Important tips to help prevent sleep-related injuries and sudden infant death syndrome
If you’re a parent, sleep is an all‑consuming topic. Between the exhaustion of broken nights, planning your day around nap schedules and counting down the hours until bedtime, sleep is always on your mind. During your baby’s first year, that focus sharpens even more as you work to ensure your child is safe while sleeping. But what does “safe sleep” actually mean?
According to the American Academy of Pediatrics (AAP), about 3,500 infants in the United States die suddenly and unexpectedly while they’re sleeping – with most of these tragic deaths due to sudden infant death syndrome (SIDS) or accidental deaths from suffocation or strangulation. So, safe sleep refers to following the AAP’s sleep recommendations – guidance rooted in decades of research aimed at reducing the risk of SIDS and other sleep‑related deaths. This includes ensuring your baby is:
Bringing home a baby is a powerful motivation to create the safest environment possible – and one of the most important steps is minimizing smoke exposure. Tobacco smoke in any form (including vaping and electronic cigarettes, both inside and outside) is a well-established risk factor for SIDS. This makes pregnancy and early parenthood an especially meaningful time to quit smoking or set firm boundaries around your baby’s environment.
“It’s important to know that smoke exposure isn’t limited to actively smoking near a baby,” says pediatrician Gaurav Nagar, MD, with Lehigh Valley Reilly Children’s Hospital, part of Jefferson Health. “Even when someone smokes outside, harmful particles and toxins can cling to clothing, hair and skin (a phenomenon often called thirdhand smoke). If a person smokes and then holds, feeds or cuddles a baby, those lingering irritants can still be inhaled. Studies show that smoke particles can remain on clothing for weeks, and smoke residue can stay in a home environment for up to a month. This means that even if smoking has stopped, the risk doesn’t disappear overnight.”
Because of this, it’s wise to be cautious about anyone who regularly smokes around your baby, including well-meaning grandparents or caregivers. Limiting contact shortly after smoking, avoiding smoke-exposed clothing and keeping your home completely smoke-free are all important protective steps to reduce the risk of SIDS and support your baby’s developing lungs.
One exciting milestone – rolling over – often brings a lot of questions and worry for parents, especially around sleep safety. Knowing what to do at each stage can help you keep your baby safe while still supporting their development.
“If your baby rolls onto their side or stomach but cannot reliably roll both ways on their own, you should gently roll them back onto their back. This applies even if rolling them back wakes them up,” Dr. Nagar says. “Babies who are not yet able to roll consistently from back to tummy and from tummy to back should not be left sleeping on their side or stomach.”
While you should always place your baby to sleep on their back until they are 1 year old, once a baby has clearly demonstrated that they can consistently roll from back to front and front to back – which typically happens between 6 and 9 months – it may be acceptable to allow them to remain in the position they move into while you are supervising them. Before this stage, however, the safest option is always to reposition them onto their back. Current guidelines recommend continuing to roll babies back for up to a month after they begin attempting to roll, until the movement is clearly consistent.
Just as important as sleep position is the sleep environment. When babies start to roll, the crib setup becomes critical. The crib should be completely empty – no pillows, soft blankets, stuffed animals or positioners. A firm mattress with a fitted sheet is all that’s needed. Dress your baby in sleepwear that will keep them comfortable for the room temperature. A clear crib, consistent back-sleeping and attentive supervision will help protect your baby during this exciting stage of development.
Late-night feedings are a reality of life with a newborn, and while they can be exhausting, safety has to come first. The most important rule is simple: The person feeding the baby must be fully awake. If you’re starting to feel drowsy, it’s time to take steps to stay alert – turn on a light, play a podcast, put on a familiar TV show or listen to soft music. Feeding while half-asleep increases the risk of accidents, especially during those long overnight hours. This is also where your support system matters.
“We often hear the phrase ‘it takes a village to raise a baby’ – and nighttime is when that village really counts,” Dr. Nagar says. “If you have a partner or another trusted adult at home, there’s no benefit to both parents being awake at the same time. Two exhausted adults doesn’t ease colic or shorten feedings; they just create two people running on empty. Instead, take turns. Try dividing the night into shifts – of six-hour blocks – so each parent gets a stretch of uninterrupted rest. For example, one parent might handle feedings and soothing from evening until the early morning, while the other sleeps, then you switch. This approach helps ensure that whoever is caring for the baby is alert and present.”
Finding a schedule that works for your family may take some trial and error, but consistency helps everyone.
“Prioritizing sleep is not a luxury – it’s a safety measure for both parents and babies,” Dr. Nagar says. “Late nights are hard, but with planning, teamwork and realistic expectations, they can be made safer – and a little more manageable.”
Colds and stuffy noses can make sleep feel harder – for babies and parents alike. When a baby is congested, lying flat can seem uncomfortable, which often leads parents to wonder whether it’s safe to prop up one side of the crib mattress to help with breathing. While the idea makes sense in theory – adults often breathe more easily when slightly propped up – it’s not recommended for babies.
“Babies are surprisingly wiggly, even as young as 1 or 2 months old,” Dr. Nagar says. “If a mattress is inclined and a baby shifts their position, they could easily turn sideways, slide or end up with their head lower than their body. That head‑down position can actually make breathing worse and increases the risk of unsafe sleep positioning.”
For this reason, propping up one end of the crib or placing blocks under the mattress can be counterproductive and potentially dangerous. Even if the baby starts out positioned safely, movement during sleep can quickly change things. Because of that unpredictability, it’s safest to keep the sleep surface flat, firm and uncluttered, just as recommended for all babies – even when they’re sick.
Instead of adjusting the crib, focus on ways to relieve congestion while maintaining safe sleep:
Are you saving a cherished heirloom for your new baby? Most cribs manufactured before 2011 do not meet current safety standards as outlined by the Consumer Product Safety Commission (CPSC). Changes beginning in 2011 do not allow cribs to have sides that drop down (kits to immobilize the sides also are not permitted). Changes also include a variety of improvements like harder woods and anti-loosening hardware. In addition, do not use a crib that has missing parts or has been recalled and not repaired.
To check if your crib complies, call the CPSC at 1-800-638-2772 or visit its website at CPSC.gov.
Families who are unable to purchase a crib may be eligible to earn a cribette by attending prenatal classes with the help of Lehigh Valley Reilly Children’s Hospital and the national Cribs for Kids® program. You can learn more about the program by talking to your doctor, nurse liaison, social services coordinator or outreach worker.
The cribette can be used until your baby reaches 30 pounds or 35 inches in length. It is compact, sturdy and easy to assemble. It also includes an insert that converts into a bassinet for your new baby, allowing them to stay close to your bed but on a separate sleep surface designed for infants. It also has wheels and a convenient travel case.
To learn more about safe sleep, go to healthychildren.org/safesleep for a complete list of recommendations.
