(312) 600-SIDS

P.O. Box 436017

Louisville, KY 40253

© 2018 Charlie's Kids Foundation. All Rights Reserved.

Safe sleep is hard. Your baby is worth it.



Approximately 3,500 infants die annually in the United States from sleep-related infant deaths, including sudden infant death syndrome (SIDS; International Classification of Diseases, 10th Revision [ICD-10], R95), ill-defined deaths (ICD-10 R99), and accidental suffocation and strangulation in bed (ICD-10 W75). After an initial decrease in the 1990s, the overall death rate attributable to sleep-related infant deaths has not declined in more recent years. Many of the modifiable and nonmodifiable risk factors for SIDS and other sleep-related infant deaths are strikingly similar. The American Academy of Pediatrics recommends a safe sleep environment that can reduce the risk of all sleep-related infant deaths.

A-level recommendations

  • Back to sleep for every sleep.

  • Use a firm sleep surface.

  • Breastfeeding is recommended.

  • Room-sharing with the infant on a separate sleep surface is recommended.

  • Keep soft objects and loose bedding away from the infant’s sleep area.

  • Consider offering a pacifier at naptime and bedtime.

  • Avoid smoke exposure during pregnancy and after birth.

  • Avoid alcohol and illicit drug use during pregnancy and after birth.

  • Avoid overheating.

  • Pregnant women should seek and obtain regular prenatal care.

  • Infants should be immunized in accordance with AAP and CDC recommendations.

  • Do not use home cardiorespiratory monitors as a strategy to reduce the risk of SIDS.

  • Health care providers, staff in newborn nurseries and NICUs, and child care providers should endorse and model the SIDS risk-reduction recommendations from birth.

  • Media and manufacturers should follow safe sleep guidelines in their messaging and advertising.

  • Continue the “Safe to 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.


B-level recommendations

  • Avoid the use of commercial devices that are inconsistent with safe sleep recommendations.

  • Supervised, awake tummy time is recommended to facilitate development and to minimize development of positional plagiocephaly.


C-level recommendations

  • Continue research and surveillance on the risk factors, causes, and pathophysiologic mechanisms of SIDS and other sleep-related infant deaths, with the ultimate goal of eliminating these deaths entirely.

  • There is no evidence to recommend swaddling as a strategy to reduce the risk of SIDS.


The levels above are based on the Strength-of-Recommendation Taxonomy (SORT) for the assignment of letter grades to each of its recommendations (A, B, or C). Level A: There is good-quality patient-oriented evidence. Level B: There is inconsistent or limited-quality patient-oriented evidence. Level C: The recommendation is based on consensus, disease-oriented evidence, usual practice, expert opinion, or case series for studies of diagnosis, treatment, prevention, or screening.


The recommendations outlined herein were developed to reduce the risk of SIDS and sleep-related suffocation, asphyxia, and entrapment among infants in the general population. As defined by epidemiologists, risk refers to the probability that an outcome will occur given the presence of a particular factor or set of factors. Although all 19 recommendations are intended for all who care for infants, the last 4 recommendations also are directed toward health policy makers, researchers, and professionals who care for or work on behalf of infants. In addition, because certain behaviors, such as smoking, can increase risk for the infant, some recommendations are directed toward women who are pregnant or may become pregnant in the near future.