A Guide to Safe Sleep
Where is the safest place for your baby to sleep?
Here are the facts so you can make your own informed decision.
The American Academy of Pediatrics (AAP) reviewed numerous studies and reports on infant tragic sleep events and came up with the following recommendations. They apply especially within the first 6 months and up to 12 months of age. According to the AAP, the safest place for babies to sleep is:
- on their own sleep surface (i.e. in their own bassinet, cot etc.)
- within sensory range of the parent (i.e. within range to hear, smell and be aware of the parent).
There is also research that studied infant breathing and arousal rates when sleeping close to their parent. Sleeping in the same room was shown to be more protective of sudden infant death syndrome (SIDS) and sudden unexpected infant death syndrome (SUIDS), particularly in, but not confined to, breastfed babies.
Sleeping with your baby
There have been many studies relating to safety when sleeping on the same sleep surface as your baby. Not all parents elect to sleep with their baby; however, if you breastfeed and lie down with your baby, it’s highly likely you may drift off to sleep. Therefore, always create a safe bed-sharing environment in advance:
- Baby needs to have their arms free, so not wrapped Sleep baby on their back at all times;
- Ensure they are clear of adult bedding, including pillows;
- Position your baby, so they can’t fall from the bed, but be mindful that babies can become trapped between the mattress and wall;
- Sleep baby on a firm mattress, so if you have a soft padded mattress, then your bed is not a safe place to sleep your baby;
- Tie back long hair; and
- Do not allow baby to sleep with animals or other children.
Never sleep with your baby if:
- You or your partner are smokers or under the influence of drugs (including sedating prescription drugs) or alcohol;
- Sleeping on an unsafe surface such as a sofa or armchair you or your partner are obese; and
- Your baby is preterm or under 2.5 kg birth weight.
If you have a side-cot arrangement, ensure the cot is securely attached to your bed, so there is NO gap between your mattress and the mattress of the cot. SIDS events have occurred with co-sleeper cots when they haven’t been used or secured properly, or when the baby has not been carefully placed into the cot
For safe co-sleeping guidelines go to http://cosleeping.nd.edu/safe-co-sleeping-guidelines/
When babies sleep with their parents in the same bed, they’re more protected from SIDS (Sudden Infant Death Syndrome) and SUIDS (Sudden Unexpected Infant Death Syndrome) when they sleep in an “in-bed” sleeper - a protected space for the baby designed to ensure airflow and reduce the risk of overheating or being rolled on.
So what about sleeping and breastfeeding?
Breastfeeding your baby, in general, has been shown to reduce the chance of SIDS/SUIDS. When sleeping with your baby, research has also shown that breastfeeding rates increase - although I don’t think we needed the scientists to tell us that one!
Safe sleeping guidelines
The SIDS safe sleeping guidelines are a compilation of research, coroners reports and other expert studies over many years. Even though there are different organisations worldwide, they all have the same recommendations to reduce the risk of infant sleep accidents.
These are the key factors
Sleep your baby on his or her back for every sleep
Not on their side or stomach. In the 1970s-90s, babies were often put to sleep on their stomach which appears to have begun with Dr Spock in 1955 as a settling technique. However, the rate of cot deaths reduced so dramatically when the ‘back to sleep’ campaign commenced that stomach sleeping is now considered a position that places babies at high risk of SIDS.
Once your baby begins to roll, ensure they have their arms free from wraps and swaddles. Do not try to prevent rolling - avoid using devices or positioners designed to stop the baby from rolling as they may create more risks than benefits. When you position your baby on their back, place their feet at the end of the cot or bassinet.
Use a firm mattress without excessive bedding. Only use the mattress designed to fit your baby’s bassinet, cot and a portable cot and maintain any sleeping space in optimal condition. Do not make modifications because manufacturers have met stringent safety standards, so modifications risk inadvertently creating unsafe sleeping conditions.
Portable cots have firm mattresses and are not designed to have layers under the sheets such as sheepskins. If you’re worried about your baby being cold at ground level, reduce airflow under the bed rather than under the mattress.
Ensure your baby’s head is uncovered
- Only place bedding up to their shoulders;
- Tuck in the blankets securely; and
- Avoid bumpers and pillows.
Sleeping Bags overcome the risk of unsecured blankets covering the baby’s face as long as the sleeping bag is well fitted around the neck, and the baby can have their arms free once they begin to roll.
Keep your baby’s life smoke-free
Both before and after birth, keep your baby free from tobacco smoke environments. If you smoke, wear a jacket or clothing you can leave outdoors where you smoke and wash your hands after smoking. Don’t smoke with your baby in the house or car.
Immunisations and SIDS
Thousands of worldwide studies have found no association between immunisations and SIDS; in fact, several studies have found unvaccinated babies to be more highly represented in SIDS studies.
Room and body temperature
There is no specific temperature that has been proven to be the safest. However, recommendations around the world generally talk about 18-21 degrees Celsius as the ideal sleeping temperature. Lower temperatures have not been identified as a sleep risk, but higher temperatures have. Hyperthermic stress is when a baby becomes overheated, which can occur if the baby is covered in too many blankets or if they are overheated either when sleeping with parents or if the air temperature is too hot.
There is detailed research that identifies overheating babies can place babies at higher risk of tragic sleep events. So, for example, if someone recommends you use additional blankets purely to help your baby sleep, this is contrary to the safe sleeping guidelines worldwide.
The ‘one more layer’ rule
The general rule of thumb, although not researched, is to cover your baby with one more layer than what you’re wearing. So if you wear pyjamas and have a doona that’s equivalent to two blankets, then that’s a total of 3 layers. So your baby can wear a onesie and be wrapped in light fabric, then covered with one heavy or two lighter blankets made of natural materials.
Sleeping Bags mean you don’t need an additional blanket on top of the sleeping bag is of a heavier material, which works particularly well when babies become active in their sleep. Sleeping bags with tog ratings offer warmth when sleeping without needing numerous layers of bedding.
How to see if a baby is too hot or cold
To get an idea of your baby’s temperature, place your first 2 fingers gently down the neckline of their clothes at the front or back and feel if they are warm, cool, cold or hot. That indicates their core temperature.
- If they’re too hot, they may feel clammy or sweaty and need fewer layers. If they’re cool or cold, then they need another layer. Baby’s hands are not a good gauge.
- If they have cold hands, it doesn’t mean they are too cold - their hands are not always a good indication of their body temperature.
- A wrap covers the baby many times as it wraps around, so what seems light, may equate to more than the light layer you think it is never sleeping baby in a hat or sleeping bag with a hood; and
- Babies can easily overheat if slept near a heater or on a heated sleep surface.
Once your baby begins to move, be aware of what they can reach when in their cot. A cord from a curtain, monitor or mobile can become a potential risk once they can reach through their cot rails. Keep their cot positioned away from leads, cords and toys that may be a potential risk when they’re sleeping unsupervised.
Other sleep places
Always watch a baby when sleeping in a car seat, pram, stroller or bouncer and even baby carriers. Babies need a clear, unobstructed airway, so make sure they have a straight neck and access to fresh air. Hammocks and portable cots rely on sensible parental use because of limited research and safety standards.
Helen Stevens. Registered Nurse, Midwife and Maternal Child and Family Health Nurse, with qualifications in Infant Mental Health and a range of early childhood interventions. As author, researcher, educator and clinician, she has specialised in infant sleep for over 20 years and has world recognition for her work. Go to www.helenstevens.com.au for more great information and help for parents.