When Can You Start Using a Pillow in a Child's Bed?
Do not place pillows in your child's sleep environment until they are at least 1 year old, and even after age 1, pillows remain unnecessary and potentially hazardous for toddlers.
Critical Safety Period: First Year of Life
The American Academy of Pediatrics explicitly states that soft materials or objects, such as pillows, quilts, comforters, or sheepskins, even if covered by a sheet, should not be placed under a sleeping infant 1. This recommendation applies to all infants younger than 1 year of age 1.
Why Pillows Are Dangerous for Infants
- Pillows increase SIDS risk up to fivefold when placed under the infant or left loose in the sleep area, independent of sleep position 1
- Pillows create suffocation and rebreathing hazards that significantly increase mortality risk 1
- Multiple infant deaths have been attributed to suffocation against soft, pillow-like materials in the sleep environment 1
After the First Year: Continued Caution
While the explicit guideline recommendations focus on infants under 1 year, the evidence suggests pillows remain unnecessary for toddlers:
- Mattress toppers designed to make sleep surfaces softer should not be used for infants younger than 1 year, indicating that firm sleep surfaces remain the standard through at least the first year 1
- The protective recommendations for firm sleep surfaces without soft bedding are specifically tied to the first year of life 1
Practical Algorithm for Parents
For infants 0-12 months:
- Never use pillows in any form (under, next to, or near the infant) 1
- Use only a firm mattress with a fitted sheet 1
- Keep the sleep area completely free of soft objects 2
For children 12+ months:
- Pillows remain unnecessary for comfort or safety 1
- If parents choose to introduce a pillow after age 1, it should be small, firm, and flat—not adult-sized or soft 1
- Continue to avoid pillow-like objects that could pose suffocation risks 1
Common Pitfalls to Avoid
- Never use pillows as substitutes for mattresses or in addition to a mattress at any age during infancy 1
- Do not use pillows to create barriers to prevent falls from sleep surfaces, as this creates greater suffocation risk than the injury risk it attempts to prevent 1
- Avoid nursing pillows in the sleep environment entirely—recent data shows 84 infant deaths in Georgia over 10 years involved nursing pillows in the sleep space, with 69% found under the infant 3
- V-shaped pillows are particularly dangerous, as infants can become trapped between the arms or underneath the pillow 4
The Bottom Line on Sleep Surface Safety
The safest sleep environment throughout the first year consists of a firm, flat surface with nothing but a fitted sheet 1, 2. Bedding use (including pillows) declined from 86% in 1993-1995 to 55% in 2008-2010, but remains far too common despite clear recommendations against this practice 5. Parents should understand that infants do not need pillows for comfort—their anatomy and developmental stage make firm, flat surfaces both safer and more appropriate 1.