Watching children develop and blossom is one of the great joys of parenthood – and of being a pediatrician. Over my nearly two decades as a board-certified pediatrician, I’ve been able to take part in thousands of happy stories. But there are risks that can turn a happy story into a tragedy. Sudden Infant Death Syndrome (SIDS) is one of those dangerous things that can change your family’s story on a dime. About 3,500 infants die each year in the United States from sleep-related causes, including SIDS and accidental suffocation or strangulation in bed.

These deaths are largely preventable if parents follow a number of well-established recommendations. Recently, the American Academy of Pediatrics (AAP) added a new recommendation that every parent should be aware of.

Primary Recommendations

For some time, pediatricians have recommended that infants be placed on their backs for sleep and that cribs or bassinets should consist only of a firm mattress tightly covered with a sheet, with no soft bedding or other materials. That means no bumper pads, no blankets or pillows and no stuffed animals – they all pose a risk of suffocation. Placing infants on their sides or stomachs to sleep is not recommended.

In October 2016, the AAP added a new recommendation to the list: parents should have their infant sleep with them in the same room, although not in the same bed. Room sharing – placing your baby’s crib, bassinet or play yard in your bedroom, ideally close to your own bed – can decrease the risk of SIDS by as much as 50 percent, according to the AAP. It’s recommended that your baby share your room for at least the first six months of life and optimally for the entire first year.

This recommendation arose from an understanding that middle-of-the-night feedings are challenging for parents and room sharing makes it easier to monitor, comfort and feed your baby. Sometimes, parents fall asleep themselves while offering the breast or bottle. Make an effort to place your baby on his or her back in the crib or bassinet right after feeding. If you happen to doze off with the baby in your bed, return him or her to the crib as soon as you wake up. If you make a habit of taking the baby into your bed for these night-time feedings, clear the sleeping area of blankets and pillows to minimize the risk of suffocation.

While it can be tempting to share your own bed with your baby, this is dangerous because you (and your partner) are at risk of rolling over onto the child. And because adult beds are softer than crib mattresses (not to mention have more layers of bedding), your baby can suffocate, strangulate or become trapped in them.

Additional Ways to Help

Avoid armchairs and couches as sleeping areas. Even feeding an infant in a heavily upholstered chair can be unsafe if you are at risk of nodding off; say, during a 3 a.m. feeding. It’s also not a good idea to let your infant sleep in car seats, strollers, swings or carriers. It increases the likelihood of reflux and flattening of the back of the head. If your baby falls asleep in one of these devices, do your best to move him or her to the crib for a proper nap. (And be sure to provide supervised daily “tummy time,” to ensure proper motor development.)

Breastfeeding and giving all recommended vaccinations help protect your baby against SIDS. It’s also helpful to offer a pacifier at nap time and bedtime. But if the pacifier comes out after your baby falls asleep, there’s no need to put it back in (and if your infant just doesn’t take to the pacifier, don’t worry about it – some babies don’t).

Overheating also has been found to increase SIDS risk. Generally, you should dress your infant for the environment, with no more than one additional layer compared to what you are wearing. Heavy outdoor clothing should come off once you move indoors. Avoid layering too much fabric around the head and face, and be alert for signs of overheating, such as sweating or skin that feels hot to the touch.

There are a number of products on the market claiming to lower the risk of SIDS, such as home monitors and devices that position infants a certain way. However, the AAP finds these devices unproven and recommends against them.

In addition to these precautions, parents should keep their infants away from cigarette smoke. We know women should not smoke during pregnancy, but even after the baby is born, smoke in the baby’s environment is a major risk factor for SIDS. The danger is especially high for infants who share a bed with a smoker, even if that individual doesn’t smoke in the bed. The same cautions apply to alcohol and drug use, both in pregnancy and after birth.

Women who received regular prenatal care and followed their doctor’s recommendations bear healthier children as a rule, and that benefit helps protect the infants from SIDS as well.

With so much to learn and adjust to in these first months of parenting, it’s easy to feel overwhelmed by all the advice and information out there. Your pediatrician is your best ally, not only to advise you on all aspects of childcare, but also to reassure you when you’re doing things correctly.

Unfortunately, national surveys have shown that just slightly more than half of parents receive advice about proper sleeping position from their pediatricians, and even fewer are instructed on the importance of providing an appropriate location for sleep. Make it a point to speak candidly with your baby’s pediatrician about questions or challenges you are having with sleep. I’ve seen the tragedies and want to avoid them just as much as you do as parents.

To learn more about the new guidelines, read the recently released policy statement from the AAP and related coverage.

Or check out the resources for parents and caregivers provided by the U.S.Centers for Disease Control.


Brent Thibodeaux, MD, is a board-certified pediatrician with the Mid-Atlantic Permanente Medical Group in the Washington, D.C., area. He serves as the Group’s pediatric chief in Northern Virginia, and sees patients in the Kaiser Permanente Reston Medical Center, Reston Hospital Center and Virginia Hospital Center in Arlington. He also serves on the board for the Medical Care for Children Partnership in Fairfax, Virginia.