Best Placement for Infants
Infants should be placed supine (wholly on their back) for every sleep by every caregiver until 1 year of age, in their own crib, portable crib, play yard, or bassinet placed in the parents' bedroom close to the parents' bed. 1
Sleep Position
- Place infants supine (on their back) for every sleep until 1 year of age, as this position confers the lowest risk of SIDS compared to side or prone positioning. 1
- Side sleeping is not safe and should not be used, as it carries significantly higher risk than supine positioning. 1
- The supine position does not increase choking or aspiration risk, even in infants with gastroesophageal reflux, because infants have protective airway mechanisms. 1
- Once an infant can roll from supine to prone and back independently, they may be allowed to remain in whatever sleep position they assume, but parents should continue placing them supine initially. 2
Special Populations
- Preterm infants should be placed supine as soon as medically stable, ideally by 32 weeks postmenstrual age, as they are at equal or higher risk of SIDS with prone positioning. 1
- Rare exceptions exist only for infants with specific upper airway disorders (e.g., type 3 or 4 laryngeal clefts) where aspiration risk may outweigh SIDS risk. 1
Sleep Location
Room-sharing without bed-sharing is the recommended arrangement, as it decreases SIDS risk by up to 50%. 1
Appropriate Sleep Surfaces
- Place the infant's crib, portable crib, play yard, or bassinet in the parents' bedroom close to the parents' bed. 1
- Use only a firm mattress designed for the specific product, covered by a fitted sheet with no gaps between mattress and crib sides. 1
- The mattress should maintain its shape and not indent or conform to the infant's head. 1
What to Avoid
- Never place infants on adult beds due to entrapment and suffocation risk. 1
- Avoid all bed-sharing, particularly when the infant is younger than 3 months, as no bed-sharing situation has been demonstrated to be protective against SIDS. 1
- Do not use devices promoted to make bed-sharing "safe" (e.g., in-bed co-sleepers). 1
- Never use sitting devices (car seats, strollers, swings, infant carriers, slings) for routine sleep, especially for infants under 4 months who are at particular risk of positional asphyxiation. 1
- If an infant falls asleep in a sitting device, move them to a crib or flat surface as soon as practical. 1
Sleep Environment Safety
- Remove all soft objects and loose bedding from the sleep area, including pillows, quilts, comforters, sheepskins, and pillow-like toys. 1
- Keep the sleep area free of hazards such as dangling cords, electric wires, and window-covering cords that present strangulation risk. 1
- Do not use portable bed rails with infants due to entrapment and strangulation risk. 1
- Avoid elevating the head of the crib, as this is ineffective for reflux and may cause the infant to slide into a compromised position. 1
High-Risk Bed-Sharing Situations to Absolutely Avoid
Parents must avoid bed-sharing in these circumstances: 1
- When the infant is younger than 3 months (regardless of parental smoking status)
- With a current smoker or if the mother smoked during pregnancy
- With someone who is excessively tired
- With someone using medications (antidepressants, pain medications) or substances (alcohol, illicit drugs) that impair alertness
- With anyone who is not a parent, including other children
- With multiple persons
- On soft surfaces (waterbed, old mattress, sofa, couch, armchair)
- On surfaces with soft bedding (pillows, heavy blankets, quilts, comforters)
Additional Recommendations
- Infants may be brought into the parental bed for feeding or comforting but should be returned to their own sleep surface when the parent is ready to sleep. 1
- For twins and higher-order multiples, provide separate sleep areas and avoid co-bedding. 1
- Provide supervised tummy time daily while the infant is awake to promote motor development and prevent positional plagiocephaly. 2