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The science behind the AAP’s safe sleep recommendations

The AAP’s updated policy statement on safe infant sleep was released this week (1). I wrote a brief article about the policy update for the Washington Post, but I wanted to dig into the science a bit more in a blog post.

As a side note, let me just say that the opportunity to write for larger media outlets is very exciting, but also very humbling. A typical blog post for me is 2000 words, but I was asked to write 500-800 for the Post. It’s really hard to include in-depth science in a piece like that, but it’s something that I will keep working to improve. Still, can you imagine how I cringed when someone commented on Facebook, “Where is the science?!” about my article? But I probably would say the same thing, and I know that many readers want to understand the evidence base behind these recommendations.

The updated policy statement represented a 2-year effort by the AAP’s Task Force on SIDS to review literature published since the last policy statement, issued in 2011. The statement includes advice on how to reduce the risk of SIDS and other sleep-related deaths such as suffocation and asphyxiation, together considered sudden unexpected infant deaths, or SUID. It is often very difficult to determine whether SIDS or accidental causes caused a death, even after a thorough investigation, and many of the risk factors for these types of deaths overlap. About 3,500 infants die of sleep-related SUID in the U.S. each year. As a parent, I know that losing one of my babies during sleep was one of my greatest fears, and that number holds an incomprehensible amount of tragedy and grief for families. The goal of these guidelines is to prevent those deaths.

The AAP’s Task Force on SIDS is a group of 5 pediatricians, most of them having spent their careers studying SUID. For this 2016 revision, the Task Force also included breastfeeding researcher Lori Feldman-Winter. She told me that she was invited to the Task Force specifically to bring more research and perspective on breastfeeding to the group and to help address the controversy around the risks of bedsharing by breastfeeding mothers (more on that in a minute). The policy statement was also reviewed by the AAP’s Section on Breastfeeding. “The final product is really a meeting of the minds so that we can feel good about what we’ve put forth as the best evidence and the recommendations that follow,” Dr. Feldman-Winter said.

The policy statement is accompanied by a technical report that is loaded with science (400 citations), and it can be accessed and read by anyone interested (2). It’s a tough job for the AAP to issue recommendations for an entire population, knowing that there are big differences in cultural practices and real-world experience, but my opinion is that these recommendations are thoughtful and evidence-based and represent the Task Force’s best advice for parents.

Many of the recommendations on SUID prevention remain the same and should be familiar to parents, although they always bear repeating. Place babies on the back for every sleep, never on the stomach or side. Babies should sleep on a firm, flat surface with no loose bedding, pillows, or toys. Breastfeeding, immunizing on schedule, and getting regular prenatal care all reduce the risk, as does avoiding exposure to cigarettes, alcohol, and drugs in pregnancy and after birth. I’ll put the full list of recommendations at the bottom of this post, but I’ll use the rest of this post to take a closer look at the science behind the recommendations that have received the most attention in the past few days.

Babies should sleep in the parents’ room, close to the parents’ bed, ideally for the first year of life but at least the first 6 months.

Roomsharing without bedsharing was also recommended in the AAP’s 2011 policy statement, but they didn’t specify how long this arrangement should last. I think many parents overlooked the roomsharing recommendation in the past, but this revision gives it new emphasis. Roomsharing for 6-12 months is also recommended in other countries, including the U.K. and Australia.


Based on the AAP’s new safe sleep policy, this is an ideal sleep environment. Image courtesy of the Safe to Sleep® campaign; Eunice Kennedy Shriver National Institute of Child Health and Human Development,

Studies have shown roomsharing without bedsharing to be protective against SIDS since at least the mid-1990’s. Here’s what I wrote about roomsharing in a blog post from last year:

One of the largest case control studies of SIDS combined data from 20 different regions of Europe, allowing researchers to look at 745 SIDS cases and the risk factors associated with them (3). The authors of this study estimated that 36% of SIDS deaths could have been prevented if infants weren’t placed for sleep in a separate room, and 16% could have been prevented if infants weren’t bedsharing. Together, this means that if all of the infants in this study had slept in the same room as their parents, but not the same bed, more than half of their deaths might have been prevented.

This same protective effect of roomsharing has been observed in several other case control studies conducted in Scotland, England, and New Zealand (4–6). The English study found a dramatic 10-fold increased risk of SIDS associated with babies sleeping in their own room. Importantly, at least one study has shown that when infants share a bedroom with other children, it is not protective.6 Instead, the presence of an adult caregiver seems to be important.

Why is room-sharing protective? We don’t know, but it is a strong and consistent effect. The running hypothesis (again from my previous post):

Babies sleeping in closer proximity to their mothers have more sensory exchange (from noises, a touch when a parent checks the baby, etc.) and thus spend more time in light sleep and have more short arousals that protect them from SIDS (5–7).

Most of the studies that have looked at roomsharing have just looked at all deaths under one year of age without trying to parse the data by age. One New Zealand study (6 published in 1996 found that roomsharing was equally protective in infants aged less than 13 weeks, 13-19 weeks, and 20 weeks and older. Without more evidence, the AAP couldn’t say that roomsharing becomes less important at any age, so they took the cautious approach of recommending it for the entire first year. (And caution is what we want when we’re talking preventing infant deaths, right?) They do note that most SIDS deaths occur in the first 6 months, so roomsharing is most important during this time.

SIDS deaths by age

Adapted from AAP, Technical Report: SIDS and other sleep-related infant deaths: expansion of recommendations for a safe infant sleeping environment. Pediatrics 128, e1341–67 (2011).

It’s worth noting that most of our understanding of how to reduce the risk of SIDS and other sleep-related deaths come from case control studies or case series, observational studies that simply can’t distinguish causation from correlation. We’re limited to these types of study designs because, thankfully, SIDS is relatively rare, and it would be virtually impossible to conduct prospective cohort studies or randomized controlled trials on SIDS. The evidence on roomsharing can’t tell us for sure that it causes a lower risk of SIDS, just that it is correlated to a lower risk of SIDS. There could be a confounding factor here – something else that roomsharing parents are more likely to do – or it could be a true effect. Either way, in recommending roomsharing, the AAP is making the best recommendation that they can based on the best evidence that they have.

Evidence also shows that most parents in the U.S. are not roomsharing much beyond the first few months of life. A study published this August in Pediatrics found that among 160 Pennsylvania babies, 55% of 3-month-olds and 74% of 6-month-olds weren’t sharing a room with their parents. Several studies show that parents who roomshare–especially in later infancy–experience more disrupted sleep and are more likely to have stressed relationships with their partners (again, this is a correlation, not necessarily caused by roomsharing). Sleep training is also usually more successful when babies sleep in their own rooms. It will be interesting to see if the stronger roomsharing recommendation will create a cultural shift in sleep environments for babies.

Bedsharing is not recommended.

The AAP’s advice against bedsharing is probably the most controversial recommendation, in part because so many families do it anyway. For some, it is a cultural norm and for others, it is seen as a way of bonding with their babies and facilitating nighttime breastfeeding. Others find that they just struggle to get a reasonable night of sleep without bringing the baby into bed. Still, the AAP is reaffirming their stance that bedsharing is a risk to babies, based on the current evidence.

It’s very clear from decades of studies of SIDS and other sleep-related deaths that bedsharing is associated with many of these deaths. What is controversial is if it is bedsharing itself that is the hazard or if it is other circumstances that might accompany bedsharing – soft mattresses, loose bedding, drug or alcohol use, or sleeping on a sofa or armchair.

Two studies addressing this question were published since the AAP’s 2011 policy statement, but they came to contradictory conclusions. A 2013 study led by Bob Carpenter concluded that, in the absence of these other risks, bedsharing still increased the odds of dying of SIDS by 2.7-fold, and in breastfed babies younger than 3 months old, the odds increased to 5-fold compared to babies roomsharing without bedsharing. However, this study was criticized for lacking much real data on parental drug and alcohol use. And then, a 2014 study led by Peter Blair found that the risk of SIDS wasn’t significantly increased with bedsharing in the absence of other risks, even in younger babies.

Given this conflicting evidence, the AAP commissioned a biostatistician who is not invested in this field to review these two studies. His conclusion? Both of these studies were small, and both had limitations. They used different control groups, which may have pushed Blair’s study towards underestimating the risk and Carpenter’s study towards overestimating the risk, so the real risk may lie somewhere in between. Given this uncertainty, Feldman-Winter said, “we can’t, based on the available evidence, rule out the fact that there is a hazard to bedsharing.”

The AAP notes that some situations make bedsharing more dangerous: when either or both parents are smokers, including if the mother smoked in pregnancy; with babies who were born preterm or low birth weight; in babies less than 4 months old; with any alcohol or illicit drug use that might impair arousal; when there are multiple bedsharers, especially if one of them is not a parent (including other children or pets). Bedsharing on very soft surfaces such as waterbeds, sofas, or armchairs is exceptionally dangerous, and loose bedding or pillows further increase the risk.

But, if parents fall asleep while feeding their babies, it is safer for this to happen in a carefully arranged bed than on a couch or chair.

This is a nuanced but important change in the AAP’s advice. The 2011 policy statement also advised that parents should not sleep on a couch or a chair with a baby, but anyone who has been through the early infancy period knows that there is a good chance of this happening at some point. “I think that what people really wanted after the last policy statement was recommendations on what to do,” said Dr. Feldman-Winter.

So, this time around, the AAP states that if you are in this precarious situation where you know that you may fall asleep while you feed your baby, that it is safer for that to happen on a carefully arranged bed than on a couch or chair.

A 2014 case series published in Pediatrics found that 1,024 infants died while sleeping on a couch or armchair in the U.S. between 2004 and 2012.8 These are preventable deaths. Other studies have found that sleeping with an infant on a couch or chair increases the risk of death by as much as 50- to 60-fold, many times the risk of bedsharing.4,5

If you do feed your baby in bed, arrange it to be as safe as you can. “We also make recommendations about keeping the bed as risk-free as possible by removing pillows and blankets and loose sheets and loose bedding, and also having a firm mattress,” said Dr. Feldman-Winter.

Ideally, the AAP says, you place your baby back in their own bed once you’re done feeding. If you fall asleep, you move your baby as soon as you awaken. I like Elissa Strauss’s suggestion at Slate on this: involve your partner by asking him or her to set an alarm for each feeding and help you move the baby should you both fall asleep.

You don’t need fancy monitors or devices or mattresses to create a safe sleep environment for your baby.

Here’s what Dr. Moon told me about creating a safe place for your baby to sleep: “You don’t need much to prepare a safe sleep environment for your baby. You want a flat, firm surface, and by firm I mean hard…. Ideally a crib, a portable crib, a playpen, or a bassinet. You want the mattress to be fitted for that device. You want a tight-fitting sheet. And then you just want the baby. You don’t want anything else in the crib, so bare is best. Ideally, we want the sleep place to be in the parents’ room, close to the parents’ bed.”

There are a ton of other products out there that promise or imply that your baby will sleep better or be safer if you use their device. There is no evidence that any device can reduce your baby’s risk of SIDS. None. Not the breathable mattresses, which I wrote about for Slate. Not the Rock n’ Play. Not baby swings or carseats. The market for infant care products is largely unregulated, Dr. Moon told me, and there is not a formal process for testing these products for safety. We generally don’t know that a product is hazardous until it causes injuries or deaths and a recall is issued. So, stick with a basic firm, flat, blanket and bedding-free bed for your baby.

Expensive monitors that track your baby’s vital signs also have not been shown to keep babies any safer when they sleep, and pediatricians worry that they might give parents a false sense of security. “I’ve heard many times that if I buy a $500 monitoring device, I don’t have to do the other sleep guidelines, that my baby can sleep prone [stomach down] because they have a pulse oximeter on them all the time,” said Kansas City pediatrician Dr. Natasha Burgert. “They think, I’m exempt from those other suggestions, because I have outsmarted the system by using this technology.”

Pediatricians should have non-judgmental conversations with parents about sleep safety

This is an important addition to the policy statement. Why? Because I know from experience that it can be hard to follow every safe sleep recommendation every night with a young infant, even when you are well-educated about the risks. Sleep is a biological need, and sleep deprivation also has very real risks. Parents are often making decisions in desperation, but a better approach is to rationally weigh risks and benefits and make a plan for sleep that reduces the risks as much possible. Pediatricians can be a great resource in that conversation, and if you’re concerned about sleep, they should be able to help you move towards better, safer sleep for your family.

Here is the full list of safe sleep recommendations from the AAP’s 2016 policy statement:

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 pacifi er 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.

What questions do you have about prevention of SIDS and other sleep-related deaths?


  1. AAP’s Task Force on Sudden Infant Death Syndrome. SIDS and Other Sleep-Related Infant Deaths: Updated 2016 Recommendations for a Safe Infant Sleeping Environment. Pediatrics e20162938 (2016). doi:10.1542/peds.2016-2938
  2. Moon, R. Y. & AAP’s Task Force on Sudden Infant Death Syndrome. SIDS and Other Sleep-Related Infant Deaths: Evidence Base for 2016 Updated Recommendations for a Safe Infant Sleeping Environment. Pediatrics e20162940 (2016). doi:10.1542/peds.2016-2940
  3. Carpenter, R. G. et al. Sudden unexplained infant death in 20 regions in Europe: case control study. Lancet 363, 185–191 (2004).
  4. Tappin, D., Ecob, R. & Brooke, H. Bedsharing, Roomsharing, and Sudden Infant Death Syndrome in Scotland: A Case-control Study. J. Pediatr. 147, 32–37 (2005).
  5. Blair, P. S. et al. Babies sleeping with parents: case-control study of factors influencing the risk of the sudden infant death syndrome. Br. Med. J. 319, 1457–1462 (1999).
  6. Scragg, R. K. et al. Infant room-sharing and prone sleep position in sudden infant death syndrome. New Zealand Cot Death Study Group. Lancet Lond. Engl. 347, 7–12 (1996).
  7. McKenna, J. J., Ball, H. L. & Gettler, L. T. Mother-infant cosleeping, breastfeeding and sudden infant death syndrome: what biological anthropology has discovered about normal infant sleep and pediatric sleep medicine. Am J Phys Anthr. Suppl 45, 133–61 (2007).
  8. Rechtman, L. R., Colvin, J. D., Blair, P. S. & Moon, R. Y. Sofas and Infant Mortality. Pediatrics 134, e1293–e1300 (2014).


  1. Sam #

    Thanks for your post on this important topic. I wrote a comment to share on the Pediatrics website but at present it hasn’t been accepted because it surpasses the word limit. I may edit and send it back but in the meantime I will share my thoughts here. The specific issue that concerns me is the room-sharing recommendation. I’m a developmental scientist, so of course I went straight to the literature to see whether there is actually solid empirical support for this recommendation. After doing so, I have serious skepticism about both the logical and empirical support for recommending room-sharing over having the infant sleep in a separate room for the first year of life, and I am strongly concerned that this recommendation will result in undue stress and other negative consequences for parents who are reluctant to share their room with their infant.

    First, even if there was clear support for sharing a room vs having the infant sleep in a crib in a separate room, there is research finding that parents who share the room with their infants sleep much more poorly than parents who have their infant in a crib in a separate room. The parents’ mental health and sleep quality needs to be considered as well in making these important decisions. Sleep deprivation, depression, and reduced marital satisfaction can all have a serious negative impact on the baby. The risk of SIDS may be outweighed by these other risks.

    Second, I have checked the primary empirical sources that are cited in support of this statement: “There is evidence that sleeping in the parents’ room but on a separate surface decreases the risk of SIDS by as much as 50%,” and as a scientist I cannot conclude that there is good evidence that having infants sleep in the same room with parents on a different surface is less risky than having infants sleep in a separate room in a crib. Here are a few problems I found with these studies:

    1) Some studies are old and predate the recommendation to have infants sleep supine. In at least one study (Scragg et al., 1996) infants may have been at a greater risk in a separate room because they may have been sleeping prone.

    2) ‘Separate room’ in many of these studies doesn’t mean sleeping in a crib alone with no soft bedding/blankets. In Blair et al., 1999, a ‘solitary sleeper’ is an infant who “usually slept in room separate from parents either alone or with other siblings.” In Carpenter et al., 2004, being last left in another room was associated with greater risk than sleeping with parent but not in the same bed. Again, it’s not clear what falls under sleeping in another room, but it’s not safe to infer that this means in a crib alone with no soft bedding/blankets/other hazards. Thus we don’t know that that the reduced risk is purely do to having parents close by to monitor the infant versus some other uncontrolled factors.

    3) In many of the studies, confounding variables are controlled, but not all the relevant variables (e.g., maternal smoking postpartum, alcohol use, bedding/blanket use). Some models control for these things to be sure, but I didn’t see any finding that clearly controlled for all relevant confounds and also defined a clear contrast between room sharing and sleeping in a separate room in a crib.

    At least one study reported a null finding, that sleeping in a separate room vs shared room was not associated with a higher risk of SIDS in non-smokers. (A significant finding was found for smokers, which makes one wonder if sometimes parents put the infant in a separate room because they smoke in bed, and that the real risk factor is the routine exposure to smoke in the home.)

    Finally, similar to another comment that was posted on the Pediatrics site, it’s not clear if the authors are indicating that the reduced risk is due to sharing the room vs separate room, or sharing the room vs. bed-sharing, or sharing the room vs. having the infant sleep on other surfaces (e.g., a couch, in another room with a sibling, etc.).

    Also, what supports the recommendation of room sharing for a year vs. six months? I didn’t see any research support for this. Research shows that many parents transition away from room sharing after 3 months, and I suspect it’s because room sharing with an infant is quite hard on the parents (also supported by research).

    I really think the authors of this report should have considered the empirical support for their recommendations more carefully, given how likely parents are to take these recommendations seriously and the impact they will have on their lives. It’s quite possible that the strong recommendation for room-sharing could inadvertently lead to more bed-sharing, which could actually increase the risk of SIDS.

    Liked by 1 person

    October 28, 2016
    • Hi Sam,

      I share your concern about possible consequences of the roomsharing recommendation in terms of decreased sleep for parents (which brings many risks), more marital stress, and even more bedsharing. I would have liked to see more acknowledgement from the AAP that parents do also have to care for their own health, which means ensuring that they get enough sleep to function well during the day (driving a car, maintaining mental health, etc). That’s important for the health of the whole family, including the health and safety of the baby. The experience in our family has been that we all sleep better once the babies move to their own rooms, and we’re less likely to end up accidentally bedsharing in the middle of the night – because the baby sleeps through the night, or wakes and stirs but goes back to sleep on their own. There are a lot of different factors that play into these decisions.

      I would need to go back and look at these studies more closely to respond to all of your comments and questions, but I agree that these studies have many limitations. They’re also the best evidence that the AAP has, and I think it is hard to ignore. However, we’re also not likely to get better evidence anytime soon. The sample size needed for prospective studies is cost-prohibitive, and even case control studies are difficult at this point because SIDS is relatively rare. You’re right that many of the studies that these recommendations are based on are from the 1990’s, when prone sleep was more common, but we may be stuck with this imperfect evidence for now. So again, I do think that the roomsharing recommendation is evidence-based, but I also agree that this will be hard for many families, and individual families have to weigh the risks and benefits based on their situation. I’m glad the AAP emphasized the 6-month-mark as being most important – that’s great information to have.

      Liked by 1 person

      October 28, 2016
    • Laura #

      I have similar concerns. We kept our children in the room with us for 4 months (which is longer than most other parents I have spoken with). While I felt justified having these “official” recommendations for room-sharing, I also know that I counted down the days until we could move ours to the nursery bc I was sleeping so poorly, and I’m not sure that I could maintain my sanity sharing a room 6 months, much less a year.

      Also, we sleep train around 5 months, which has been a great experience both times (my children learn quickly, and we all sleep better). I’m not sure that it would go very well if our children could wake up and see us in the room!

      Final thought: most children will start pulling up (and need a full-size crib for safety) well before a year, closer to 6 months, really. Hopefully the recommendations make it clear that basinets and mini-cribs are not sufficient in these cases.

      We are planning to have more kids, and I’m really not sure what balance we will strike moving forward…. :-/

      Liked by 1 person

      October 28, 2016
  2. thank you! This is an excellent, comprehensive look at the AAP recommendations.


    October 28, 2016
  3. Alexandra Cannon #

    How did immunizations topic get into the AAP sleep policy? Is there a connection between following the CDC vaccination schedule and sleep-related SUIDs?


    October 28, 2016
    • Hi Alexandra – great question. A 2007 meta-analysis found that immunization was associated with a 50% reduction in odds of SIDS. Why that is isn’t clear. We do know that babies who die of SIDS are more likely to have mild respiratory illnesses, so it could be that babies that are immunized on schedule are just less likely to be sick. On the other hand, it could be that babies that are sick are less likely to get their shots on time – something called the “healthy vaccinee effect.” So, as with some of these other recommendations, it isn’t clear if immunizations directly protect babies from SIDS or if it’s just a correlation. Either way, recommending that children be immunized on time is evidence-based and good for their health for other reasons:)


      October 28, 2016
  4. Pam #

    I always appreciate your in-depth, scientific approach to these important topics and I share them with my clients and followers. I’d like to learn more about what you mean by, “It will be interesting to see if the stronger roomsharing recommendation will create a cultural shift in sleep environments for babies.”

    I have concerns for the moms with postpartum anxiety or difficulty sleeping when baby is in the room with them at night. The policy statement doesn’t address how to make this work without causing devastating effects to some families. I’d be curious about the number accidents, injury or deaths caused by severe sleep deprivation, anxiety and stress on families compared to the number of SUIDS accidents from babies in separate rooms.


    October 29, 2016
    • Hi Pam – I agree that there could be risks to this recommendation and share your concern. I’m struggling to know how to quantify them or how they could be integrated into recommendations about safe sleep, but it’s something that I’m still thinking about.

      What I mean by the statement that you quoted is that moving our babies to separate rooms after the first few months of life is currently the cultural norm in the U.S., but it isn’t in other parts of the world. In the FB discussion about this post, several commenters from the U.K. and Australia said that at least 6 months of roomsharing is the recommendation in their countries, and their observations were that most mothers they know follow this recommendation. I do think that part of our hesitancy about it could be overcome if this just becomes more of the expectation. It doesn’t mean that it will be easy for all families, but it might work better than many people think.


      November 3, 2016
  5. Sarah #

    Thank you for such a thoughtful, detailed post! I’m curious, when “following all the safe sleep guidelines” intersects with “baby doesn’t sleep at all,” is there any way parents can find out whether certain products designed at helping baby sleep better are genuinely safe? Things like all the creative swaddling devices, the Slumber Sleeper or the Safe T Sleep that keep baby centered and on his back without being a loose sleep positioner, or Dr. Harvey Karp’s new “SNOO,”–products like these that still follow the Alone-Back-Crib guidelines–does the AAP ever give a thumb’s up to anything of the sort?


    October 29, 2016
    • Unfortunately, there just aren’t safety data on these sorts of products, so the AAP can’t really offer a comment on them. Dr. Moon told me that when evaluating products like this, look for something that really provides a firm, flat sleep surface, tight-fitting sheet and nothing more, with no padded sides or soft fill anywhere. The policy statement doesn’t specifically comment on products that actually restrain baby on his or her back, and I haven’t heard anyone from the SIDS Task Force comment on them. I’m personally not a big fan, because I think it developmentally makes more sense to give babies the freedom to move their bodies and find comfortable positions for sleep as they grow stronger, but I don’t have any evidence that there are risks to these products. I will say that there is not evidence that babies are suddenly at greater risk of SIDS when they start rolling from back to tummy and back again, so long as their sleep environment is kept clear of loose bedding per the guidelines. I dislike the marketing claims from these companies that their products somehow make babies safer by restraining them on their backs, because there just isn’t evidence to support those claims, so I think they’re using fear to sell their products. I’m curious why these products might make for better baby sleep? I understand that the SNOO has built in movement and noise, so I get that, but do you think the Slumber Sleeper and Safe T Sleep make for better sleep? Because it allows you to keep older babies swaddled longer? My experience with both of mine was that they slept better once they were able to roll to their tummies and get cozy (I always continued to place them on their backs, of course, but then let them choose their sleep position).


      November 3, 2016
      • Sarah #

        I fully agree there’s no reason to keep a baby on his back once he’s capable of rolling. Mine were like yours–they liked tummy sleeping once they got used to it on their own. I was thinking of these products and various swaddles (like the “Zen Swaddle” which claims to use a magical kind of specific weighting… *shrug*) as being ways to safely allow baby to feel snuggled and kind of “held.” The MamaRoo and the Rock ‘n Play would be other products that do the same thing, but they don’t provide that firm, flat sleep surface–that’s why I’m curious about the claims of other devices that seem to fit the safe guidelines. The Pediatrics article from earlier this year that looked at sleep environments highlighted how often parents go from following the safe sleep guidelines to deviating from them during the night–baby goes back to sleep on his tummy after waking up instead of being put on his back again, reactive co-sleeping, using a swing or car seat instead of going back in the crib, that sort of thing. And we know that there’s a huge risk associated with a lot of these things. If parents are switching to something potentially more dangerous during the middle of the night, might there be a way to add more soothing in a safe way for babies who like that feeling of being cradled? I’m curious if simply having a good swaddle would have improved consistent safe sleep practices in the Pediatrics study.


        November 9, 2016
  6. Fage #

    Hi. I’m very interested to know more about the studies, findings and information gathered.
    Particularly when it comes to sleep safety and vaccinations .


    October 29, 2016
    • The full AAP policy statement has an extensive list of references.


      October 29, 2016
      • Fage – I also responded to Alexandra’s question above about the association between immunizations and lower risk of SIDS.


        November 3, 2016
  7. Thank you for this insightful review! Any thoughts on when an infant can’t sleep well in the parents room? Our daughter started sleeping 12 hours once we moved her out of our room at 8 weeks. She’s now 11 weeks and now has regular naps and barely cries when being put down. She is very alert and sleeping in our room was very distracting for her.


    November 2, 2016
    • That’s pretty amazing sleep! It’s definitely normal to have more wakings with baby in your room (for both babies and their parents!), so I think you have to figure out what will work for you. She might get used to sleeping in your room if you tried it again, or she might continue to be a bit more wakeful. White noise may help to decrease sleep disruptions from sounds in the room.


      November 3, 2016
  8. Margaret #

    They seem to be recommending nursing at night in (a well-prepared) bed over nursing in a chair because of the risk of falling asleep in the chair, but I wonder how the risks really compare. In two total years of nursing my two kids, I could count on one hand the number of times I fell asleep in the glider with the baby in my lap. But nursing in bed seems like it would lead to a lot more falling asleep with the baby there (everyone I know says that’s the big benefit of doing it that way, in fact). So I wonder what is really safer. Falling asleep with the baby in a chair is less safe, but is also probably less likely to happen.


    November 2, 2016
    • Yes, I think you’re right. This perfectly illustrates the challenge for the AAP of giving advice that will actually keep babies safer. I think it’s smart to emphasize how dangerous it is to fall asleep with a baby in a couch or chair, but I can also see how feeding in bed could lead to more bedsharing. That was my experience, anyway. I would still choose to feed in bed if there was a chance that I would fall asleep, but if I was certain I could stay awake, I would choose to feed upright because I knew I could do a quick feeding and place the baby back in his own bed, and then we both would usually get a better chunk of sleep and longer feeding interval in that arrangement vs. feeding in bed, which could turn into an all-night buffet in which neither of us fully woke. I really think we have to think ahead to the likely scenarios and make the best choices we can.


      November 3, 2016
  9. Stephanie #

    Hi Alice, thanks for the in-depth explanation. I can see how room sharing would be the safest bet with a baby up to a year, but our small apartment bedroom won’t fit anything more than a bassinet next to the bed. Our baby is due late December, and we’re struggling to find something small enough to fit by our bed that will keep a baby safe for sleeping for up to a year. I’m worried we’ll have to take our chances and transfer her to the crib in our second bedroom when she starts turning over and outgrows the bassinet. Any words of wisdom?


    November 7, 2016
  10. I love science and journalism and learning and being a mom! Huge fan of your site. Sleep is a giant fuzzy monster in our house. I knew all the rules and tried so hard (SO HARD) to follow them. Ultimately, we did create the safest environment possible for co-sleeping and I came to love it. Our daughter is 16 months now and did eventually come to sleep in her crib in her own room. Hoping to find a better balance with our next kid, though. Ideally I’ll be world’s wiser next time 😉


    November 23, 2016
  11. tyn #

    I love science and learning and being a mom. Huge fan of your site! And I’m especially interested in this post as sleep is a giant, fuzzy monster in our house. As a new mom and a complete rule-follower, I tried so hard to follow all of the safe sleep recommendations. I also keep one foot strongly in the holistic camp and I have plenty of friends who advocate co-sleeping and nursing all night long. It can be very stressful as a parent to get everyone the sleep they need while checking off all the boxes for safe sleep recommendations. (And who wouldn’t want to, when it’s lives at stake). If/when we get to have another kid, I look forward to being worlds wiser and calmer the next time 😉


    November 23, 2016
  12. Cassandra Weber #

    I saw nothing in the article on how immunizations decrease the risks of SIDS? Where is this recommendation coming from? Is there research on this topic in particular?


    December 27, 2016
  13. Nice information


    April 7, 2017
  14. Really good article – It’s just good to see the science behind these big authorities’s advice.


    May 9, 2017
  15. Sleep Deprived Mama #

    Thank you for providing information on the background/supporting research behind AAPs recommendation.

    I am also struggling with AAP recommendation on room sharing up to a year. Even at 4 months my daughter has outgrown her bassinet, there simply is not enough room for her to be able to move freely. Several weeks ago, we transitioned her from the bassinet to a crib in a separate room. (Just want to say I would have loved to keep her close, but there is no room in our bedroom for anything larger than a bassinet.) It has been very difficult on me knowing that we were going against AAP recommendation and not keeping her in the room with us for at least 6 months. I have been feeling guilty and nervous that i might be somehow endangering her by not keeping her nearby.

    I would really like to see some more evidence from AAP on what was included in the category of “crib in a separate room”. As many have pointed out, there are a number of differences from the practices the research sites vs now (for example: the use of bumpers, sleeping in prone vs supine position, etc). How much of that vs simply being in a separate room was the contributing factor?

    I also noticed that since transition her quality of sleep has improved and she only occasionally wakes up for a feed during the night. (I am still struggling and are up several times per night to check on her. So I cant say my sleep has improved).


    July 17, 2017

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