Module 15

Safe Sleep Environment Checklist

AAP safe sleep guidelines translated into a room-by-room action list

The American Academy of Pediatrics updated their safe sleep guidelines in 2022. These recommendations apply for the entire first year. Some of these feel extreme. They're based on data from thousands of infant deaths. Follow them all.

Sleep Surface

Firm, flat mattress that fits snugly in the crib— No gap larger than two fingers between mattress and crib side

Crib meets current CPSC safety standards— Manufactured after June 2011. No drop-side cribs.

Fitted sheet only — nothing else in the crib— No blankets, pillows, bumpers, stuffed animals, or wedges

Mattress is NOT inclined— Flat surface only. Inclined sleepers were recalled after 100+ infant deaths

No sleep positioners or nests— DockATots, Snuggle Me, Boppy loungers are NOT safe for sleep

Bassinet/crib is structurally sound— No broken slats, loose hardware, or missing parts. Check monthly.

Sleep Position

Always placed on BACK for every sleep— Back sleeping reduces SIDS risk by more than 50%. Every nap. Every night. Every caregiver.

Once baby rolls both ways independently, they can stay in the position they choose— Still place them on their back. If they roll to stomach on their own, that's okay.

No swaddle once rolling begins— Transition to sleep sack/wearable blanket when first signs of rolling appear

Room Environment

Room temperature 68-72°F (20-22°C)— Overheating is a SIDS risk factor. Feel the back of baby's neck — it should be warm, not sweaty.

Room-sharing (same room, separate surface) for at least 6 months— AAP recommends ideally 12 months. This reduces SIDS risk by up to 50%.

No bed-sharing— Especially dangerous with smoking, alcohol, medications, or soft bedding

Fan or white noise machine for air circulation— A fan in the room has been associated with a 72% reduction in SIDS risk in one study

Blackout curtains or shades— Darkness triggers melatonin. Not a safety issue, but dramatically improves sleep quality.

No cords, blinds strings, or hanging objects within reach— Strangulation hazard

What to Dress Baby In

Swaddle (0-8 weeks, or until rolling)— Arms in, hips loose. Stop immediately at first roll attempt.

Wearable blanket / sleep sack after swaddle phase— TOG rating matched to room temperature

No hats or hoods for indoor sleep— Baby regulates temperature through their head

Dress in one more layer than you'd wear— Onesie + sleep sack is usually right for a 68-72°F room

Additional Protective Factors

Offer a pacifier at sleep time— Associated with reduced SIDS risk. Don't reinsert if it falls out. Okay if breastfed baby refuses.

Breastfeeding (any amount)— Exclusive breastfeeding for 6 months shows strongest protective effect

Smoke-free environment— No smoking anywhere in the home. Thirdhand smoke on clothing is also a risk.

Up-to-date immunizations— Evidence shows fully immunized infants have a lower risk of SIDS

Tummy time when awake and supervised— Builds the neck and core strength needed for safe repositioning

All caregivers know these rules— Grandparents, babysitters, daycare. Print this and share it.

Important

Car seats, swings, bouncers, and strollers are not safe sleep surfaces. If your baby falls asleep in one, transfer them to a firm, flat surface as soon as possible. An estimated 350 infant sleep deaths per year in the U.S. are linked to sitting devices.