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 
Safe sleeping techniques 

While in the NICU or SCN, 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. 
2. Keep baby’s face and head uncovered. 
3. Keep baby smoke free, before and after birth. 
4. Safe sleeping environment, day, and night – A safe cot that meets Australia standards, flat and firm mattress, no soft bedding, toys, loose blankets, pillows, or cot bumpers.  
5. Sleep baby in parents’ room in a safe cot – for the first 6-12 months. 
6. Breastfeed baby - 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 

Co sleeping may be a regular and treasured practice for many families. However, it is important to recognise it may increase the risk of sudden and unexpected death in infancy (SUDI). If you are wondering about co-sleeping, Red Nose also provides tips for parents and care givers to remind you of ways to reduce the risks associated with sharing a sleep space with your baby. 

It is equally important to first consider any risks factors that may make your baby more vulnerable to SUDI, such as prematurity, small for gestation age, illness or infection, or congenital abnormality. These are all reasons your baby may be more susceptible to SUDI, particularly in the first six months.  

If you do choose to co-sleep with your baby, Red Nose recommends that you: 

• Place baby on their back to sleep (NEVER on the tummy or side). 
• Make sure the mattress is firm and clean. 
• Make sure baby is not wrapped or swaddled, as this restricts arm and leg movement. As an alternative to bedding, an infant sleeping bag can be used so baby does not overheat or suffocate in the adult bedding. A safe infant sleeping bag is one with a fitted neck and armholes. 
• Make sure bedding cannot and does not cover baby’s face. 
• Use only lightweight blankets. Keep pillows, doonas, lambswool and any other soft items far away from baby. 
• Place baby to the side of one parent - not in between two parents, as this increases the likelihood of baby being covered or slipping underneath adult bedding – this in turn increases the risk of overheating and suffocation. 
• Ensure baby is not close to the edge of the bed where they can fall off. Do not place pillows at the side of the baby to prevent rolling off. A safer alternative is to place the adult mattress on the floor. 
• Avoid pushing the bed up against the wall as baby can get trapped between the bed and the wall. 
• Tie up your hair to prevent baby from becoming entangled or suffocated. 

More information on this can be found here: https://rednose.org.au/article/Cosleeping_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 NICUs and SCNs 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 sooth 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. 

SUDI and SIDS are rare and the risk of your baby dying from these is very low. The rate of SIDS deaths has declined in Australia due to safe sleeping campaigns. In 2020, 100 babies in Australia died of SUDI (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 

Miracle Babies Foundation 

https://www.miraclebabies.org.au

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/ 

Red Nose Australia 

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

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