"Baby Comes Home: A Parent’s Guide to a Healthy and Well First 18 Months"

As most parents know, there are plenty of opinions out there on the best way to put your baby down for naps or bedtime. But the safest method for putting your baby down to sleep is more than just a matter of personal preference. Research has shown that some methods carry serious risks, including accidental injury, suffocation, or SIDS. However, you can lower these risks by making sure your baby has a safe sleep environment.

Experts on child health and sudden infant death agree that the safest place for a baby to sleep during the first six months of life is on his or her back, in a crib in your room (which should be smoke-free). Having your baby close to you will make night-time breastfeeding easier, and may help reduce the risk for SIDS. It’s also safer than having your baby in bed with you, since bed-sharing has been shown to increase the risk of suffocation and SIDS.

Read more: Sleep training 101: Expert tips on making it through the night

Below are Current Sleep Safety Recommendations for a safe sleeping environment for infants.

Don’t Bed-Share

Sharing an adult bed, sofa, or other soft sleeping surface with your baby increases the risk of SIDS. Your baby is also at risk of becoming trapped, smothered, or suffocated.

Use a Crib

Place your baby to sleep in your room, in a crib, cradle, or bassinet that meets current applicable safety regulations. Your baby’s mattress should be firm, flat, and fit snugly in the frame. Strollers, swings, bouncers, and car seats are not intended for sleeping infants. Never put a baby to sleep on a waterbed, sofa, couch, soft mattress, pillow, adult bed, or other soft surface.

Place Your Baby on His or Her Back To Sleep

While babies should spend some supervised time every day on their tummies to help them develop their neck muscles, at naptime and bedtime, they should be put on their backs.

Keep Soft Materials out of Your Baby’s Crib

Don’t use sleep positioners, or place bumper pads, comforters, stuffed animals, pillows, or other items in your baby’s crib or bassinet.

Read more: Preventing SIDS

Make Sure Your Baby’s Room Is Not Too Warm

Dress your baby in light sleepwear that’s comfortable at room temperature, 20° C (70° F). If a blanket is needed, use only a thin, lightweight, and breathable one.

Keep Your Baby Away From Tobacco Smoke

Make your baby’s room and your house smoke-free, and choose a non-smoking caregiver. Don’t allow anyone to smoke around your baby.

SIDS: Sudden Infant Death Syndrome

Tragically, SIDS, sometimes referred to as crib death, is a leading cause of death in babies. In the USA there are more than two thousand SIDS deaths per year. Ninety percent of SIDS deaths occur during the first six months of life, most between two and four months of age. The SIDS death rate has been steadily decreasing since the new recommendation was issued to place all babies on their backs to sleep. SIDS occurs more often in male babies. Also, African-American and Native American infants have a higher rate of SIDS as compared with Caucasian, Asian, and Hispanic babies.

It is also known that SIDS victims are more likely to be born to a young mother with a lower educational level. SIDS tends to occur more in colder geographic areas and during the winter. Recent illness, such as an upper respiratory infection or gastroenteritis, is commonly reported in relation to the baby’s death.

Read more: Let them cry or rock-a-bye?

What Causes SIDS?

SIDS is technically defined as the sudden death of a previously healthy baby younger than one year of age. An infant’s death is attributed to SIDS only if no other cause of that death is found after a thorough investigation. There are many misconceptions about what causes SIDS, and although the exact cause is not understood, it is known that SIDS is not caused by infections, vaccinations, or immunizations.

SIDS is not thought to be caused by suffocation, vomiting, choking, or child abuse. The current thinking seems to focus on three main factors: the age of the child, combined with a problem in the control of breathing, as well as the presence of certain risk factors. These risk factors include the following:

• Prone sleeping position (sleeping on the stomach);

• Soft bedding;

• Cigarette smoke exposure (even during pregnancy);

• Overheating;

• Prematurity.

NOTE: Prone sleeping (sleeping on the stomach), the most important risk factor within a parent’s control, increases the risk of SIDS by ten to fifteen times.

Read more: Diary from the trenches — my first 3 months as a new mom

Prevention of SIDS

The only and best approach to SIDS is prevention, aiming to eliminate some of the risks that are within a parent’s control.

Sleep Position

Sleeping your baby on her back is the most effective way to reduce the risk of SIDS. This applies to night-time as well as daytime naps at home, at the babysitter’s, and even in daycare. SIDS can occur during the day and 20 percent of SIDS deaths occur in childcare settings, while a baby is at the babysitter’s or at daycare. Remember that a baby can be in the prone position (on their stomach) while he is awake. Since experts began promoting the baby-on-back sleep position in 1992, the number of SIDS deaths in the US has declined by 40 percent from 1.2 to 0.7 deaths per thousand births.

Important: Babies who sleep on their side are at twice the risk of SIDS as babies who sleep on their backs. The side position is not very stable, so a baby can easily roll onto the prone (on stomach) position.

Here are some other tips on how to make sure your baby’s sleep environment is safe:

• In baby’s crib: Avoid soft bedding, including blankets, comforters, quilts, pillows, stuffed toys, sheepskins, and crib bumpers.

• If blankets are necessary, only one thin blanket should be used, and it should be tucked in so that it cannot cover baby’s head. In cold weather, a blanket sleeper is an alternative to a blanket.

• Select a crib that conforms to current safety and consumer standards, which has a firm and snug-fitting mattress.

• Never put a baby to sleep on a waterbed, sofa, couch, soft mattress, pillow, adult bed, or other soft surface.

• Avoid overheating your baby. Use light clothes for sleep and keep the room at a temperature of about 20° C (70° F).

• It’s important to realize that removing risk factors decreases but does not completely eliminate the risk of SIDS.

Read more: 10 sleep tips for traveling with babies

No Smoking

Cigarette smoke exposure during pregnancy and second-hand smoke exposure after birth are important risk factors for SIDS. The more a baby is exposed to smoke, the higher the risk. This is one risk factor that parents can definitely control.

Breastfeeding Protects Against SIDS

For reasons not well understood, breastfeeding may have a protective effect against SIDS. This is yet another good reason to breastfeed your baby.

Practical issues

Are There Adverse Effects if Babies Sleep on Their Back all the Time?

Very few. Studies have shown that babies who sleep on their backs have a slightly higher incidence of diaper rash and cradle cap as compared with babies who sleep on their stomachs. A flattening of the back part of the baby’s head (positional occipital plagiocephaly) tends to be more common in babies who sleep on their backs. See the chapter on Head, Neck, and Related Concerns in the previous section of this book.

Can My Baby Choke When Sleeping on his Back?

Multiple studies have not shown any increase in the rate of choking (aspiration of spit-up) related to sleeping on the back.

Can I Ever Put My Baby On His Stomach?

Yes. The baby-on-back position recommendation applies only for sleep time. As a matter of fact, the American Academy of Pediatrics recommends that infants spend time on their tummy every day while awake and supervised. This decreases the incidence of positional plagiocephaly and also promotes motor development.

Is Sleeping With Baby Dangerous?

Co-sleeping (sharing a bed with your baby) on the surface seems to make breastfeeding easier and is more convenient for tired parents. Sleeping with baby in the same bed as the parents occurs in many cultures outside North America. However, there is much controversy about the benefits and risks of co-sleeping. The fear is that although co-sleeping may facilitate breastfeeding and promote bonding, it may also result in overheating, exposure to passive cigarette smoke, and the risk of smothering or suffocation, all factors known to be associated with SIDS.

For years, health experts have been warning parents that babies need to be put to bed in a safe sleep environment. Unsafe sleep environments include parents’ beds. Babies can be accidentally smothered by a parent, and adult mattresses are not suited for babies. Experts also fear that baby may be sleeping on a soft mattress with pillows and quilts, and may be at risk of getting caught or trapped between the bed and the wall, or the bed and the headboard. According to the American Academy of Pediatrics, co-sleeping does not protect against SIDS and in fact, may increase the risk of accidental suffocation.

My recommendation is that parents can be close to their baby by placing the baby’s crib next to their bed. In this way, they can respond to baby’s needs immediately, including quick access to breastfeeding, while not putting the baby at risk. I do not think that this prevents effective breastfeeding or bonding with baby.

Our babies are among our most precious treasures in life. It is worth every effort to make sure that their home and sleep environments are as safe as possible!

Pediatrician Dr. Paul Roumeliotis, Associate Faculty Member, Johns Hopkins School of Public Heallth and Adjunct Professor of Pediatrics, McGill University, is a writer, publisher, and producer of multi-format health and wellness resources. Dr. Paul’s first published book, "Baby Come Home – A Parent’s Guide to a Healthy and Well First 18 Months," focuses on early child development support and its effects.