Why is safe sleep important for babies?

Babies spend a large part of their day and night sleeping. It’s important that parents and caregivers do all that they can to reduce risk factors for harm during sleep.

Evidence has shown that there has been an 85% reduction in SIDS (sudden infant death syndrome) deaths since the 1990s. This is largely because of recommendations from experts to place babies to sleep on their back from birth.

What is sudden unexplained death in infancy (SUDI and SIDS)?

When a baby dies and there is no apparent cause of death, this is called sudden unexpected death in infancy (SUDI). This includes sudden infant death syndrome (SIDS) and what are called ‘fatal sleep accidents’. We used to call SIDS ‘cot death’ though now it’s more commonly known as SIDS.

Why do babies need to sleep on their back?

One of the main reasons why back sleeping is recommended is because healthy babies are less likely to choke on vomit if they are positioned on their back. Their airways are positioned above their oesophagus (food pipe) and babies protect their airways by swallowing regurgitated milk.

Babies who sleep on their side are more likely to roll onto their tummy.

What should I do when my baby starts to roll?

If your baby sleeps in a bassinet, move them into a cot as soon as they first show signs of being able to roll.

Once your baby can roll in both directions by themselves — rolling onto their side and front, and then back onto their back — then you can put your baby to sleep on their back and let them find their own natural sleeping position. It's not necessary to wake them during the night to turn your baby over to the back position.

If your baby can only roll one direction on their own, gently roll them on to their back whenever you see they have rolled onto their front or side.

What is unsafe sleep?

Unsafe sleep means that protective, safe sleeping factors aren’t in place. For example, it is unsafe if the baby sleeps on a soft surface and bedding, their face is covered, and toys and cot bumpers are in the cot. All of these can make a sleeping environment unsafe and increase the risk of SIDS.

Soft bedding can cover a baby’s face and obstruct their breathing. It can also cause a baby to overheat.

Babies don’t know what could cause them harm and are naturally curious. Parents and caregivers need to do what they can to reduce the risk factors for SIDS.

Babies should always be placed on a firm, flat surface when they are sleeping. Placing a baby in an inclined or sloped position, like in a bouncinette or sitting up against a pillow or lounge, is not recommended.

When a baby falls asleep sitting up or inclined, their head can fall forwards, pushing their chin down towards their chest. This can block their airway.

Can my baby sleep in bed with me?

At some stage many parents are tempted to co-sleep with their baby. However, co-sleeping can be dangerous and in some cases, it can increase the risk of SUDI. The safest place for your baby to sleep is in their own safe cot.

It’s important not to co-sleep if:

• you are overly tired or sick
• you or your partner have recently drunk alcohol
• you or your partner smoke
• you or your partner have taken any drugs that make you feel less alert or sleepy
• your baby is premature or small for their gestational age (SGA)

If you do choose to co-sleep, you should make sure to:

• Always place your baby on their back to sleep.
• Keep their head and face uncovered and move any bedding away from your baby.
• Use a safe sleeping bag on your baby.
• Make sure your mattress is firm and flat. Don’t co-sleep in a waterbed.
• Tie up any long hair and remove any jewellery which could cause strangulation.
• Move the bed away from the wall so your baby can’t become trapped.
• Make sure your baby can’t roll off the bed. Move your mattress onto the floor if rolling is a possibility.
• Create a clear space for your baby to sleep on their back, to the side of one parent and away from the bed edge.

Room sharing

The safest place for your baby to sleep is in their own safe cot, in the same room as you for at least the first 6 months. Room sharing reduces the risk of SUDI by up to 50%. Room sharing helps parents to become more in tune with their baby’s sleep and check easily on them. It also supports breastfeeding.

Many parents choose to use a bassinet in their room since cots can take up a lot of room.

Unlike cots, there are no current safety standards for bassinets in Australia.

When choosing a bassinet, make sure:

• the base is wide and stable so it won’t tip over
• all 4 sides are at least 30cm from the top of the mattress
• the mattress is firm and flat and no thicker than 75mm
• the sides of the bassinet should be wide enough to provide good air flow and ventilation

Can babies get too hot or cold?

Just like adults do, babies can get hot or cold. It can be difficult for parents to know how to dress their baby comfortably for the weather. Babies control their temperature mainly through their head and face, which is another reason why back sleeping is protective.

Dress your baby as you would dress yourself for the temperature of the room, comfortably warm, not too hot or cold.

Keep your baby’s head uncovered

Even when the weather is cold, it’s important to remove any hats, beanies or head covering from your baby before they go to sleep. Keep their head and face uncovered to avoid overheating. Research has shown that there is a link between overheating and an increase in the risk of SUDI.

What should I have in my baby’s cot?

Keep your baby’s cot free from soft bedding, which can increase the risk of suffocation and overheating. Make sure there are no bumpers, doonas, lamb’s wool, pillows, teddies or soft blankets in your baby’s cot.

• Ensure the mattress is firm, flat and the right size for the safe cot and meets the Australian Standards - AS/NZS 8811.1:2013.
• Only use safe bedding, which is lightweight, firmly tucked in and only pulled up to the baby’s chest.
• Use a safe sleeping bag that is well fitted across the neck and chest. Don’t use a sleeping bag with a hood and make sure your baby’s arms are out.

Are sleeping bags safe?

Sleeping bags are a good option as long as they are the right weight and size for the baby.

Sleeping bags can be protective because they help to:

• reduce the risk of bedclothing covering the baby’s face
• delay rolling onto the tummy during sleep until the baby is past the peak risk of SUDI
• promote back sleeping
• keep the baby’s temperature at a more constant level during sleep

Many sleeping bags come with a Thermal Overall Grade (TOG) rating which indicates its warmth. Choose a sleeping bag with the right TOG rating for the room where your baby sleeps. Sleeping bags should also have a fitted neck and armholes with no hood. Ensure to choose the right size for your baby.

Other tips for safe sleep

Never let your baby sleep:

• unattended on an adult bed or bunk bed
• on a waterbed, beanbag, couch, pillow or cushion
• with a sleeping adult or child on a couch, sofa or chair
• in a cot that is near anything hanging, including curtains, curtain cords, cords from electrical appliances, or pictures or mirrors
• in a cot with an electric blanket, hot water bottles or wheat bags

Resources and support

Speak with your child health nurse or your GP for more information on safe sleep for babies.

Visit Red Nose for more information on safe sleep.

Looking for information for Aboriginal and/or Torres Strait Islander people?

Product Safety Australia has information and a video called Sleep Bub Safe.