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SIDS and Safe Sleep Procedures

Updated: Sep 26, 2023

It is a horrible and sad realisation for parents (new and old) that literally thousands of infants die every year during their sleep, from unknown causes.

Pregnant mother looking into a crib with a bumper and toys

The risk factor for SIDS (Sudden Infant Death Syndrome) is thought to be somewhere between 1 in 1000 to 1 in 10,000 with many influencing factors.

What is known is that the increased awareness of “safe sleep” procedures has drastically reduced the incidents of SIDS. For example, between the period 1992 and 2005 the incidence of SIDS in the US declined by as much as 55%, believed to be largely due to proactive campaigns to make parents and caregivers aware of safer sleep procedures.

It is important to qualify that this article, and any recommendations leading from this, are for healthy infants up to 1 year of age. Infants with medical conditions will require specific consideration and should always be discussed with your health practitioners or specialist.

Keeping your infant as safe as possible at night does not require a significant outlay of money. Here are the basic points to remember:


This means you should place your infant on their back to sleep (during naps and at night).

If your infant rolls over on their own – if they are not capable of rolling from back to tummy and tummy to back unaided then you should return them to a safe “back to sleep” position. Once they are able to roll front to back and vice versa easily you can allow them to sleep uninterrupted without moving them, unless there are other contributing factors that should be discussed with your health practitioner or specialist.

If your infant falls asleep in a car safety seat, stroller, swing, infant carrier, infant sling or any similar product they should be moved to a firm sleep surface as soon as possible.

Swaddling may help calm a crying infant and is normal for many parents and caregivers. However when an infant starts to roll it is essential that their arms are no longer restricted. If you believe swaddling assists your infant then consider products that allow developmental free arm movement for transitioning (like fitted sleep sacks).

Baby in a safe sleep position in an empty crib


This can be a cot, crib, bassinet, Moses basket, portable crib, but not a cardboard box as some people may jokingly advise (as the sides of a box do not allow for good ventilation).

Do not incline the sleep space.


If using a sheet ensure it is fitted and the correct size with no loose material.

Do not use blankets, pillows.

Do not use soft toys or objects.

Do not use bumper pads.

4. ROOM-IN (for at least the first 6 months)

Keep the cot, crib or bassinet within an arm’s reach of your bed.

Do not sleep in, or on, the same space as the infant.

Private or public recommendations for or against the use of bedside sleepers or in-bed sleepers are typically in relation to the ease of breastfeeding. however it is the author’s opinion that not enough research has been done to comment on any correlation to SIDS or safe infant sleep.


Keep the room where your infant sleeps at a comfortable temperature.

Dress your infant in no more than one extra layer than you would wear. Your infant may be too hot if she is sweating or if their chest feels hot.

If you are worried that your infant is cold, use a wearable blanket, such as a fitted sleeping sack.

Newborn wearing pajamas lying on a bed


Breastfeeding, and extracted breastmilk, has a correlation to a lower risk of SIDS.

Schedule and go to all recommended well-child visits, including but not limited to general wellness, weight, growth, development and immunisations.

Do not smoke, during pregnancy or after birth, and keep your infant away from smokers and places where people smoke.

If it will not interrupt feeding you can offer a pacifier at nap time and bedtime. This has been shown in studies to reduce the risk of SIDS. Always avoid pacifiers with attachments, clips etc.


Audio - some parents and caregivers find it reassuring to have a monitor between rooms. It enables them to hear unusual noises from an infant’s room. They do not monitor breathing or sleeping position. Please remember that room-sharing is recommended for the at least the first 6 months of life as this infant care practice has been shown to reduce the risk of sudden unexpected infant death). May also monitor environmental factors like room temperature.

Visual – essentially a camera that can be viewed using radio or Wi-Fi networks. Can often be linked to smart devices including phones and tablets. May also monitor environmental factors like room temperature.

Movement monitors - a mat type monitor records infant’s movement and alarms after a pause in movement of 15 to 20 seconds. This monitor is placed beneath the bedding in a flat cot or bassinet. Please note that there are no approved standards for this type of monitor for commercially available products, although A ASTM International safety standard (F2951) requires that electrical cords on baby monitors be labelled with a strangulation hazard warning.

Heart and breathing monitors - register chest movement and the electrical activity of the heart.

Oxygen measurement monitors and oximeters - frequently used in hospital but are rarely used at home. Despite recent developments and improvements in these monitors, many false alarms are still reported.


It is the authors opinion that there is not enough positive research to recommend the use cardiorespiratory monitors outside of a clinical environment.

The use of visual and audio monitors is beneficial to monitor infants sleep position, room temperature and audible sounds from your infant.

The use of visual and audio monitors can be beneficial to reduce parental anxiety.

For movement, heart, breathing or oxygen type monitors false alarms may occur if the infant is breathing shallowly, rolls off a mat, or there are technical problems with the machine A monitor can therefore be disruptive for the family and can increase anxiety.

Some manufacturers of home monitors make false claims that they prevent sudden death. There is currently no evidence, that this author could find, to support these claims.


Baby resting on his elbows and tummy in an empty crib


  • Dress your infant in no more than one extra layer than you would wear. Your infant may be too hot if she is sweating or if the chest feels hotJMra080383

  • Fern R. Hauck and Kawai O. Tanabe, ‘International Trends in Sudden Infant Death Syndrome: Stabilization of Rates Requires Further Action’, Pediatrics September 2008, 122 (3) 660-666; DOI:

  • Jacqui Wise. ‘Cardboard infant boxes should not be promoted as safe to sleep in, warn experts’, BMJ 2018;363:k4311, doi: (Published 17 October 2018)

  • Fern R. Hauck, John M. D. Thompson, Kawai O. Tanabe, Rachel Y. Moon and Mechtild M. Vennemann, ‘Breastfeeding and Reduced Risk of Sudden Infant Death Syndrome: A Meta-analysis’, Pediatrics July 2011, 128 (1) 103-110; DOI:

  • E.A. Mitchell, Associate Professor in Paediatrics, University of Auckland, Auckland, New Zealand J. Milerad, Associate Professor of Paediatrics, Department of Women and Child Health, Astrid Lindgren Children Hospital at Karolinska Institute, Stockholm, Sweden, ‘Smoking and Sudden Infant Death Syndrome’, WHO World Health Organisation, WHO/NCD/TFI/99.11

  • Rachel Y Moon 1, Kawai O Tanabe, Diane Choi Yang, Heather A Young, Fern R Hauck, ‘Pacifier use and SIDS: evidence for a consistently reduced risk’, Matern Child Health J. 2012 Apr;16(3):609-14. doi: 10.1007/s10995-011-0793-x.

  • Christopher P. Bonafide, MD, MSCE1; A. Russell Localio, PhD2; Daria F. Ferro, MD3; et alEvan W. Orenstein, MD3; David T. Jamison, MBA, BSEE, PMP4; Chris Lavanchy, BS, BSME4; Elizabeth E. Foglia, MD, MSCE5 ‘Accuracy of Pulse Oximetry-Based Home Infant Monitors’, JAMA August 21, 2018 2018;320(7):717-719. doi:10.1001/jama.2018.9018

  • American Academy of Pediatrics. Committee on Fetus and Newborn. (2003). Apnea, Sudden Infant Death Syndrome, and home monitoring. Pediatrics, 111(4), 914-7


This information is provided for information purposes only. No claim is made as to the accuracy or authenticity of the content. The author does not accept any liability to any person for the information or advice (or the use of such information or advice) which is provided or incorporated into it by reference. The information is provided on the basis that all persons accessing undertake responsibility for assessing the relevance and accuracy of its content. No responsibility is taken for any information or services which may appear on any linked or referenced websites. The author did not receive any payment or direct funding for any content in this article.

Last modified 2020/August/03


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