5 Safe Sleep Rules You’re Probably Breaking

Here are some safe sleep rules we don’t need to break on a regular basis to make sure our little lamb is snug and safe as a bug in a rug.

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When I was pregnant with my firstborn I lived in Scotland. I had a midwife, in fact, I never saw a doctor that whole pregnancy. Not even at delivery.

My midwife gave me some things early on that helped me tremendously. First, she gave me a DVD (yes, a dvd!) on how to get a good latch. Second, she told me about safe sleep in no uncertain terms. Flat no surface, no fluff, no decorations, nothing.

She said in the ten years since they’d recommended this, SIDS occurrences had decreased 90%.

We had a few hairy nights when I depended upon my own swaddling skills and was unbearably anxious all night. So I swapped to this swaddle and that was it.

This topic is close to my heart, because I come into contact with so many parents who are using unsafe sleep practices. Sometimes it is from misinformation or lack of awareness, but more often, it’s from sheer desperation.

The numbers are heartbreaking

The numbers are clear, about 3,500+  infants die from sleep related causes every year, including SIDS. A young baby is far more likely to die from SIDS or SUID while sleeping in a grown-up’s bed (check out the evidence and the difference between SIDS/SUID here).

As awful and heart-wrenching as those statistics are, if there is any good news in it, it’s that through prevention and education, many potential future deaths can be avoided.

This article is not a comprehensive list of safe sleep practices. But is a list of the safe sleep practices I most commonly see broken and the reasons this often happens, so that I can help you figure out what to do instead.

Because it’s one thing to KNOW the safe-sleep rule, but it’s an entirely different thing to actually follow it when it turns out following it means endless nights of no sleep.

#1 Baby should always sleep on a flat surface

This is one of the most fundamental recommendations for safe sleep. With the invention and promotion of so many baby products that enable upright sleeping positions it’s not uncommon for some babies to not do any of their sleep on a flat surface.

Instead, they’re using things like the rock’n play, or automatic baby bouncers like the Mamaroo, or just a basic baby swing. Even though these products specifically say they are not for sleep, and that babies should always be supervised, this is often disregarded.

Why breaking it is so dangerous:

A baby sleeping in an upright position is at risk of having his head tilt forward so much that it cuts off his airway and blocks his breathing. There is also the less dangerous but very real risk of baby developing flathead (positional plagiocephaly.)

Why we break it anyway

Baby won’t sleep anywhere else. They seem to want to be upright, or at least tilted up, and cuddled up more, like in the swing or rock’n play. Or, baby falls asleep in the car seat or stroller and is not transferred. Also, motion will lull the babies to sleep when nothing else works.

It’s not deep restorative sleep, according to studies, but at least they aren’t screaming!

Another common reason is that your baby has reflux. This is such a tough one, because they seem truly uncomfortable laying flat on their backs. They also often need to be kept awake after feeds, which can contribute to over-tiredness, making sleep even harder.

Read: How to Stop Contact Naps (Peacefully)- and What to Do Instead

WHAT TO DO INSTEAD

Make sure you swaddle your baby securely and safely, so that they have the comfort of the womb and their startle reflex is in check. Follow wake times to make sure overtiredness isn’t contributing to their inability to sleep flat.

Also, when transferring a sleeping baby from your arms to the crib, have his feet touch the mattress first, not his shoulders or head (which can make babies feel like they’re falling and trigger the startle reflex.)

If you’re finding safe-sleep impossible with your newborn because of genuine reflux, talk about the options for medication with your pediatrician. Continue holding baby upright after feeds, but then place him down on his back.

#2 Baby should always sleep on a firm surface

Along with sleeping on a flat surface, it should also be firm. So, this means never place your baby to sleep on a couch, waterbed, memory foam mattress, pillow of any kind, Boppy, etc.

Why breaking it is so dangerous:

Baby’s head can make an indentation. This means they could bury their face into it. Of course, this potentially leads to suffocation or creating a little air-pocket in which they can re-breathe their own carbon-dioxide.

Why we break it anyway

This one is sometimes accidentally not followed. Mom may fall asleep on the couch or memory foam mattress while nursing the baby. Other times, parents think their child will be more comfortable on a softer surface, not realizing this is unsafe.  

WHAT TO DO INSTEAD

Always check to make sure the surface your baby is sleeping on is approved for BABY sleep. If the product has the word “crib”, “bassinet” or “play yard” in it, it is approved.

Make sure to stay awake while feeding the baby and, if you fall asleep with the baby on an unsafe surface, as soon as you realize it, transfer the baby to a safe sleep space.

#3 Baby should always be placed to sleep on their back for sleep

When the AAP started recommending back for sleep, instead of tummy or side position, SIDS deaths decreased by 40% in a 2 year span. That is a pretty incredible result.

Even so, when parents are desperate and babies will actually sleep on their tummies… they let them. One reason babies sleep on their tummies is they are not able to startle themselves awake. Swaddling will accomplish the same thing, but safely.

Why breaking it is so dangerous

Research isn’t clear about exactly why tummy sleep is such a SIDS risk. It could be because a tummy sleeper is more likely to breathe into the mattress. This creates a pocket of air where they are re-breathing their own carbon-dioxide. This is one of the leading theories on the cause of SIDS.

Who knows why, but research is clear that back sleeping reduces the risk drastically.

Why we break it anyway

Some babies sleep much better on their tummies, and parents are desperate for sleep. Also, some parents worry about a baby with reflux choking on their own spit up. 

WHAT TO DO INSTEAD

Put baby to sleep on their backs and teach them to self-settle. Again, swaddling and following wake-times is extremely important to make sure they are catching their ideal “sleep wave” and not going to sleep overtired.

Also, make sure their sleep environment is optimal.

Some babies who prefer tummy sleep might also benefit from a swaddle or sleep sack like the Nested Bean, which puts a gentle amount of pressure on their chests, similar to what they feel with their chest against the mattress. 

In regards to choking on their spit up, thankfully no research has shown this to be a risk because babies have preventative mechanisms to prevent choking. Babies may cough a little, but they don’t actually choke (choking = blocked airway). So you can rest assured they are safe on their backs. 

#4 Babies should room-share but not bed-share

I go into room sharing strategies here, but this is important to mention.

Though bed-sharing can be done in a safe way, there are so many specific guidelines to follow to make it safe that most parents are not doing it safely. In fact, much of bed sharing is actually done in reaction to baby not sleeping.

Not as a proactive choice. And to be fair, sleeping with baby in a bed is still safer than falling asleep with baby on a sofa.

The scary reality is that the risk of SIDS skyrockets for babies who are sleeping in adult beds unsafely. Mainly because there are too many big blankets and pillows around, the bed is up high and up against a wall, and parents are extremely exhausted.

The risk goes up even higher if there is any smoking, alcohol, obesity, or exhaustion (hello new parents!). People who recommend bed-sharing make the assumption that this will help everyone get MORE sleep.

But the reality is that bed-sharing often leads to extreme exhaustion, which is one of the HUGE safety risks of bed-sharing.

Why breaking it is so dangerous

Bed-sharing increases accidental death by SIDS by up to 40%. This is mostly because of the risk of rolling on top of your baby. Also, baby can get wedged between the mattress and a wall. Other reasons include baby having too many pillows and blankets near his face, or baby overheating. 

Why we break it anyway

Some babies will only sleep attached to their milk source, essentially replacing their beloved mommy pacifier all night. Other reasons include cultural norms, wanting extra bonding at night, and that it’s easier to breastfeed. 

WHAT TO DO INSTEAD

Unless you’re going to follow every single guideline for safe bed-sharing, please just draw the line. Do not pull your baby into bed with you when you know you’ll fall asleep, especially if you’re sleep deprived.

But I’ll say it again, falling asleep with baby in your bed is still safer than falling asleep with baby in a recliner, chair, or sofa. So please weigh these risks with your doctor.

Work towards encouraging healthy sleep habits from the beginning. Keep your baby in a co-sleeper right next to you, if that helps give you peace of mind.

#5 Do not put anything in the crib or bassinet with the baby

Tiny little babies in their big cribs, or even just their empty bassinets can seem so…lonely. It can be tempting to add some cute stuffed animals, a warm blanket, or comfy pillow to help them feel more cozy.

But, this truly goes against the basic safe sleep recommendations from the AAP.

Their cribs or bassinets should be basically empty besides the baby and what baby is wearing.

This includes any baby positioners, wedges, or large “loungers” like the Dock-a-tot and the SnuggleMe. Resist the temptation to put the cute stuffed bear from Grandma in there. Except for a quick photo op, of course. Blankets used to securely swaddle or tightly tucked in (not loose) can be used.

Why breaking it is so dangerous

Having things like bumpers, pillows, loose blankets, or stuffed animals in the crib increases the risk of baby overheating. Or accidentally creating that air-pocket where they re-breathe their own carbon-dioxide.

Thin blankets and the ties of bumpers are also a strangulation risk.  

Why we break it anyway

I remember going into a baby shop in Australia and asking for a crib bumper. She asked how old my baby was and, when I told her, she said, “No, we don’t sell them for babies until they’re 1.” I honestly hadn’t known, but was so glad she told me.

Crib bumpers are still sold and seem cute and cozy and some parents, like myself, didn’t know. Or parents might feel bumpers are necessary for a baby who bangs their head on the crib slats or gets limbs stuck between the slats.

Sometimes parents want to provide more warmth or comfort by adding blankets and pillows. Parents often overestimate how warm a baby needs to be. 

What to do instead

Resist the urge. Focus on dressing baby properly for warmth, and know that babies don’t actually need pillows for sleep. If you use a blanket, make sure it’s tucked into the mattress lower than baby’s shoulders and not loose.

What About These Products…

Here are some more specific things, while we’re at it.

Baby sleep positioners

While playing and hanging out? Sure. While napping or sleeping? Nope. Not safe even to keep baby on his back. These are made of soft materials that are basically little pillows, therefore, not safe, according to the AAP.

If baby is rolling himself to his belly or side it’s okay to let him sleep that way, but he should start off on his back.

A blanket for warmth

There is no need. Just use a swaddle and warmer pajamas, as needed. One extra layer of clothing more than what you’re wearing is fine, if you’re concerned. Feel their ears to see if they truly are cold, and if so, add a onesie under their pajamas, turn up the thermostat slightly, or get a thicker swaddle.

A baby that is too warm is also at an increased risk for SIDS, so remove layers if they are sweating or their chest feels hot to the touch.

The Dock-a-tot?!

Ok, don’t send me hate mail for this. I know a lot of moms swear by the Dock-a-tot for improving their newborn’s sleep, but someone’s gotta say it. Dock-a-tots are NOT safe for unsupervised sleep. I know this is hard to hear for moms who had one of those babies who started magically sleeping through the night after introducing one of these.

As I dug deeper into the Dock-a-tot’s claims about it being a safe-sleep option, it’s mostly based on it being a flat, firm(ish) surface. And it being made out of a “breathable” material, which sounds good, but in reality, “breathability” is not a term monitored by the AAP or verifiable in any way.

Even “breathable” materials can create that air-pocket where they are re-breathing their own carbon-dioxide.

Again, the only things approved for sleep by the AAP is anything labeled “crib”, “bassinet”, or “play-yard”.

“Bouncer”, “napper”, “lounger”, etc. are cleverly thought-out marketing terms but are definitely NOT approved for sleep. 

Is the Mamaroo safe?

It’s safe to sit baby in. To let baby rock and swing and play in. It is not safe to put baby in for their naps and certainly not for their nighttime sleep. Not only is it not flat, firm, and unable to allow baby to sleep on their back, it also swings and any movement keeps baby into lighter sleep.

You can use it to get some free hands and let siblings play and cuddle with baby, but not for sleep.

Let me end this mega post by saying this….

You can teach your little one to sleep without having to go through tricks and do things that are unsafe. It isn’t worth being stressed, anxious, worried, and losing sleep over.

Babies can sleep great in a safe environment – it can take some worth, but it’s totally worth it.