Let’s Start with Practical Advice for Parents

Always place your baby on their back to sleep for naps and at night until they’re 1 year old. If your baby rolls over on their own, you don’t need to reposition them.
Use a firm, flat sleep surface covered only with a fitted sheet. Avoid soft mattresses, memory foam, pillows, blankets, and stuffed animals.
Room-share, don’t bed-share. Keep your baby’s sleep area in your room, close to your bed, but on a separate surface designed for infants for at least the first 6 months.
Dress your baby appropriately for sleep using sleep sacks or wearable blankets instead of loose blankets. Don’t use weighted sleepwear or put hats on babies indoors once they’re home from the hospital.
Consider offering a pacifier at nap time and bedtime, which may help reduce the risk of SIDS.
Avoid products that claim to reduce SIDS risk but don’t meet safe sleep guidelines, such as in-bed sleepers, sleep positioners, or home cardiorespiratory monitors.
Breastfeed if possible, as it’s associated with reduced SIDS risk.
Keep immunizations up to date, as evidence suggests this may help protect against SIDS.
Avoid smoke exposure during pregnancy and after birth.
Give your baby supervised “tummy time” when they’re awake to help develop neck and shoulder muscles and prevent flat spots on the head.

Recent Changes to the Safe to Sleep Campaign

The Safe to Sleep campaign, a 30-year federal initiative aimed at preventing infant sleep-related deaths, has recently been impacted by significant funding changes. In April 2025, the Trump administration cancelled federal participation in the program through the National Institutes of Health (NIH). This defunding comes at a particularly concerning time, as infant sleep-related deaths have increased by approximately 12% between 2020 and 2022.

Though the NIH has stated that “no final decision has been made regarding the future of the Safe to Sleep campaign” and that campaign materials remain available online, many resources are listed as “temporarily unavailable for order.” First Candle, a nonprofit organization that has worked with the federal government on Safe to Sleep since its inception, has expressed that the elimination of NIH’s participation is “absolutely devastating” as SUID rates have begun to climb again.

Impact and History of the Safe to Sleep Campaign

The Safe to Sleep campaign began in 1994 as the “Back to Sleep” initiative, focusing specifically on reducing Sudden Infant Death Syndrome through parent education. The program proved remarkably effective, with SIDS cases decreasing from 4,037 in 1994 to 2,226 in 2009. Since the campaign’s launch, the incidence of SIDS declined by more than 50%.

Dr. Rachel Moon, a pediatrician and researcher at the University of Virginia who helped write the American Academy of Pediatrics’ guidelines on safe infant sleep, stated: “At the very beginning of Back to Sleep, the number of deaths decreased by 50%, which is huge. We’ve saved thousands and thousands of babies’ lives because of this.”

In 2012, the National Institute of Child Health and Human Development expanded the initiative’s scope and renamed it Safe to Sleep. This evolution addressed comprehensive safe sleep practices beyond simply recommending back sleeping positions.

Safe Sleep Resources

Each organization offers different types of visual resources that can complement your guide on infant sleep safety.

Current Statistics on Infant Sleep Deaths

According to the CDC, about 3,700 babies died suddenly and unexpectedly in the United States in 2022. While the sudden unexpected infant death rate has declined since the 1990s, significant racial and ethnic disparities persist. Of these deaths in 2022, 41% were classified as SIDS, 31% as unknown cause, and 28% as accidental suffocation and strangulation in bed (ASSB).

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The rate of sleep-related infant death declined significantly in the 1990s after the AAP and others recommended that babies be placed on their backs to sleep, but rates have since plateaued. SIDS remains the leading cause of postneonatal mortality. Black and Native American/Alaska Native infants die at rates more than double that of white babies.

In 2022, the overall infant mortality rate in the United States was 5.6 deaths per 1,000 live births, with more than 20,500 infants dying that year. Sudden infant death syndrome ranked as the third leading cause of infant death, after birth defects and preterm birth/low birth weight.

Current Safe Sleep Recommendations

The American Academy of Pediatrics (AAP) provides evidence-based recommendations to prevent infant sleep deaths. Here are the key guidelines:

Sleep Position and Environment

Infants should be placed on their backs for sleep until they reach 1 year of age. Side sleeping is not safe and is not advised. When babies sleep on their backs, they can turn their head left to right to clear their airway if they spit up, but if they’re on their stomach, they can only turn their head into the mattress.

Babies should sleep on a firm sleep surface (e.g., mattress in a safety-approved crib) covered by a fitted sheet with no other bedding or soft objects to reduce the risk of SIDS and suffocation. A firm surface maintains its shape and will not indent or conform to the shape of the infant’s head.

Use a crib, bassinet or portable play yard with a firm, flat mattress and a fitted sheet. Avoid sleep on a couch or armchair or in a seating device, like a swing or car safety seat (except while riding in the car).

Sleep Location

It is recommended that infants sleep in the parents’ room, close to the parents’ bed, but on a separate surface designed for infants, ideally for the first year of life, but at least for the first six months. There is evidence that sleeping in the parents’ room but on a separate surface decreases the risk of SIDS by as much as 50 percent.

The AAP reiterates its stance against bed-sharing: it’s not considered safe under any circumstance and increases the risk of infant death. Sleeping with an infant on a couch or armchair does as well.

Items in the Sleep Area

Keep soft objects, such as pillows, pillow-like toys, comforters, quilts, sheepskins and loose bedding such as blankets and unfitted sheets, away from the infant’s sleep area to reduce the risk of SIDS, suffocation, entrapment and strangulation.

The AAP’s updated guidance states that weighted swaddles, blankets, and sleepers should not be placed “on or near” an infant while they sleep. Caregivers should avoid putting a hat on their infants indoors, with exceptions for the first few hours of life and in the NICU.

Infant sleep clothing, such as a wearable blanket, is preferable to blankets and other coverings to keep the infant warm while reducing the chance of head covering or entrapment that could result from blanket use.

Additional Recommendations

Breastfeeding is associated with a reduced risk of SIDS. Unless contraindicated, mothers should breastfeed exclusively or feed with expressed milk for six months. The protective effect of breastfeeding increases with exclusivity, but any breastfeeding has been shown to be more protective against SIDS than no breastfeeding.

When an infant shows signs of starting to roll over, stop swaddling your infant during sleep.

Products with inclines of more than 10 degrees are unsafe for infant sleep. The Safe Sleep for Babies Act signed by President Biden in May banned the manufacture and sale of crib bumpers and sleepers with an incline of more than 10 degrees.

Resources for Parents

Despite the federal funding cuts, several organizations continue to provide safe sleep education and resources:

First Candle – A nonprofit organization that continues to provide education on sleep-related infant deaths and support to grieving families (firstcandle.org)
American Academy of Pediatrics – Offers safe sleep guidelines and resources at healthychildren.org
Charlie’s Kids Foundation – Provides safe sleep education including the board book “Sleep Baby Safe and Snug”
Safe to Sleep website – Materials remain available for download at safetosleep.nichd.nih.gov

As nonprofits and other organizations work to continue the Safe to Sleep campaign without federal leadership, they face significant resource challenges. Alison Jacobson of First Candle noted that as a nonprofit, they “don’t have a budget like the NICHD did” to provide the same level of educational resources.

The evidence is clear: following safe sleep guidelines dramatically reduces the risk of sudden unexpected infant deaths. While federal participation in the Safe to Sleep campaign has been reduced, parents, caregivers, healthcare providers, and community organizations must continue emphasizing these evidence-based practices to protect infants during their most vulnerable first year of life.

Resources Used in This Article

The Safe to Sleep Campaign: Recent Changes and Preventing Infant Sleep Deaths

Let’s Start with Practical Advice for Parents

Recent Changes to the Safe to Sleep Campaign