It is not safe for newborns or infants to use a pillow. Medical and safety organizations, including the American Academy of Pediatrics (AAP), strongly advise against the use of any soft bedding, including pillows, until a child reaches an age where the risk of suffocation and sleep-related death is significantly reduced. This recommendation applies to all types of pillows, including small or specialty pillows marketed for infants. The sleep environment should remain completely bare to maximize safety for the baby.
Why Pillows Pose a Risk to Newborn Sleep Safety
Soft objects like pillows introduce substantial hazards into an infant’s sleep space because a baby lacks the necessary motor skills to move out of a dangerous position. A primary danger is the potential for rebreathing carbon dioxide (CO2) if the infant’s face becomes pressed into the soft material. When a baby re-inhales their own exhaled air trapped in the fibers, oxygen levels in their blood drop, which can lead to death.
The presence of a pillow also significantly raises the risk of positional asphyxia, a form of suffocation where the infant’s airway is physically blocked. A pillow can cause an infant’s head to flex forward, pushing the chin toward the chest and obstructing the narrow, flexible airway. Since the newborn’s neck control is underdeveloped, it is difficult to lift or turn the head to clear the obstruction. These suffocation mechanisms are directly linked to the increased risk of Sudden Infant Death Syndrome (SIDS) associated with soft bedding.
Essential Components of a Safe Sleep Environment
Creating a safe sleep environment requires strict adherence to the “bare is best” principle for the crib interior. The infant must be placed to sleep on their back on a firm, flat surface for every nap and nighttime sleep. A firm mattress should not indent or conform to the infant’s head, which helps prevent the creation of a pocket that could increase the chance of rebreathing. The mattress should be covered only with a tight-fitting sheet, ensuring there is no loose fabric.
All other items must be kept out of the crib:
- Loose blankets
- Quilts
- Comforters
- Bumper pads
- Soft toys
Instead of loose blankets, caregivers can use a wearable blanket or sleep sack to keep the infant warm without the risk of covering the baby’s face or causing overheating. Room sharing is recommended, where the baby sleeps in the parents’ room on a separate, approved sleep surface like a crib or bassinet. This practice decreases the risk of SIDS by as much as 50 percent and is preferred over bed-sharing.
Developmental Milestones for Introducing Bedding
The consensus among pediatric experts is that a child should not be given a pillow until they are at least two years old. This age guideline is based on the child’s improved motor skills and the significant reduction in SIDS risk after the infant stage.
By two years of age, a child typically has sufficient head and neck control and the ability to maneuver themselves out of positions that obstruct breathing. This is also commonly the time when children transition from a crib to a toddler bed or a standard bed. When a pillow is introduced, it should be small and relatively firm, rather than a large, adult-sized pillow. Introducing a small, firm pillow at this developmental stage provides proper neck support without the suffocation hazard present for an infant.