Summary and Strength of Recommendations

Level A recommendations
    Back to sleep for every sleep
    Use a firm sleep surface
    Room-sharing without bed-sharing is recommended
    Keep soft objects and loose bedding out of the crib
    Pregnant women should receive regular prenatal care
    Avoid smoke exposure during pregnancy and after birth
    Avoid alcohol and illicit drug use during pregnancy and after birth
    Breastfeeding is recommended
    Consider offering a pacifier at nap time and bedtime
    Avoid overheating
    Do not use home cardiorespiratory monitors as a strategy for reducing the risk of SIDS
    Expand the national campaign to reduce the risks of SIDS to include a major focus on the safe sleep environment and ways to reduce the risks of all sleep-related infant deaths, including SIDS, suffocation, and other accidental deaths; pediatricians, family physicians, and other primary care providers should actively participate in this campaign
Level B recommendations
    Infants should be immunized in accordance with recommendations of the AAP and Centers for Disease Control and Prevention
    Avoid commercial devices marketed to reduce the risk of SIDS
    Supervised, awake tummy time is recommended to facilitate development and to minimize development of positional plagiocephaly
Level C recommendations
    Health care professionals, staff in newborn nurseries and NICUs, and child care providers should endorse the SIDS risk-reduction recommendations from birth
    Media and manufacturers should follow safe-sleep guidelines in their messaging and advertising
    Continue research and surveillance on the risk factors, causes, and pathophysiological mechanisms of SIDS and other sleep-related infant deaths, with the ultimate goal of eliminating these deaths entirely
  • These recommendations are based on the US Preventive Services Task Force levels of recommendation (

  • Level A: Recommendations are based on good and consistent scientific evidence (ie, there are consistent findings from at least 2 well-designed, well-conducted case-control studies, a systematic review, or a meta-analysis). There is high certainty that the net benefit is substantial, and the conclusion is unlikely to be strongly affected by the results of future studies.

  • Level B: Recommendations are based on limited or inconsistent scientific evidence. The available evidence is sufficient to determine the effects of the recommendations on health outcomes, but confidence in the estimate is constrained by such factors as the number, size, or quality of individual studies or inconsistent findings across individual studies. As more information becomes available, the magnitude or direction of the observed effect could change, and this change may be large enough to alter the conclusion.

  • Level C: Recommendations are based primarily on consensus and expert opinion.