Safety in the Sleeping Environment

Creating a safe sleep environment for our children involves considering many factors. Let’s start by reviewing the recommendations from the American Academy of Pediatrics (AAP), a leader in infant mortality research in the United States. These guidelines are based on extensive research to reduce the risk of Sudden Infant Death Syndrome (SIDS) and accidents during sleep.

SIDS is a subcategory of sudden unexpected infant death (SUID) and occurs when no explanation is found after a thorough investigation, including an autopsy. Distinguishing between SIDS and other causes of SUID, such as accidental suffocation, can be difficult because autopsies often cannot provide clear answers. The risk factors for SIDS and suffocation are very similar, so these guidelines aim to minimize both risks during a child’s first year.

AAP Recommendations for a Safe Sleep Environment

• Always put your child to sleep on their back.
• Use a firm, flat mattress: The sleeping surface should not curve downward at the buttocks. If the curve is greater than 10°, it is not considered safe.
• A firm mattress retains its shape when the child is placed on it and does not dent where the child’s head rests.
• Breastfeed if possible.
• Let your child sleep in your room, near your bed but in their own sleeping space, for at least the first six months.
• Keep the bed completely empty—no loose sheets or soft objects.
• Avoid using weighted blankets or other weighted products.
• Dress your child in layers rather than using loose blankets.
• Offer a pacifier at bedtime: If breastfeeding, wait until breastfeeding is well established before introducing a pacifier.
• Avoid smoking during pregnancy and after birth. Ensure the child is in a smoke-free environment.
• Avoid alcohol and drugs during pregnancy and after delivery.
• Do not overheat the room or cover the child’s head or face.
• Do not put a cap on the child indoors except immediately after birth or in a neonatal intensive care unit.
• Pregnant women should attend regular prenatal check-ups.
• Ensure your child is vaccinated according to the recommended schedule.
• Avoid using advertised products that do not conform to safe sleep guidelines.
• Do not rely on cardiorespiratory monitors to reduce the risk of SIDS. While these devices are not harmful, they do not replace a safe sleep environment.
• Provide supervised tummy time while awake, starting soon after birth. Gradually increase tummy time to 15–30 minutes per day by seven weeks of age.
• Swaddling does not reduce the risk of SIDS. If swaddling is used:
• Always place your child on their back to sleep.
• Ensure the swaddle is snug around the chest but loose around the hips to support hip development.
• Stop swaddling when your child shows signs of rolling over (usually around 3–4 months).

Bed-Sharing and AAP Guidance

The AAP acknowledges that some parents choose to share a bed with their child for various reasons, such as facilitating breastfeeding or believing it is better and safer for the child. However, based on research, the AAP cannot recommend bed-sharing under any circumstances.

Risk factors that increase the dangers of bed-sharing include:

• A parent has reduced alertness due to alcohol, drugs, or extreme tiredness.
• A parent smokes or the mother smoked during pregnancy.
• The child sleeps on a soft mattress, such as a waterbed, old mattress, sofa, or armchair.
• The child is younger than 4 months old.
• The bed is shared with someone other than the parents.
• The child is premature or has a low birth weight.
• There are soft blankets, pillows, or comforters in the bed.

A Bed Shared Safely: Perspectives from James McKenna

Scholars like James McKenna have criticized the blanket avoidance of bed-sharing, arguing that it can be done safely under strict conditions. Here’s how to ensure safer bed-sharing if you choose this option:

Conditions for Safe Bed-Sharing:

• The child sleeps on a firm, empty mattress. Avoid mattresses with headboards or footboards.
• The environment is completely smoke-free.
• The child is placed on their back to sleep, and if breastfeeding, returned to their back after feeding.

Avoid Bed-Sharing If:

• Your child is not breastfed.
• Parents are under the influence of alcohol or drugs.
• Parents are excessively tired or unwell, making it difficult to respond to the child.
• The mattress has gaps where the child could become trapped.
• An older sibling or pet is in the bed.
• You use thick blankets or pillows. Instead, use a fitted sheet or a breathable cotton blanket. In colder weather, use thin layers rather than thick comforters.
• The child’s head or face is covered, or they are overdressed.
• A parent has long hair that isn’t tied back, or there are strings or laces on clothing that could pose a strangulation risk.

Never leave a child unattended in an adult bed.

Want to Help Your Child Sleep Safely and Comfortably?

My online course, The Baby Sleep Blueprint: A Proven, Gentle Method to End Sleepless Nights, contains everything you need to help your child learn to sleep well and safely.
https://www.sleepeatlove.is/The-Baby-Sleep-Blueprint