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Information for Parents and Caregivers

There are lots of ways you can help make your baby’s sleep space safe, prevent Accidental Suffocation, and reduce the risk of Sudden Infant Death Syndrome (SIDS).


ABCs of Safe Sleep: Baby should always be alone, on their back, and in a crib














Answers to Frequently Asked Questions

ALWAYS place baby on its back to sleep and at nap times. Place baby on its belly for supervised play time as this will help strengthen their neck muscles to help lift the head and body and prevent the baby from getting a flat spot on the back of the head.

Babies should ALWAYS be placed alone in a crib and should never sleep on a bed or sofa, or share a sleep space with another person, sibling, or another infant. Babies can easily be smothered or crushed when placed on a couch or bed.

Sudden Infant Death Syndrome (SIDS) is the sudden death of a baby less than one year of age that cannot be explained after a complete autopsy, review of the death scene and medical history. When a baby dies and there is no obvious explanation for the death, an investigation is conducted by law enforcement and the medical examiner.

Accidental Suffocation happens when a baby is unintentionally suffocated during sleep and can be caused by several things; a baby is placed on its stomach to sleep on a pillow or blanket, is put to sleep on an adult bed, is sleeping with a parent/caregiver, siblings or both, or is put to sleep on it’s stomach on a soft surface such as a sofa, making it hard for the baby to breathe.

Babies less than 1 year of age are at HIGHEST RISK of dying from Accidental Suffocation and SIDS. All babies are at risk of SIDS since the cause is unknown but Accidental Suffocation is preventable by taking the right steps to make your baby’s sleep area safe during sleep.

Due to their limited physical and developmental capabilities, babies are not able to protect their own airway or be easily aroused during sleep. However, studies show there are factors that can cause your baby to be at higher risk for Accidental Suffocation and SIDS.

Factors for Risk of Accidental Suffocation:

  • Age – All infants and children especially babies from birth to 1 year of age are at risk.
  • Sleep position – babies who are placed on their backs to sleep are less likely to die of SIDS than babies who are placed on their stomachs. Placing a baby on its back to sleep is the number one way to help reduce the risk of SIDS.
  • Sleep Surface – babies should be placed in a safety approved crib, alone, with a firm crib mattress and tightly-fitted sheet. Babies should not be placed on adult beds, pillows, quilts, loose bedding, sofas, or any other soft surface to sleep or nap.
  • Sleep Area – a baby’s sleep space should be free from toys and soft objects such as pillows, loose blankets, quilts, sheepskins, stuffed animals, bumper pads or pillow-like bumpers. Babies should always sleep alone with nothing else in the crib.
  • Co-Sleeping – babies should never sleep next to or with adults, other children, or other babies. Babies are safest when they sleep alone in the proper sleep environment.

Factors for Risk of SIDS:

  • Age - All babies from birth to 1 year of age are at risk. Studies show babies less than 6 months of age are at greatest risk of dying from SIDS.
  • History of Chronic Illness – Studies show babies with a history of chronic illness (i.e. respiratory illnesses) are at greater risk of dying from SIDS.
  • Prematurity – babies born premature (less than 37 weeks) are at greater risk of dying from SIDS than babies who are not born premature. Babies who are born premature are more likely to be born with chronic respiratory illnesses.
  • Sleep position – babies who are placed on their backs to sleep are less likely to die of SIDS than babies who are placed on their stomachs. Placing a baby on its back to sleep is the number one way to help reduce the risk of SIDS.
  • Sleep Surface – babies should be placed in a crib with a safety approved crib mattress with a tightly-fitted sheet. Babies should NOT be placed on adult beds, pillows, quilts, loose bedding, sofas, or any other soft surface to sleep or nap.
  • Sleep Area – a baby’s sleep space should be free from toys and soft objects such as pillows, loose blankets, quilts, sheepskins, stuffed animals, bumper pads or pillow-like bumpers.
  • Overheating – Avoid letting your baby overheat during sleep. Babies should be dressed in light sleep clothing and keep the room at a temperature that is comfortable for an adult.
  • Co-Sleeping – babies should never sleep next to or with adults, other children, or other babies. Babies are safest when then sleep alone in the proper sleep environment.
  • Smoking – Smoking during pregnancy, around a baby, or exposure to clothing and objects that contain smoke residue (i.e. furniture) can increase your baby’s risk of SIDS.

To date there is no known cause of SIDS. Studies of past SIDS cases have helped identify factors most commonly found among SIDS deaths. Knowing these factors cannot prevent SIDS but can help reduce your baby’s risk of dying from SIDS. More research on Sudden Infant Deaths due to SIDS is needed to help find the cause of SIDS.

The only items that should be in the crib with your baby are:
smiley faceA firm mattress that fits snugly in the crib
smiley faceA tight- fitting mattress sheet
smiley faceIf needed, a light weight blanket, tucked in on 3 sides at the end of the crib (blanket should be placed no higher than the baby’s waist)

The following items should not be placed in the crib with the baby:
frowning facePillows
frowning faceFluffy blankets
frowning faceStuffed animals or other toys>
frowning faceBumper Pads
frowning faceAnother infant or twin


Be sure the crib is away from any window shade strings, curtains, or other objects that can cause accidental strangulation. Your baby will be standing and climbing before you know it so make sure there is nothing dangerous within its reach.

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Check out the brochure What does a safe sleep environment look like?.


  • Crib slats should be no wider than a soda can (about 2 ½ inches)
  • No fancy cut outs
  • All screws and hardware should be tight and in place
  • No broken or missing parts

Safe Crib Guidelines can be found at: Consumer Product Safety Commission
*New national requirements are that all cribs in public accommodations (child care included) meet the NEW standards: 16 CFR 1219 (for full size cribs) or 16 CFR 1210 for non-full size cribs. Child care facilities have until December 28, 2012 to comply.


All licensed child care facilities in North Carolina are required to place babies on their backs to sleep and discuss safe sleep policies with parents before the child is enrolled.

Be sure to check with your child care facility!


In some cases it may be medically necessary for a baby to sleep on their stomach. Your doctor or pediatrician will tell you if this is how the baby should sleep. But, newborns and infants are safest when put on their backs to sleep.


The risk of Accidental Suffocation is higher for babies who sleep on an adult bed compared to babies who sleep in a crib. The most common cause of death for babies who sleep in an adult bed is entrapment.

Entrapment is when a baby becomes wedged between a part of the bed and the wall or between the bed and the headboard or footboard.

The mattress on an adult bed is less firm than those made for cribs. Due to this safety issue, mattresses in cribs are purposely made extra firm. Babies need to sleep on a firm mattress because they lack the motor skills to escape threats to their safety and breathing. In an adult bed, soft bedding such as pillow top mattresses, big pillows, big blankets, comforters, and spaces between the bed frame and mattress or space between the wall and the bed can put a baby at risk of injury or death.


It is unsafe for a baby to sleep in an adult bed with a caregiver and/or other children due to the risk of overlaying.

Overlaying is when a parent/caregiver rolls over on a baby while they are sleeping or shifts their body during sleep so that an arm, leg, or part of the body covers the baby’s mouth or nose making it hard for the baby to breathe.This can lead to suffocation.

Co-Rooming (or Room-sharing) is when you put your baby’s crib in your room either near your bed or somewhere in the room nearby. This is the best way for your baby to sleep safely alone and for you to easily attend to your babies needs while getting the rest you need.


You should not sleep with your baby to sooth it. Babies cry most when they are 6-8 weeks of age. It is normal for babies to cry anywhere from one to four hours a day. Ways to sooth a fussy baby can include rocking it in a chair, gently stroking the baby’s head, offering the baby a pacifier, taking your baby for a walk or rocking in place while you are holding the baby, giving the baby a warm bath, playing soft music or singing softly to the baby, or asking a friend or relative for help. There are many reasons why a baby can be fussy and sometimes babies cry for no reason at all. If the crying is causing you concern, talk with your doctor about why your baby might be fussy.


Studies show the issue of safe sleep is too strong to ignore. Babies who die from Accidental Suffocation due to unsafe sleeping conditions are preventable. People take risks all the time but the more we know about proper safe sleep practices and share this information with others, the more babies we will prevent from dying of Accidental Suffocation and reduce the risk of SIDS.

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Yes. Breastfeeding is very important for a baby’s health and for you to bond with your baby. If you want to breastfeed in bed, you should put your baby’s crib or sleep surface in your room or near the edge of your bed and lay the baby in the crib when you are done feeding. This will allow the baby to sleep safely alone and for you to get the proper amount of rest you need.


Studies show that twins should sleep alone in their own cribs. When twins sleep together they often move closer to one another making it harder for them to breathe fresh air around them. Twins who sleep facing each other often breathe the exhaled air from the other twin which has a high amount of Carbon Dioxide in it. The breathing of Carbon Dioxide by babies is thought to increase the risk of SIDS. Babies can also get too warm if they are next to each other.


Playpens, pack n plays, and portable cribs can be used as a sleep surface if you are away from home as long as you DO NOT put anything else in it except your baby. It should be free of any pillows, blankets, stuffed animals, bumper pads, couch or other cushions, other children, or any other objects. The baby should be placed on its back with nothing else around it. You should review the manufacturer’s instructions to make sure your baby is the appropriate age and/or weight to sleep in one of these types of items.

If a bassinet, play pen or pack n play is NOT available, you can an empty drawer or large box you can set on the floor near you to put your baby to sleep in. Place a very thin, small blanket or sheet in the drawer or box and place your baby on its back. A car seat can be used but it is not a good long-term solution. This will help keep your baby safer during sleep while you are away from home.

Strollers and swings are NOT safe sleep spaces for babies.

Sleeping an Infant in a Pack n Play
Consumer Product Safety Commission Playpen Safe Sleep information English | Spanish


You should talk with your babysitter, grandparent, or any caregiver who will be watching your baby, about how you put your baby to sleep. You should tell them how you want your baby to sleep while you are gone and make sure they understand why a safe sleep space is better for the baby.


Studies show that exposure to smoke puts your baby at risk of death due to SIDS. Smoking during pregnancy, second-hand smoke, and third hand smoke (smoke residue on objects such as clothing or furniture) have been shown to increase a baby’s risk of death due to SIDS. Smoking can cause long-term health problems for you and your baby so it is best not to smoke, especially if you are pregnant or have an infant in your home.


Everyone wants to feel like they are a good parent and doing everything they can for their baby. Having a baby can be stressful and when the baby cries a lot this can be very frustrating. Crying is the number one reason why parents/caregivers shake, hurt, or commit acts of violence toward their babies. Here are some things you need to know to help you deal with a crying baby.

The Period of Purple Crying helps parents to understand that sometimes babies are just going to cry and can cry for long periods of time. If your baby is not ill and you have tried several ways to soothe your baby, it is okay if you cannot stop your baby from crying. Starting at about two weeks of age, some babies begin crying more and may be hard to soothe causing you to become frustrated. This may leave parents/caregivers feeling guilty and angry if they are not able to stop the baby from crying. It DOES NOT make you a bad parent if you cannot stop your baby from crying.

The letters in PURPLE stand for the common parts of non-stop crying in babies:
P - Peak pattern (crying peaks around 2 months, then decreases)
U – Unpredictable (crying for long periods can come and go for no reason)
R - Resistant to soothing (the baby may keep crying for long periods)
P - pain-like look on face (the crying is making it hard for the baby to breathe)
L - Long bouts of crying (crying can go on for hours)
E - Evening crying (baby cries more in the afternoon and evening)

A crying baby can be hard to deal with no matter what age you are or how many children you have. It is important to know that it is not your fault and that there are things you can do to help soothe your baby. Here are some things you can do to help you if you feel like your baby is crying all the time or is in the Period of Purple Crying.

  • Hold Your Baby – Put your baby in your lap or against your chest and remember to support your baby’s head. You can sing to your baby or gently walk around the room. You can also gently stroke your baby’s head.
  • Feed Your Baby - Your baby might be hungry. Sometimes it is possible for a baby to be hungry even though it may not seem like that long ago when you fed the baby. Babies often cry is because they are hungry.
  • Take Your Baby’s Temperature - Your baby might be fussy because he/she is not feeling well. A fever may be a sign that your baby is ill and causing your baby to be upset. Use a clean digital thermometer under the arm. If your baby is less than 3 months old and the temperature is above 100.4° F, call the doctor.
  • Your Baby Might Need A Diaper Change - Your baby may be crying to let you know it is time for diaper a change. It is normal for babies to have between 8-10 wet diapers a day. Keep a watch out for diaper rash, which can make babies fussy. Ask your doctor what to use to treat diaper rash.
  • Is Your Baby Too Hot or Cold? - Your baby’s clothes may be causing the baby to be uncomfortable. If the baby’s clothing is too tight, or it is dressed to warmly or not enough then the baby might be letting you know something is wrong.
  • Ask A Friend/Family Member For Help – If you are feeling a little overwhelmed, then take your baby over to a friend or family member’s house. Sometimes having other people around to help with the baby can be a change of scenery and help you relax.


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