Safe sleep comes down to a short list that applies to every sleep, day and night, for the first year: your baby on their back, on a firm, flat, level mattress, in their own cot or bassinet, with nothing soft or loose around them and their head and face uncovered. Keep them in a smoke-free home, and keep their cot in your room for at least the first 6 months. Never fall asleep with your baby on a sofa or armchair.
The main safe-sleep bodies in Australia, the UK and the US agree on all of this. The Red Nose six safe sleep recommendations, the NHS guide to SIDS, the Lullaby Trust's safer sleep advice, the AAP's safe sleep guide for parents and the NICHD Safe to Sleep list differ only in some details, which this guide points out. These steps lower the risk of sudden infant death syndrome (SIDS) and fatal sleep accidents, together known as sudden unexpected death in infancy (SUDI). No step removes the risk completely, which is why the whole list matters.
What are the safe sleep rules for babies?
| Rule | What it looks like |
|---|---|
| On the back | Every nap and every night, from birth |
| Firm, flat, level surface | A mattress that fits the cot and doesn't dip or tilt |
| Own safe sleep space | A cot or bassinet that meets your country's standard |
| Clear cot | Fitted sheet and safe bedding only, no soft items |
| Head and face uncovered | No hats indoors, no hood, bedding no higher than the chest |
| Room-sharing | Cot in your room for at least the first 6 months |
| Smoke-free | No smoking in pregnancy or around your baby |
| Breastfeed if you can | Any breast milk helps |
The AAP says its recommendations apply to babies up to 1 year of age. NICHD adds that babies who were born early and babies with reflux should also be placed on their backs to sleep until they are 1 year old. Side sleeping isn't a safe middle ground, and Red Nose says to avoid products designed to hold a baby in one sleeping position.
Why on the back, and what if my baby rolls over?
Red Nose explains that sleeping on the back helps keep your baby's airway clear and makes sure their protective reflexes work, and that it reduces the risk of suffocation, overheating and choking. Start every sleep on the back, even once your baby can roll.
Rolling changes what you do during the sleep, not how you start it. The sources agree:
- Rolls one way only: gently turn your baby onto their back. Red Nose's rolling advice and NICHD both say this, and the NHS says to move your baby onto their back until they can roll onto their front and back again by themselves.
- Rolls both ways unaided: you can let them find their own position. Red Nose says you don't need to wake during the night to turn them back, and the AAP says the same once your baby rolls both ways comfortably.
- Either way: keep the cot completely clear, so a rolling baby has nothing to press their face into.
Red Nose says most babies begin to show signs of rolling from about 4 months, and that it's time to move from a bassinet to a cot as soon as your baby first shows signs of rolling. It also recommends extra supervised tummy time while your baby is awake, which builds the strength to roll back over. See tummy time and rolling over.
Rolling is also the point to stop wrapping with the arms in. The AAP says to stop swaddling once your baby shows signs of trying to roll, NICHD says once they start to roll (usually around 3 months), and Red Nose's wrapping advice says to stop as soon as your baby shows signs of beginning to roll or reaches 3 months, whichever comes first. The swaddling guide covers how to transition.
What should be in my baby's cot, and what should stay out?
The mattress. The AAP says a safe mattress shouldn't indent when your baby lies on it, and that any surface inclined more than 10 degrees isn't safe for sleep. NICHD describes firm as returning to its original shape quickly when pressed. The Lullaby Trust's mattress advice says your baby's head should sink no more than a few millimetres, with no raised or cushioned edges. In Australia, Pregnancy, Birth and Baby says the gap between mattress and cot side should be no more than 2 cm with the mattress centred. The sleep environment guide covers choosing and fitting a cot and mattress in detail.
Bedding. Use a fitted sheet, then either a safe sleeping bag or light blankets:
- A sleeping bag should be well fitted across the neck and chest, with your baby's arms out and no hood, according to Red Nose.
- Blankets should be lightweight and firmly tucked in. Red Nose says pull them up only to the chest; the Lullaby Trust says no higher than the shoulders.
- Put your baby's feet at the bottom of the cot (feet to foot), as Red Nose and the NHS advise, so they can't wriggle down under the covers.
Keep out. Red Nose lists doonas, loose blankets, pillows, cot bumpers, lambswool and soft toys, including a teddy or comforter. The NHS adds pods, nests and anything else meant to keep your baby in place. The AAP says not to use weighted blankets, sleepers, swaddles or other weighted objects on or near your baby. Sleep products to avoid explains why.
Temperature. Overheating raises the risk of SIDS, the AAP says. The NHS suggests a room of about 16–20°C and removing a layer if your baby's skin is hot or sweaty. Red Nose doesn't set a room temperature and says to dress your baby as you would dress yourself for the room. Red Nose, the NHS, the AAP and NICHD all say to take hats off indoors or for sleep. See dressing your baby for sleep.
Monitors. The AAP says not to use home heart and breathing monitors as a way to reduce the risk of SIDS, and NICHD says to avoid relying on any monitor for this. The Lullaby Trust's room-sharing page says no device can replace a parent or carer being in the same room.
How long should my baby sleep in my room, and is bed-sharing ever safe?
Every major source now gives the same minimum: your baby in their own cot or bassinet, in your room, for at least the first 6 months. That's the wording from Red Nose, the NHS, the Lullaby Trust, the AAP and NICHD. The NHS and the Lullaby Trust both say this covers every sleep, day and night. The Lullaby Trust notes you can still pop out of the room briefly, but your baby is safest with you close by most of the time. "At least" means 6 months is a minimum rather than a deadline; moving your baby to their own room covers the move.
The sofa is the most dangerous place to fall asleep with your baby. The AAP says the risk is up to 67 times higher when babies sleep with someone on a couch, and the NHS says never to sleep on a sofa or in an armchair with your baby. Red Nose's safe environment page adds adult beds, bunks, waterbeds, beanbags, pillows and cushions to the list of places a baby should never be put to sleep.
On bed-sharing, the AAP says to avoid it in any circumstances, including with twins. The NHS says a separate cot is safest and never to share a bed if you or your partner smoke, if either of you has had 2 or more units of alcohol, taken recreational drugs or medicine that makes you sleepy, or if your baby was born before 37 weeks or weighed under 2.5 kg (5.5 lb). The bed-sharing guide covers the evidence and how to make a bed safer in case you fall asleep.
If night feeds are where you're most likely to doze off, plan ahead: feed somewhere you won't fall asleep on soft cushions, and have your baby's cot within reach so you can put them straight down.
Can my baby sleep in a pram, car seat, sling or somewhere else?
Babies fall asleep wherever they are, and that's fine. What matters is what happens next.
- Car seats, swings and carriers: the AAP says if your baby falls asleep in one, move them to a firm sleep surface on their back as soon as possible. NICHD says not to use sitting devices such as car seats and strollers for routine sleep.
- Travelling by car: the NHS says it's fine for your baby to fall asleep in the car seat while travelling, but to take them out once you arrive. See car seat safety.
- Slings: the NHS says to follow the TICKS rules (tight, in view, close enough to kiss, keep chin off the chest, supported back) and that it isn't safe to feed your baby while they're in a sling. See contact napping.
- Away from home: Red Nose suggests calling ahead to check there's a cot or portable cot that meets Australian safety standards. Pregnancy, Birth and Baby says to use a portable cot only with its own thin mattress, never a thick mattress or extra layer.
Handing over to another carer
Grandparents, babysitters and childcare educators may have learnt different rules. A short handover helps everyone use the same ones:
- Show them the cot and check it together.
- Say plainly: on the back, nothing in the cot, no sofa naps.
- Pass on the last feed and sleep times, and any care instructions from your baby's health team.
- Point them to this page or the original source for your country.
What else lowers the risk of SIDS?
- Smoke-free, before and after birth. Red Nose says smoking in pregnancy and around your baby, including second-hand smoke, increases the risk of sudden infant death, and to never smoke where your baby sleeps. NICHD says to stay smoke- and vape-free during pregnancy.
- No alcohol or drugs. The AAP advises avoiding alcohol, marijuana, opioids and illicit drugs during pregnancy and after your baby is born. NICHD says anyone caring for your baby should be drug- and alcohol-free too.
- Breastfeed if you can. Red Nose says breastfeeding has been shown to reduce the risk of sudden infant death. NICHD recommends human milk for at least your baby's first 6 months. If you formula-feed, every other step on this page still lowers the risk.
- Consider a dummy for sleep. The AAP says dummies help reduce the risk of SIDS even if they fall out once your baby is asleep, and to wait until breastfeeding is established before offering one. The NHS says to think about using a dummy to settle your baby to sleep. Never hang one around your baby's neck. See dummies.
- Keep vaccinations up to date. NICHD says vaccinated babies are at lower risk of SIDS, and the NHS lists routine vaccinations among its safer sleep steps.
- Regular care in pregnancy. NICHD lists regular medical care throughout pregnancy as one of its risk-reduction steps.
Does the advice differ between Australia, the UK and the US?
On the basics, no. The differences are in the details:
| Topic | Australia | UK | US |
|---|---|---|---|
| Room-sharing | At least 6 months | At least 6 months | At least 6 months |
| Bed-sharing | Don't share a bed, couch or chair | Cot is safest; never in high-risk situations | Avoid in any circumstances |
| Blankets | Light, tucked, up to chest | Light, tucked, no higher than shoulders | Keep loose bedding out |
| Room temperature | No set figure | About 16–20°C | No figure; avoid overheating |
Sources: Red Nose for Australia, the NHS and the Lullaby Trust for the UK, and the AAP and NICHD for the US. If you live elsewhere, check your local public-health guidance, and use cots and mattresses that meet the standard where you live.
Does safe sleep advice change for premature babies or twins?
Premature babies. The NHS says to follow the safer sleep advice for a year from your baby's due date, not their birth date, and the Lullaby Trust says 12 months after the due date for premature or low birthweight babies, who are particularly vulnerable to SIDS. NICHD says preterm babies should sleep on their backs too. Pregnancy, Birth and Baby notes that babies in neonatal intensive or special care are sometimes positioned differently because they are under constant medical supervision; once home, follow the standard advice unless your baby's care team gives you an individual plan.
Twins and multiples. The AAP advises against bed-sharing with twins and other multiples. Pregnancy, Birth and Baby says each cot is made for one child, so separate cots are best. The Lullaby Trust says never to put twins together in a Moses basket or small cot, because they could overheat, and to move them into their own cots before they're big enough to roll.
When to get help
These signs come from the NHS SIDS page and its list of when to get urgent help. The NHS advises calling for an ambulance rather than driving to hospital yourself in this situation. An infant first-aid course, including CPR, is worth doing before you need it.
Act straight away if you find your baby slumped with their chin on their chest in a car seat, sling, bouncer or pram. Lift them out and lay them on their back on a firm, flat surface. If they're not breathing normally or don't respond as usual, call your local emergency number (000 in Australia, 999 in the UK, 911 in the US).
Talk to your GP or child-health nurse if you've been told your baby needs a special sleep position or product for a medical reason, if your baby was premature and you want an individual plan, or if reflux or a flat spot on the head is worrying you. Never change your baby's sleep position on your own to manage reflux.
Ask for support if you're so exhausted that you're worried about falling asleep while holding your baby. Talk to your own GP about how you're coping, and contact a parenting support service (Tresillian or Karitane in Australia, your health visitor in the UK, your pediatrician's office in the US) for help planning safer nights. See sleep deprivation for ways to share the load.
