Safe Sleep Environments for Infants

The California State SIDS Advisory Council on July 23, 2019, reviewed and unanimously endorsed the use of the 2016 AAP Recommendations for all educational activities in California. On January 22, 2013, the Council endorsed the NICHD Safe to Sleep Campaign and their educational materials/publications for use in California. The updated and expanded 2016 AAP recommendations for safe sleep and the sleep environment supported by scientific studies, for infants up to one year of age, are summarized below.

AAP Recommendations

1. Back to sleep for every sleep.
2. Use a firm sleep surface.
3. Breastfeeding is recommended.
4. It is recommended that infants sleep in their parents' room, close to the parents' bed, but on a separate surface designed for infants ideally for the first year of life, but at least for the first six months.
5. Keep soft objects and loose bedding away from the infant's sleep area to reduce the risk of SIDS, suffocation, entrapment, and strangulation.
6. Consider offering a pacifier at nap time and bedtime.
7. Avoid smoke exposure during pregnancy and after birth.
8. Avoid alcohol and illicit drug use during pregnancy and after birth.
9. Avoid overheating and head covering in infants.
10. Pregnant women should obtain regular prenatal care.
11. Infants should be immunized in accordance with recommendations of the AAP and Centers for Disease Control and Prevention.
12. Avoid the use of commercial devices that are inconsistent with Safe Sleep recommendations.
13. Do not use home cardiorespiratory monitors as a strategy to reduce the risk of SIDS.
14. Supervised awake tummy time is recommended to facilitate development and to minimize development of positional plagiocephaly.
15. There is no evidence to recommend swaddling as a strategy to reduce the risk of SIDS.
16. Health care professionals, staff in newborn nurseries and NICUs, and child care providers should endorse and model the SIDS risk-reduction recommendations from birth.
17. Media and manufacturers should follow safe sleep guidelines in their messaging and advertising.
18. Continue the "Safe Sleep" campaign, focusing on ways to reduce the risk of all sleep-related infant deaths, including SIDS, suffocation, and other unintentional deaths. Pediatricians and other primary care providers should actively participate in this campaign.
19. Continue research and surveillence on the risk factors, causes, and pathophysiologic mechanisms of SIDS and other sleep-related infant deaths, with the ultimate goal of eliminating these deaths altogether.