What are the recommended sleep guidelines for a 4-month-old infant?

Safe Sleep Guidelines for a 4-Month-Old Infant

Place your 4-month-old infant on their back to sleep on a firm, flat surface in your bedroom (but not in your bed) for every sleep period, with no blankets, pillows, or soft objects in the sleep area. This approach reduces the risk of SIDS by up to 50% and prevents suffocation, strangulation, and entrapment. 1, 2

Sleep Position

• Always place your infant on their back (supine position) for every sleep, including naps and nighttime sleep. 1, 3
• At 4 months, your infant is at particularly high risk if placed in sitting devices (car seats, swings, infant carriers) for routine sleep, as they may assume positions that create suffocation or airway obstruction risk. 1
• If your infant falls asleep in a sitting device, move them to a crib or flat surface as soon as practical. 1

Sleep Surface Requirements

• Use a firm, flat mattress in a safety-approved crib, bassinet, portable crib, or play yard that meets Consumer Product Safety Commission standards. 1, 2
• The mattress must maintain its shape and not indent or conform to the infant's head shape—avoid memory foam mattresses. 1
• Cover the mattress with only a fitted sheet and nothing else. 1, 2
• Never place your infant on beds, couches, or armchairs for sleep due to entrapment and suffocation risk. 1, 4

Sleep Environment Setup

• Room-share without bed-sharing: Place the crib, bassinet, or play yard in your bedroom close to your bed, ideally for the first year but at minimum for the first 6 months. 1, 4
• This arrangement decreases SIDS risk by as much as 50% while facilitating feeding, comforting, and monitoring. 1, 4
• Keep the sleep area free of hazards including dangling cords, electric wires, and window-covering cords. 1

What to Keep OUT of the Sleep Area

• Remove all soft objects and loose bedding: no pillows, quilts, comforters, sheepskins, blankets, bumper pads, or stuffed toys. 1, 2
• These items can obstruct your infant's nose and mouth, creating suffocation risk. 2
• Even when covered by a sheet, soft materials should never be placed under or around a sleeping infant. 1, 2

Keeping Your Infant Warm Safely

• Use infant sleep clothing such as a wearable blanket instead of loose blankets to keep your infant warm. 2
• Dress your infant in no more than one layer more than an adult would wear to be comfortable in that environment. 2
• Avoid overheating. 1, 3

Bed-Sharing: Critical Avoidance at 4 Months

Never bed-share with your 4-month-old infant. 1, 4

Your infant is at particularly high risk because:

• Bed-sharing when the infant is younger than 3 months is dangerous regardless of parental smoking status. 1, 4
• At 4 months, your infant remains in the highest-risk period for SIDS and sleep-related deaths. 4

Additional bed-sharing situations to avoid at all times:

• Bed-sharing with a current smoker or if the mother smoked during pregnancy. 1, 4
• Bed-sharing with someone who is excessively tired. 1, 4
• Bed-sharing with someone using medications or substances (alcohol, illicit drugs, certain antidepressants, pain medications) that could impair alertness. 1, 4
• Bed-sharing with anyone who is not a parent, including other children. 1

You may bring your infant into bed for feeding or comforting, but return them to their own crib or bassinet when ready to return to sleep. 1

Sleep Duration Recommendations

• A 4-month-old infant should sleep 12 to 16 hours per 24 hours (including naps) on a regular basis to promote optimal health. 5
• Adequate sleep is associated with better attention, behavior, learning, memory, emotional regulation, and physical health. 5

Additional Protective Measures

• Breastfeed if possible, as breastfeeding is associated with reduced SIDS risk, with protective effects increasing with exclusivity. 1, 6
• Consider offering a pacifier at naptime and bedtime. 1, 3
• Avoid smoke exposure during pregnancy and after birth. 1, 3
• Avoid alcohol and illicit drug use during pregnancy and after birth. 1, 4, 3
• Ensure your infant receives routine immunizations according to AAP and CDC recommendations. 1, 3

Developmental Considerations

• Provide supervised, awake tummy time when your infant is awake to facilitate development and minimize positional plagiocephaly. 1, 6
• This should only occur when your infant is observed and awake, never during sleep. 1

Common Pitfalls to Avoid

• Do not think placing blankets "away from the baby's face" is safe—infants move during sleep and can become entangled. 2
• Do not use devices promoted to make bed-sharing "safe" (such as in-bed co-sleepers)—these are not recommended. 1
• Do not elevate the head of the crib—this is ineffective for reducing reflux and may cause the infant to slide into a position that compromises respiration. 1
• Do not use commercial devices inconsistent with safe sleep recommendations. 1