SIDS and Other Sleep-Related Infant Deaths: Updated 2016 Recommendations for a Safe Infant Sleeping Environment


Pediatrics, October 2016, From the American Academy of Pediatrics, Policy Statement


Approximately 3500 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 non modifiable 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. Recommendations for a safe sleep environment include supine positioning, the use of a firm sleep surface, room-sharing without bed-sharing, and the avoidance of soft bedding and overheating. Additional recommendations for SIDS reduction include the avoidance of exposure to smoke, alcohol, and illicit drugs; breastfeeding; routine immunization; and use of a pacifier. New evidence is presented for skin-to-skin care for newborn infants, use of bedside and in-bed sleepers, sleeping on couches/armchairs and in sitting devices, and use of soft bedding after 4 months of age. 

Summary of Recommendations With Strength of Recommendation

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 a

fter 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