Why are the SIDS and Kids 6 safe sleeping recommendations

Why are the SIDS and Kids 6 safe sleeping recommendations
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Why are the SIDS and Kids
6 safe sleeping recommendations
so important?
The chance of babies dying suddenly and unexpectedly
is greater if they sleep on their tummies or sides.
Babies who are placed on their tummy sleep more deeply, are
less reactive to noise, experience less movement, and are less
able to be aroused than babies who sleep on their back. All of
these characteristics place an infant at a higher risk of SIDS.
Healthy babies placed to sleep on the back are less likely to
choke on vomit than tummy sleeping babies. In fact, sleeping
baby on the back actually provides airway protection. The
tummy position increases the risk of baby inhaling milk or fluids
into their airway. Research shows that all babies, including
babies with reflux, should be placed on their back, and that
there is no evidence to support the tilting of the head
of the cot or elevating the mattress.
Some babies with rare medical conditions, might have to sleep on
the tummy or side, but only do this if the baby’s medical practitioner
advises to do so in writing. The side position can increase the risk
of SIDS as this position is unstable and encourages an infant to
roll on their tummy. All aids and devices intended to keep infants
in a certain sleep position do not prevent/reduce SIDS or prevent
infants from rolling onto their tummy. Positional sleep devices are not
recommended; they limit movement of the infant as they get older
and have been linked to suffocation deaths.
In the back position the airway is above
the oesophagus (food tube), therefore fluid
can easily be swallowed preventing fluid
entering the airways (choking).
When a baby is placed on their tummy,
the food tube sits above the airway. If a
baby vomits, fluid is more likely to enter
the baby’s airway and lungs therefore
increasing the risk of choking.
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To avoid suffocation, airway obstruction and
overheating ensure that baby’s face and head
stays uncovered during sleep.
The best way to achieve this is to use a baby sleeping bag.
However, if you decide to use blankets ensure that the baby’s
feet are at the bottom of the cot, so that baby can’t slip down
under the blankets. Use lightweight blankets that can be tucked
in securely. Soft items in a baby’s sleeping environment can
increase the risk of sudden unexpected infant death. It is
best to remove quilts, doonas, duvets, pillows, cot bumpers,
lambswool and fluffy toys.
They may cover the baby’s face and obstruct breathing or
cause overheating. Older babies in a cot can be at an
increased risk of a sleeping accident by using pillows and
bumpers as a step to climb up and fall out of the cot. It is safer
to wait until the child starts to sleep in a bed before introducing
a pillow or other soft bedding.
Baby on back. Feet to bottom of cot.
Blankets tucked in firmly.
Use a safe sleeping bag with
a fitted neck and armholes.
Babies who are exposed
to tobacco toxins during
pregnancy or after birth have a
significantly higher risk of SIDS
and the risk increases if a baby
sleeps with a parent who is a
smoker. These risks still remain
even if parents smoke outside,
away from their baby. To reduce
the risk of SIDS don’t let anyone
smoke near your baby – not in
the house, the car or anywhere
else that your baby spends time.
Cots, mattresses and environments that are unsafe increase the
risk of sudden unexpected infant death.
• See Safety Tips for Infant Sleep
Never share a sleep surface with baby if you or your partner
smokes, are under the influence of alcohol or drugs that cause
sedation or are excessively tired. Babies must never be left alone
on an adult bed or put to sleep on a sofa. There is a very high
risk of infant death and sleeping accidents when a baby shares
a sofa or couch with an adult during sleep.
Sleeping with baby on the same sleep surface can increase the
risk of sudden infant death and fatal sleep accidents.
These risks include rolling on top of baby or adult body part
obstructing baby’s airway, entrapment or wedging between the
mattress and another object such as a wall, suffocation from
pillows and blankets and overheating caused by adult and or
infant bedding and adult body heat.
Breastfeeding babies more than halves the chances of a baby
dying suddenly and unexpectedly. Numerous studies show that
along with maternal and infant health benefits, breastfeeding helps
reduce the risk of sudden and unexpected infant death, including
SIDS. Any duration of breastfeeding is protective against SIDS,
while the protective effect is stronger for exclusive breastfeeding.
The protective effect of breastfeeding is believed to be due:
•Babies who are breastfed are more easily aroused during deep
sleep than formula fed infants which is protective for a baby’s
breathing and swallow mechanisms.
•Breast milk helps to boost a baby’s immune system to fight
infection. When a baby is born they have some immunity
passed on from their mother, however by 2 – 4 months of
age (peak age for SIDS) baby’s own levels are low and their
maternally acquired levels are decreasing.
•Babies who are breastfed tend to have reduced respiratory and
gastrointestinal infections. Infants whose deaths are attributed
to SIDS and sudden unexpected deaths in infancy often have
had a minor infection in the days before the death that was
not sufficient alone to cause the death, but which may have
contributed in some way.
Baby on back. Feet to bottom of cot.
Blankets tucked in firmly.
SIDS and Kids recommends sleeping with baby in a cot next to
the parent’s bed for the first six to twelve months of life.
Research in New Zealand and the UK has shown that sleeping baby
in the same room, but not in the same bed, with the parents in the first
six to twelve months of life is protective. This is thought to be because
parents can see the baby and easily check to see that baby is safe.
This protective effect does not work if the baby is in a room with other
children probably because the children do not know if the baby is
safe or not. Recent evidence from the UK indicates that sharing the
same room during baby’s daytime sleeps is also protective.
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There is no Australian Standard for bassinettes, unlike cots. We
are aware of reports of accidents associated with bassinette use.
Australian and US governments’ guidelines on ways to reduce
these types of accidents include:
•Ensure that it has a wide stable base and that it is placed on
a stable surface.
•Remove all ribbons and ties to prevent strangulation
•The sides should be at least 300mm high measured from the
top of the mattress base.
•Use a firm mattress that is a snug fit and is not thicker than 75mm.
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ALERT: Make sure baby sleeps on the back with face uncovered.
It may be better to use an infant sleeping bag when using a
bassinette. Only use a lightweight blanket for additional warmth if
it is possible to tuck blankets under the mattress.
• Check there are no fittings (including bolts, knobs and corner
posts) that might catch onto your child’s clothing and cause
distress or strangulation.
•Wobbly or broken parts can make the cot weak.
•Paint may contain toxic substances such as lead.
If you are buying a rocking cradle, make sure that it complies
with the safety requirements of the voluntary Australian standard
AS/NZS 4385. Look for a label or sticker that says the rocking
cradle complies with this voluntary standard. If there isn’t one, ask
the retailer. If the retailer cannot verify that it complies, ask if there
is an alternative that does comply.
Babies can become trapped in a tilted rocking cot or cradle.
If you have a cradle or cot that rocks and has a child-resistant
locking pin, make sure that you secure the locking pin firmly in
place whenever you leave your baby and double check it making
sure the cradle cannot move when you are not there to supervise.
ALERT: Old or second hand cots may be dangerous for the
following reasons:
Only use the firm, thin, well-fitting mattress that is supplied with
the portable cot (portacot). Never add a second mattress or
additional padding under or over the mattress, which has been
specifically designed for the portacot, as baby may become
trapped face down in gaps between the mattress and the sides.
The Australian Standard for portable cots is AS/NZS 2195.
•Look for a label or sticker that says the portacot complies with
this mandatory standard.
Ensure the cradle has a tilt limiter to limit the angle of tilt to no
more than 10 degrees from the horizontal.
•If you are accepting a second-hand portacot ensure that the
base is flat and that there is no torn mesh or broken parts.
•Regularly check the portacot for these signs of damage. Only
use a portable cot that has the mesh intact and that has no
broken parts.
There is no Australian standard covering the use and manufacture of
hammocks for baby.
While we are not aware of any research on the safety of
hammocks or guidelines for their use for babies, we are aware
of case and injury reports documenting a number of hospital
admissions of infants following a fall from a hammock. Babies
sleeping in hammocks are at risk of incurring a falling injury.
ALERT: Babies should not be left unsupervised in these devices
as they are not designed as an infant sleeping place.
A safe cot is one that meets the Australian Standard for cots.
All new and second-hand cots sold in Australia must meet the
Australian Standard for Cots (AS 2172) and will carry a label to
say so.
If you are planning to use a second-hand cot, check that it meets
those standards.
• The mattress must be flat and fit snugly to within 25 mm of cot
sides and ends. The cot sides or end need to be at least 500
mm higher than the mattress. Sides that are too low can be
climbed over by active toddlers.
• The spacing between the bars or panels in the cot sides and
ends needs to be between 50 mm and 95 mm—gaps wider
than 95 mm can trap a child’s head.
• Any spacing smaller than 50mm can trap arms, legs or fingers.
Helping you protect your family’s health.
•Do not use bedding that has exposed elastic as this presents
a strangulation hazard for baby.
•Do not use a portable cot if your child weighs more than 15kg
(or check instructions of your particular model).
Babies control their temperature through the face. Sleeping
baby on the back and ensuring that the face and head remains
uncovered during sleep is the best way to protect baby from
overheating and suffocation. Sleeping baby in a sleeping bag
will prevent bedclothes covering the baby’s face.
If blankets are being used instead of a sleeping bag, it is best to
use layers of lightweight blankets that can be added or removed
easily according to the room temperature and which can be
tucked underneath the mattress.
When dressing a baby you need to consider where you live,
whether you have home heating or cooling and whether it is
summer or winter. A useful guide is to dress baby as you would
dress yourself – to be comfortably warm, not hot or cold. It is
not necessary to leave the heating on all night or to monitor the
room temperature with a thermometer, but ensure that baby is
dressed appropriately for the room temperature.
A good way to check baby’s temperature is to feel baby’s chest,
which should feel warm (don’t worry if baby’s hands and feet
feel cool, this is normal). Another way to prevent overheating is to
remove hats or bonnets from baby as soon as you come indoors or
enter a warm car, bus or train, even if it means waking the baby.
ALERT: Never use electric blankets, wheat bags or hot water
bottles for babies.
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For more Safe Sleeping information go to
www.sidsandkidswa.org or contact the
SIDS and Kids WA Perth office on 9474 3544
There has been recent media attention in relation to a theory that
there may be a link between SIDS and a certain bacteria found in
second-hand mattresses.
However, the bacteria in question are normally found on the skin
and in the nose and throats of healthy adults and infants. There
is no evidence to show that there is an increased risk of SIDS for
babies who sleep on a second-hand mattress providing that baby:
•Sleeps on the back.
•Sleeps on a flat, firm, clean, well fitting mattress that is in
good condition.
•Sleeps with no bedding covering the face or head.
•Is not exposed to tobacco toxins before birth or after.
Infant wrapping or sometimes called swaddling
is a safe and effective strategy when trying to
settle a baby to sleep on their back. However
not all babies like to be swaddled and
wrapping techniques need to be modified to
meet the baby’s developmental changes. For
example, a baby less than 3 months may
have their arms included in the wrap whilst
a baby more than 3 months of age and is
able to roll from back to tummy may have
their lower body wrapped with their arms free.
Discontinue wrapping when baby can roll from
back to tummy and back again.
Most SIDS occurs under 6 months of age so try not to have baby
sleep on the tummy before this time.
Most back-sleeping babies can’t actually roll onto the tummy by
themselves until about 5–6 months of age although a few can roll
from a younger age. Babies who sleep on their back tend to roll
onto their tummy later than side sleeping infants. This probably
plays a part in why the back position is safer for babies as they
do not roll into the high risk tummy position during a vulnerable
period of development. The delay in rolling is normal and does
not affect the baby’s later development.
Steps to follow when babies start to roll on to the tummy:
•Give baby extra tummy time to play when awake and
supervised as this helps baby to develop stronger neck and
upper body muscles which in turn enables them to roll back over.
It is best to start giving baby supervised tummy time from birth.
•Use an infant sleeping bag as this can delay rolling over.
•If you use blankets rather than a sleeping bag, make sure that the
baby’s feet are touching the bottom of the cot to prevent baby
wriggling under the blankets and tuck the blankets in securely.
•Make sure that baby is on a firm and well fitting mattress that
is flat (not tilted or elevated).
•Make sure that baby’s face and head remains uncovered
(avoid lambswool, duvets, pillows, cot bumpers and soft toys)
0–3 months
If you choose to swaddle,
As babies grow and develop they become very active and learn
to roll around the cot. Put them on their back anyway but let them
find their own position of comfort. Remember to reduce the risks
in other ways.
•Ensure that baby is positioned on the back with
the feet at the bottom of the cot.
Caution is advised when using infant slings as they pose a
suffocation and injury risk. Slings are not recommended especially
for babies younger than four months of age, babies of low birth
weight, premature infants and babies with respiratory problems
such as colds. Babies less than four months of age have weak neck
muscles and are not able to control their heads.
•Ensure that baby is wrapped from below the
neck to avoid covering the face.
•Sleep baby with face uncovered (no doonas,
pillows, cot bumpers, lambswool or soft toys in
the sleeping environment).
•Use only lightweight wraps such as cotton or
muslin (bunny rugs and blankets are not safe
alternatives as they may cause overheating).
3–6 months
•The wrap should not be too tight and must allow for hip and chest
wall movement.
•Make sure that baby is not over dressed under the wrap. For
example, a nappy and singlet in warmer weather and adding
a lightweight grow suit in cooler weather. See How much
Clothing/Bedding does my Baby need?
A sling keeps the infant in a curled position bending the chin
toward the chest, restricting the airway and limiting oxygen
supply. The sling’s fabric can press against an infant’s nose
and mouth blocking breathing. Injuries can also occur from
baby falling from the sling if the parent trips or falls, the product
malfunctions or its hardware breaks.
•Babies must not be wrapped if sharing a sleep surface such as
couch, sofa, recliner, adult bed.
ALERT: SIDS and Kids recommend the use of only lightweight
wraps such as cotton or muslin. Some swaddling products can
be unsafe. Wrapping/swaddling products that restraint the infant
can increase the risk of a sudden infant death.
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Chin up; face
visible; nose and
mouth free
Baby’s face
is covered
Baby is too low
Baby is hunched
with chin
touching chest
Baby’s face is
pressed tight
against wearer
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