Safe bedding for babies: what the evidence says

Newborn · Sleep · Reviewed 20 June 2026 · All articles

Safe sleep is one of the most important things a new parent can get right, and bedding choices sit at the heart of it. What goes into a baby's sleep space, what stays out, and how the sleep environment is set up together make a significant difference to the risk of sudden unexpected death in infancy (SUDI), which includes sudden infant death syndrome (SIDS) and fatal sleeping accidents.

Guidelines from Red Nose Australia, the American Academy of Pediatrics (AAP), and the NHS in the UK are broadly consistent. They are built on decades of research and are updated as new evidence emerges. This article draws on all three to give you a clear picture of what the evidence supports and why each recommendation exists.

Why bedding matters for infant safety

Newborns have limited head and neck control. If loose fabric covers their face during sleep, they cannot reliably move it aside or turn their head to clear their airway. This is the central reason why loose bedding is considered a hazard in the first year of life.

Research consistently shows that soft sleeping surfaces and loose bedding are among the modifiable risk factors most strongly associated with SIDS and fatal sleep accidents. Red Nose Australia notes that the risk of SUDI is significantly elevated when babies sleep on soft surfaces or with loose items in the sleep space. The AAP's 2022 safe sleep update reinforces this, stating that a firm, flat, separate sleep surface free of soft items is the cornerstone of safe infant sleep.

Understanding the mechanism helps parents apply the principles beyond specific products. The problem is not a particular brand of blanket or pillow. The problem is any soft item near a baby's face that can obstruct breathing or trap re-breathed air. That framing helps when navigating the enormous variety of products marketed as safe or suitable for babies.

Choosing the right sleep surface

Before any bedding decision, the mattress itself matters. All three organisations are clear: the mattress must be firm and flat. When you press on it with the flat of your hand, it should not sink noticeably or leave a significant impression. Soft mattresses, memory-foam layers, pillow-top inserts, and sheepskin underlays are all considered unsafe for infant sleep.

The mattress must also fit the cot or bassinet snugly. Gaps between the mattress and the sides of the sleep space can trap a baby's head. Red Nose Australia recommends checking that you cannot fit more than two fingers between the mattress edge and the sides of the cot. A standard-size cot mattress should always be used with the cot it was designed for, and the same principle applies to travel cots and bassinets.

Keep the mattress clean and dry. A waterproof fitted sheet underneath a standard fitted sheet is a practical approach used by many parents. The key is that only a firm, flat, properly fitted sheet should be in contact with the baby. Nothing should be folded underneath the mattress to raise one end, as inclined sleep surfaces have been associated with infant deaths and are not recommended by any of these guidelines.

Loose bedding and what to use instead

Loose blankets, duvets, quilts, comforters, and pillows should all be kept out of a baby's sleep space for at least the first twelve months. This covers the period when babies are most vulnerable and least able to control their head and neck movements.

The recommended alternative is a baby sleep bag, also called a sleeping bag or sleep sack. A well-fitting sleep bag wraps around the baby without riding up over the face and provides warmth without the hazard of loose fabric. Red Nose Australia recommends baby sleep bags as a safe alternative to blankets. The NHS similarly recommends them as the safest way to keep a baby warm at night.

When choosing a sleep bag, check the TOG rating against the room temperature. TOG is a measure of thermal insulation. A higher TOG means more warmth, suitable for cooler rooms; a lower TOG is better in warmer conditions. Most manufacturers provide a guidance chart. The general aim is to keep the room at around 16 to 20 degrees Celsius (61 to 68 degrees Fahrenheit) and dress the baby appropriately for that temperature. Overheating is itself a risk factor for SIDS, so the goal is warmth without overheating.

If you want to use a cellular cotton blanket in the early weeks, the safest approach is the "feet to foot" method: position the baby with their feet touching the bottom of the cot, then tuck the blanket firmly under the mattress on three sides so it reaches only as far as the baby's chest. This reduces the chance of the blanket working its way up over the baby's face. However, a sleep bag remains the simpler and more reliably safe option.

Sleep position and how bedding interacts with it

Back sleeping is the single most important safe sleep recommendation across all three guidelines. Babies should be placed on their back at the start of every sleep, from birth until they can roll over reliably and move back to their preferred position independently. The phrase used by Red Nose Australia is "back to sleep, tummy to play."

The interaction between sleep position and bedding is important. A baby placed on their back on a firm, flat surface with no loose items nearby has the safest profile. The moment soft items enter the picture, the risk increases, because there is more material that could migrate toward the face if the baby moves during sleep.

Some parents are concerned about flat head syndrome (positional plagiocephaly) and wonder whether a soft insert or head support could help. The AAP is clear that no soft inserts should be used in the sleep space for this purpose. Supervised tummy time while the baby is awake is the correct way to address head-shape concerns and strengthen neck muscles.

Once a baby begins rolling and can move from tummy to back and back to tummy independently, it is no longer necessary to reposition them if they roll during sleep. Before that point, always place the baby on their back and gently return them if you find them face-down and they cannot yet roll back.

Items to keep out of the sleep space

Beyond blankets and pillows, several other items are commonly placed in cots but are not recommended in the first twelve months.

Cot bumpers, including the mesh or "breathable" varieties, are not recommended by the NHS, the AAP, or Red Nose Australia. The NHS removed them from its advice as a safe alternative and now advises against all cot bumpers. The concern is entanglement and the potential for fabric to still restrict airflow even when marketed as breathable.

Soft toys, stuffed animals, and comfort objects should be kept out of the sleep space in the first year. This can be emotionally difficult because these items often have significant meaning for families, but the risk they pose outweighs the benefit during sleep. They are entirely fine to use during supervised awake time and playtime.

Nappy bags, muslin cloths, and other items often left in the cot for convenience should be removed before the baby sleeps. The same applies to clothing items, spare nappies, or any other object that is not part of the intended sleep setup. A clear, minimal sleep space is easier to manage consistently, especially during night feeds when tiredness makes careful checks harder.

Room temperature and overheating

Overheating is an independent risk factor for SIDS. Red Nose Australia, the NHS, and the AAP all identify it as something parents should actively monitor and manage.

The recommended room temperature range is 16 to 20 degrees Celsius (approximately 61 to 68 degrees Fahrenheit). A simple room thermometer is a useful, low-cost purchase for the nursery. Keeping a window slightly open for ventilation can help in warmer weather, but direct draughts on the baby should be avoided.

Checking for overheating by feeling the back of the baby's neck or their tummy (not their hands or feet, which are naturally cooler) is a reliable method. A baby who is too warm will feel hot to the touch, may be sweating, or may have flushed cheeks. If any of these signs are present, remove a layer of clothing or swap to a lower-TOG sleep bag.

Do not place the baby's cot near a radiator, in direct sunlight from a window, or next to other heat sources. During heatwaves, extra attention to room temperature and dress is important, and it may be worth moving the baby's sleep space to a cooler part of the home.

Swaddling in the newborn period

Swaddling, the practice of wrapping a newborn snugly in a thin muslin or cotton cloth, is widely used and can help some babies settle. Red Nose Australia and the NHS both provide guidance on how to swaddle safely rather than advising against it outright.

The key rules for safe swaddling are: always place a swaddled baby on their back; never swaddle above the shoulders or cover the face; do not swaddle too tightly, particularly around the hips, as this can affect hip development; use a thin, breathable fabric and do not add extra layers on top; and stop swaddling as soon as there are any signs the baby is attempting to roll, typically around three to four months.

Once rolling begins, swaddling becomes a hazard because a swaddled baby who rolls face-down cannot use their arms to push up. The transition from swaddling to a sleep bag should happen before rolling is established, not after.

The AAP, the NHS, and Red Nose Australia all recommend that babies sleep in the same room as a caregiver for at least the first six months, ideally the first twelve. This is distinct from bed-sharing, which is discouraged. The baby sleeps on their own firm, flat surface close to the adult bed.

Room sharing allows a parent to hear the baby and respond quickly. Research cited by the AAP suggests that room sharing without bed-sharing is associated with a lower risk of SIDS compared with the baby sleeping in a separate room. The proximity matters even when there is no obvious reason for it to make a difference mechanically. Current understanding is that parental presence may influence arousal patterns or that parents respond more quickly to subtle signs of distress.

Bedside bassinets and bedside cribs that attach to the adult bed are a practical way to maintain room sharing without bringing the baby onto the adult sleep surface. They keep the baby at arm's reach for night feeds while preserving a separate, firm, flat sleep space.

Frequently asked questions

Are blankets safe for newborns in a cot?

Health bodies including Red Nose Australia, the AAP and the NHS advise against loose blankets in a baby's sleep space for at least the first twelve months. Loose bedding can bunch up around a baby's face and restrict breathing. A fitted sheet on a firm, flat mattress, combined with a well-fitting baby sleep bag rated for the room temperature, is the recommended approach instead of a blanket.

What type of mattress is safest for a baby?

A firm, flat, clean mattress that fits snugly inside the cot or bassinet with no gaps at the sides is the safest choice. The mattress should not depress significantly when pressed with your hand. Soft mattresses, memory-foam toppers, and pillow-top surfaces are not recommended because they can mould around a baby's face. The Red Nose Australia guidelines specify that the mattress must be firm and the correct size for the sleep space.

Can I use a sleep sack or swaddle instead of a blanket?

Yes. A correctly sized baby sleep bag or sleeping bag (sometimes called a sleep sack) is recommended by Red Nose Australia, the NHS and the AAP as a safer alternative to loose blankets. It keeps the baby warm without the risk of loose fabric covering the face. For newborns who are not yet rolling, a firm swaddle wrap is also widely used in early weeks, but swaddling should stop once a baby shows signs of rolling, typically around three to four months.

When can I add a pillow or soft toy to my baby's sleep space?

Major health guidelines recommend keeping pillows, soft toys, cot bumpers, and any loose items out of the sleep space for the first twelve months. After twelve months the risk profile changes as babies have stronger neck and head control. However, there is no universal age at which these items are declared safe, and many parents choose to wait longer. If in doubt, speak with your child health nurse, health visitor or GP.

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