You should not put a pillow in a crib at all. The safest time to introduce a pillow is after your child has transitioned out of the crib and into a toddler bed, which typically happens between 18 months and 3.5 years of age. While your child sleeps in a crib, the mattress should have nothing on it except a fitted sheet.
Why Pillows Are Dangerous in Cribs
A pillow in a crib creates two separate suffocation risks, and either one can be fatal on its own. The first is airflow resistance. When a baby’s face presses into soft material like a pillow, the material conforms around their nose and mouth, physically blocking air from getting in. Infants lack the neck strength and motor coordination to reliably lift or turn their heads to clear the obstruction.
The second risk is carbon dioxide rebreathing. Even if the pillow doesn’t fully block the airway, soft, thick material can trap exhaled air in a pocket around the baby’s face. The baby then breathes in that stale air, which is lower in oxygen and higher in carbon dioxide than fresh air. This form of suffocation can cause death without any significant blockage of airflow, which is part of what makes it so dangerous. These two hazards can also occur together, compounding the risk.
The American Academy of Pediatrics recommends that infants sleep on a firm mattress covered by a fitted sheet with no other bedding or soft objects. That means no pillows, quilts, bumper pads, comforters, or stuffed animals. The NHS in the UK gives similar guidance, advising against pillows or duvets for any child under age 1.
The Right Time to Introduce a Pillow
The clearest guideline is this: wait until your child is out of the crib entirely. Many families make the switch to a toddler bed somewhere between 18 months and 3.5 years. Common triggers include a child repeatedly climbing over the crib rails, or the top of the rail reaching only to the child’s chest (around nipple height), which makes climbing over much easier. If your child sleeps well in the crib and isn’t climbing out, there’s no rush to make the switch.
Once your toddler is sleeping in a bed rather than a crib, you can consider adding a pillow. But even then, your child may not actually need one right away. Toddlers have been sleeping without pillows their whole lives and are perfectly comfortable on a flat surface. A pillow becomes more useful as their shoulders grow wider than their head, since side sleepers in particular benefit from having their head supported to keep their spine aligned.
Signs Your Toddler Is Ready
Some children will show you they want a pillow before you think to offer one. If your toddler starts propping their head on a stuffed animal, bunching up a blanket under their head, or resting their head on their arm while sleeping, they’re seeking out the comfort and support a pillow provides. These are good signals that they’d sleep more comfortably with one. Without a pillow, toddlers who sleep on their side sometimes rest their head on their arm, which can make the shoulder fall asleep and cause discomfort when they wake up.
Choosing the Right First Pillow
An adult pillow is too large and too soft for a toddler. A pillow that’s too big can overwhelm a small child and potentially cause entrapment. Standard toddler pillows measure about 13 by 18 inches, roughly a third the size of an adult pillow, making them proportional to a toddler’s body.
Firmness matters more than you might expect. A very soft pillow that loses its shape still poses a suffocation risk, even for toddlers. Look for a pillow that holds its form when you press on it. Toddlers actually tend to sleep more comfortably on firmer options because they’re not used to cushioning and because their necks are still relatively weak. A firmer pillow provides consistent support without letting the head sink in. A loft (thickness) of about 3.5 inches gives adequate support without pushing the head and neck up at an unnatural angle.
A pillow that’s too firm will force the head upward, and one that’s too soft won’t support the neck at all. The goal is a middle ground where the head, neck, and spine stay in a neutral line, similar to what you’d want from your own pillow.
Toddler Bed Options for the Transition
When you’re ready to move your child out of the crib, the type of bed matters less than you might think. Dedicated toddler beds are small, sit low to the ground, and have built-in guardrails. A full-size bed works too, as long as you protect all sides from falls. Some families simply place a crib mattress, futon, or regular mattress directly on the floor, which is both practical and eliminates the risk of falling from a height. Bunk beds should be avoided until a child is at least 6 years old.
Whatever bed you choose, this transition is the appropriate time to introduce a pillow if your child seems to want one. Keep the rest of the sleep environment simple, and choose bedding sized for your toddler rather than repurposing adult bedding that could bunch up around their face during the night.