Creating a Safe Sleep Environment for You and Your Baby

What is Sudden Unexpected Death of an Infant (SUDI)?

Sudden unexpected death of an infant is any infant death that is unexpected and initially unexplained. Frequently, the cause of the death is determined after a thorough investigation and autopsy by a medical examiner and coroner. The deaths that remain unexplained are defined as sudden infanct death syndrome (SIDS). Therefore, SIDS is a type of sudden unexpected death of an infant.

What is Sudden Infant Death Syndrome (SIDS)?

Sudden infant death syndrome (SIDS) is the sudden death of an infant under 1 year of age, which remains unexplained after a thorough investigation including a complete autopsy, examination of the death scene and review of the clinical history. Causes of SIDS remain unexplained. However, SIDS is not caused by suffocation, child abuse, immunizations, vomiting, choking or by minor illnesses such as a cold or infection. SIDS is not contagious.

What practices may contribute to Sudden Unexpected Death of an Infant?

  • Placing the infant on tummy or side when sleeping.
  • Placing the baby on loose bedding or soft sleep surfaces such as, quilts, comforters, sheepskin, pillow-like toys, pillows; or sleeping on a waterbed, couch or chair. These keep the baby from breathing easily.
  • Exposing the baby to any tobacco smoke during and after pregnancy.
  • Sharing a bed with the baby and other children, adults, or pets.
  • Overdressing or bundling the baby too tightly in heavy blankets or a room that is too hot.

Tips for Creating a Safe Sleep Environment

Review these steps with anyone who cares for the baby, including relatives, grandparents, childcare providers and babysitters:

  • Place babies on their back to sleep. Side sleeping is not advised. Do not use any pillows, cushions or blankets to prop the baby.
  • Use a firm mattress, closely fitted to the sides and bottom of the crib.
  • Use a crib that meets the current safety standards (2-3/8 inch openings).
  • Keep the crib free of soft objects such as pillows, comforters, soft bedding or stuffed animals.
  • Don't bundle the baby too tightly in heavy blankets or clothing. The bedroom temperature should be kept comfortable for a lightly clothed adult.
  • Keep the head and face uncovered. Consider using a one-piece sleeper/suit. If a blanket is used, it should be tucked in firmly and only reach as far as the baby’s chest.
  • Never smoke around a baby.
  • Babies should sleep separate from, but close to the parents. It is suggested that parents place a crib, bassinet or cradle that meets safety standards near the bed, instead of having the baby sleep in bed with the parents. Do not put the baby to sleep on an adult bed or sofa. Sometimes a baby is injured by rolling off an adult bed or sofa.
  • Breastfeeding has important health benefits for babies. Babies may be brought into bed for breastfeeding or comforting, but should be returned to the crib/bassinet when the parent is ready to sleep.
  • Never let a baby fall asleep with another person, especially if that person is smoking, tired or ill, has taken medication, drugs, alcohol, or substances that cause drowsiness, or is extremely overweight.
  • The American Academy of Pediatrics recommends that babies be offered a pacifier at nap time and bedtime. Do not reinsert the pacifier if the baby refuses it or falls asleep. Do not coat the pacifier with anything sweet. The pacifier should be cleaned regularly. Delay pacifier use until after 1 month of age if the baby is breastfeeding.
  • Encourage “tummy time” when the baby is awake and observed by an adult. This will encourage motor development.

What about babies sleeping in cardboard boxes?

Parents may have questions about the recently available cardboard boxes that are made for babies to sleep in. These are sometimes referred to as “Finnish baby boxes” because they are used in Finland. There have been stories in the media suggesting that baby boxes are responsible for the low infant mortality rate in Finland. However, the research studies show that many Western countries have seen a similar decline in infant mortality since the early 1900’s. There are many reasons for this decline, such as improved care of premature babies, better control of infectious diseases, and more. The Vermont Department of Health does not currently support the use of cardboard boxes for infants due to the lack of research on their relative safety. We suggest parents use a crib or portable crib that meets the safety standards set by the Consumer Product Safety Commission. Find out more information on the American Academy of Pediatrics website.