Sleep-Related Infant Deaths: Updated 2022 Recommendations for Reducing Infant Deaths in the Sleep Environment
Study by R. Y. Moon, R. F. Carlin and I. Hand, for the American Academy of Pediatrics Task Force on Sudden Infant Death Syndrome and Committee on Fetus and Newborn
Policy Statement · Pediatrics (Vol. 150, Issue 1, e2022057990) · DOI: 10.1542/peds.2022-057990
Key Takeaway
Babies Should Sleep on Their Backs on a Firm, Flat Surface With No Soft Bedding
What was tested: This is not a single study. It is the American Academy of Pediatrics' 2022 policy statement on safe infant sleep, written by its expert task force. The evidence behind it is set out in a companion technical report (Moon et al., 2022).
What the numbers showed: About 3,500 U.S. infants die each year of sleep-related deaths, including sudden infant death syndrome (SIDS) and accidental suffocation or strangulation in bed. After a large drop in the 1990s, the rate has stayed about the same since 2000.
What this means for you: Put babies to sleep on their backs on a firm, flat surface that is not tilted, with no soft bedding, and share a room but not a bed. The U.S. Safe to Sleep campaign describes firm as a surface that returns to its shape quickly when pressed, covered only by a fitted sheet (Safe to Sleep).
Key Numbers
How the Study Was Done
The statement was written by the academy's Task Force on Sudden Infant Death Syndrome and its Committee on Fetus and Newborn. It gives a strength of evidence for each recommendation, and the reasons are discussed in a separate technical report (Moon et al., 2022).
The authors describe a "triple risk" model: SIDS happens when a baby with a hidden weakness, such as a poor ability to wake up, meets an outside trigger like an unsafe sleep space during a sensitive stage of development.
Safe and Unsafe Sleep Places
Safe Sleep Surface
Firm, flat and level, like a table, covered only with a fitted sheet.
Unsafe Sleep Places
Tilted or inclined products, couches and armchairs, and any bedding beyond a fitted sheet.
What the Study Found
The core advice is back sleeping; a firm surface that is not tilted; room sharing without bed sharing; and no soft bedding or overheating. To lower SIDS risk further, the statement also advises breast milk feeding, keeping babies away from nicotine, alcohol, marijuana, opioids and illicit drugs, routine shots and pacifier use (Moon et al., 2022).
New in 2022 is advice on surfaces that are not tilted, short-term emergency sleep spots, cardboard boxes as beds, bed sharing, substance use, home breathing monitors and tummy time. Safe to Sleep adds that tilted surfaces are unsafe because a baby can slide down, and that couches and armchairs are never safe places for a baby to sleep (Safe to Sleep).
We read the published abstract and the Safe to Sleep summary. The full statement is on the publisher's site. An earlier version of this page cited a New England Journal of Medicine article that could not be found and gave a share of suffocation deaths linked to adult beds or plush mattresses. We found no source for that figure, so it has been removed, along with the crib mattress product picks.
How to Apply This Study When Choosing a Mattress
What it tells you: For a baby, use a firm, flat crib or bassinet mattress with only a fitted sheet.
Do not add pillows, bumpers, blankets or other bedding, and do not let a baby sleep on an adult bed, couch or armchair. Safe to Sleep says research links bumpers and bedding beyond a fitted sheet to serious injuries and deaths.
Study Scope and Limitations
This is a set of expert recommendations, not a single study, and it applies to infants, not adults. We read the abstract and the U.S. Safe to Sleep summary rather than the full statement. It does not rate or recommend any mattress brand.
Primary Citation
Moon, R. Y., Carlin, R. F., Hand, I., & Task Force on Sudden Infant Death Syndrome and the Committee on Fetus and Newborn. (2022). Sleep-related infant deaths: Updated 2022 recommendations for reducing infant deaths in the sleep environment. Pediatrics, 150(1), e2022057990. https://doi.org/