Practice Guidelines

SIDS and Safe Sleeping Environments for Infants: AAP Updates Recommendations


Am Fam Physician. 2017 Jun 15;95(12):806-807.

Author disclosure: No relevant financial affiliations.

Key Points for Practice

• For the first six to 12 months of life, infants should sleep in the same room as the parents, on a separate surface near the bed.

• To avoid overheating, infants should be dressed properly for the sleep environment.

• Breastfeeding is associated with a lower risk of SIDS, and infants should be breastfed exclusively for the first six months unless contraindicated.

• Use of commercial devices that are inconsistent with safe sleep recommendations should be avoided.

From the AFP Editors

Sudden and unexpected deaths that occur in infancy are called sudden unexpected infant death (SUID) or sudden unexpected death in infancy (SUDI). These types of death can be caused by suffocation, asphyxia, entrapment, infection, ingestions, metabolic diseases, arrhythmia-associated cardiac channelopathies, or trauma. If no cause can be determined, the death is attributed to sudden infant death syndrome (SIDS), which is a subcategory of SUID and difficult to distinguish from SUIDs. A conclusive diagnosis often cannot be made via autopsy. The American Academy of Pediatrics (AAP) updated its recommendations to reduce the risk of SIDS and suffocation, asphyxia, and entrapment associated with sleep, focusing on SUIDs that transpire during sleep in infants one year or younger.


Grades for these recommendations are based on the Strength-of-Recommendation Taxonomy. Level A recommendations are based on good-quality patient-oriented evidence. Level B is based on inconsistent or limited-quality patient-oriented evidence. Level C is based on consensus, disease-oriented evidence, usual practice, expert opinion, or case series. No randomized controlled trials exist on SIDS or other deaths associated with sleep; therefore, case-control studies are considered standard evidence.


For the first six to 12 months of life, infants should sleep in the same room as the parents, on a separate surface near the bed. This has a greater likelihood of preventing suffocation,

Author disclosure: No relevant financial affiliations.

Coverage of guidelines from other organizations does not imply endorsement by AFP or the AAFP.

This series is coordinated by Sumi Sexton, MD, Associate Deputy Editor.

A collection of Practice Guidelines published in AFP is available at



Copyright © 2017 by the American Academy of Family Physicians.
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May 15, 2018

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