Safe Sleeping

Evidence 

https://www.sciencedaily.com/releases/2017/06/170626124347.htm  

Robin Lally “Premature infants still have a greater risk compared to full-term babies of dying of SIDS and other sleep-related infant deaths despite recommendations.” 

In a 2017 study, researchers found babies born between 25 to 27 weeks gestation had a more than three times higher chance of dying before their first birthday of a sudden unexpected infant death such as SIDS or another sleep-related death, compared to babies born full term. Researchers reported the risk remained high even when they removed factors such as smoking and low prenatal care. Furthermore, while babies born premature closer to a full term gestation had a lower level of risk for dying of SIDS, it was still significantly higher than full term babies. 

Read about how Red Nose research is studying sleep related deaths in Australia here: https://rednose.org.au/research/bridging-the-gap-between-human-postmortem-tissue-analysis-and-animal-models  

Education 

While in the Neonatal unit, your baby may have benefited from being placed in the prone position (on their stomach) or being ‘nested’ with soft bedding. However, once your baby is home they should be put to sleep on their back, as babies who are born prematurely, of low birth weight, from a multiple birth or with neonatal health problems are at an increased risk of sudden infant death syndrome (SIDS), compared to infants born at term. SIDS is the sudden and unexpected death of a baby with no known cause. It is one of the leading causes of death in infants under 12 months of age and was previously known as ‘cot death’. 

Red Nose (Formerly SIDS and Kids) has compiled evidence backed ‘Six Safe Sleep Recommendations’, to help reduce the risk of SIDS and other sleep related accidents. 

It is important to acknowledge that every family and baby is unique, and you need to make the best decision for you and your family, including whether you choose to co-sleep with your baby.  

Red Nose is considered the recognised national authority on safe sleeping practices for infants and children, and so it is helpful to consider their advice and tips for safe sleeping practices. 

The Red Nose six safe sleep recommendations: 

1. Always place baby on their back to sleep 

Placing baby on their back to sleep helps keep their airway clear and ensures their protective reflexes work. Back sleeping reduces the risk of suffocation, overheating and choking. 

2. Keep baby’s face and head uncovered

Babies control their temperature through their face and head, so keeping baby’s face and head uncovered during sleep helps reduce the risk of overheating. It also helps keep their airways clear which reduces the risk of suffocation. 

3. 3. Keep baby smoke free, before and after birth

Smoking during pregnancy and around baby once they are born increases the risk of sudden infant death – this includes second-hand smoke. 

If you or your partner smoke, don’t smoke around baby and never smoke where baby sleeps. 

For free help to quit smoking call Quitline on 13 78 48. 

4. Safe sleeping environment, night and day

The safest place for baby to sleep is in their own safe space, with a safe mattress, and safe bedding. Baby should always be placed on their back to sleep, with their feet at the bottom of the bassinet or cot. 

• Safe cot - Meets Australian standard AS/NZS 2172:2003. 

• Safe mattress - Firm, flat, right size for your safe cot, meets voluntary Australian standard (AS/NZS 8811.1:2013). 

• Safe bedding - Lightweight bedding, firmly tucked in and only pulled up to the chest. 

• Safe sleeping bag - Well fitted across the neck and chest, with baby’s arms out, and no hood. 

5) Sleep baby in their own safe sleep space in the same room as their parent or caregiver for at least the first 6 months 

5. 5. Sleep baby in their own safe sleep space in the same room as their parent or caregiver for at least the first 6 months

The safest place for baby to sleep is in their own safe space, in the same room as their parent or adult caregiver for at least the first 6 months. 

6. Breastfeed baby

Breastfeeding has been shown to reduce the risk of sudden infant death. For mums not breastfeeding, follow the first five steps to help keep baby safe. 

More information on this can be found here: https://rednose.org.au/article/red-nose-six-safe-sleep-recommendations 

Co-Sleeping 

The safest place for a baby to sleep is in their own safe sleep space. Red Nose does not recommend co-sleeping (sharing a sleep surface); however, they acknowledge that some parents choose to co-sleep while others may find themselves co-sleeping unintentionally.  

If you choose to co-sleep, it is important to know how to reduce the risks, as there are some circumstances where co-sleeping with your baby can be especially dangerous. 

Tips for safer co-sleeping: 

• Place your baby on their back to sleep (never on their tummy or side). This helps to protect their airways. 

• Keep baby’s head and face uncovered by keeping pillows and adult bedding away from your baby. Use a safe sleeping bag with no hood with baby’s arms out – don’t wrap or swaddle baby when bed-sharing or co-sleeping. 

• Make sure the mattress is firm and flat. Don’t use a waterbed, or anything soft underneath – for example, a lamb’s wool underlay or pillows. This can increase the risk of overheating and suffocation. 

• Tie up long hair and remove anything else that could be a strangling risk, including all jewellery, teething necklaces and dummy chains 

• Move the bed away from the wall, so baby can’t get trapped between the bed and wall. 

• Make sure your baby can’t fall out of bed. Consider sleeping on your mattress on the floor if it’s possible your baby might roll off the bed 

• Create a clear space for your baby and place your baby on their back to the side of one parent away from the edge, never in the middle of two adults or next to other children or pets as this can increase the risk of overheating and suffocation.

When not to co-sleep: 

You should never co-sleep or lie down holding baby if: 

• You are overly tired or unwell. 

• You or your partner have recently consumed alcohol. 

• You or your partner smoke, even if you don’t smoke in the bedroom. 

• You or your partner have taken any drugs that make you feel sleepy or less aware. 

• Your baby was premature or small for their gestational age.

Falling asleep holding baby on a couch or chair is always unsafe – move yourself and baby to a safe sleep environment if you think you might fall asleep. 

More information on this can be found here: https://rednose.org.au/article/Co-sleeping_with_your_baby

Advice for the grandparents 

It is common for grandparents to help care for their grandchildren, and so it is equally important that they too understand the safe sleeping techniques and recommendations to avoid SIDS. 

Other than educating them on the Six Safe Sleeping Recommendations, Red Nose has also created a special video guide for grandparents to help explain what has changed in the safe sleeping space since the 1980s – and why it is so important to sleep baby on their back from birth.​  

You can view it here: https://rednose.org.au/article/grandparents-and-safe-sleeping  

For more information on SIDS and safe sleeping please call the Red Nose 24/7 support line on 1300 308 307 or visit their website  https://rednose.org.au/  

Other Environments 

Prams, Bouncers & Cars: 

• Always do up the restraints when baby is in a pram, stroller, bouncer, or any other baby/toddler equipment. It can be dangerous if baby becomes tangled in loose restraints. 

• Make sure the footrest on the stroller is strong and secure. A weak footrest may give way & cause baby to become trapped. 

• Hats or bonnets should be removed when baby is taken inside. 

• Avoid covering a pram or stroller with a blanket or sheet as it can create an unsafe and hot environment for baby with little airflow. 

• Remember: Practice Safe Sleeping principles in all environments. It is not safe for a baby or child to sleep unattended in a pram, baby rocker or bouncer. 

Tummy Time: 

• Tummy Time is encouraged when baby is awake and supervised by an adult. 

• Tummy Time is important to baby’s development as it strengthens muscles. 

• Place baby on tummy or side to play. 

• Move toys around to keep baby active and stimulated. 

Wrapping or Swaddling:

Premature babies like full term babies feel more secure when they are swaddled. Many Neonatal wards promote swaddling of premature babies with their legs tucked up and hands brought together in front of them. 

Some Benefits of Wrapping or Swaddling: 

• Can help soothe and settle. 

• Can help babies sleep comfortably on their back reducing the risk of SIDS. 

• Reduce arm movements which can disturb sleep. 

• Hands can be wrapped close to a babies face so they can self-comfort easily. 

Safe wrapping: 

• The recommended fabrics are muslin or light cotton. Baby blankets or bunny rugs are not suitable as they may cause the baby to overheat. 

• Swaddling should be snug and secure. Allow for some movement especially around the legs so baby can bend their legs at the hips. 

• Do not swaddle baby higher than their shoulders as the wrap could cover baby’s face and head.

Empowerment 

Young children and babies rely on adults in their world to provide safe sleeping environments, educating yourself and family members on how your baby can sleep safely. 

The risk of your baby dying from SIDS are rare and very low. The rate of SIDS deaths has declined in Australia due to safe sleeping campaigns. In 2020, 100 babies in Australia died of SIDS (data from Queensland, New South Wales, Victoria and Western Australia only). 

Minimising the risk of SIDS - video 

https://www.healthdirect.gov.au/sudden-infant-death-syndrome-sids?videoId=5772322199001 

Make sure the cot, mattress and bedding are safe and meet Australian standards. 

https://www.productsafety.gov.au/products/babies-kids/kids-furniture 

Useful Links 

Special thanks to Red Nose Australia for content sharing and providing support for families.  

Red Nose Australia 

https://rednose.org.au/section/education 

Health Direct Australia 

https://www.healthdirect.gov.au/sudden-infant-death-syndrome-sids 

Royal Children’s Hospital, Melbourne 

https://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/Safe_sleeping/ 

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