This is the one article on this site we will not soften, because it is the one that saves lives. It is a plain-language version of the American Academy of Pediatrics’ current safe-sleep recommendations (the 2022 policy statement, still in force), followed by three numbers that get far less airtime than they deserve.
The checklist
- On the back, for every sleep. Naps included. By whoever is doing the settling. Until a year old. Once a baby can roll both ways on their own they may stay where they roll — but they are still placed on the back, and the space must be clear.
- A firm, flat surface that meets federal safety standards. A crib, bassinet, play yard or bedside sleeper. Nothing inclined: surfaces angled more than ten degrees are unsafe, and inclined sleepers have been unlawful to sell in the US since late 2022.
- Nothing in the sleep space but a fitted sheet. No pillows, blankets, quilts, bumpers (mesh ones included), positioners, wedges, nests, loungers or soft toys. If you want your baby covered, a well-fitting sleep sack does the job with nothing that can ride up over the face.
- Their own surface, in your room, close to your bed, ideally for at least the first six months. Room-sharing is associated with roughly halving the risk.
- No sleep in sitting devices at home. Car seats, swings, bouncers, carriers. If your baby falls asleep in one, move them to a flat surface as soon as you can.
- Dress for the room, not the season. No more than one layer more than an adult would wear to be comfortable in that room. No hats indoors. Check the chest or the back of the neck, not the hands and feet — cool hands are normal. The AAP does not publish a room-temperature number, so any “the AAP recommends X degrees” is quoting something that does not exist.
- No weighted sleep sacks, swaddles or blankets. Ever, at any age. This is the clearest “do not use” in the current product landscape.
- If you swaddle, stop at the first sign of trying to roll. That can be as early as two months and is common by three or four. The trigger is attempting, not succeeding.
- Offer a pacifier at naps and bedtime if it suits you, once breastfeeding is well established. Don’t reinsert it all night; if it falls out after sleep onset, leave it.
- No smoke or vape exposure, during pregnancy or after.
- Monitors and “smart” socks do not reduce risk. You may buy one. You may not relax anything above because you own one.
The three numbers nobody tells you
Unaccustomed tummy sleeping. A baby who normally sleeps on their back, placed on their stomach “just this once” — by a grandparent, at daycare, on holiday — carries an adjusted risk many times higher than a baby who always sleeps prone, with odds ratios in the studies running from roughly nine to over forty. This is the single most useful sentence for a family with more than one caregiver: the same way, every sleep, by everyone.
Sofas and armchairs. Falling asleep with a baby on a sofa or armchair is the most dangerous sleep situation there is, with the risk roughly eighteen times higher in the UK case-control data and up to sixty-seven-fold in the AAP’s technical report. It almost never happens on purpose. It happens at three in the morning when you sit down to feed so you won’t wake your partner. So decide now where night feeds happen and what happens if you drop off. The AAP’s own words: if you are going to fall asleep with the baby, the adult bed is less hazardous than the sofa (though still not recommended), and the baby goes back to their own surface the moment you wake.
Head covering. When researchers pooled ten studies, about one in four babies who died of SIDS was found with the head covered — by a blanket, a sheet, a pillow or bedding that had ridden up — and the researchers estimated that avoiding it might prevent more than a quarter of these deaths. This is why the crib is empty and why a sleep sack beats a blanket. It is a large, free, entirely preventable risk that usually appears as a clause inside a bedding sentence rather than as a headline.
If you are already bed-sharing
The AAP is unable to recommend bed-sharing under any circumstances, and we won’t tell you otherwise. We also won’t withhold information from a family who has made a choice. The risks in bed-sharing are not evenly spread: they multiply enormously with smoking (including in pregnancy), with any alcohol or sedating medication, with prematurity or low birth weight, with other children or pets in the bed, with soft surfaces — and above all with sofas. If any of those apply, your baby needs their own surface tonight, and the thing driving the bed-sharing (usually exhaustion or feeding) is what we would work on with you.
Nothing here is medical advice. It is the public guidance of the AAP, put into plain words. If you have any concern about your baby’s breathing, colour or wellbeing, call your pediatrician; in an emergency, call 911.