

Updates and Education Aim to Reduce SIDS Even Further

According to a news release from the AAP, “We’ve made great strides in learning what keeps infants safe during sleep but much work still needs to be done…A baby’s death is tragic, heartbreaking and often preventable. If we’ve learned anything, it’s that simple is best: babies should always sleep in a crib or bassinet, on their back, without soft toys, pillows, blankets or other bedding,” said Dr. Moon, professor of pediatrics at the University of Virginia School of Medicine and lead author of the statement.

The AAP notes that the number of SIDS deaths experienced a significant decline since 2000, following a change in recommendations for supine (back) sleeping and an educational campaign. However, close to 3,500 infants still die from sleep-related infant deaths annually in the United States. 

The AAP hopes to reduce SIDS deaths even further with a combination of improved recommendations, educational campaigns, and the Safe Sleep for Babies Act, signed by President Biden last year.

To reduce the risk of sleep-related infant death, the AAP recommends:

  • The baby should sleep on a firm, flat, non-inclined surface that, at a minimum, adheres to the June 2021 Consumer Product Safety Commission’s rule that any infant sleep product must meet existing federal safety standards for cribs, bassinets, play yards, and bedside sleepers. Parents should not use products for sleep that aren’t specifically marketed for sleep.
  • Sitting devices, such as car seats, strollers, swings, infant carriers, and infant slings, are not recommended for routine sleep in the hospital or at home, particularly for infants younger than 4 months.
  • Breastfeeding reduces the risk of sleep-related infant deaths, and while any human milk feeding is more protective than none, 2 months of feeding at least partial human milk feeding has been demonstrated to significantly lower the risk of sleep-related deaths. The AAP recommends exclusive human milk feeding to 6 months, with continuation of human milk feeding for 1 year or longer as mutually desired by parent and infant.
  • AAP recommends that parents sleep in the same room – but not in the same bed as a baby, preferably for at least the first six months.
  • Avoid parent and infant exposure to nicotine, alcohol, marijuana, opioids, and illicit drugs.
  • Make sure the baby receives routine immunizations.
  • Pacifier use is associated with reducing risk.
  • Avoid the use of commercial devices that claim to reduce the risk of SIDS or other sleep-related deaths. There is no evidence that any of these devices reduce the risk of these deaths. Importantly, the use of products claiming to increase sleep safety may provide a false sense of security and complacency for caregivers. Do not use home cardiorespiratory monitors as a strategy to reduce the risk of SIDS.
  • Supervised, awake tummy time is recommended to facilitate infant development and to minimize development of positional plagiocephaly. Parents are encouraged to place the infant in tummy time while awake and supervised for short periods of time beginning soon after hospital discharge, increasing incrementally to at least 15 to 30 minutes total daily by 7 weeks of age.
  • There is no evidence to recommend swaddling as a strategy to reduce the risk of SIDS. If infants are swaddled, always place them on the back. Weighted swaddles, weighted clothing or weighted objects on or near the baby are not safe and not recommended. When an infant exhibits signs of attempting to roll (which usually occurs at 3 to 4 months but may occur earlier), swaddling is no longer appropriate, as it could increase the risk of suffocation if the swaddled infant rolls to the prone position.


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