Infants are unable to control their sleeping environment and providing a safe sleeping environment is the best way to reduce the risk of Sudden Unexpected Death in Infancy (SUDI).
SUDI is a broad term that includes all sudden and unexpected deaths less than 12 months old and this includes sudden infant death syndrome (SIDS) which is commonly known as ‘cot death’ and deaths from undetermined causes.
SUDI is the leading cause of infant death with a peak age between 2-4 months.
In the UK, around 200 babies die suddenly and unexpectedly every year. This statistic may sound alarming, but SIDS is rare and the risk of your baby dying from it is low.
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Safer Sleeping Guidance to Reduce the Risk of SUDI
The safest place for a baby to sleep at all times is always in their own cot or moses basket.
Do
- Place your baby on their back in the “feet to foot” position – with their feet touching the end of the cot, Moses basket, or pram
- Your baby should sleep in the same room as you for all their sleeps for at least the first 6 months
- Keep your baby’s head uncovered – their blanket should be tucked in no higher than their shoulders
- If using a baby sleeping bag, make sure it is fitted with neck and armholes and no hood
- Baby should sleep in a cot or Moses basket which is clear of toys, bumpers, pillows, duvets, sleep positioners or weighted bedding
- Use a mattress that’s clean, firm, flat, waterproof and in good condition
- If you can, breastfeed your baby for at least 2 months as this is protective
- Make sure you use a sling or baby-carrier safely. Do not cover their head with the sling or a muslin
- Infants cot should be away from blinds/curtains/electrical appliances
Don’t
- Do not smoke during pregnancy or let anyone smoke in the same room as your baby – both before and after birth as this can increase risk
- Never sleep in an armchair or sofa with your baby
- Do not share a bed with your baby if you or your partner smoke or take drugs, have recently drunk alcohol or if your baby was born prematurely or weighed under 2.5kg when they were born
- Do not let your baby get too hot or too cold – a room temperature of 16C to 20C, with light bedding or a lightweight baby sleeping bag, will provide a comfortable sleeping environment for your baby. Remove hats, hoods and outdoor clothing
- Never cover you baby’s head
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Bedsharing and SIDS
The safest place for a baby to sleep at all times is always in their own cot or moses basket.
Some parents however choose to sleep with their baby in bed and some fall asleep with their baby during the night while feeding and comforting – whether they intend to or not so it is very important to read the following guidance to reduce the risk:
- Put the baby on their back in a clear, flat sleep space
- Keep pillows and adult bedding away from the baby – to avoid obstructing breathing or over heating the baby
- Do not leave a baby alone in an adult bed
- Make sure the baby cannot be trapped, wedged or fallout of bed or get trapped between the mattress and wall
- Do not have other children sharing the bed
- Keep pets away from the bed
You should NEVER bed share with your baby if any of the following apply:
- If you or your partner smokes
- Either you or your partner has drunk alcohol or taken drugs (including medications that may make you drowsy)
- Your baby was born prematurely (before 37 week gestation)
- Your baby was born at low weight 2.5kg or 5lbs or less
We acknowledge it is normal for young babies wake and feed frequently in the night as young babies are not capable of ‘learning’ to defer their needs.
Around half of all parents will sleep with their baby at some point, be this planned or unplanned, and, although SIDS is very rare, it is much more likely to happen in the circumstances outlined above.
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Car Seats and SIDS
It is essential for safety that babies travel in a car seat.
However, it is recommended that you avoid travelling in cars with pre-term and young babies for long distances.
Research into the link between car seats and SIDS found young babies may be at risk of breathing difficulties if they travel while sitting in an upright position for too long.
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Swaddling and SIDS
If you choose to swaddle your baby or use a sling it is very important to follow guidelines to reduce the risk of SIDS.
Swaddling Your Baby
Swaddling is a common practice used to help settle young babies and promote sleep. We recognise that in some parts of the world this is also referred to as wrapping, but in the UK is referred to as swaddling. Parents/carers who wish to swaddle should be informed how to do this correctly to reduce the chance of SIDS:
- Never put a swaddled baby to sleep on their front or side
- Stop swaddling (with arms wrapped inside the material) when a baby shows signs of rolling as they could roll onto their tummy and won’t be able to roll back. Use materials such as a thin muslin or thin cotton sheet – DO NOT USE blankets or place any additional bedding over a swaddled baby, this could cause them to overheat
- Ensure baby is not overdressed under the swaddle, has their head uncovered and does not have an infection or fever
- Check baby’s temperature to ensure they do not get too hot – check the back of their neck. If baby’s skin is hot or sweaty, remove one or more layers of bedclothes.
- Baby should be swaddled securely to reduce the risk of face-covering by loose material.
- Swaddles should not be applied very tightly around the hips as this is strongly associated with developmental dysplasia of the hip. However, the swaddle should also be secure enough not to come apart, as loose soft bedding can increase the chance of SIDS if pulled over a baby’s head, causing a baby to over-heat or obstruct their breathing.
- There are various swaddle products on the market for example swaddle blankets, swaddle sacks and swaddle bags. We can’t comment on their safety but parents/carers need to ensure the products meets necessary safety standards. They should be well fitted.
- Parent/Carers should ensure they follow the product guidance. Some swaddle manufacturers recommend their product is used when a baby is a certain weight, rather than age so it is best to check on the swaddle product they choose to use.
- We do not advise on a specific tog rating for swaddle products, we advise parents/carers to use a lower tog rating/lightweight to reduce the chance of baby overheating.
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Using Slings and Baby Carriers and SIDS
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.
When wearing a sling or baby carrier, please keep in mind the TICKS guidelines:
- Tight
- In view at all times
- Close enough to kiss
- Keep chin off the chest
- Supported back
Useful Websites and Videos
Watch this short animation on safer sleep for babies from The Lullaby Trust:
Caring for your baby at night and when sleeping – UNICEF
Safer Sleeping: Reducing the Risk of Sudden Infant Death – PHA