Whether your baby sleeps in a cot; in a bassinet, crib or ‘sidecar’; or ‘co-sleeps’ next to you in bed, there are some general principles that will make your baby’s sleep as safe as possible. These principles apply to all babies under one.

1. Put your baby on the back or side to sleep
Babies are more at risk of Sudden Infant Death Syndrome (SIDS) when they sleep prone or face down. A baby in the prone position can’t get rid of body heat as efficiently and can’t kick off excess bedding- both factors contribute to overheating, a risk factor for SIDS. ‘Back to back’ campaigns in Australia and overseas have reduced the number of babies dying of SIDS by up to 60-70%. If you choose the side position, make sure your baby’s lower arm is well forward, because you want to prevent your baby from rolling onto the tummy. A co-sleeping baby will almost always sleep on their side or back, facing the mother.

2. Keep your baby’s head uncovered during sleep.
Babies are safest without soft bedding items around them. This includes pillows (no child under 1 needs a pillow), quilts/doonas/duvets (blankets are safer), cot bumpers (not recommended) and soft toys, all of which can end up over the baby’s head. Sheets need to be tucked in firmly or fitted snugly so that they can’t come loose.
Babies in a cot are safest tucked in firmly with their feet at the bottom of the cot. Co-sleeping babies also need to be kept from slipping under the bedding. Waterbeds and beanbags are not safe places for sleeping babies, as they can slip into a soft pocket of bedding. Firm mattresses are recommended wherever your baby sleeps.

3. Avoid entrapment hazards
A small baby can become wedged in a gap and suffocate. This hazard applies to the gap between a mattress and the side of a cot (Australian standards allow a gap no greater than 25mm for cots); between the mattress of an adult bed and the wall; and between a mattress and bed guard rail (bed guard rails are not recommended for children under 1)  An adult mattress may be safer on the floor well away from walls-always ensure that the baby cannot become trapped or injured if they roll-off.

4. Avoid strangulation hazards
Check your baby’s sleep environment for long strings or ties. This applies to mobiles hung over cots, and it is also recommended that co-sleeping adults prevent entanglement and/or strangulation by tying up their hair if it is longer than waist-length. As above, cot bumpers (with or without ties) are not recommended.

5. Dress your baby appropriately for the room temperature
It is important to avoid both over and under heating. In winter, your baby does not need both very warm clothing and very warm bedding. A solitary sleeping baby can be dressed in a one-layer ‘blanket sleeper’, and securely tucked into bedding appropriate to the season. A co-sleeping baby will be kept warm by body contact and also does not need more than one layer of clothing- a cotton singlet or T-shirt, long or short-sleeved according to the climate, and a nappy, is usually sufficient. Natural fibre (cotton, wool, hemp, silk) clothing and bedding is recommended. Also, ensure that the room is not over-heated or too cool- consider whether the heating, bedding and clothing would add up to a comfortable sleeping temperature for you.

6. Keep your baby smoke and drug-free
This means avoiding smoking during pregnancy as well as after birth- studies show that babies born to mothers who smoked in pregnancy have an increased risk of SIDs, and it is recommended that these mothers do not co-sleep with their babies. After birth, keep cigarette smoke away from your baby at all times. For mothers who cannot quit, cutting down will reduce the risk to some extent. Babies are also generally safer from SIDS if the father does not smoke, but co-sleeping next to the mother, with a smoking father in the same bed, has not been shown to increase the risk of SIDS.
It is also important that co-sleeping parents are not under the influence of drugs or alcohol. These can make them sleep too deeply and increase the risks of ‘overlaying’

7. Do not put your baby to sleep alone in an adult bed
Adult beds have entrapment risks, as above, as well as the danger of suffocation from soft bedding. Your baby is safer sleeping alone in a cot or on the floor. It is also considered dangerous to sleep a baby with a sibling who might roll onto the baby. Cultures with low SIDS rates incorporate baby sleep time into family life, eg sleeping babies in a family room, rather than isolating them at sleep time. Most babies will sleep happily with a large amount of noise and activity around them (consider how noisy and active it was in your belly!).

8. Ensure that older babies in cots cannot climb out or fall out
Once your baby can sit, lower the mattress if adjustable. Once they can stand, put the mattress at the lowest level and ensure that there are no ‘aids to escape’- ie items they can stand on or pull down into the cot. Measure your child against the side rail- when they are taller than ¾ of the height, they have outgrown the cot.

9. ;Do not put your baby to sleep on a sofa or chair
Not only is this dangerous in terms of falling off, but babies can become entrapped in the gaps of a sofa or chair. Also check your baby’s pram or pusher, if they are sleeping without adult supervision, as babies can also become entrapped or suffocated while sleeping in these as well.

10. Consider wrapping your baby’s mattress
A non-government campaign has been running in New Zealand aimed at reducing the risk of SIDS by wrapping the baby’s sleeping mattress in heavy plastic polythene. This wrapping is said to prevent the baby inhaling toxic fumes from old mattresses, and supporters say that no baby has died from SIDS on a wrapped mattress.

References and Resources

Australian standards and recommendations for cots

Choice Guide to Baby products (book) 7th edition, 2001 $20

Australian SIDS Recommendations

Reducing the Risk of Sudden Infant Death Syndrome (SIDS)- brochure
Published by SIDS Melbourne 1997