By Raising Children Network
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image of baby sleeping, credit Lukic
It’s natural to find yourself checking your sleeping newborn to make sure everything is OK. You can also take simple and effective safe sleeping steps to minimise the risk of sudden unexpected death in infancy (SUDI) including SIDS and fatal sleeping accidents.

SUDI including SIDS and fatal sleeping accidents: risk factors

Investigations into the deaths of children from sudden unexpected death in infancy (SUDI) including SIDS and fatal sleeping accidents, both in Australia and overseas, have consistently shown that one or more of the following risk factors are associated with almost all SUDI-related infant deaths:

  • sleeping baby on her tummy and side
  • sleeping baby on soft surfaces (sofa, soft mattress, pillow, waterbed, lamb’s wool), with or without a parent
  • baby’s face and head getting covered by bedding – this can lead to accidental suffocation and overheating, which is a known cause of SUDI including SIDS and fatal sleeping accidents
  • smoking during pregnancy or after birth.

Over the years, SIDS deaths have been decreasing in Australia. This is because we have been discovering and using safe sleeping practices for our babies. These safe sleeping practices can also reduce sudden unexpected deaths in infancy (SUDI).

When a baby dies unexpectedly and for no obvious reason, it’s often described as sudden unexpected death in infancy (SUDI). SUDI is a broad term that includes SIDS and fatal sleeping accidents. Although SIDS is better known, SUDI, SIDS and fatal sleeping accidents share common risk factors.

Safe sleeping steps to avoid SUDI risk factors

1. Put babies to sleep on their backs
This is the safest position for healthy babies. Babies are more likely to die of SUDI including SIDS and fatal sleeping accidents if they sleep on their sides or tummies.

If you’re worried about your baby choking on vomit, it might help to know that healthy babies put to sleep on their backs are less likely to choke on vomit than babies put to sleep on their tummies or sides.

Once your baby can roll over (at around 4-6 months), keep putting him to sleep on his back, but let him find his own sleeping position.

2. Make sure babies’ heads can’t get covered while they’re sleeping
Put your baby low down in the cot, so her feet are near the bottom end. Tuck in the bed sheets securely so they can’t cover your baby’s head. You could use a safe infant sleeping bag instead of blankets. Sleeping bags with a fitted neck and armholes and no hood are the safest.

3. Avoid smoking
There’s strong evidence that exposure to second-hand smoke harms babies, and that smoking during pregnancy and after birth increases the risk of SUDI including SIDS and fatal sleeping accidents. The link between SUDI and smoking is strong even when parents smoke away from their baby.

If you want to quit smoking and you’re finding it hard, call Quitline on 137 848. You could also speak to your doctor or a child and family health nurse.

4. Use a cot that meets current Australian safety standards
Only well-maintained cots built to strict safety standards are good enough for your baby. Cots that meet the standard will have a clear label – AS/NZS 2172:2003 for cots and AS/NZS 2195:1999 for portable cots.

Cots that don’t meet the standards have many risks, including lead paint, gaps that a young child can get caught in, and sides that are too low and that your child could climb over.

5. Share a room
Have your baby in a cot in your room for the first 6-12 months.

6. Breastfeed your baby if you can
Breastfeeding reduces by more than half the risk of SUDI including SIDS and fatal sleeping accidents. Parents and carers of both breastfed and bottle-fed babies are advised to follow safe sleeping practices.

7. Avoid cot bumpers, soft toys, pillows and doonas
Babies have suffocated when they’ve rolled into cot bumpers, pillows, doonas or soft toys. It’s safest to keep them out of your baby’s cot.

8. Use a firm and well-fitting mattress
Make sure there are no gaps between the mattress and the edge of the cot, where a baby’s head could get jammed. Don’t tilt the mattress. If you’re using a portable cot, use only the firm, thin, well-fitting mattress that comes with it. Don’t add a second mattress or any padding over the mattress.

9. Avoid baby sleeping on couches or makeshift bedding
Sleeping on a couch, with or without someone else, is very dangerous for babies. Also beware of makeshift bedding. Some situations where your baby might be in danger include getting wedged between a mattress and a wall, getting stuck between pillows or cushions, or slipping down until his head is covered by blankets.

10. Dress your baby in clothing that’s warm, but not hot
Overheating is a risk factor for SUDI including SIDS and fatal sleeping accidents. Ask yourself what you would wear to bed and use that as a guide. Keep your baby’s head uncovered indoors – this allows your baby to cool and not overheat. Don’t worry if your baby’s hands and feet feel cool – that’s normal.

11. Make sure your baby’s carers know how to protect against SUDI including SIDS and fatal sleeping accidents
It’s best not to assume that other people know about safe sleeping practices, even professional child carers. Have a look at the planned sleeping arrangements, and make sure yourself that your baby will be positioned safely for sleep. For example, it isn’t recommended to leave a baby sleeping in a pram unsupervised.

Video Minimising the risk of SIDS

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This short video shows how to reduce the risk of SUDI (including SIDS and fatal sleeping accidents). It also includes tips on safe sleeping, sleeping baby on back, sleeping baby at the end of the cot, avoiding a flat head, and sleeping arrangements. It highlights the importance of providing a smoke-free sleeping environment for your baby.

Flat spots on baby’s head

When babies are young, their heads are still very soft. Sleeping on their backs can sometimes make the backs of their skulls a little bit flat over time. This is called positional plagiocephaly. It normally gets better without any medical help by the time babies are 12 months old.

If it’s worrying you, you can gently alternate the tilt of your baby’s head each time you put baby into bed to sleep. But always put babies on their backs to sleep. Then keep them off the back of their heads as much as possible when awake.

  • Last updated or reviewed 17-03-2016
  • Acknowledgements This article was developed in collaboration with SIDS and Kids.