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Health Consultants For Child Care

Enhancing Health, Safety & Learning for Minnesota Child Care Providers since 1993

To provide a safe sleep environment emphasis is placed on eliminating modifiable risk factors.  Certain factors in addition to those included in the triple risk model increase an infant’s risk of SUID/SIDS.  Even though there is no way to know which babies might die of SIDS, there are some things that can be done to make a baby safer.  Experts feel that by removing as many of these risk factors from a baby’s environment as possible during the critical first year of life will get them developmentally “over the hump”. 

One of the best ways to provide a safe sleep environment is to put a baby on his or her back to sleep, even for naps.  In 1992, the American Academy of Pediatrics (AAP) released a statement recommending that “all healthy infants be placed down for sleep on their backs”.  Side sleeping was also suggested as an option.  This recommendation was based on numerous reports that babies who sleep prone (on their tummy) have a 10-15 fold increased risk of SIDS.  In 1994 the AAP reaffirmed this recommendation and launched the national campaign known as “Back to Sleep”. The SIDS rate declined by more than 50% but has plateaued over the years with suffocation and strangulation being on the rise.  In 1996, the AAP reaffirmed that although side sleeping is safer than tummy sleeping, it still carries twice the risk of SIDS as back sleeping does and recommended back sleeping only.  “A child facing upward is more likely to maintain a flow of free air and has less potential for re-breathing carbon dioxide”. In 2011 recommendations were expanded to reduce other sleep related deaths resulting in the name change from Back to Sleep to Safe To Sleep in 2012.  The AAP 2016 guidelines remain the same.

In addition to back sleeping only, the recommendations listed below identify other practices in providing a safe sleep environment. 

They include the following: 

  • Place baby on a firm, tight-fitting mattress in their own crib that meets current safety standards with a tight fitting sheet.
  • Do not place baby on a waterbed, adult bed, sofa, soft mattress, beanbag cushions, pillow or other soft surface to sleep.
  • At least for the first six months keep baby’s sleep area close to, but separate from adults or other children.  “Room sharing without bed sharing”.
  • Remove soft objects and loose bedding:  pillows, quilts, comforters, sheets, blankets, sheepskins, stuffed toys, and bumper pads.
  • Establish a blanket free sleep environment.  Use sleep clothing, such as sleepers, sleep sacks, and wearable blankets. 
  • Keep baby’s head uncovered during sleep.
  • Avoid overdressing or overheating baby.
  • Devices to keep babies on their back or side are not to be used unless indicated in writing by a healthcare provider for use for medical reasons.
  • Do not use breathing monitors or products marketed as “ways to reduce SIDS”.
  • Encourage prenatal care, breast feeding, regular check-ups and routine immunizations.
  • Create a smoke-free environment (a child care license mandate) for the baby, prenatally (before birth) and thereafter.
  • Consider using a clean, dry pacifier when placing an infant down to sleep.  Don’t force a baby to take it or reinsert it once a baby falls asleep.

References: First Candle, Rachael Moon: Are you talking to parents about SIDS?, Caring for Our Children, AAP Talk Force on Infant Sleep Position and SIDS