What the AAP Recommends for Sleep vs. What Real Parents Do

In 1992, a lot changed for the health and life expectancy of newborn babies. That was the year that the American Academy of Pediatrics (AAP), in an attempt to lower the risk of Sudden Infant Death Syndrome (SIDS), began recommending that parents put their babies to bed on their backs, instead of their stomachs. This recommendation ended up drastically reducing the number of infant deaths that the country saw in a given year. Over the years since, the AAP has added to and amended its list of newborn sleep guidelines to help parents feel more secure about the well-being of their babies during their first year of life.

According to one of the AAP’s publications, here are a few of the sleep recommendations that are supposed to help prevent SIDS:

  • Put the baby on his or her back to sleep
  • Use only a firm sleep surface
  • Breastfeeding is recommended
  • Keep soft objects and loose bedding away from the infant’s sleep area to reduce the risk of SIDS, suffocation, entrapment, and strangulation.
  • Offer pacifier at bed and nap time
  • Avoid smoke exposure during pregnancy and after birth
  • Avoid alcohol and drug use during pregnancy and after birth
  • Avoid overheating and head covering in infants

Just recently, the AAP made yet another suggestion regarding sleep for newborns: “It is recommended that infants sleep in the parents’ room, close to the parents’ bed, but on a separate surface designed for infants, ideally for the first year of life, but at least for the first 6 months.”

It was this last part that I found the most interesting. As the mother of a two-year-old and a four-week-old, I couldn’t imagine having my baby in the room with me for an entire year. When my toddler was an infant, he was a terrible sleeper. He was colicky, he had awful reflux, and when we put him in his co-sleeper every night, he sounded like a congested teacup pig, snorting and gurgling incessantly. Then his hiccups took over, leading to more spit-up and then a crying jag. It was exhausting. By the time he hit three months, my husband and I made the decision to evict him from our room so that we could get more than ten minutes of sleep at a time. We had been functioning (perhaps “functioning” isn’t the right word) on that little sleep for months. We were wrecks and were desperate. Putting our son in his own room truly saved us.

Now that I have a newborn again, I looked at the AAP recommendations and quickly realized that they’re not all always feasible or practical. I reached out to several friends and acquaintances who have had children in recent years to get a sense of what parents are really doing when it comes to sleep.

Next page: It’s not as simple as the AAP makes it sound

In a perfect world…

Sure, in an ideal world, our little ones would sleep in their own, firm bassinet (free of pillows, blankets, crib bumpers, and stuffed animals) on their backs, right next to their parents’ bed for an entire year. They would be breastfed for at least a year as well, would take well to pacifiers when they sleep, and would have parents who do not indulge in drinking, smoking, or drug use.

But there are perils associated with sleep-deprived parents:

A recent New York Times article on the topic mentioned the importance of sleep for parents in these scenarios:

Depriving parents of good sleep can also endanger babies. Sleep-deprived people can have decreased empathy. Sleep deprivation is associated with an increase in car accidents (which are a top killer of older children). It stresses marriages and families and is significantly associated with an increased risk of postpartum depression.

Now let’s look at what parents are doing in reality – mostly out of desperation because of their uncooperative newborns:


Many of the parents I spoke with told me that they co-sleep to some extent with their babies. This means that they put the baby in the bed with them. For some, it is a conscientious choice because they believe in attachment parenting. But for others (myself included) co-sleeping has become a necessity to squeeze a few more minutes of sleep out of the night. Especially for breastfeeding families, putting the baby in a side-lying position to eat and then fall asleep (while mom gets some rest as well) is more prevalent than I had thought. In most of these cases, dad gets the boot from the bed to help keep baby safe. I found that some families put their child in bed with them from day one and let him or her sleep there for years, while others engage in co-sleeping as necessary to get through a rough night (or few weeks) in a newborn’s life.

Baby on back?

Putting the baby on his or her back on a flat surface turned out to be another issue for many parents. Both my kids experienced uncomfortable congestion when put on their backs. That gurgling, snorting sound that would keep me up at night is apparently very common in small babies, causing many parents to put their kids to sleep in a bouncy seat or Rock ‘n Play because they provide an inclined surface. My sons’ own pediatrician said that her kids slept in their car seat for this very reason. Other parents mentioned that the only way the baby (and the parents for that matter) could get some rest was when the baby slept on his or her tummy directly on mom or dad’s chest. So much for a bassinet next to the crib.

Pacifier Shmacifier

I recently offered my newborn a pacifier, which is supposed to help reduce the risk of SIDS. It’s great and he loves it. Only it falls out of his mouth every four minutes. This means that in the rare event that he’s actually lying on his back in his own little bed, I pass out only to get yanked from my REM cycle a few minutes later when he needs me to put his paci back in his mouth. This does not result in a good amount of sleep for anyone.

What should you do with your personal baby?

While every parent wants what is best for his or her new baby, there are limits to what parents can actually do. The reality is that the day-to-day with a newborn (or a child of any age for that matter) is far more complicated than what any guidelines will have you believe. Common sense and doing what is best for your specific situation and household seem to be what works these days. Guidelines are guidelines, and parents need to make whatever adjustments are necessary to get through the day (or sleepless night).