Few topics generate as much conflicting advice as baby sleep, and baby products don’t always help: plenty of items sold for sleep don’t match what pediatric guidance recommends. This guide summarises the current recommendations from the American Academy of Pediatrics (AAP), last fully updated in 2022, along with the U.S. Consumer Product Safety Commission’s (CPSC) rules for sleep products.

The ABCs: alone, on the back, in a crib

The core of current guidance is often summarised as Alone, Back, Crib:

  • Alone: your baby should sleep on their own sleep surface, with no pillows, blankets, bumpers, soft toys or other people.
  • Back: place your baby on their back for every sleep, naps included, until their first birthday. Once a baby can roll both ways (back to front and front to back) on their own, you don’t need to turn them back over, but keep placing them on their back to start.
  • Crib: use a firm, flat, level surface in a product made for infant sleep, such as a crib, bassinet, play yard or portable crib that meets CPSC safety standards, with only a fitted sheet.

A firm, flat and empty sleep space

“Flat” matters. The AAP recommends that sleep surfaces are not inclined, and CPSC rules now require products marketed for infant sleep to meet a mandatory safety standard (such as the standards for cribs, bassinets and play yards), which limits the sleep surface incline to 10 degrees or less. The Safe Sleep for Babies Act of 2022 banned the sale of inclined sleepers and padded crib bumpers in the United States.

In practice:

  • Use the mattress made for, or specified for, your crib or bassinet. It should fit snugly with no gaps at the sides.
  • Use a fitted sheet only. Keep loose blankets, pillows, positioners, wedges, bumpers and soft toys out of the sleep space.
  • Don’t add extra padding or toppers to make a mattress “softer”.
  • If you want to keep your baby warm, use a wearable blanket (sleep sack) instead of a loose blanket, and dress them in no more than one extra layer than an adult would wear to be comfortable.

Room-sharing without bed-sharing

The AAP recommends that babies sleep in the parents’ room, close to the parents’ bed but on a separate surface, ideally for at least the first six months. Room-sharing makes it easier to feed, comfort and watch your baby.

The AAP doesn’t recommend bed-sharing. The risk is higher in some situations, including when a baby is younger than four months or was born preterm, when an adult in the bed smokes or has used alcohol or sedating medication, and when sleeping on a soft surface such as a sofa or armchair. Falling asleep with your baby on a sofa or armchair is especially dangerous.

If you’re feeding your baby in bed at night and think you may fall asleep, the AAP advises removing pillows and blankets from around the baby, and moving the baby back to their own sleep space as soon as you wake up.

Sitting devices are not for routine sleep

Car seats, strollers, swings, bouncers, infant carriers and slings are not designed for routine sleep. If your baby falls asleep in one, move them to a firm, flat sleep surface as soon as it’s practical and safe to do so. For car seats, that means once you’ve reached your destination and taken the seat out of the car.

Babies do sleep in car seats while travelling, and a correctly installed car seat is the safest place for them in a vehicle. The concern is using a car seat, or any sitting device, as a regular sleep space outside the car.

Swaddling

Swaddling can help some young babies settle, but it needs care:

  • Always place a swaddled baby on their back.
  • Keep the swaddle snug around the chest but loose around the hips and legs, so the hips can bend and move.
  • Stop swaddling as soon as your baby shows signs of trying to roll over.
  • Avoid weighted swaddles.

Other steps that lower risk

The AAP’s recommendations also include:

  • Offer a pacifier at nap time and bedtime. If you’re breastfeeding, you can wait until breastfeeding is well established. You don’t need to put it back in if it falls out after your baby falls asleep.
  • Avoid overheating and don’t cover your baby’s face or head while they sleep.
  • Keep your baby away from smoke, including during pregnancy, and avoid alcohol and drug use around infant care.
  • Breastfeeding is associated with a lower risk of sudden infant death, if it’s possible for you.
  • Keep up with routine vaccinations.
  • Supervised tummy time while your baby is awake helps development and reduces flat spots on the head.

A word about monitors and gadgets

Products marketed as reducing the risk of sudden infant death syndrome (SIDS) aren’t a substitute for a safe sleep environment. The AAP advises against using home cardiorespiratory monitors or consumer devices to reduce the risk of SIDS. A baby monitor can be convenient for hearing or seeing your baby from another room, but it doesn’t make an unsafe sleep space safe.

Quick checklist

  • Baby on their back for every sleep
  • Crib, bassinet or play yard that meets current CPSC standards
  • Firm, flat mattress with a fitted sheet and nothing else
  • Wearable blanket instead of loose bedding, if needed
  • Room-sharing, on a separate surface, for at least the first six months
  • No inclined sleepers, bumpers, positioners or weighted sleep products
  • Move sleeping babies from car seats, swings and carriers to a flat surface when practical

For product-specific advice, see our Nursery & Sleep guides, and check whether any sleep products you already own have been recalled with our guide to checking baby product recalls.