SUDI including SIDS and fatal sleeping accidents: risk factors

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.

Deaths from SUDI including SIDS and fatal sleeping accidents have decreased a lot in Australia. This is because we understand more about safe sleeping practices for our babies, and we’ve been following these practices.

Safe sleeping practices can reduce the risk of SUDI including SIDS and fatal sleeping accidents.

Download or print our illustrated guide to reducing the risk of SUDI including SIDS and fatal sleeping accidents.

Safe sleeping tips to reduce the risk of SUDI, including SIDS and fatal sleeping accidents

1. Always put your baby on their back to sleep
This is the safest position for healthy babies. Babies are more likely to die of SUDI if they sleep on their sides or tummies.

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

2. Keep your baby’s face and head uncovered
This reduces the risk of overheating and suffocation. Overheating is a risk factor for SUDI.

To prevent bedding from covering your baby’s head, put your baby with their feet down at the bottom of the cot. Use only lightweight bedding and tuck it in securely at chest level. You could use a safe infant sleeping bag instead of blankets.

3. Keep your baby’s environment smoke free, before and after birth
Exposure to second-hand smoke harms babies, and smoking during pregnancy and after birth increases SUDI risk. The link between SUDI and smoking is strong even when parents smoke away from their babies.

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

4. Use a cot that meets current Australian safety standards
Well-maintained cots that meet strict safety standards are safest for your baby. Look for Australian/NZ Standards AS/NZS 2172 for cots and AS/NZS 2195 for portable cots. And check that cots meet current standards by looking at Product Safety Australia’s guide to keeping baby safe.

Second-hand cots should meet safety standards, be less than 10 years old and in good working order, and not have any loose parts or sharp edges.

Cots that don’t meet the standards have many risks, including lead paint, unstable drop sides, gaps that children could get caught in, and sides that are too low and that children could climb over.

5. Use a safe mattress
Use a firm, clean mattress that’s in good condition. Look for Australian/NZ Voluntary Standard AS/NZS 8811.1:2013.

Put the mattress in the centre of the cot and check that it has no more than a 20 mm gap between the mattress and the cot sides and ends. Gaps can increase the risk of your baby’s head becoming wedged or jammed. The mattress should be flat, not tilted.

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. A soft mattress or sleeping surface can increase the risk of SUDI.

6. Don’t use soft objects and surfaces where your baby sleeps
Doonas, pillows, cot bumpers, mattress padding, soft toys, sheepskin or lamb’s wool significantly increase the risk of SUDI. This is because babies can suffocate or overheat by rolling into or being covered by these soft objects and surfaces.

7. Don’t sleep your baby on couches or makeshift bedding
Sleeping on a couch, with or without someone else, is very dangerous for babies and can increase the risk of SUDI.

Avoid makeshift bedding like beanbags or pillows. These are very dangerous for your baby and can affect their ability to breathe properly. Your baby might get wedged between a mattress and a wall, get stuck between pillows or cushions, or slip under loose blankets.

Also avoid leaving your baby to sleep unsupervised in a pram, car restraint or capsule.

8. Dress your baby in clothing that’s warm, but not hot
If you use a safe infant sleeping bag, you don’t need sheets or blankets over the top. If your baby’s head and face are uncovered, your baby is more likely to stay cool and not overheat. Don’t worry if your baby’s hands and feet feel cool – that’s normal.

9. Share a room
It’s safest for your baby to share a room with you, sleeping in a cot next to your bed, for the first year of life or at least the first 6 months.

10. Make sure your baby’s carers know how to protect against SUDI
It’s best not to assume that other people know about safe sleeping practices, even professional child carers. Look at the sleeping arrangements at your baby’s child care setting, and make sure that your baby will be positioned safely for sleep. It’s also OK to ask carers about sleep arrangements.

Breastfeeding reduces by more than half the risk of SUDI including SIDS and fatal sleeping accidents. But regardless of whether your baby is breastfed or bottle-fed, it’s still very important to follow safe sleeping practices to reduce the risk of SUDI.

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 usually 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 your baby into bed to sleep. But always put your baby on their back to sleep. Then keep your baby off the back of their head as much as possible when awake. Tummy time can help you do this.

If you’re worried about the shape of your baby’s head, speak to your GP or child and family health nurse.