Safe Sleep for Babies

Sudden Infant Death Syndrome (SIDS), or cot death, is the sudden and unexplained death of a baby where no cause is found. While SIDS is rare, it can still happen day or night and there are steps parents and carers can take to help reduce the chance of this tragedy occurring.  The Lullaby Trust has many more resources, information and advice on their website.  Below is a good portion of the advice provided by The Lullaby Trust

If you have any questions about SIDS or safer sleep, please call The Lullaby Trust information line on 0808 802 6869 (lines open Monday-Friday 10am-5pm).

Things you can do:

Sleeping your baby on their back

• Always place your baby on their back to sleep.  Not on their front or side.  Sleeping your baby on their back (known as the supine position) every night is one of the most protective actions you can take to ensure your baby is sleeping as safely as possible.  There is substantial evidence from around the world to show that sleeping your baby on their back  at the beginning of every sleep or nap (day and night) significantly reduces the risk of sudden infant death syndrome (SIDS).
  
• If your baby rolls onto their tummy?  Once your baby can move themselves from their back to their front and back again by themselves, they will be able to find their own sleeping position.  The first few times they roll onto their tummy, you might like to gently turn them back, but do not feel you have to get up all night to check. Give them some time to play on their tummy while they are awake to help their development, but make sure you supervise them while they are on their front.
• Some parents worry that by sleeping their baby on the back they will be at a greater risk of choking on their own vomit. However, no research has found this to be the case, and we now know that babies are far safer sleeping on their back. 
• All babies should be slept on their backs unless there is medical advice saying something different. If your baby has reflux, or any other on-going health condition, speak to your doctor about the best care for them.  You should not sleep your baby on their front unless you have been advised to do so by a medical professional.

Room Sharing

• The safest place for your baby to sleep for the first 6 months is in a separate cot or Moses basket in the same room as you.
• The chance of SIDS is lower when babies sleep in a separate cot in the same room as their parents.

Never sleep on a sofa or in an armchair with your baby

• Sleeping on a sofa or in an armchair with your baby is one of the most high-risk situations for them.
• Studies have found that sharing a sofa or armchair with a baby whilst you both sleep is associated with an extremely high risk of SIDS. One study found that approximately one-sixth of infants in England and Wales who died of SIDS were found sleeping with an adult on a sofa.
• Make sure that you do not accidentally fall asleep with your baby on a sofa. If you think you might fall asleep, put the baby down in a safe place to sleep.
• If you are breastfeeding, have your partner stay up with you, breastfeed in a different position where you are confident you might not fall asleep, or feed the baby somewhere else.
• Sleeping on a sofa or armchair with your baby can increase the risk of SIDS by 50 times. Find out more here.

Co-sleeping with your baby

Some parents choose to bed share with their babies. This means that their baby shares the same bed with an adult for most of the night, and not just to be comforted or fed. Some parents also choose to sleep with their baby in other places.

When you should not co-sleep

It is important for you to know that there are some circumstances in which sharing a bed with your baby can be very dangerous.

Bed sharing increases the chance of SIDS and is particularly dangerous if:

• Either you or your partner smokes (even if you do not smoke in the bedroom)
• Either you or your partner has drunk alcohol or taken drugs (including medications that may make you drowsy)
• You are extremely tired
• Your baby was born premature (37 weeks or less)
• Your baby was born at a low weight (2.5kg or 5½ lbs or less)

You should never sleep together with your baby if any of the above points apply to you.

You must be especially careful when giving feeds that you are not in a position where you could both fall asleep in the bed together.

If you choose to bed-share

Parents may still choose to bed-share with their baby. If this is your choice, it is important that you are informed about how to minimise the risks.

If you choose to share a bed with your baby:

• Ensure there are no pillows, sheets, blankets or any other items in the bed with you that could obstruct your baby’s breathing or cause them to overheat. A high proportion of infants who die as a result of SIDS are found with their head covered by loose bedding.
• Follow all of our other safer sleep advice to reduce the risk of SIDS.

The safest place for your baby to sleep for the first 6 months is in a separate cot or Moses basket in the same room as you.

Co-sleeping with your baby: FAQs

I am worried I might fall asleep in bed while I breastfeed my baby at night, is this ok?

Breastfeeding reduces the chance of SIDS, so we would always try and help you work out a way to continue breastfeeding in the safest way possible. If you feel you might fall asleep because you are lying down, it might be worth trying to feed in a sitting position or step outside of bed to breastfeed. Make sure you know the advice on when never to bed share so you know when to take particular care. However, it is really important that you do not accidentally fall asleep with your baby on a sofa. If you think you might fall asleep, put the baby down in a safe place to sleep. If you are breastfeeding, have your partner stay up with you, breastfeed in a different position where you are confident you might not fall asleep, or feed the baby somewhere else.

My baby won’t settle in their cot and only sleeps well in our bed, help!

Unfortunately there is no easy fix to a baby’s sleeping habits – but keep persevering! Babies can get used to different sleeping places but it can take a while. Try moving their cot close to your bed so you can still put your hand on them if needed and they know you are close by.

Do I need to bed share to breastfeed successfully?

There is no evidence to say that you need to bed share to breastfeed. For night feeds it is easy to bring your baby into bed to feed or settle, but they are safest then going back into their cot to sleep.

Do you advise against bed sharing?

We do not tell parents to never bed share. However, as a charity committed to reducing the number of babies dying from SIDS, we try to give parents the best advice we can, so they know the things they should never do, and what are the safest ways to look after their baby so they can make informed choices. The Lullaby Trust and the NHS, and many professional and parenting organisations all agree that the safest place for a baby to sleep is in their own cot or Moses basket in their parents’ bedroom until they are at least six months old.

Unicef baby friendly publications

The Lullaby Trust has worked with Unicef in the wording of two publications to support families and health professionals with the challenge of addressing co-sleeping, given the association with SIDS.

You might be interested in reading the two Unicef Baby Friendly publications, which are both endorsed by The Lullaby Trust:

• Unicef’s leaflet on Caring for Your Baby at Night
• Unicef’s guide Co-sleeping and SIDS: A Guide for Health Professionals
• Unicef Foreign Languages Resources

The safest room temperature for babies

It is important to make sure that your baby is a comfortable temperature – not too hot or too cold. The chance of SIDS is higher in babies who get too hot.

A room temperature of 16-20°C – with light bedding or a lightweight, well-fitting baby sleep bag– is comfortable and safe for sleeping babies.  Use a thermometer.

How to check if your baby is too hot or too cold

Every baby is different and our advice on room temperature is intended as a guide. So while it’s important to be informed about overheating, you need to check your baby regularly to see if they are too hot.

Feel your baby’s tummy or the back of their neck (your baby’s hands and feet will usually be cooler, which is normal). If your baby’s skin is hot or sweaty, remove one or more layers of bedclothes or bedding.

Why do babies who are unwell need fewer layers?

When babies feel unwell, with a cold or fever, they may be warmer than usual. It is important that you put fewer layers on an unwell baby so they have the opportunity to lower their body temperature – don’t feel tempted to wrap an unwell baby up more than usual.

If your baby shows signs of being significantly unwell you should seek medical advice. You may also find it helpful to use our Baby Check guide to monitor your baby’s symptoms.

Use a firm, flat and waterproof mattress in good condition

You should use a firm and flat mattress that is protected by a waterproof cover. This will help keep the mattress clean and dry, as the cover can be wiped down.

Make sure your baby’s mattress is in good condition and that it fits the Moses basket or cot properly.

Avoid using soft or bulky bedding

Firmly tucked in sheets and blankets (not above shoulder height) or a baby sleep bag are safe for a baby to sleep in. Be sure to remove any soft toys from the cot before each sleep period.

Sleep your baby in the feet-to-foot position and avoid using soft or bulky bedding such as quilts, pillows and duvets.

Pillows can increase the risk of SIDS

Pillow use alone has been shown to increase the chance of SIDS occurring by up to 2.5 times. If you were thinking of using a pillow with your baby due to concerns for plagiocephaly (or ‘flat head syndrome’). There are techniques you can use that could help plagiocephaly which will not increase the risk of SIDS.

We understand that plagiocephaly usually corrects itself within a year, but if you feel it is severe you may want to speak to your health professional or seek corrective treatment.

Find out more about The Lullaby Trust advice for a clear cot here.

We advise that babies have plenty of supervised tummy time in their waking hours to minimise time spent on their back, and you should also avoid letting babies sleep in harder contained sleep environments such as car seats and other travel systems.

Advice for using second-hand mattresses

It can be common to use a second-hand mattress either from friends and family, or from your previous children. There is some research that found an increased chance of SIDS when using a second-hand mattress  brought in from outside of the family home, although the link is not yet proven.

To help reduce this risk, if you are using a second-hand mattress make sure the mattress you choose was previously completely protected by a waterproof cover, with no rips or tears and is in good condition. The mattress should also still be firm and flat to keep your baby sleeping safely.

Remove cot bumpers

Cot bumpers can pose the risk of an accident to your baby once they begin to roll and move about the cot. There have been a number of cases in the UK and abroad where infants have become entangled in the ties and material, or fallen from pulling themselves up on the bumpers.

A simple mattress in your cot with no loose bedding or bumpers is the safest sleeping place for a baby. Find out more about the Lullaby Trust advice on cot bumpers here.

Mattresses and bedding: FAQs

Our room is very small and we can only squeeze in a travel cot, is this safe?

The same ‘safer sleep’ rules apply to a travel cot, which should have a rigid frame and base, and a firm, flat mattress, covered in a waterproof material.

Travel cot mattresses are often thinner and feel harder than those in a permanent cot, but don’t be tempted to place folded blankets or a quilt under the baby to make them ‘more comfortable’.

If you are very tight for space, you may have to consider re-arranging the furniture in the room to ensure that the travel cot isn’t against a radiator, in direct sunlight, and is out of reach of blind cords and hazards.

We have been given a cot and mattress second-hand. Is it safe to use with our new baby?

Generally we would advise it is safest to have a new mattress for each baby, though we know this is not always possible.

There is some evidence to suggest that bringing in a mattress from another home might increase the risk of sudden infant death very slightly. When using your own mattress for a second (or more) time, ensure it is still firm and flat with no tears or holes, and is not sagging in places. Thoroughly clean the waterproof layer and ensure the mattress is clean and dry before making it up with fresh bed clothes.

Can I put my twin babies in the same cot to sleep?

The Lullaby Trust has no evidence that putting twins in the same cot, in the early months, places them at greater risk of sudden infant death.

However, there are some things you can do to increase safety:

• Never put twins together in a Moses basket or a small cot as they may overheat in the restricted space.
• If you chose to sleep them side by side in one cot, only do this in the early weeks, when there is no danger of them rolling towards or over each other.
• It is also an option, right from the start, to place them at opposite ends of the cot, each of them ‘feet to foot’. Each twin therefore has their own firmly tucked in bedclothes or baby sleeping bag.
• Do not use rolled towels, foam wedges, or other objects between their heads.

By the time the twins are big enough to roll over they should be moved into their own separate cots. All the safer sleep advice applicable to single babies should be followed whether the babies are in the cot together or not.

Is it okay for my baby to sleep in a car seat?

It is fine for your baby to fall asleep when they are in their car seat, but once you get home we would advise that you move your baby to their usual firm, flat surface to sleep. Our advice is that the safest place for your baby to sleep – both during the day for naps and during the night – is in a cot or Moses basket in a room with you for the first six months.

It is important to check on your baby regularly when they are asleep.

If your baby is being transported in a car, they should be carried in a properly designed and fitted car seat, facing backwards, and preferably be in sight of an adult. Be careful that your baby doesn’t get too hot and remove hats and outdoor coats when you get in the car.

On long car journeys, stop for breaks so your baby is not in the car seat for prolonged periods (some manufacturers recommend a maximum period of 2 hours in car seats).

Premature babies who may slump need particular care when travelling in a car seat.

Ask your car seat manufacturer if they have any safety advice about the specific model you are using.

Swaddling your baby

Some believe swaddling young babies can help them settle to sleep. Whilst we do not advise for or against swaddling, we do urge parents to follow the advice below.

If you decide to adopt swaddling, this should be done for each day and night time sleep as part of a regular routine:

• Use thin materials
• Do not swaddle above the shoulders
• Never put a swaddled baby to sleep on their front
• Do not swaddle too tight
• Check the baby’s temperature to ensure they do not get too hot

Using slings and baby-carriers

Slings and baby-carriers are useful for holding a baby hands-free, however they are not always used safely. Although there is no reliable evidence that slings are directly associated with SIDS, there have been a number of deaths worldwide where infants have suffered a fatal accident from the use of a sling. These accidents are particularly due to suffocation, and particularly in young infants.

The risk appears to be greatest when a baby’s airway is obstructed either by their chin resting on their chest or their mouth and nose being covered by a parent’s skin or clothing.

The safest baby carrier to use will keep the infant firmly in an upright position where a parent can always see their baby’s face, and ensure their airways are free. Complete guidance is available by visiting The Royal Society for the Prevention of Accidents.

A clear cot is a safe cot

Babies are at higher risk of SIDS if they have their heads covered, so it is safest to keep baby’s cot clear of any items such as bumpers, toys and loose bedding. Unnecessary items in a baby’s cot can also increase the risk of accidents.

Babies need just a few basic items for sleep: a firm flat surface and some bedding.

New parents now have a massive range of baby products to choose from and it can be really confusing to know what is needed. The Lullaby Trust advice is simple: the safest cot is a clear cot.

The Lullaby Trust advice on choosing sleeping products for your baby

There is evidence to suggest that babies are at higher risk of SIDS if they have their heads covered and some items added to a cot may increase the risk of head-covering. Unnecessary items in a baby’s cot can also increase the risk of accidents.

While evidence on individual items is not widely available, it makes sense to be as cautious as possible.

We therefore recommend babies are slept in cots or Moses baskets that are kept as clear as possible and specifically advise:

• No pillows or duvets;
• No cot bumpers;
• No soft toys;
• No loose bedding;
• No products (such as wedges or straps) that will keep your baby in one sleeping position.

Read more advice on how to choose sleeping products here.

No product can reduce the risk of SIDS

We cannot comment on individual products, but would advise parents to read the safety advice when making choices. Sadly there is no product that can reduce the chance of SIDS and we would advise parents to be cautious about any product that makes such a claim.

We also encourage parents to check that any product they buy has passed the necessary safety checks and follow the manufacturer’s care instructions that come with the product.

Reducing the risk of SIDS for premature babies

Babies who are born prematurely (before 37 weeks) or of low birth weight (under 2.5kgs) are particularly vulnerable and it is important that all the safe sleep advice is followed. Premature babies are sometimes slept on their front in hospital for special medical reasons. When they are getting ready to go home these babies should always sleep on their back to reduce the risk of sudden infant death.

For professionals we have a leaflet Time to Get Back to Sleep, which highlights the importance of back-sleeping, and addresses commonly asked questions on sleep position for these vulnerable babies.

To order these publications call 020 7802 3200.

What is sudden infant death syndrome (SIDS)?

The sudden and unexpected death of a baby is usually referred to by professionals as ‘sudden unexpected death in infancy’ (SUDI) or ‘sudden unexpected death in childhood’ (SUDC), if the baby was over 12 months old. The death of a baby which is unexpected is also sometimes referred to as ‘sudden infant death’.

Some sudden and unexpected deaths can be explained by the post-mortem examination, revealing, for example, an unforeseen infection or metabolic disorder. Deaths that remain unexplained after the post-mortem are usually registered as ‘sudden infant death syndrome’ (SIDS) or SUDC in a child over 12 months. Sometimes other terms such as SUDI or ‘unascertained’ may be used.

While SIDS is rare, it can still happen and there are steps you can take to help reduce the risk for your baby.

What causes SIDS?

We do not know what causes SIDS. For many babies it is likely that a combination of factors affect them at a vulnerable stage of their development, which leads them to die suddenly and unexpectedly.

However, we do know you can significantly reduce the chance of SIDS occurring by following safer sleep advice.

What age babies are most at risk of SIDS? When does the risk decrease?

Around 89% of SIDS deaths happen when a baby is six months old or less.

To reduce the risk of SIDS for your baby, follow our evidence-based safer sleep advice –such as sleeping your baby on their back in a clear cot or Moses basket – for the first six months.

After this time, the risk is reduced, however SIDS can still happen so it is best to continue the safer sleep routines you have built up over time.

Does SIDS have any symptoms?

There is currently no evidence to suggest that any babies who have died from SIDS had any previous symptoms.

However, researchers around the world are currently engaged in a number of research projects that aim to find the underlying cause of SIDS and any factors that might suggest that a baby is at a higher risk. The conclusions of this research may lead to doctors being able to identify whether a baby is at a higher risk, and they could then work with the parents to decrease the risk for that baby.

Why don’t we use the term ‘cot death’?

‘Cot death’ was a term commonly used in the past to describe the sudden and unexpected death of an infant. It has largely been abandoned, due to its misleading suggestions that sudden infant death can only occur when a baby is asleep in their own cot, which we know to be untrue.

Is SIDS very common?

While SIDS is comparatively rare – 216 babies died of SIDS in the UK in 2015 – it can still happen and there are steps you can take to help reduce the chance of it occurring.

Can SIDS be prevented? What are the biggest risk factors?

While SIDS cannot be completely prevented, you can reduce the risks of it occurring considerably by following our safer sleep advice. For example:

• Sleep your baby on their back for all sleeps – day and night – as this can reduce the risk of SIDS by six times compared to sleeping them on their front.
• Share a room with your baby for the first six months – this can halve the risk of SIDS.
• Keep your baby smoke-free during pregnancy and after birth – this is one of the most protective things you can do for your baby. Around 60% of sudden infant deaths could be avoided if no baby was exposed to smoke during pregnancy or around the home.
• Never sleep on a sofa or armchair with your baby as this can increase the risk of SIDS by 50 times.
• Do not co-sleep with your baby if you or your partner has been drinking, is a smoker, has been taking drugs or is extremely tired; these factors can put babies at an extremely high risk of SIDS when co-sleeping. One study found that the risk of SIDS when co-sleeping is six times higher in smokers than in non-smokers.

The above is especially important for babies who were born premature or of low birth weight, as these babies are at a higher risk of SIDS.

I’m worried about the risk of SIDS for my baby. Who can I speak to?

Our support team are here to answer your questions about SIDS or safer sleep for babies. You can ring our information line on 0808 802 6869 or email info@lullabytrust.org.uk.

You can also talk to your midwife or health visitor if you have any questions or concerns.

What research is being done to find out the cause of SIDS?

This is why research into the risk factors and causes of SIDS is needed and why we have been funding cutting-edge research into the causes and risk factors of SIDS since 1971.

If the cause of SIDS was found, health professionals might be able to identify which babies are most at risk and work with their parents and families to ensure they can reduce the risk factors as much as possible.

What can I do if I or someone I love has lost a baby to SIDS?

If your child has died, or someone close to you is bereaved, we are so sorry and we are here to offer our support.

Our confidential support services are here for anyone affected by the sudden and unexpected death of a baby or young child, whether the death was recent or many years ago. You can call our bereavement support helpline on 0808 802 6868 or email support@lullabytrust.org.uk. Find out more about how we can support you here.

Safe Sleep for Babies - Winter Advice Booklet