Reviewed by Neha Pathak, MD on February 12, 2018
From the WebMD Archives

Feb. 12, 2018 -- Sam and Maura Hanke were over the moon when they welcomed their first child, Charlie, into the world in 2010. They quickly settled into life with the healthy newborn and loved the joys and challenges that came with realizing their dream of becoming parents.

One night when he was 3 weeks old, Charlie was fussier than normal and was up late into the night, struggling to sleep. Since Maura was breastfeeding, Sam offered to hold him so his wife could get some rest. The new father sat down on the couch to watch television and fell asleep with Charlie lying on his chest.

“When I woke up, he was gone,” Hanke said. “I would do everything in my power to have another day with him.”

Charlie was a victim of an unsafe sleep environment. About 3,500 infants die every year in the U.S. from sleep-related deaths. But while the number of babies that die from sudden infant death syndrome (SIDS) has been falling, the number of babies dying from accidental suffocation and strangulation in bed skyrocketed 184% from 1999 to 2015, according to new statistics released Monday by the American Academy of Pediatrics.

SIDS is not 100% preventable, but the American Academy of Pediatrics (AAP) says a safe sleep environment can cut the chance of getting it. The group’s latest safe sleep recommendations -- issued in 2016 -- say parents should not share a bed with their babies. But they should share a bedroom. They also recommend against napping with your baby on your chest.

Despite the recommendations, the new analysis said that bed sharing or co-sleeping is on the rise. The percentage of babies sharing a sleep surface rose from 6.5% in 1993 to 13.5% in 2010.

Recently, co-sleeping deaths have also led to criminal charges when alcohol or drugs have been involved. A South Carolina woman, who local media say had drugs in her system, was charged in last month in connection with the co-sleeping death of her 7-week-old son. And a Michigan mom was charged with involuntary manslaughter and child abuse in 2017. Authorities say she drank alcohol and slept in the same bed as her 6-month-old baby, who suffocated when he got stuck between the bed and the wall.

What Is Safe Sleeping?

Co-sleeping or bed sharing is when parents put the baby in their adult bed with them to sleep. Room sharing involves putting the baby on its own safe surface, like a crib or bassinet, that is separate from an adult’s bed but near it so a parent can hear if a child is in distress during the night or needs to be fed or changed.

The AAP says evidence shows sleeping in the parents’ room on a separate, safe surface lowers the chance of SIDS by as much as 50%. It also helps prevent suffocation, strangulation, or entrapment that can happen when babies are sleeping in bed with adults. A large percentage of babies who die of SIDS are found with bedding covering their head, so no bedding should be in a bed while a baby is in it.

The first 6 months of a child’s life is the most critical time to follow this practice, since that is when rates of sleep-related deaths are the highest. SIDS risk generally goes away at 12 months.

“It is dangerous to put babies in another room. There is a tenfold increase risk of SIDS from solitary sleep for an entire year,” says Lori Feldman-Winter, MD, a pediatrician who was on the task force that wrote the AAP’s safe sleeping guidelines. But she also stresses that for babies under 4 months of age, there is a fivefold increase in SIDS from bed sharing. “The evidence doesn’t allow us to say that bed sharing is safe at this time.”

Experts say that even includes naps on the couch or accidentally falling asleep after nursing. If you are holding a baby, doctors say, you need to be awake.

“An awake adult holding a sleeping baby on their chest should be OK, although the preferred position for sleep is supine” (lying on the back), Feldman-Winter says. “If this is more than a quick nap, the infant should be placed supine in a crib, Pack 'n Play, or other safe surface.”

The group says that parents often fall asleep while feeding babies. Evidence shows that is less hazardous when it happens in an adult bed, compared with a sofa or armchair.

Couches and armchairs put infants at a high risk of sleep-related death through suffocation or being trapped between seat cushions. Experts say parents and caregivers need to be very cautious and make sure they are awake when feeding children on these pieces of furniture.

The AAP says there isn’t evidence to say whether bed-sharing devices like in-bed sleepers are safe. So the group says that if you bring a baby into bed to feed them, you should put them back in their crib or bassinet to sleep. It also says there isn’t enough data for it to take a position on baby boxes that are getting more popular -- cardboard boxes with a firm mattress. It also says there is no evidence that swaddling makes SIDS less likely and some evidence that it may raise the risk because it leads to a deeper sleep, Feldman-Winter says

“There is no one be-all, end-all piece of advice that will eliminate the risk. We don’t know that we can prevent SIDS altogether,” Feldman-Winter says. “All we can do is our best to implement as many safe sleep strategies as possible to reduce the risk the baby will succumb to SIDS or other sleep-related death.”

Co-sleeping debate

Backers of co-sleeping point to a small 2011 study out of South Africa that counters the AAP recommendations. It found that when babies slept alone rather than skin-to-skin with their mothers, their heart rate increased, indicating it was stressful for them.

Many new parents say they co-sleep with their children because it’s practical and easier for breastfeeding and to deal with nighttime waking.

But Hanke argues that those who think co-sleeping is safe have just been lucky. “Many think it’s OK because they did it and nothing happened. That’s like saying you didn’t use a car seat and didn’t get in an accident,” he says. “Just because it didn’t happen to you doesn’t mean it is OK.”

The ABCs of Safe Sleep

People often cite the ABCs of safe sleep to remember what makes up a safe sleeping environment for infants. They are:

A -- Alone. The AAP recommends infants sleep in the parents’ room, close to the parents’ bed but on a separate, firm surface designed for infants -- ideally until the age of 1, but at least for the first 6 months.

B -- On their back. Babies should always be placed on their back to sleep up to 1 year of age. Before that, they may not be able to move their head to breathe while on their stomach.

C -- In a crib or bassinet that meets current safety standards. That means slats on a crib should be spaced less than 2 3/8 inches apart, and cribs shouldn’t have drop sides

Other AAP recommendations for safe infant sleep include:

  • Never leave a baby sleeping on a bed, sofa, armchair, or sitting devices.
  • Avoid soft bedding and overheating.
  • Do not put anything else in the crib while the baby is sleeping there, including bumpers, bedding, blankets, pillows, stuffed animals, or toys.
  • Keep the baby’s sleep area free of hazardous materials like dangling cords, electric wires, or parts of window coverings.
  • Breastfeed for at least 6 months when possible since it is associated with a lower chance of SIDS.
  • Offer a pacifier once breastfeeding is established. Studies have shown that pacifiers have a protective effect on SIDS, although it’s not understood why. Pacifiers should not be hung around a child’s neck or attached to their clothing while they sleep.
  • Sleep positioning devices aren’t recommended because they can pose a danger to children if they roll out of them.
  • Use wearable blankets to keep babies warm.
  • Avoid exposing your baby to smoke, alcohol, and illicit drugs.

The Hankes say the death of a child tests your faith to its core and forever leaves you with a broken heart. In their case, it also spurred Sam, a pediatric cardiologist, and Maura, a kindergarten teacher, into action.

One year later, on what would have been their son’s first birthday, the couple founded a nonprofit they called Charlie’s Kids Foundation to raise awareness of pediatric sleep-related deaths. The foundation provides resources for new parents, educates families, and promotes dialogue about safe sleep practices.

“We have made it a mission of ours to try and do everything we can to make sure other families don’t suffer that loss,” Sam Hanke says. “We have to share our story -- even if it hurts -- because it is so hard to hear when others lose their babies. This can be prevented, and spreading that message is what keeps us motivated.”

The Hankes now have two other children and say they stress to parents that following these recommendations may not always be easy, but the alternative is unbearable.

“Anyone who has had kids and been up at 3 a.m. and can’t get their babies to sleep knows the challenge of doing this. Safe sleep is hard, but your baby is worth it,” Hanke says. “You never get over the loss of a child. Having our other children helped heal some wounds, but it is also a constant reminder of what we lost as they develop and grow in ways we never got to see Charlie do.”

Show Sources

Sam Hanke, Cincinnati, OH.

Lori Feldman-Winter, MD, Rowan University, Camden, NJ.

E. Colson, JAMA Pediatrics, November 2013.

NJ Bergman, Biological Psychiatry, November 2011.

M. WIllinger, Archives of Pediatrics & Adolescent Medicine. January 2003. 


American Academy of Pediatrics: “Safe Sleep.”

Charlie’ “About Us,” “Help your baby sleep safe and snug.” “The ABCs of Safe Sleep.”

Safe to Sleep: “SIDS is not.”

People magazine: “Mich. Mom Charged with Involuntary Manslaughter After Baby Suffocates While Sleeping with Her in Bed,” Sept. 19, 2017.

New York Post: "Young mom charged in baby's co-sleeping death," Jan. 10, 2018.


CDC, National Vital Statistics Reports, June 29, 2011.

U.S. Consumer Product Safety Commission: “Injuries and deaths associated with nursery products in children younger than age five,” December 2017.


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