Safe sleep for your baby

As a new parent, one of the most important things you can do for your baby is to ensure they are getting restful and safe sleep. However, with so much conflicting information out there, it can be overwhelming to know where to start. That's why I've put together this short guide on safe sleep for your baby. In this post, we'll cover everything from creating a safe sleep environment to following the latest recommendations from the American Academy of Paediatrics and The Lullaby Trust. By the end, you'll have a better understanding of how to keep your little one safe and comfortable while they sleep. It's a serious topic, and one I've tried to do justice in this short blog summary. As a sleep coach, safer sleep is at the heart of everything I do and teach parents, so links for further, more in-depth information than this blog can give are provided too.

Safe environment

Put your baby to bed in a safe environment. This means eliminating known hazards such as:

• Bumpers. They may look pretty but they are proven to be unsafe and are unnecessary. As a sleep coach I often see cot bumpers in baby's sleep space. The first thing I do is ask parents to remove them as they are implicated in so many SIDS cases.
• Duvets and pillows. These are unsuitable for babies under 1 year of age. They can overheat a baby and increase the risk of suffocation. Loose blankets are also unsafe, as they present a risk of suffocation to your baby so shouldn't be used. Age and room temperature-appropriate sleeping bags are always the best approach. Often, sleeping bags (such as the Gro-bags we used) will come with a free room thermometer and guide on how to dress your baby for bed. Weighted blankets or sleep sacks are also not recommended.
• Soft toys. These can increase the risk of suffocation and strangulation, as well as providing a climbing platform once your baby learns to move. They may look cute, so take your photos, then remove them from the sleep space and let your baby play with them whist they're awake under your supervision.
• Wedges and sleep positioners. Just because they are sold, does not mean that they are safe. Evidence shows that the safest place for a baby to sleep is on a firm, flat mattress in a clear cot. These are things like dock-a-tots, swings, bouncy chairs...... Although they're marketed as baby sleep spaces, if you actually look at the instructions you'll see that they say never leave baby to sleep in them! I'll be honest here and say that I hadn't given sleep positioners much thought until I did my Sleep Coach training.
• Window cords. Even if they may seem out of reach, the risk of strangulation is well documented. Buy cordless blinds, if you can't, make sure that the cord poses no risk to your baby by having it safely tucked/tied away completely out of reach.
• Windows or radiators against the cot. Avoid having the sleep space next to a radiator or window if you can, as this means the temperature can be unpredictable and difficult for you to manage your baby's temperature for safe aleep. If room size means you can't do this, make sure that you don't have the heater on when the baby is in the sleep space (and that it's cooled right down before baby goes to bed!), and provide thick curtains to help prevent heat loss and draughts.

Use an approved crib, bassinet, or portable play yard for sleep

• Make sure that your sleep space conforms to current safety standards in your country. If you have a second-hand or older family cot, cot bars should be no more than 6.5cm apart to prevent your baby from getting stuck between the bars. Distance from the mattress to the top of the cot should be at least 50cm to try to prevent your baby from climbing out when they become mobile. Those old family hand-me-downs may be traditional, cute and the way your families babies have always slept, but they can literally be a death trap, and absolutely do not provide a safe sleep space. You'd be amazed how many families put their child at risk because they don't want to offend Great Aunt Jenny. Take the photo in the hand me down, send it in a nice card to Great Aunt Jenny and then put it away never to be seen again!
• Cots/bassinets/cribs should have the recommended firm, flat mattress, and conform to current safety standards for safe sleep in your country. Where possible, any mattress used should be new to your baby. As the Lullaby Trust suggests, if this is not possible, the mattress should be thoroughly checked to ensure it is clean, dry and free from cracks or tears. The mattress should be wipe clean, or have a removable top panel that can be removed and washed at high temperatures or be used with a removable mattress protector. Your mattress should fit the cot snugly with no large gaps that your baby could get trapped in.
• The American Association of Paediatrics (AAP) states that sleeping on a couch/chair or seating device (such as a swing) is not suitable for infant safe sleep. Car seats should only be used whilst in the car and for short periods, this is because of the difference in angle of the car seat in the car as opposed to a flat surface in the home. You should schedule regular stops on long car journeys to ensure your baby gets regular breaks out of the car seat. Sadly this could mean lifting a sleeping baby out of their seat- but safe sleep first!

Preventing SIDS

AAP has published recommendations for safe sleep to help prevent Sudden Infant Death Syndrome (SIDS)/Unexplained Sudden Death (USD) in infants. I've summarized these below, but remember, they are just a summary and further information is available in the links at the bottom of the page.

• Back to Sleep for every sleep. Baby should be placed in their own sleep space, with no other people. They should be placed on their backs for safe sleep. Research has shown that deaths from SIDs have decreased since the back-to-sleep campaign in the 90s.
• Feeding human milk wherever possible (breast or expressed). WHO recommends exclusive breastfeeding until 6 months of age, then continuing to give some form of breastmilk until the age of 2 where possible. For some Mums, for various reasons, this simply isn't possible. We do the best we can with what we have!
• Use a firm/flat sleep surface for safe sleep designed specifically for infants.
• As above, keep soft objects/additional items out of the sleep space and avoid overheating your baby. Use a room thermometer so you are more easily able to regulate the temperature of the room.
• Offer a pacifier at naptime/bedtime. This should be considered in accordance with your chosen feeding method, and if baby doesn't want or won't take a pacifier, don't force it.
• Avoid smoke/nicotine exposure during pregnancy and after birth.
• Avoid illegal/illicit drug usage during pregnancy/after birth.
• Encourage ‘tummy time’ to increase baby’s neck strength, but only when awake and supervised.

Update, Feb 2023

The Lullaby Trust has recently updated UK guidance with regards to co-sleeping, or bedsharing. Previously, UK guidance has stated the same as the AAP guidance, that baby should sleep in their own sleep space without anyone else present. The guidance has changed due to the sheer numbers of babies in the UK who co-sleep/bedshare. In any one night, 20% of babies are bedsharing in the UK. That is a LOT of babies! Another statistic is that 50% of babies have co-slept/bedshared by 3 months of age. Incredible. If so many families are doing it, then we absolutely MUST open up discussion around it, normalise it, and make it safer for those practicing it.  Check out the Lullaby Trust for more information on bedsharing/co-sleeping.

Cot safety features: sleeping safely in a cot

Safe sleep

Sleep-related infant deaths