A Statement from Cribs for Kids on a Harm Reduction Approach to Infant Sleep
Cribs for Kids adheres to the American Academy of Pediatrics (AAP) evidence-based safe sleep recommendations1, which do not support bedsharing (i.e. co-sleeping, surface-sharing) due to the significant risk of suffocation associated with adult mattresses, soft bedding, and the presence of other individuals in the sleep space. For this reason, Cribs for Kids refers to harm reduction in this context more specifically as “suffocation risk reduction”.
Cribs for Kids does not support a suffocation risk reduction approach in broad public health messaging or educational campaigns, which are designed to provide clear, consistent, and evidence-based safe sleep guidance across populations.
The AAP acknowledges that some families fear unintentionally falling asleep with their infant or may face emergency situations or unavoidable circumstances which lead to bedsharing. Cribs for Kids recognizes the importance of preparing professionals to navigate conversations with families thoughtfully when such situations arise. After discussing barriers, identifying family needs, and exploring alternatives that avoid bedsharing, the following strategies may reduce – but will never eliminate – the risk of suffocation when no other safe sleep option is available:
- Remove all blankets, pillows, and loose bedding and ensure the mattress is firm and flat
- Always place the infant on their back to sleep
- The caregiver should wear warm, fitted sleepwear to avoid the need for blankets; tie back long hair or wear a fitted head covering (e.g. bonnet or scarf)
- Never sleep with an infant on a couch, chair, or recliner
- Do not allow another adult, child, or pet in the bed
If any of the following risk factors are present, the infant and caregiver should not bedshare under any circumstances and should strictly adhere to safe sleep practices:
- The infant was born premature or at low birth weight
- The caregiver smokes
- The caregiver has recently used any substance that could cause impairment
- The caregiver is excessively fatigued or difficult to arouse
Suffocation risk reduction guidance is incorporated into our Professional Training Series for Child Welfare workers, Home Visitors, Nurses, and Doulas as these professionals routinely engage in individualized conversations with families about infant sleep. Cribs for Kids encourages communities to ensure professionals working with families receive standardized safe sleep training to support these discussions with intention, nuance, and care. Broad public health messaging and educational campaigns should continue to uphold evidence-based safe sleep recommendations as the standard of care, while suffocation risk reduction strategies should be reserved for individualized counseling when necessary.
Please explore our Safe Sleep Ambassador training for guidance on the AAP’s recommendations, including information about safe temporary sleep space alternatives and creating a safe infant feeding zone.
