First Six Months
Safe sleep is critical during this time – no exceptions! As you learned earlier, babies should sleep in a separate, safe sleep space placed alongside the adult bed for at least the first six months. They should be placed on their back, on a firm mattress covered with only a tight-fitting sheet and everything soft, loose or fluffy removed from the sleep space. See Lifesaving Safe Sleep Tips for more information.
Today, research shows that using a pacifier every time you place your baby down to sleep can greatly reduce the risk of SIDS. Doctors say that by using the following guidelines, pacifiers will not cause any problems for your baby. Remember that using a pacifier does not replace other important recommendations on reducing the risk of SIDS such as putting your baby to sleep on his or her back in a crib that meets current safety standards and removing all soft, fluffy or loose bedding and other soft items. Some parents are hesitant to use a pacifier because of concerns about possible harmful effects such as breastfeeding challenges, ear infections and dental problems. Rest assured, research clearly shows that the potential benefits of pacifier use in reducing the risk of SIDS far outweigh any potential negative affects.
Guidelines for safe and effective pacifier use:
- Offer a pacifier every time you put your baby down to sleep. This will maximize the protective benefits.
- If you are breastfeeding wait until nursing is going well (usually 3-4 weeks) before offering a pacifier.The risk of SIDS is very low during the first month.
- Limit pacifier use to the first year of life. This includes the peak ages for SIDS risk and the 1 to 5 month period when the baby’s need for sucking is the highest.
- Pacifiers should not be used as a substitute for nursing or feeding. The pacifier should be offered following a feeding session as you place the baby down to sleep.
- After the baby falls asleep, there is no need to reinsert the pacifier if it falls out. Experts feel that frequent pacifier users may undergo adaptive changes that are beneficial even when the pacifier is not in the mouth.
- Infants who refuse a pacifier should not be forced to take one.
- Pacifiers should not be coated with any sweet solutions.
- Do not use a string or other device to attach pacifiers around your baby’s neck or to clothing.
- Otitus Media. The risk of otitis media is relatively low in the first year of life. Frequent cleaning and replacement of damaged pacifiers can further reduce this risk.
- Breastfeeding Success. In randomized, controlled trials, pacifier introduction after one month was not detrimental to breastfeeding duration. Other trials did not show an effect of pacifiers on breastfeeding duration among term or preterm infants. Mothers should receive regular support, encouragement and assistance with developing proper breastfeeding techniques to build confidence and ensure success.
- Dental Problems. According to the American Academy of Pediatric Dentistry policy on oral habits, pacifiers are unlikely to cause long-term problems if stopped by age three. In addition, it has been shown that infants not offered pacifiers were more likely to suck their fingers, a problem that is more difficult to break and more likely to cause dental problems.
- Reductions in frequency and duration of crying spells
- Satisfies need for non-nutritive sucking considered normal in infants and young children
- Among preterm infants, non-nutritive sucking reduced the length of the hospital stay by an average of seven days and was not found to have any adverse outcomes
- Download Pacifiers and SIDS: Reducing the Risk Brochure (PDF)
- Download our position statement on Pacifiers
- See also: Do Pacifiers Reduce the Risk of Sudden Infant Death Syndrome? A Meta-analysis. PEDIATRICS Vol. 116 No. 5 November 2005, pp. e716-e723. Fern R. Hauck, MD, MS, Olanrewaju O. Omojokun, MD and Mir S. Siadaty, MD, MS.
- See also: Pacifier Use: Promoting a New Recommendation on Reducing the Risk of SIDS
Supervised tummy time is important. Because babies spend so much time sleeping on their backs, it is important to provide exercise time for them to strengthen their upper body muscles (neck, arms and chest). This should be done while they are awake and being watched. Lots of tummy time will also help prevent a flat spot from forming on the back of your baby’s head. Start by placing your newborn across your lap for short periods of time, gradually working toward placing them on a quilt or play mat on the floor with toys in front of them. This is also a great way to spend quality time with your baby – playing together on the floor! Watch for signs that your baby is tiring and change their position or activity. If your baby falls asleep during tummy time, immediately place him on his back in his crib for a nap.
There seems to be a common misconception that vaccines are somehow associated with SIDS deaths. This is not true! Experts warn that the risk of leaving your baby unprotected is 1,000 times greater than any increased risk for SIDS. Because infants receive many immunizations during the critical development period from two to six months of age, and 90 percent of SIDS deaths occur within this time frame, it is only logical that many SIDS victims have recently received vaccines. This does not mean that the immunization had anything to do with the infant’s subsequent sudden and unexpected death. The cause and effect of immunizations and SIDS has been comprehensively studied for more than two decades. In fact, in countries where immunization schedules are different from those in the United States, the peak incidence of SIDS is still between two to four months. Currently, both the Centers for Disease Control & Prevention and the American Academy of Pediatrics recommend that infants receive multiple vaccines during their first year of life. If there were no vaccines, there would be many more cases of disease and along with them, more deaths. For more information, see the CDC’s immunization recommendations and the AAP’s immunization recommendations.
What happens when my baby begins to roll over? Eventually your baby will want to determine his or her own sleep position and may begin rolling to their tummy during sleep. Experts say this is normal – we want babies to learn to roll – and parents should not disrupt everyone’s much needed rest by continually flipping them back. You can rest more easy once you know your baby can roll both ways, back to tummy and tummy to back. Remember – lots of tummy time when baby is awake and playing! This will help strengthen your baby’s upper body muscles that don’t get used as much with the back sleeping position. If your baby is determined to sleep on her tummy, take extra care to ensure that there is nothing in the sleep area she can get her face next to and try and relax, knowing that you’ve done everything you can to protect your precious bundle!