Ultimate Safe Infant Sleep Guide: Crib, Nursery, Traveling, ClothingMay 01, 2023
There is a lot of information available to new parents regarding their baby’s safety as an infant, including sleep safety. As a baby sleep expert, it’s important for me to share (judgment-free) safety information; but ultimately, it’s up to you to do your own research so you can make informed decisions about what’s best for your family! Baby sleep safety recommendations become especially important during phases where babies are having a hard time sleeping well which can often lead to parents making potentially unsafe decisions for their child’s sleeping arrangements out of exhaustion and frustration. The transition from no kids to a parent of a newborn trying to work on healthy sleep habits can be especially exhausting and confusing.
In this blog, I’ll lay out both "protective factors" (actions you can take to decrease risk) that I recommend implementing with your child, as well as "risk factors" (actions that increase risk) that I recommend avoiding. Keep in mind, there are also actions you may take that are neither a protective factor, nor a risk factor - these would be considered a baseline factor.
To add more clarity, here’s an example of a baseline factor vs a protective factor vs a risk factor: moving a baby to their own room before 6 months doesn't increase the risk of a sleep-related injury or death (though it also doesn't decrease it - this would be a baseline factor), whereas putting a baby down on their tummy does increase that risk (making it a risk factor). Using a pacifier for sleep would help decrease risk (this is a protective factor - but not doing it would keep it at a baseline). This can be a confusing topic, but it’s important to understand these differences when making decisions for your family.
If you’re new to learning about sleep safety, the American Academy of Pediatrics is a great place to start when researching safe baby sleep and ways to reduce the risk of SIDS (Sudden Infant Death Syndrome), SUID (Sudden Unexplained Infant Death), suffocation, strangulation, or other injuries. Here are some of the basic intro guidelines they recommend:
- Using a firm infant mattress that properly fits the crib or bassinet with only a tight-fitted sheet
- To stop swaddling at 8 weeks or at the first signs of rolling, whichever comes first.
- Always placing your baby down on their back to sleep (even if they are able to roll independently and end up rolling over after being placed down that way)⠀⠀⠀⠀⠀⠀⠀⠀
- Putting nothing inside the crib or bassinet - no blankets, pillows, toys, bumpers
- Room-sharing for 6-12 months is recommended, bed-sharing is not
- Avoiding overheating - watch your baby’s layers and room temperature (68-72 degrees is ideal) and don’t use head coverings or hats for sleep
Check out this blog for the AAP’s full updated list of sleep safety guidelines and more details on each one.
If your little one is having night wakings and you’re at a loss for why and how to help get them sleeping 10-12 hours a night safely and independently, check out my Mastering Baby Sleep 101 sleep guide!
General Sleep Safety Guidelines for Your Baby’s Location, Position, and Clothing [Updated in 2023]
There are a lot of things to keep in mind when it comes to safe baby sleep; does their crib meet safety requirements? Is there anything in their room that could pose a safety risk?
Just as equally important, is making sure your baby is safe no matter where they are sleeping.
- The AAP recommends room sharing for the first 6 -12 months of life. A wonderful option for this is a bassinet next to a caregiver. The baby is close by but on their own safe, separate surface! Many parents ask for my opinion on bed-sharing. I do not recommend it, because the AAP’s stance on bed-sharing is clear; it poses a large risk factor for safety. And while there are absolutely ways to decrease the risk of bedsharing, the largest issue remains that adult mattresses in the U.S. are simply not firm enough to remove the risk of re-breathing for a newborn or infant. And in that case, even a family following all the recommendations for decreasing the risk of bedsharing has the possibility of suffering potentially dire consequences. (If you are currently bed-sharing and looking for help transitioning your baby to their own sleep space, know you’re not alone. Check out my sleep training guide offers step-by-step support and guidance).
- Always place your baby on their back to sleep, even if they can roll to their tummy independently and they’re not swaddled. Check out this blog for information on this!
- Pay attention to your baby’s core temperature to make sure they don’t overheat. To avoid overheating, it is recommended that your baby does not wear hats during sleep and that their room is kept between 68-72 degrees Fahrenheit. Also, keep what they are wearing in mind. If that temperature is not possible for your home or where you live, you can add or remove clothing layers, use fans to cool a space down, or add rugs and curtains, as well as use a space heater to warm up a space. Just remember to always turn off a space heater before the last adult goes to sleep.
- Don’t keep anything attached to your baby’s clothes during sleep (pacifiers, stuffed animals, etc.). These things are strangulation risks. Always remember, just because something is manufactured does not ensure it’s safe to use (especially for sleep!).
- Use sleep sacks or wearable blankets to add warmth layers to your child and keep the sleep sack’s TOG (the measure of thermal insulance of the garment) in mind based on the temperature inside the room where your baby is sleeping. Usually, a TOG of 1.0 works for the ideal temperature of 68-72 degrees, but you can go up or down depending on whether your home or climate is warmer or cooler.
- Weighted sleepwear is not safe (this is a new AAP guideline from their 2022 safety update). The weighted factor of these products can inhibit a child from rousing out of sleep to safely roll when needed or make it more difficult for them to get out of a potentially dangerous position.
- Check your baby 10 minutes after they’ve fallen asleep. They should be warm and dry. If they feel at all sweaty, adjust layers, the sleep sack TOG, room temperature, add a fan, etc., and then check them again after another 10 minutes.
- If you swaddle, it’s safest to stop and transition to a sleep sack at the first signs of rolling. This can be as early as 8 weeks old, though most commonly between 3-4 months old. But the idea here is that you don’t want to learn that your child can roll in the middle of the night while you’re sleeping. So, it’s best to err on the side of caution with this, especially since some children roll without any overt attempts leading up to the first time. Though, here are some subtle attempts at rolling that you may not know if a preliminary sign that it could be coming soon:
- Rocking on their back and belly
- Lifting up their upper body more during tummy time
- Rolling onto their shoulders
- Kicking their legs and crossing them one over the other
- Scooting around in a circle using their legs while on their back
How to Set up Your Baby’s Room Safely
Before transitioning a baby into their own room, it’s best to double-check the space to make sure you hit all the elements of a safe nursery. Though, it’s also important to remember that all of these guidelines also apply to your bedroom while room-sharing:
- Make sure the crib is not directly under a window. If there’s an accident and the window breaks, the glass would fall into the crib.
- Keep the crib one foot away from any other furniture in the room to limit the risk of injury or entrapment between two surfaces in the event that your child attempted to climb out of the crib.
- Use cordless blinds or install a cord wind-up to wrap blind cords around to avoid a strangulation risk.
- Mount all heavy furniture to the wall. It’s extremely common for larger furniture items like dressers, TV stands, and bookcases to fall.
- Don’t hang items over the crib that pose the risk of falling into the crib (especially heavy items or things that could pose a strangulation risk).
- Use a sturdy changing table with at least 2-inch guardrails and always have your hand on your baby’s body to avoid your baby rolling off of the changing table. Or, it’s always safe to change your little one on the floor.
- Keep your diaper station stocked and within arms reach so there’s no temptation to step away from your little one while they’re on the changing table.
- Routinely check your fire and carbon monoxide detectors to ensure they’re working properly.
- If you’re using a sound machine, ensure to decibel level is at or under 50dBa when testing from inside the crib. There are free apps you can download to test this.
Crib Safety Guidelines for Safe Sleep 2023
Here are 10 important guidelines to keep in mind for ensuring the crib is as safe as possible for your infant or toddler:
- Try your best to use a crib made after June 2011 to adhere to the newest safety standards (no drop-side cribs). It should be noted that older and borrowed cribs from too many years past may have been denigrated over time and may not be up to the safest standards.
- Use a firm infant mattress that fits the frame of the crib. No more than two fingers should fit in the spaces between the mattress and frame.
- Crib slats should be no more than 2 3/8 inches apart (most cribs made after 2011 will adhere to this standard).
- No cutouts on the headboard or footboard. Keep in mind, this does not refer to crib slats. This refers to cutout design elements that some cribs have. It’s ok to have a crib with slats all the way around.
- Use ONLY a tight-fitted sheet; nothing else in the crib - this includes blankets, toys, stuffed animals, or bumpers. You can consider a lovey after 15 months. The safest time to introduce anything extra to your child is once they’re out of the crib and into a toddler bed, but this is a personal choice to make.
- Make sure no wall hangings or other items can fall into the crib at night and that there are no cords or strings nearby to the crib.
- Lower the crib mattress to the middle or lowest setting before your baby begins to sit up.
- Check the crib periodically for loose screws, chipped wood, etc.
- Do not alter the crib in any way that isn’t specified in the manual. This includes using crib covers to try to prevent climbing out.
- Follow the crib manual for lowering the crib mattress and keep these guidelines in mind:
- First level - safe until your baby attempts to sit up.
- Second level - safe until your baby attempts to pull to stand.
- Bottom level - safe until your child attempts to climb out of the crib or is 35 inches tall (this is typically when the top rail is at chest height).
Also, follow the crib manufacturer guidelines for height and weight for when to transition to a toddler bed or floor bed. Make the transition if your child has attempted to climb out and do not place the crib mattress on the floor with the crib frame. Check out this blog for some more guidance on this!
Safe Baby Sleep in the Car & Traveling
These are some of the most critical elements of sleep on the go when it comes to the car seat, stroller, and pack n’ play:
Car Seat Sleep Safety:
- NEVER leave a sleeping (or awake!) baby alone in the car, even for a “quick second,” for any reason, even with the air on.
- Do not let your baby sleep in the car seat outside of the car/car seat base AND don’t loosen your baby’s harness for comfort in OR outside of the car. The concern here is positional asphyxia. The car seat is at a specific angle while properly installed in the base. The harness also plays a role in the position of your little one while they’re in the seat.
- Don’t cover your baby with a blanket - especially while driving. This also applies to the stroller. If you’re in the car and concerned with light, I recommend finding window coverings for the car to block direct sunlight.
- If you’re driving, plan for short breaks every 2 hours or so (feed, diaper change, etc.) No long or overnight sleep in the car. More frequent breaks are better the younger the child. We want to keep a close eye on newborns, especially.
Stroller Sleep Safety:
- Only use an upright seat if your baby can sit up unassisted.
- No extended periods of sleep in the stroller over 1-2 hours (especially for younger babies, and don’t leave them unattended).
- If your child is sleeping in the stroller, keep an eye on the position of their neck and head so as to confirm their airway remains open (head not too far back or forward).
- Don’t place a blanket over the bassinet or stroller, especially unattended or outside in the heat. This is a risk for overheating and suffocation if it were to fall into the bassinet or stroller.
Pack N’ Play Sleep Safety:
- Follow manufacturer guidelines on height/weight and check to ensure the pack n’ play you are using is rated for overnight sleep.
- Only use the mattress meant for your specific pack n’ play (don’t add things or alter it)
- Keep the pack n’ play away from loose cords or cables, including blind cords (3ft minimum, like a crib).
- Don’t place your pack n’ play in the doorway of a hotel room (the bathroom CAN be ok if there is proper airflow [open door] and checked for other hazards [wires, space between furniture, etc.], but not suggested for newborns).
- If your pack n’ play has multiple modes, change it as outlined in the user manual to ensure proper usage (ex: bassinet mode, etc.).
Safe Places for Babies to Sleep
The safest spaces for babies to sleep overnight are:
- The crib or bassinet (flat, firm surface that hasn’t been altered in any way)
- A pack n’ play rated for overnight sleep
Both of these options should be empty with only a tight-fitted sheet, as outlined above. The reason these are the safest place for a long or overnight sleep is that they are flat, firm surfaces that are separate from an adult mattress.
The safest spaces for short periods of sleep or naps are:
- A car seat that is properly installed in the base/car, as this keeps the seat at the correct angle and not in danger of being knocked over (i.e. placing the car seat on a high up or uneven surface outside of the car).
- Bassinet stroller (or regular stroller if baby sits unassisted)
- On an awake adult’s body (wraps, carriers, body, etc.)
Keep in mind if your little one is sleeping on your body, you’ll want to ensure you’re fully awake. If you feel yourself getting sleepy, make sure to place your baby in a safe sleep space. If you find that you have fallen asleep with your baby in your arms, place your baby back in their safe sleep space as soon as you wake up. If your baby is sleeping on your body in a wrap or sling, ensure there is no part of the fabric covering your baby’s face and that your baby’s airway is clear (i.e. head isn’t too far forward or backward).
Places that are not recommended for safe sleep and increase the risk of infant injury, SIDS, suffocation, positional asphyxia, or re-breathing:
- Bouncers, rockers, swings
- A car seat that is not installed in the base
- Loungers (like the SnuggleMe or the DockAtot)
- On a sleeping adult's body on a couch or chair
- On an adult mattress
It’s important to understand that so many of the sleep safety guidelines are not only created to help prevent SIDS (which most parents are aware of, and if you aren’t or want to dive deeper into the details, I recommend this reading from the AAP), but also to prevent serious injury, suffocation, strangulation, positional asphyxia, and re-breathing.
Most of us are aware of what SIDS, suffocation, and strangulation are, but some lesser-known terms that are extremely important to understand in relation to safe infant sleep are positional asphyxia and re-breathing. And these terms are ones that tend to get lost in the shuffle when it comes to information regarding safe infant sleep and the controversial topic of bedsharing.
Positional asphyxia is a condition that occurs when an individual's position restricts their ability to breathe properly. In infants, this can happen when they are placed in positions that put pressure on their chest, neck, or face, thereby obstructing their airway. Positional asphyxia is a major concern for infants sleeping in angled places like rockers, bouncers, swings, and car seats that are not installed in the base, because they can easily slip into positions where their airway becomes compromised. This can be particularly dangerous if a child is left unattended, as they may not be able to move themselves into a safe position and a sleeping baby looks exactly the same as a baby who isn’t breathing.
Re-breathing is another sleep safety concern for infants, especially those bedsharing with adults. It occurs when a baby inhales carbon dioxide that has been exhaled into the air around them, rather than fresh air. This can happen when a baby is sleeping on an adult mattress, which may have a soft surface that allows the baby's face to sink in, creating a pocket of exhaled air. Re-breathing can lead to oxygen deprivation and can be especially dangerous for young infants who are not yet able to roll over or move their heads to get fresh air. To reduce the risk of re-breathing, infants should be placed on a firm, flat surface with a tight-fitting sheet and no pillows or soft bedding, as detailed above.
I know that all of this information can feel overwhelming! And it’s not meant to scare you - it’s meant to give you all of the relevant information possible to make the best choices for your family. But, remember that this information is there to keep your little one as safe as possible. And, if you weren’t aware of some of these guidelines until now, that’s ok! As parents, we are always learning and growing and it’s impossible to know everything all the time. Once we learn new information, we can always make changes moving forward.
So, if you have done or are currently doing any of these things and weren’t aware of the risks - don’t beat yourself up! I’ve been there myself and that’s why it’s so important to me to share the things I’ve learned along the way to help spread this knowledge.
If you find yourself still struggling with your little one’s sleep, wanting to help them get to sleep in their safe sleep space, but can’t seem to make progress or are feeling defeated, please know that you are not alone and that I am here to help. Download one of my comprehensive sleep guides or check out my 1-on-1 email support package for personalized troubleshooting guidance.
Need help transforming your child's sleep? Check out my sleep offerings for children 0-3 years old!
Want to receive updates from Baby Sleep Dr. straight to your email?
Join my mailing list to receive the latest news, blogs, and updates! Don't worry, your information will not be shared.
I hate SPAM. Your information, for any reason, will never be shared with a third party.