Safe sleep for babies and toddlers
safe; sleep; babies; cots; bedding; mattress; bedclothes; sleeping; strollers; bouncinettes; basinet; rocking; cradles; beds; SIDS; bag; sleepingbag; portable; beanbags; guard; rails; bunks; curtains; cords; ropes; toy; sudden; infant; death; syndrome; pillows; pillow; bassinettes; cribs; waterbed; pram; prams; safety; nursery; doona; quilt; bumper; electric; blanket; dummy; hammock; dummies; pacifier; U; U-pillow; u-shaped; donut; lounge; chair; sofa; sheep; skin; lamb; wool; tea-tree; ti-tree; play; horseshoe; horse; shoe; pets; cats;
Contents
While babies are asleep they may get into dangerous situations. They may:
- suffocate under bedding
- choke on toys or other objects
- be caught between the cot side and mattress
- be strangled on cords and ribbons.
The reasons for this are that they:
- are not able to control their own sleeping situations
- cannot understand danger
- may not be able to move out of a dangerous situation
- may place things in their mouths or around their necks and choke.
There are steps that can be taken to make sleep environments safer for babies.
There are many different kinds of cots and bedding on the market for babies. Babies don't care about how smart their beds look, but what is important is that they are safe.
Sleeping position
Babies should always sleep on their backs.
- Many babies can roll from their sides onto their tummies, so they should not be put to sleep on their sides.
Put babies into the cot with their feet at the end of the cot.
- Put your baby's feet at the bottom of the cot, then cover him so that he cannot wriggle under the bedding.
- Make up the cot so that the bedclothes just come up to the baby's shoulders and the baby's head cannot go down under the bedclothes. See the topic Sudden unexpected deaths in infancy (including SIDS) which shows how this is done.
Some babies sleep better when they are wrapped. For more information about safe wrapping of babies have a look at the topic Wrapping babies.
Children have died in accidents related to cots. Young babies are at risk of suffocating or choking. Toddlers are at risk of injury from falling while trying to climb out of a cot.
There is information about cot safety and buying a cot in the topic 'Cots'.
There is also a pamphlet published by the ACCC which has a picture that shows the features of a safe cot: 'Cots'
Mattresses
Mattresses need to fit a cot well so there is no risk of the child becoming trapped between the mattress and the side of the cot. Also some mattresses are not safe for babies. There is information about safe matresses in the topic 'Cots'.
Make sure that your baby's face and head are not covered when she is asleep.
The best way to do this is to use a baby sleeping bag which is made so that the baby cannot slip inside the bag and become completely covered.
- The sleeping bag should have fitted neck and arm holes and should not have a hood.
- Make sure that your baby has enough clothes on under the sleeping bag so that you do not need to use any other bedding (no sheets or blankets).
If you need to use sheets or blankets
- Use only light bedding that can be tucked in firmly.
- Dress your baby in clothing that will keep him warm enough so he does not need much bedding. Then it does not matter if he wriggles out from under a blanket.
- To avoid your baby being strangled, make sure that clothing does not have any long strings, ribbons or cords. If you use a cord or ribbon to attach a dummy to clothing, make sure that it is less than 10 cm long.
- If your baby needs to be wrapped to go to sleep, use a sheet over light clothing and place the baby on his back. See the topic 'Wrapping babies'.
- Doonas, thick quilts or heavy blankets may cause your baby to over heat and are not recommended for this reason.
- Make sure that baby’s face and head remains uncovered (avoid sheep's skins, quilts, pillows, cot bumpers and soft toys). Cot bumpers are not needed to protect your baby. Babies have been found with their faces pressed against bumpers. This can cause breathing problems.
- Do not use pillows in a cot. Babies do not need pillows to sleep.
- It is not safe to use a hot water bottle or electric blanket for babies or young children because of the risk of burns. Heat packs can also cause burns and should not be used with babies and very young children.
- Pillows could be dangerous for babies.
- They can cause suffocation, either by the baby turning face down and burying his face in the pillow or by getting his head under the pillow. This is rare.
- Babies do not need a pillow to sleep comfortably.
- Do not use pillows until the child moves from the cot into a normal bed, usually at 2 to 3 years. Even then pillows are not essential, but children usually want to have one to be like everyone else. Once our shoulders are wider than our heads, most of us sleep more comfortably with a pillow.
- Young children should start with a flattish and fairly firm pillow. Older children usually choose the type and size they prefer. The type of filling does not matter unless there is an allergy problem.
The main concerns with portable cots is that they could be dangerous if they collapse. The collapsed side could trap a child, or the child's head may get caught between the mattress and the sides of the cot (these may be stretchable).
There is more information about portable cots in the topic 'Cots'.
Where to put a cot
Cots need to be well maintained (making sure that all bolts and screws are tight for example), and the cot needs to be in a safe place in the house. For more information have a look at the topic 'Cots'.
You can get cot and bed restraints which are meant to stop babies rolling over onto their tummies. These may not be safe.
U-shaped pillows
Babies should not be left on adult sized u-shaped pillows while they are sleeping, or left alone there while they are awake.
- There have been a number of deaths in South Australia associated with accidental asphyxiation (smothering) in infants who had been left unattended on adult size U-shaped pillow. In some of those cases, the pillows were considered to be part of the cause of death, because they blocked the infants’ airways.
- U-shaped pillows are unsafe for use as babies may accidentally suffocate if trapped between the two arms, or under the pillow.The use of such pillows to maintain the body position of sleeping infants can be unsafe.
- They are also not recommended for use when babies are awake. If U-shaped pillows are used for playtime, babies should not be left in them by themselves if you need to move away. Lift your baby out and place her on the floor, or other safe surface, or take her with you.
Play pillows
Play pillows are small horse-shoe shaped cushions that can be used to support young babies during play and to help hold babies in a comfortable position for breastfeeding. These pillows may also be called play donuts or play rings.
There have not been any reports of deaths of babies left in play pillows but it seems wise to use them with care. We advise parents that babies should not be left in play pillows for sleep, and they should not be left in them unsupervised while they are awake.
Waterbeds
Waterbeds are not safe for babies and young children.
- They are soft, so it is much easier for a child to roll over, and babies will not be able to lift their head so they can breathe.
- Babies and young children need firm mattresses.
Sofa (lounge chair)
Do not let your baby sleep on a sofa as your baby might roll and get trapped in the angle between the back and the seat, making it difficult for your baby to breathe. It is also not safe for you to sleep with your baby on the sofa or lounge chair.
Rocking cradle
- Make sure the rocking cradle cannot tilt while the baby is asleep.
- Make sure the cradle has a tilt limiter so that it won't tilt more than 10 degrees.
- Make sure the locking pin/bolt is in place when you leave the baby and that a baby or another child can't take it out.
Bassinettes
Some parents use bassinettes for the early weeks. It is not necessary to have a bassinette - they are an extra expense and babies usually settle well in a cot even when they are very small.
- They have the advantage that they don't take up a lot of space and you can wheel them from room to room.
- Bassinettes can be rocked with a head-to-toe movement which some babies like.
- On the other hand babies are not in them for very long because once the baby grows too long for the bassinette, or starts to roll over or pull up on things, they are no longer safe.
There are no safety standards for bassinettes but here are some things to check.
- Make sure the bassinette has a sturdy, wide based stand that will not tip easily.
- Make sure the mattress fits well.
Many bassinettes are made of wicker or cane. Make sure that the wicker has not dried out and become brittle as pieces could break off and stick into your baby or choke her.
Prams and strollers
- Before you buy a pram or stroller check that the pram or stroller meets the Australian Standard AS/NZS 2088. There is information about the standard in the topic 'Prams and Strollers'
- Make sure it is strong, stable and that it does not collapse until the lock is released.
- A baby in a pram or stroller should not be left unattended - as the pram or stroller may tip over. Also a baby in a stroller may slide down and become tangled in the stroller straps.
- Always use the safety harness when your baby is in the pram. Even young babies can move.
- Make sure that you use the tether strap so that you retain control of the pram when using it.
Also for more information about pram and stroller safety, see "Prams and Strollers" section in "Keeping baby safe" from the Ministerial Council on Consumer Affairs
http://www.consumer.gov.au/html/pdf/baby.pdf
Baby hammocks may not be safe for babies.
- Do not put a baby on a bean bag.
Changing from a cot to a bed
- Children over 2 years are generally old enough to sleep on a mattress on the floor or in a regular bed with guard rails.
- They will be safer if the mattress is on the floor and they can climb in (and out) easily.
- When a young child is moved out of a cot onto a bed, make sure that there are no gaps between the mattress and the wall, or bed head, or rails, etc, where the child's head may be trapped.
Have a look at the topic 'Toddlers - moving from a cot to a bed' for more information.
Bunk beds
- Bunk beds are not safe for children under 9 years.
- While some falls occur during sleep, there is also a danger of falling when children play on the bunk bed.
For more information have a look at the topic 'Bunk beds'.
- Toys and pets can smother a baby.
- It is best to remove toys while a baby sleeps.
- Make sure that pets cannot climb into the cot or bassinette.
- Do not let your pet sleep in the cot or bassinette even when your baby is not in there, as the pet may want to sleep there when the baby is there.
- Do not use mobiles or toys with stretch or elastic cords in cots.
- By the age when a child may want a teddy or some other toy for comfort (usually over 1 year), there is little or no risk, but it is not recommended before this age.
Sleeping with others
- When babies sleep in their parents' room the risk of SIDS is lower, and they often sleep better. The safest place for a baby to sleep is in a separate cot or bassinette next to their parents' bed. It seems wise to do this at least until the baby is one year of age, after which the risk of SIDS is very small.
- But there is a risk if babies sleep in the same bed with an adult or child. The main way this happens is that the baby gets under the bed clothes or a pillow.
- The risk is higher if parents smoke, have drunk alcohol or used drugs which cause them to sleep more heavily.
- See the topic 'Sleeping with your baby' for more information.
Smoking
- No-one should smoke in the same room as your baby or child because they also inhale the smoke. It is now illegal in South Australia to smoke in a vehicle with a baby or child.
See the topic Sudden unexpected deaths in infancy (including SIDS).
Dummies
There is some evidence that using a dummy during sleep may protect a child from SIDS. The evidence is not yet clear enough for 'Sids and Kids' to make any recommendations about use of a dummy. See the topic Sudden unexpected deaths in infancy (including SIDS).
- When babies are learning to breastfeed (in the first 6 or so weeks), dummies may interfere with this learning.
- Dummies are often used in the early weeks for bottle fed babies.
- If you use a cord or ribbon to attach a dummy to clothing, make sure that it is less than 10 cm long.
- Always check that the dummy is not worn or damaged before you give it to your baby. Small pieces can break off.
If your baby or child has a dummy it may become something which helps your child to feel relaxed at sleep time. It is best not to take the dummy away until the child is ready, usually about 3 years of age. For more information about this have a look at the topic 'Dummies, thumbs and other comforters'.
For more information about dummies and safety have a look at the ACCC 'Babies dummies - keep baby safe' pamphlet
References
Some information in this topic was based on the 'Safe Sleeping for Under 2's' pamphlet, released by a joint working party involving the Women's and Children's Hospital, Child and Youth Health, Kidsafe and SIDS and Kids
Other references and resources
Australian Competition and Consumer Commission (ACCC) 'Cots'
Kidsafe - Child Safety Australia:
http://www.kidsafe.com.au/
Ministerial Council on Consumer Affairs. (Australia). 'Keeping baby safe - A guide to nursery furniture':
http://www.consumer.gov.au/html/pdf/baby.pdf
SIDS and KIDS (Australia):
http://www.sidsandkids.org/
Sids and Kids 'Information statement - Pacifier/dummy use' December 2005
http://www.sidsandkids.org/documents/05Pacifiers2.pdf
The information on this site should not be used as an alternative to professional care. If you have a particular problem, see a doctor, or ring the Parent Helpline on 1300 364 100 (local call cost from anywhere in South Australia).
This topic may use 'he' and 'she' in turn - please change to suit your
child's sex.