Making sure your baby is sleeping as safely as possible will help reduce his or her risk of Sudden Infant Death Syndrome (SIDS), also known as cot death.
SIDS is, thankfully, pretty rare: of the 700,000 babies born in this country every year, about 300 die from SIDS. But it is the most common cause of death in babies under 1 year old – which means, of course, that every parent should take the risks very seriously.
There are 7 simple must-dos (below), almost all of them related to how and where your baby sleeps, that will help reduce your baby’s SIDS risk.
What are the safe-sleep rules?
- Always put your baby down to sleep on his or her back
- Keep your baby’s bed clear
- Make sure your baby’s bed is a firm, flat and has a waterproof cover
- Don’t let your sleeping baby get too hot
- Keep your baby smoke-free
- Never sleep with your baby on a sofa or armchair
- Room-share with your newborn, day and night
These must-dos apply most importantly to your baby’s first 6 months (when every baby’s SIDS risk is highest).
And they are particularly important to follow if:
- your baby is born prematurely (before 37 weeks)
- your baby had a low birth weight (under 2.5kgs)
The 7 safe sleeping rules: explained
1. Always place your baby to sleep on his or her back
Back in the day, mums were told to lie babies down to sleep on their front – as it was thought this might help stop babies choking if they were sick. But now we know, from substantial worldwide research, that it’s much, much safer to put babies down on their back.
That’s because your baby’s SIDS risk rises 6-fold if she’s sleeping on her front, rather than her back. Since official NHS advice changed from prone (front-down) sleeping to supine (front-up) sleeping in the early 1990s, the ‘cot-death’ rate in the UK has dropped by 70%. And, for babies who sleep on their back, there has been no rise in choking.
So, make sure you place your baby down on her back for every day and nighttime sleep from day 1 (unless your doctor explicitly advises otherwise). And keep doing it: safe-sleep experts at The Lullaby Trust (formerly FSID) say the SIDS risk substantially rises for babies who are sometimes put down on their side or front instead.
If your baby rolls onto her tummy, gently turn her back again. But, once your baby is able roll over onto her tummy and back again (which usually happens at about the age of 6 months), it’s fine to let her find her own sleeping position once you’ve put her down.
2. Keep your baby’s bed clear
Don’t put any soft toys in your baby’s cot, crib, Moses basket or baby box. Duvets, quilts, cot bumpers, pillows and other loose, soft or bulky bedding are a no-no, too. All of these things are a suffocation risk (and, in the case of cot bumpers, a strangulation risk) for any sleeping baby under 12 months old – as is anything that could slip down or up to cover your baby’s face (such as a headband or hat, or a loose sheet).
It’s particularly important to avoid using pillows: according to The Lullaby Trust, pillow use alone can more than double your baby’s risk of SIDS. (If you’re worried about your baby getting a ‘flat head’ from sleeping on her back so much, and are tempted to buy a special pillow, do seek medical advice or talk to a helpline adviser at The Lullaby Trust on 0808 802 6869 first).
To make sure you’re arranging your baby’s bedding as safely as possible, you can either:
- Firmly tuck in sheets and blankets – not above shoulder height. And place your baby with his feet at the foot of his bed (so he can’t wriggle down and get the sheets over his head)… or…
- Use a baby sleeping bag – which means your baby won’t need sheets and blankets at all. Be sure to buy the correct size (so that your baby can’t slip down inside) and the right tog for the room temperature and season.
Is it safe to swaddle my baby?
Yes, as long as you use thin materials, do not swaddle too tightly or above the shoulders, and follow all the 7 safe-sleep rules. You could stop swaddling once your baby is able to roll (that’s roughly about 4 months).
3. Make sure your baby’s bed is firm, flat and has a waterproof cover
Whether you’re putting your baby down in a Moses basket, cot, crib, baby box or sleep pod – or some combination of any of these throughout the day and night – you should ensure the mattress is firm and flat, and protected by a waterproof cover (that will help keep the mattress clean and dry).
The mattress should fit the bed and, be new with each child. The danger with a secondhand mattress is that it can lose its shape and may contain hidden bacteria and dust mites. It will also probably be less comfortable.
Also, there’s evidence to suggest that SIDS, or cot death, is linked to secondhand mattresses, so we at MFM don’t recommend it.
Can twins sleep in the same bed?
Yes, twins can co-bed by sharing a cot (but not the smaller-sized bed space of a Moses basket, crib or singleton baby box) for the first few weeks – as long as you follow all 7 safe-sleep rules.
It’s safest to position them at either end of the cot so that each twin can sleep in the ‘feet to foot’ position, with his or her own bedding properly tucked in. Once one of your twins has learn to roll (roughly about 4 months) the Lullaby Trust recommends moving your twins to separate beds.
4. Don’t let your baby get too hot
Your instincts tell you to wrap your baby up warm but, actually, being too hot can increase the risk of SIDS.
This is especially important to remember when it’s cold outside. The only recent rise in unexplained infant deaths, according to Office of National Statistics, was in February and March 2013 – one of the coldest winters for several years.
“Babies need a cooler room than most people might assume,” say the experts at The Lullaby Trust. The recommended safe room temperature for babies is 16-20ºC (60.8-68ºF), with 18ºC (65ºF) being ‘just right’.
Don’t rely on how the room feels to you; use a room thermometer to check (take a look at our guide to the best room thermometers).
As well as keeping an eye on the room temperature, you should check your baby to ensure she’s not overheating. Feel your baby’s tummy or the back of her neck (don’t go by how cold your baby’s hands or feet feel, because, like with us grown-ups, these can often be much cooler than the rest of her body). If your baby’s skin feel hot or sweaty, remove one or more layers of bedclothes.
5. Keep your baby smoke-free
This safe-sleeping advice starts in pregnancy – because, say The Lullaby Trust experts, there is a clear link between parents who smoke and SIDS. It’s thought that 30% of sudden infant deaths could be avoided if women didn’t smoke when they were pregnant.
They advise that you:
- quit smoking in pregnancy – and ask your partner to give up, too
- don’t let anyone smoke in the same room as your baby
- ask visitors to your house to smoke outside (or not at all)
- don’t take your baby into smoky places
It’s also really important to know that, if you are thinking about sharing a bed with your baby (see more on bedsharing, below), and you or your partner smoke, you should think again. Being a smoker greatly increases the chance of SIDS if you bed-share – even if you do not smoke in the bedroom.
6. Never sleep on a sofa or in an armchair with your baby
It’s all too easy to nod off in front of the TV holding your baby but sofa-sleeping with your baby is dangerous, increasing the risk of SIDS 50-fold. That’s because your baby can slip into the gap between the cushions, or between the cushions and the sofa back, or you may roll or slip down on top of your baby.
“The number of UK deaths occurring when a parent and baby fall asleep on the sofa has risen,” says medical statistician Dr Pete Blair, a recognised SIDS expert based St Michael’s Hospital, Bristol. “It’s the only area where SIDS is increasing.”
If you’re feeding your baby on a sofa or armchair and are worried you might doze off, set an alarm on your phone to keep you alert. If you’re sitting with your baby on the sofa and feel tired, put him in his cot, crib, Moses basket or baby box.
7. Room-share with your baby
For the first 6 months, the safest place for your baby to sleep – day or night – is, according to the Lullaby Trust, is in a traditional cot, a crib, a co-sleeper cot, a Moses basket, a baby box or a sleep pod in whichever room you’re in.
A 2013 study, funded by The Lullaby Trust, showed that 75% of babies who died of SIDS during the day were sleeping in a room on their own.
“It might be that having the parent nearby has a protective effect – or simply that you’re better placed to respond if your baby needs you,” says Dr Blair, “but room-sharing definitely reduces the risk of cot death.”
It may sound obvious but it’s worth pointing out that room-sharing isn’t the same a bedsharing or co-sleeping. While room-sharing is a safe-sleep must-do, taking your baby into the same bed as you is not. For more on this, see Can I bedshare with my baby?, below.
Is it OK to breastfeed my baby in bed?
Yes, of course. But the Lullaby Trust strongly recommend you put your baby back into his or her cot or in a bedside cot/co-sleeper cot afterwards – and particularly in the first 3 months.
Other steps that may help your baby sleep safer
In addition to the 7 safe sleep rules, above, there are a couple of other measures that can help – if you’re able to do them (we know not everyone can or will want to).
1. Breastfeed your baby
Numerous studies over the past 50 years have shown a link between breastfeeding and a lower risk of SIDS – even if you only breastfeed for a short time, or end up combining breast and formula-feeding.
“Exclusive breastfeeding is associated with the lowest risk,” say The Lullaby Trust, “but breastfeeding of any duration may be beneficial for lowering the chance of SIDS, compared to formula-feeding alone.”
Of course, not all of us find it easy – or even possible – to breastfeed, so this can be a quite scary safe-sleep fact to take on board.
What’s key to remember here, though, is, while breastfeeding can undoubtedly reduce your child’s SIDS risk, if you choose to formula-feed (for whatever reason) but follow all the other 7 safe sleep rules, above, your baby’s SIDS risk will still be extremely low.
2. Give your baby a dummy for sleeping or napping
There is some research suggesting that giving your baby a dummy when you put her down to sleep could reduce the risk of SIDS.
If you’re breastfeeding, it’s generally advised that it’s best to wait till your baby’s about 4 weeks old (by which time breastfeeding is usually well established) before introducing the dummy. And it’s also recommended that you then stop offering a dummy when your baby’s 6 months to 1 year old.
It’s important to choose a dummy with an orthodontic teat and to only use it for sleeping (or napping) – to avoid any damage to those baby teeth.
What we all need to know about bedsharing (having your baby sleep in the same bed as you) is that, according to the Lullaby Trust, there is a risk that your baby could overheat or accidentally suffocate – either because you (or your partner) roll on top of your baby while you’re asleep, or because your baby gets tangled up in the bedclothes or gets lodged between the mattress and the bed frame.
In 2017, according to the Department of Education, 141 babies lost their lives in cases where ‘co-sleeping was a factor’.
Having said that, the Lullaby Trust have recently (March 2019) acknowledged that many of us parents do bedshare (either every night or some nights) and they are now keen to make we know there are ways to help minimise this accidental overheating/suffocation risk.
So, if you are considering bedsharing, you should know that there are some scenarios when it is particularly risky and should be avoided.
Don’t bedshare if:
- your baby was born before 37 weeks or weighed less than 2.5kg at birth
- you or your partner smoke (even if you don’t smoke in the bedroom)
- you or your partner have been drinking alcohol
- you or your partner have taken drugs or any medication that makes you drowsy
- you feel very tired
The Lullaby Trust also points out that bedsharing with a baby under 3 months has been shown to increase the SIDS risk 5-fold, even if you’re breastfeeding and don’t smoke.
If none of the scenarios above apply and you want to bedshare, then…
- keep the space around your baby clear of pillows and duvets (and anything else that could obstruct your baby’s breathing or cause him or her to overheat)
- make sure your baby cannot fall out of bed or get trapped between the bed or mattress and the wall
- always make sure your baby sleep on his or her back
- never leave your baby alone in the bed
- don’t let pets or other children into the bed
Another option might be to try using high quality co-sleeper or bedside cot. These are cots designed to fit safely onto the side of your bed, offering you a similar sense of intimacy as bedsharing but actually providing your baby with a separate surface to sleep on.