Unfortunately—although it may be tempting—babies under the age of 1 should not sleep with a pillow. It may be difficult to wrap your head around this since the idea of a grown-up sleeping without a pillow sounds pretty strange. But according to the Academy of American Pediatrics (AAP), babies should sleep on a firm mattress with nothing else, including pillows. Let’s take a look at why the guidelines advise against the use of pillows for babies, what the risks are, how to keep your baby comfortable despite this restriction, and when it might be appropriate to add a pillow into your child’s sleeping space.
When Is It Safe for My Baby to Use a Pillow?
The Academy of American Pediatrics, along with the Centers for Disease Control and Prevention, make it clear that putting a pillow—or really anything inside your baby’s crib besides your baby themselves—is not a good idea. This recommendation holds for the entire first year of your baby’s life. The reason for this, according to the AAP, is because any extra items in your baby’s crib can increase their chances of SIDS (Sudden Infant Death Syndrome), a tragedy that affects up to 2,300 babies each year. Additionally, sleeping with a pillow increases your baby’s risk of suffocation, strangulation, and entrapment. You might wonder what to do if your baby is cold, and how you can keep them cozy and comfortable at night without blankets or pillows. If your baby is cold, the AAP recommends dressing your baby in a sleep sack, or a wearable blanket. Swaddling your baby is also an acceptable practice, but you should ensure that your baby sleeps on their back while swaddled and that the swaddle isn’t too tight around their hips. As for sleep positioners, sleep wedges, or sleeping “nests,” these are not considered safe either, and the FDA warned against these products in 2019. “Using side wedges or hot dog-shaped cushions poses a danger, as these devices can force a baby’s face flat against the mattress or sleep surface, blocking her or his breathing airways,” Megan Shimkaveg, MD, a pediatrician at the University of Maryland St. Joseph Medical Center, explains. In addition to recommending against pillows or other loose objects in cribs, the AAP advises that you put your baby to sleep on a firm crib or bassinet mattress with a secure, fitted sheet. Importantly, you should always put your baby to sleep on their back. You should continue all of the recommended sleep precautions for the first year of your baby’s life. “The general rule of thumb is that when a child is mobile—able to control her or his own movements and able to sit up, crawl or walk on their own—a pillow, a blanket or stuffed animal in their sleep space should not pose a substantial risk,” says Dr. Shimkaveg. If you are not sure whether your toddler can transition to a pillow, you should ask your pediatrician for advice.
Risks of Using a Pillow for Babies
There are several reasons why the AAP and other major medical organizations recommend against the use of pillows as well as any extraneous items in a baby’s sleeping space. None of us want to consider anything harmful happening to our babies, but the reason that pediatricians urge such caution is because allowing a baby to sleep with a pillow could pose serious dangers.
SIDS Risk
One of the main reasons pillow use is not recommended is because of the risk of SIDS. Babies are at the highest risk of SIDS in their first year of life, and especially in their first four months of life. “While the cause of SIDS is still in question, the medical community has found ways to reduce its occurrence by avoiding certain risk factors,” says Dr. Wilhelm. “The current recommendation is for infants to sleep on a firm mattress with a taut fitted sheet.” Dr. Wilhelm says that some parents wonder if a firm pillow would be okay to use, but even that is not recommended and can increase your baby’s risk of SIDS. “The shape of the infant’s head is more rounded in the back compared to the shape of an adult head, resulting in the chin being rotated down and potentially compromising the airway if a firm pillow is used,” he explains.
Risk of Suffocation
Another reason that the AAP recommends against the use of pillows is that they increase your baby’s risk of suffocation. Babies have much less head and neck strength than adults or older children, so sleeping with a pillow is not safe. “The newborn and young infant does not have the strength to roll over or adjust their own head,” Dr. Wilhelm describes. “If an infant was to turn their head into a pillow and could not readjust, the fear is having a baby accidentally suffocate him or herself.”
Risk of Entrapment or Strangulation
Having any loose objects in your baby’s sleeping space, including pillows, increases their risk of strangulation or entrapment, says the AAP. Besides pillows, they warn against crib bumpers, toys, stuffed animals, and blankets. If your baby becomes entangled or entrapped under any of these objects, they do not have the strength to easily remove themselves from them. “No pillows, no sleeping wedges or cushions, no blankets, no stuffed animals,” Dr. Shimkaveg advises. “These kinds of items are all things that a baby could inadvertently wiggle under or uncontrollably sink into—and without the ability to move themselves, this can result in suffocation.”
A Word From Verywell
The idea that your baby should not use a pillow might seem odd to you at first, and you might be disappointed that all the sleep guidelines mean you can’t create a cozy, fluffy “nest” for your baby. You might also feel like there are just too many sleep “rules” out there. Try to keep in mind that these rules were created with your baby’s health and best interests at heart. And before you know it, your baby won’t be a baby anymore and will be able to move into a “big kid” bed, along with a pillow and blanket. Again, it’s important to keep your baby’s sleeping space free of pillows until they are at least 12 months old. At that time, be sure to consult with your pediatrician before adding in any soft bedding.
