SIDS and Other Sleep-Related Infant Deaths: Evidence Base for 2016 Updated Recommendations for a Safe Infant Sleeping Environment

Pediatrics. 2016 Nov;138(5):e20162940. doi: 10.1542/peds.2016-2940.


Approximately 3500 infants die annually in the United States from sleep-related infant deaths, including sudden infant death syndrome (SIDS), ill-defined deaths, and accidental suffocation and strangulation in bed. After an initial decrease in the 1990s, the overall sleep-related infant death rate has not declined in more recent years. Many of the modifiable and nonmodifiable risk factors for SIDS and other sleep-related infant deaths are strikingly similar. The American Academy of Pediatrics recommends a safe sleep environment that can reduce the risk of all sleep-related infant deaths. Recommendations for a safe sleep environment include supine positioning, use of a firm sleep surface, room-sharing without bed-sharing, and avoidance of soft bedding and overheating. Additional recommendations for SIDS risk reduction include avoidance of exposure to smoke, alcohol, and illicit drugs; breastfeeding; routine immunization; and use of a pacifier. New evidence and rationale for recommendations are presented for skin-to-skin care for newborn infants, bedside and in-bed sleepers, sleeping on couches/armchairs and in sitting devices, and use of soft bedding after 4 months of age. In addition, expanded recommendations for infant sleep location are included. The recommendations and strength of evidence for each recommendation are published in the accompanying policy statement, "SIDS and Other Sleep-Related Infant Deaths: Updated 2016 Recommendations for a Safe Infant Sleeping Environment," which is included in this issue.

Publication types

  • Review

MeSH terms

  • Advisory Committees
  • Bedding and Linens / adverse effects
  • Cause of Death*
  • Environment
  • Evidence-Based Medicine
  • Female
  • Humans
  • Infant
  • Infant Mortality / trends
  • Infant, Newborn
  • Male
  • Pacifiers / adverse effects
  • Practice Guidelines as Topic / standards
  • Prone Position
  • Risk Assessment
  • Safety Management / standards*
  • Sleep Wake Disorders / diagnosis
  • Sleep Wake Disorders / mortality*
  • Sudden Infant Death / epidemiology*
  • Sudden Infant Death / prevention & control
  • United States / epidemiology