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Safe sleep for babies and toddlers

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While babies are asleep they may get into dangerous situations, eg suffocate under bedding or be caught between the cot side and mattress.

There are steps that can be taken to make sleep environments safer for babies.

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.

Reducing the risks of SIDS (Sudden Infant Death Syndrome) and fatal sleep accidents

  1. Sleep baby on the back from birth, not on the tummy or side.
  2. Sleep baby with head and face uncovered.
  3. Keep baby smoke free before birth and after.
  4. Provide a safe sleeping environment.
  5. Sleep baby in their own safe sleeping place in the same room as an adult care-giver for the first six to twelve months.  

The Australian Competition and Consumer Commission (ACCC) has published a booklet 'Keeping baby safe - a guide to infant and nursery products' which has more information about many of the products listed below. It is available as an electronic version which can be downloaded free (pdf - 2.9MB) or as a free printed booklet. 
http://www.productsafety.gov.au/content/index.phtml/itemId/972363 

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.
  • Click here to view a diagram of a safe cot.

Sleeping with your baby

Sharing a sleep surface (such as the parents' bed or a sofa) with a baby has lead to the death of some babies.

It is recommended that babies sleep in a cot in the same room as their parents for the first 6 to 12 months of life, as this has been shown to lower the risk of SIDS.

There appears to be no increased risk of SIDS or fatal sleep accidents when a baby shares a sleep surface during feeding, cuddling and playing providing the baby is returned to a cot or a safe sleeping surface before the parent goes to sleep.

The risk is higher if parents smoke, have drunk alcohol or used drugs which cause them to sleep more heavily.

There is more about this in the SIDS and Kids Information Statement 'Sleeping with a baby' 
http://www.sidsandkids.org/wp-content/uploads/Sleeping-with-Baby.pdf 

Wrapping babies

Some babies sleep better when they are wrapped. For more information about safe wrapping of babies have a look at the topic Wrapping babies.

Sleeping bags 

Sleeping bags can reduce the risk of SIDS. A safe sleeping bag is made in such a way that the baby cannot slip inside the bag and become completely covered. Sleeping bags can prevent legs from dangling out of the cot rails.  Babies in sleeping bags can be positioned anywhere in the cot if no extra bedding is used

  • The sleeping bag should be the correct size, with a fitted neck and arm holes and no hood.
  • Dress your baby according to the room temperature and do not use doonas or quilts. 
  • Check the label on the sleeping bag as there are summer weight and winter weight bags
  • If additional warmth is needed a light sheet or blanket is usually all that is required, but take care to tuck the blanket in firmly so it cannot ride up and cover baby’s head during sleep. 
  • If babies are too hot they may be restless and flushed in the face and sweating.

When changing from wrapping your baby to using a sleeping bag you might like to start with wrapping your baby with arms out, this may help with the transition.

Buying a cot

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 - safety alert

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 mattresses in the topic 'Cots'.

See also the Fact Sheet: Never add extra cushioning (PDF document - SA Health web site)

Bedding

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.  

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. Cots are designed so that a baby's head, arms or legs cannot get trapped in the sides of the cot. Babies have been found with their faces pressed against bumpers. This can cause breathing problems.
  • Products such as Airwrap mesh may also be a risk for stangling a baby (advice from Public Health, SA Health 2013).
  • 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

  • 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.

Portable cots

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'.

Cot and bed restraints (positioners)

You can get cot and bed restraints which are meant to stop babies rolling over onto their tummies. 

The U.S. Consumer Product Safety Commission (CPSC) and the U.S. Food and Drug Administration (FDA) have warned consumers to stop using infant sleep positioners. Over the past 13 years, CPSC and the FDA have received 12 reports of infants between the ages of 1 month and 4 months who died when they suffocated in sleep positioners or became trapped and suffocated between a sleep positioner and the side of a crib or bassinet. (29 September 2010)

The marketers of sleep positioners typically claim that they help keep infants on their backs and reduce the risk of Sudden Infant Death Syndrome (SIDS), however deaths have occurred when babies have rolled within the positioner, or when the baby has rolled out of the positioner.

The CPSC and the FDA recommend that they are not used. "We want to make sure parents, health care professionals, and childcare providers understand the potential risk of suffocation and stop using infant sleep positioners."

"The deaths and dangerous situations resulting from the use of infant sleep positioners are a serious concern to CPSC," said CPSC Chairman Inez Tenenbaum. "We urge parents and caregivers to take our warning seriously and stop using these sleep positioners, so that children can have a safer sleep."

For more information have a look at the statement 'Deaths prompt CPSC, FDA warning on infant sleep positioners' http://www.cpsc.gov/cpscpub/prerel/prhtml10/10358.html

Baby slings

Baby slings are great to provide the comfort and contact that babies need when you have something else to do. However some babies have suffocated in baby slings - they need to be used with care. Babies are not able to move out of dangerous positions that block their airways.

The Australian Competition and Consumer Commission (ACCC) has released a safety alert about baby slings. 

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.

Further information: 
Product Safety Australia  'Prams & strollers'
http://www.productsafety.gov.au/content/index.phtml/itemId/974044/fromItemId/971500

Baby hammocks

One of the really important safety differences between a household cot and a baby hammock is that there is no Australian Standard for hammocks. A cot can't be sold in Australia unless it meets a whole range of safety tests designed to protect your baby. These sorts of safety tests don't apply to baby hammocks and for that reason we don't recommend them.

In some hammocks a baby might roll to one side and end up with their face pressed against material they can't breathe through. In a cot a baby lies flat, but in some hammocks the base may be so flexible a baby's chin could be pushed forward onto their chest making breathing difficult. Babies old enough to roll over have fallen out of hammocks, and babies have strangled in hammocks which have strings or cords.

It is for these reasons that we don't recommend using hammocks as safe places for a baby to sleep, unless your doctor specifically recommends one for special medical reasons.

Bean bags


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 on and off 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

  • 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.

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 pamphlet 'Babies dummies -  safety alert' 

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 Accident Foundation of Australia:
http://www.kidsafe.com.au/ 

Australian Competition and Consumer Commission  'Keeping baby safe - A guide to infant and nursery products': 
http://www.productsafety.gov.au/content/index.phtml/itemId/972363 

SIDS and KIDS (Australia):
http://www.sidsandkids.org/

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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.

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