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Safe Sleep Frequently Asked Questions
- Are there risks associated with swaddling?
Yes. Multiple risks are associated with swaddling if done incorrectly. They include:
▪ Suffocation: Suffocation occurs when the swaddle becomes loose or undone and obstructs the infant’s mouth or nose. It is difficult for infants to breathe when their mouth or nose is blocked. Suffocation may also occur when swaddled infants roll over on to their stomachs, which makes it more difficult for them to flip back on to their backs. Swaddling should be discontinued as soon as babies show signs of attempting to roll onto their stomachs from their backs.
▪ Overheating: The risk of overheating occurs when swaddled infants are placed to sleep on their stomachs, additional blankets are placed over them while swaddled, or when they are fully clothed underneath swaddling blankets. Overheating puts babies at increased risk of dying suddenly and unexpectedly.
▪ Sudden and unexpected death: Swaddling can increase the risk of sudden deaths when
infants are placed to sleep on their sides or stomachs. This happens when infants who are
swaddled roll on to their stomachs and are unable to flip back on to their backs after they
roll on to their stomachs. Infants who roll on to their stomach while swaddled are at
increased risk of accidental suffocation and overheating.
▪ Developmental hip dysplasia: Developmental hip dysplasia occurs when the ball and socket of the hip joint do not fit properly together in infants and young children. This causes the joint in their hip to be loose or dislocated. Swaddling keeps babies’ knees and hips straight and squeezed together, which increases their risk for hip dysplasia. Babies or young children who are never treated for this condition could experience a limp, hip pain, and stiff joints when they are older.
2. When is it safe for a child to sleep with a blanket or a stuffed animal? A child can sleep with a blanket or a stuffed animal only after he or she turns one year of age. It is never safe for babies under one year old to sleep with a blanket or stuffed animal. A bare crib with a fitted sheet is the safest place for babies under age one to sleep or nap. The American Academy of Pediatrics (AAP) recommends that infants or children under one year of age sleep in a safety-approved crib, bassinet, or play yard, free of soft objects such as toys, stuffed animals, pillows, quilts, comforters, blankets, bumper pads, and loose bedding. The presence of these objects in an infant’s sleep space can increase the infant’s risk of entrapment, suffocation, or strangulation during sleep or nap time.
- What’s the difference between a swaddle and sleep sack?
A swaddle is made using a thin or light blanket or the swaddle attachment on an infant’s
sleepwear to wrap a baby’s body snugly. The swaddle should wrap over the infant’s arms,
fasten securely only across the upper torso, and not constrict the hips or legs. Swaddles can restrict the movement of babies’ arms and legs and can cause injuries or even death when done incorrectly. The American Academy of Pediatrics suggests that swaddling should be discontinued as soon as babies begin to show signs that they are attempting to roll over on their own. Babies usually start to show signs of rolling over on their own around two months of age. Sleep sacks are an acceptable and preferred alternative to swaddle blankets because they can reduce babies’ risk of suffocation and entrapment. There are several designs and types of sleep sacks. However, an appropriate sleep sack is one that has not been recalled and allows for an infant’s arms and legs to move freely.
Some sleep sacks have swaddle attachments or a wrap that look like “wings” and are designed to fasten securely around an infant with Velcro® or other types of fasteners. Like other swaddles, sleep sacks with swaddle attachments are a cause for concern because when used incorrectly, they can increase the risk of injuries, suffocation, strangulation, and even death. They should not be used when a baby shows signs of attempting to roll over from their back onto their stomach.
Note: According to Minnesota Statute 245A.1435, licensed providers can only swaddle an
infant with a parent or guardian’s written permission and can never use a blanket to swaddle.
- Can an infant safely sleep in a sleep sack once he or she can roll over?
Yes. It is generally safe for infants to sleep in a sleep sack which allows their arms to be free and hips and legs to move once they start to roll over. This ensures that they are able to move about freely and can push themselves up when they start to roll over on their own. Babies should not wear sleep sacks with swaddle attachments or wraps once they start to roll over on their own because they could become entrapped or suffocate. Parents or caregivers are strongly encouraged to check on their babies periodically while they are asleep to ensure that they are safe.
- How do I find out if an infant sleepwear product has been recalled?
Parents or caregivers can visit the Consumer Product Safety Commission’s (CPSC) website to review the Recall List (https://www.cpsc.gov/Recalls) of products that have been recently
recalled to determine if their child’s sleepwear is on the list. They may also visit the
SaferProducts.Gov (https://www.saferproducts.gov/PublicSearch) website to search for
products that have ever been recalled by the CPSC using the manufacturer’s name, model, and brand name. Parents or caregivers should keep in mind that the CPSC does not test all
sleepwear. Therefore, just because an item has not been recalled does not mean that it has
been tested and deemed safe.
- Are all infant sleepwear products marketed or sold in stores or on the internet safe for babies to sleep in?
No. Not all products marketed or sold in stores or on the internet are safe for babies to sleep in. Parents or caregivers should be especially skeptical of any product such as mattresses or sleepwear that claim to prevent sudden infant death syndrome (SIDS). To determine if a product has ever been recalled, search the Recall List (https://www.cpsc.gov/Recalls) or the SaferProducts.Gov (https://www.saferproducts.gov/PublicSearch) website.
- Is it safe for infants to use weighted blankets?
The American Academy of Pediatrics does not recommend using weighted blankets in, on, or near an infant’s sleep space because they are not safe. For more information on safest sleep for infants, please refer to the American Academy of Pediatrics safe sleep recommendations
(https://publications.aap.org/pediatrics/article/150/1/e2022057990/188304/Sleep-RelatedInfant-Deaths-Updated-2022?autologincheck=redirected).
- Is it safe for infants to use weighted sleepwear?
The American Academy of Pediatrics (AAP) does not recommend using weighted sleepwear on infants because they are not safe. For more information, refer to the American Academy of Pediatrics safe sleep recommendations
(https://publications.aap.org/pediatrics/article/150/1/e2022057990/188304/Sleep-RelatedInfant-Deaths-Updated-2022?autologincheck=redirected).
- Why should babies sleep on their back?
The American Academy of Pediatrics (AAP) recommends that the safest position for infants under 1 year old to sleep and nap in is on their backs. Placing babies on their backs to sleep makes it easier for them to breathe, clear reflux or spit up, and helps to prevent choking, overheating, and suffocation. The diagram below shows that when babies are on their back, the location of their lungs in relation to their stomach makes it easier for them to clear fluids and prevents choking.
- Should infants wear a mask to prevent them from contracting the COVID-19 virus?
No. The Centers for Disease Control and Prevention (CDC) and the American Academy of
Pediatrics (AAP) do not recommend that children under 2 years of age wear a mask to prevent them from getting the virus. This recommendation applies when they are awake or asleep, or when they are in childcare or at home. Wearing a mask can make it harder for infants and very young children to breathe, thereby increasing their risk of suffocation.
Resources:
Safe to Sleep Campaign (https://safetosleep.nichd.nih.gov/). Eunice Kennedy Shriver National Institute of Child Health and Human Development Safe to Sleep Campaign.
Frequently Asked Questions (FAQs) About SIDS and Safe Infant Sleep
(https://safetosleep.nichd.nih.gov/safesleepbasics/faq)
About SIDS and Safe Infant Sleep (https://safetoskeep.nichd.nih.gov/safesleepbasics/faq)
Sleep-Related Infant Deaths: Updated 2022 Recommendations for Reducing Deaths in the Sleep Environment (https://publications.aap.org/pediatrics/article/150/1/e2022057990/188304/SleepRelated-Infant-Deaths-Updated-2022?autologincheck=redirected?nfToken=00000000-0000-0000-0000-000000000000). The Task Force on Sudden Infant Death Syndrome and the Committee on Fetus and Newborn, Pediatrics, July 2020, 150 (1): e202057990.
Recommendations for Parents / Caregivers About the Use of Baby Products (fda.gov)
How to Keep Your Sleeping Baby Safe: AAP Policy Explained (healthychildren.org)
Baby Products with SIDS Prevention Claims (fda.gov)