Ten tips for safe sleeping

Dr Sarah J Buckley 2005 www.sarahjbuckley.com

A previous version of this article was published in Natural Parenting no 4, Spring 2003.

This version updated March 2005 and features in Sarah's book, Gentle Birth, Gentle Mothering: The Best Articles on Gentle Choices in Pregnancy, Birth and Parenting.

Whether your baby sleeps in a cot, bassinet, crib, 'side car', or co-sleeps next to you in bed – there are some general principles that will make your baby's sleep as safe as possible. These apply to all babies under one.

1. Put your baby on their back to sleep

Babies are more at risk of sudden infant death syndrome (SIDS) when they sleep prone, or face down. A baby in the prone position can't get rid of body heat as efficiently, and can't kick off excess bedding. Both factors can contribute to overheating, a risk factor for SIDS. 'Back to back' campaigns in many countries have reduced the number of babies dying of SIDS by up to 60-70 percent.

Although the side position is not dangerous, there is a chance that a side-sleeping baby could roll onto their front. Solitary sleeping babies should always be put to sleep on their backs. A co-sleeping baby will almost always sleep on their side or back, facing the mother.

2. Keep your baby's head uncovered during sleep

Babies are safest without soft bedding items around them. This includes pillows (no child under one needs a pillow), quilts/doonas/duvets (blankets are safer), cot (crib) bumpers (not recommended) and soft toys, all of which can end up over the baby's head.

Sheets need to be tucked in firmly, or fitted snugly so that they can't come loose.

Babies in a cot are safest tucked in firmly with their feet at the bottom of the cot. Co-sleeping babies also need to be kept from slipping under the bedding.

Waterbeds and beanbags are not safe places for sleeping babies, who can slip into a soft pocket of bedding. Firm mattresses are recommended wherever your baby sleeps.

3. Avoid entrapment hazards

A small baby can become wedged in a gap and suffocate. This hazard applies to the gap

' between a mattress and the side of a cot (Australian standards allow a gap no greater than 25mm (one inch) for cots)

' between the mattress of an adult bed and the wall or adjoining furniture

' between the mattress and head or foot boards and railings

' between a mattress and bed guard rail (bed guard rails are not recommended for children under one, but I highly recommend the simple 'Humanity family co-sleeper' for a safe guard system- see references).

An adult mattress may be safer on the floor well away from walls, but always ensure that the baby cannot become trapped or injured if they roll off.

Also ensure that bedding is fitted firmly, and unable to come loose. Loose bedding can cover and suffocate.

4. Avoid strangulation hazards

Check your baby's sleep environment for long strings or ties. This also applies to mobiles hung over cots. It is recommended that co-sleeping adults prevent entanglement and/or strangulation by tying up their hair if it is longer than waist-length. As above, cot bumpers (with or without ties) are not recommended.

5. Dress your baby appropriately for the room temperature

It is important to avoid both over- and under-heating.

In winter, your baby does not need both very warm clothing and very warm bedding. A solitary sleeping baby can be dressed in a one-layer 'blanket sleeper', and securely tucked into bedding appropriate to the season.

A co-sleeping baby will be kept warm by body contact and also does not need more than one layer of clothing. A cotton singlet or T-shirt, long or short sleeved according to the climate, and a nappy/diaper, is usually sufficient. Natural fibre (cotton, wool, hemp, silk) clothing and bedding is recommended.

Also ensure that the room is not over-heated or too cool. Consider whether the heating, bedding and clothing would add up to a comfortable sleeping temperature for you.

6. Keep your baby smoke and drug free

This means avoiding smoking during pregnancy as well as after birth. Studies show that babies born to mothers who smoked in pregnancy have an increased risk of SIDS, and it is recommended that these mothers do not co-sleep with their babies.

After birth, keep cigarette smoke away from your baby at all times. For mothers who cannot quit, cutting down will reduce the risk to some extent. Babies are also generally safer from SIDS if the father does not smoke, but co-sleeping next to the mother, with a smoking father in the same bed, has not been shown to increase the risk of SIDS.

It is also important that co-sleeping parents are not under the influence of drugs or alcohol. These can make them sleep too deeply, and increase the risks of overlaying.

7. Do not put your baby to sleep alone in an adult bed

Adult beds have entrapment hazards, as noted above, as well as the danger of suffocation from soft bedding. Your baby is safer sleeping alone in a cot or in a safe place on the floor, away from pets and other small children. It is also considered dangerous to sleep a baby next to a sibling or young child who might roll onto them.

Cultures with low SIDS rates incorporate baby sleep-time into family life, for example sleeping babies in a family room, rather than isolating them at sleep-time. Most babies will sleep happily with a large amount of noise and activity around them. (Consider how noisy and active it was in your belly!)

8. Ensure that older babies in cots cannot climb or fall out

Once your baby can sit, lower the mattress if adjustable. Once they can stand, put the mattress at the lowest level and ensure that there are no aids to escape – that is, items they can stand on or pull down into the cot.

Measure your child standing against the side rail – when they are taller than three-quarters of the height, they have outgrown the cot.

9. Do not put your baby to sleep on a sofa or chair

Not only is this dangerous in terms of falling off, but babies can become entrapped in the gaps of a sofa or chair.

Also check your baby's pushchair or stroller if they are sleeping without adult supervision. Babies can become entrapped or suffocated while sleeping in these, which are not designed for unsupervised sleep..

10. Breastfeed your baby

In some studies, breastfeeding has been shown to give added protection against SIDS. Breastfed babies are more easily roused from active sleep (when pauses in breathing, which can lead to SIDS, are more common). Breastfed babies also have more mature brain development, possibly because of the beneficial fats in breastmilk.

Breastfeeding and co-sleeping are also an ideal combination, because co-sleeping babies nurse more often but with less effort on the mother's part. This extra breastfeeding provides more nourishment for the baby and benefits the mother by delaying the return of her fertility acting as a natural birth control mechanism.

References

Information for this article is drawn from the following sources: Sleeping with your baby – the world's top scientists speak out. Mothering no 114, Sept–Oct 2002, special edition, especially the following articles:

Safe Environment Safety Checklist – Patricia Donohue-Carey,pp 44–7

The New Zealand Experience – how smoking affects SIDS rates. Taylor B, Baddock S, Mitchell E, Ford R, Tipene-Leach D, Galland B. pp 62–7

Breastfeeding and Bedsharing – Still Useful (and Important) after All these Years. McKenna J. pp 28–37

All on-line at

www.mothering.com/articles/new_baby/sleep/sleep.html

Sharing a bed with your baby (brochure) UNICEF/UK Baby Friendly Hospital Initiative

http://www.babyfriendly.org.uk/parents/sharingbed.asp

Humanity Family Bed Co-sleeper

http://www.humanityinfantandherbal.com/humanityfamilybed.html

Australian SIDS Recommendations

Reducing the Risk of Sudden Infant Death Syndrome (SIDS) – brochure

Published by SIDS Melbourne 1997

http://www.sidsandkids.org/resources.html

Australian standards and recommendations for cots

www.consumer.gov.au/html/babysafe/housecots.html

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