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What  you can do  t o  r e d u c e  t h

 e  r i s k   o f  s u

 d d e n  i n f a n

 t  d e a  t  h

  a n d  s

  l e e p   b

  a  b  y  s

  a  f e  l  y

The term SIDS or SuddenInfant Death Syndrome,

is used when a babydies suddenly, withoutwarning, while they areasleep and where thebaby’s death remains

unexplained after aninvestigation of thecircumstances of death,a complete autopsy anda review of the baby’sclinical history. When

no cause is found for thedeath, it is called SIDS.

Between 1985 and 2005,deaths from SIDS in Australia

have fallen by 83%. Thisdecline is directly linked to

a public health campaign whichpromoted safe sleeping practices,

and particularly the use of the back sleeping position. However, fatal

sleeping accidents have not decreasedin recent years.

Many of the risk factors for SIDS are commonto SUDI and fatal sleep accidents, thereforesafe sleeping strategies will target all threeof these causes of infant death. The risk of SIDS,SUDI and fatal sleeping accidents can be

reduced by following some simple advicefor taking care of baby.

•  Sleep baby on the back from birth– never on the tummy or side

• Sleep baby with head and faceuncovered

•  Avoid exposing babies to cigarettesmoke, before and after birth

• Provide a safe sleeping

environment, night and day:safe cot, safe mattress, safebedding and safe sleeping place.

• Sleep baby in their own cot orbassinette in the same room as theparents for the first 6-12 months.

A safe sleeping place reduces the risk of sudden infant death and fatalsleeping accidents. To provide a safesleeping environment for your baby:

• Put baby’s feet at the bottomof the cot

• The cot must meet the Australianstandard for cots

• No additional mattresses or extrapadding should be placed ina travel cot

• Tuck in bedclothes securelyso bedding is not loose

• Keep quilts, doonas, duvets, pillows,cot bumpers, sheepskins and soft toysout of the cot or sleeping place

• Use a firm, clean mattress that fitssnugly in the cot

Bouncinettes, prams and strollershave not been designed as sleepingproducts and therefore no babyshould be left unsupervised if theyfall asleep in these environments.

Make sure that everyone who cares

for your baby uses the safe sleepingrecommendations to put your babyto sleep.

Sudden Unexpected Death in Infancy (SUDI) isthe sudden, unexpected death of a baby, usuallyduring sleep. SUDI is a broad category of suddenand unexpected deaths which include SuddenInfant Death Syndrome (SIDS), illnesses andconditions the baby may have been born with,injuries, and other undetermined or ill-definedcauses. Most SUDI deaths occur as a result of either SIDS or a fatal sleep accident.

REDUCING THE RISK OF

SUDDEN INFANT DEATH

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Countries which have implementedpublic health campaigns to promotethe use of the supine (on the back) sleepposition for infants have reduced theirrates of sudden infant death. The 83%decline in Australia’s SIDS rate has beendirectly linked to parents using theSafe Sleeping recommendation whichsupports babies being placed on theirback to sleep.

 The side position, although less dangerousthan sleeping baby on the tummy (proneposition), does increase the risk for SIDS.

Much (but not all ) of the risk associatedwith the side position is related to the risk of the infant rolling onto their tummy.Side sleeping is not recommended as a safe alternative to sleeping on theback. All aids and devices intended to keepinfants in a certain sleep position do notprevent infants from rolling prone, arenot recommended, and limit themovements of the baby as they get older.

Premature, low birth weightand sick infantsBabies admitted to a special or intensivecare nursery due to premature birth, lowbirth weight or a medical condition areoften nursed in a variety of positionsincluding on their tummy or side, mostcommonly if they require respiratorysupport, e.g. oxygen or ventilation.

Why sleeping your baby on the back is importantBabies with refluxSleeping baby on the back does notincrease the risk of milk aspiration. Babieswith gastro-oesophageal reflux shouldbe placed on the back to sleep on afirm, flat mattress that is not elevated. Healthy infants protect their airway whenplaced supine, provided that swallowingand arousal mechanisms are normal. Thetummy position (Figure 1) increases therisk that baby may inhale milk or fluidsinto their airway. Research shows thatall babies, including babies with gastro-oesophageal reflux, should be placed

on their back to sleep, and that thereis no evidence to support the elevationof the head of the cot.

It is important to remember that thesebabies are monitored while they are inhospital. Premature birth and low birthweight are associated with an increasedrisk of sudden infant death, but some of this risk is associated with side or tummysleeping after these babies are dischargedhome. It is especially important for babieswho are admitted to special or intensivecare nurseries to get used to sleepingon their back before they are discharged.Back sleeping needs to be introducedas early as possible (i.e. as soon as babyis medically stable and out of oxygen)

before discharge, in all maternity andneonatal care facilities.

Parents of some babies with a raremedical condition may be advisedby their doctor to sleep babyon their side or tummy, but onlydo so if your baby’s doctor advisesyou in writing.

Older babiesAs babies grow older beyond5-6 months, they will move around thecot and roll over. Settle baby to sleepon their back but let them find the sleepposition they feel most comfortable in.A safe cot and safe sleep environmentis still necessary for older babies.

In the supine position the upper respiratory airwaysare above the oesophagus (digestive tract), thereoreregurgitated milk can be easily swallowed and aspirationinto the respiratory tract avoided. When baby is placed ontheir tummy the digestive tract sits above the baby’s upper airways. I baby regurgitates or vomits milk or fuid, thesesubstances are more likely to be inhaled into the baby’sairway and lungs.

Figure 1: Infant in supine and prone position

Infant sleeping bagsSafe infant sleeping bags have severalbenefits. An infant sleeping bag that is thecorrect size for baby with a fitted neck, armholes or sleeves and no hood, is the best wayto keep a baby’s head and face uncoveredas it makes extra bedding unnecessary.Sleeping bags also delay baby from rollinginto the high-risk tummy position duringsleep and prevent the baby’s legs fromdangling out of cot rails. If additional warmthis needed you can dress baby in layers of clothing within the sleeping bag, but makesure this is appropriate to room temperature

(dress baby as you would dress yourself).

Infant WrappingWrapping is a safe and effective strategyto try if you are having difficulty settlingyour baby and will help baby to settle andstay in the safe, supine sleeping position.If you choose to wrap your baby, make surebaby’s head is not covered, and wrap babyfirmly but not too tightly. Wraps should beof lightweight cotton or muslin material,and ensure baby is not overdressed underthe wrap. Baby should always be placedon their back to sleep, with their feet tothe bottom of the cot. Babies must not bewrapped if they are sharing a sleep surfacewith another person.

Infantsleeping

Digestive Tract

Airways

Milk

Digestive Tract

Airways

Milk

Supine (on back) Prone (on tummy)

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Many parents bring their babyinto bed at some time, especially

if baby is breastfeeding. In some circumstances, sharing a sleepsurface with a baby increases therisk of sudden infant death andfatal sleeping accidents. Currentevidence has shown that it is notso much bed-sharing, but thecircumstances in which bed-sharing occurs that carries the risk.No sleeping environment is risk free. SIDS and Kids recommendssleeping with a baby in a cot nextto the parents’ bed for the first

six to twelve months of life asthis has been shown to reducethe risk of SIDS.

It is not safe to share a sleep surfacewith a baby if:

• You or your partner is a smoker

• You are under the influence of alcohol or drugs that cause sedation,or are excessively tired

If parents choose to share asleeping surface with their baby,the following strategies will help

to reduce the risk of sudden infantdeath and fatal sleeping accidents:

•  Sleep baby on the back from birth– never on the tummy or side.

• Make sure the mattress is firm.

• Make sure that bedding cannot coverbaby’s face (use lightweight blankets;remove pillows, doonas and othersoft items from the environment).

• Sleep baby beside one parent only(not between two parents) to reducethe likelihood of baby becomingcovered by adult bedding.

Sleeping with your baby

• Instead of bedding, an infant sleepingbag may be used so baby does notshare the adult bedding.

• Do not wrap baby if sharing a sleepsurface as this restricts arm and legmovement.

• Make sure baby cannot fall off thebed. A safer alternative is to place themattress on the floor (be aware of potential situations where baby canbecome trapped).

• Pushing the bed up against the wallcan be hazardous. Babies have diedafter being trapped between the bedand the wall.

• Never place a baby to sleep in a bedwith other children or pets (see SIDSand Kids Frequently Asked Questionsfor specific advice about the safest wayto sleep twins).

•  Babies must never be left aloneon an adult bed or put to sleep ona sofa, bean bag, waterbed orsagging mattress.

• Parents are advised to share thesame room as their baby during thefirst 6-12 months of life as this practiceis associated with a reduced risk of sudden infant death. Sharing thesame room during a baby’s daytime

sleep is also protective. Safety of thebaby’s sleep environment should beviewed as a priority over sharing thesame room as baby for daytime sleeps;i.e. sleeping baby on a sofa during theday is not safe.

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Baby’s Head Shape Tummy Time while awakeis very important

A baby’s skull is soft and flattenedspots in head shape (called positionalplagiocephaly) can occur if a baby alwaysplaces their head in the same position.

 These flattened head spots do not affectbrain growth, and for most babies headshape becomes rounder as the babydevelops. The most effective strategyto prevent flattened spots is to ensurebaby spends time on their tummy severaltimes per day from birth, while theyare awake and supervised

by an adult. Tummy time is importantfor normal growth and developmentas this position helps baby learn to lifttheir head, use their arms and explorethe world. Other strategies include

• settle baby on the back, but changebaby’s head position, right to left,every sleep

• place baby to sleep at either end of thecot (always feet to foot of cot)

• position cot to face a differentdirection

• avoid prolonged periods in car seatsand prams

• carry baby in a sling.

• Remember ‘Supine to sleep, proneto play, sit up to watch the world’.

Dummy usePresently evidencerelating to dummy useas a strategy to reducethe risk of SIDS isinconclusive. If parents chooseto use a dummy, and wish to breastfeed,it is recommended that dummies onlybe introduced after the first 4-6 weeksfor breastfed babies, as dummy use mayinterfere with breastfeeding becomingestablished.

SmokingOver 60 studies frommany countries havedemonstrated a verystrong relationshipbetween smoking andsudden infant deathsyndrome. Smokingduring pregnancyincreases the risk,while smoking after thebaby is born increasesthe risk further. Babieswho are exposed to

cigarette smoke from anyhousehold member areat an increased risk. Thecar and home should besmoke free zones. Reducingthe number of cigarettessmoked in the household,reduces the risk. Room-sharing for sleep isrecommended forbabies for the first 6-12months of life, as long as this room is keptsmoke free and is well ventilated. Sharinga sleep surface with your baby if you are asmoker is not safe and is not recommended.

MedicinesParents are advised to seek medicaladvice before providing infants withany medication that will alterconsciousness level.

ImmunisationImmunisation is a safe and effective wayto protect children from serious diseases.Immunisation is not associated with anincreased risk of SIDS. Parents are advisedto immunise their babies according to thenational vaccination schedule.

NOTE: Many parents worryabout the chance that their

baby may die from SIDS.Most babies will not die

suddenly and unexpectedly.The evidence-based strategiesoutlined in this resource havebeen shown to reduce the risk 

of sudden unexpectedinfant death.

Further informationFor further information see the Queensland Health State-wide Policy for Safe Infant Careto Reduce the Risk of Sudden Infant Death, available atwww.health.qld.gov.au/ph/documents/childhealth/29567.pdf.

SIDS and Kids Frequently Asked Questions and evidence-based Information Statementson Wrapping Infants, Baby’s Head Shape, Sleeping with a Baby, Room-sharing, Breastfeeding,Pacifier/Dummy Use and Immunisation. are available at www.sidsandkids.org underCurrent Topics. Queensland Health gratefully acknowledges the contribution of SIDS and Kidsin the development of Safe Infant Sleeping resources for parents and health professionals.

BreastfeedingBreastfeeding is associated with reducedinfant mortality and morbidity worldwide.Breastfeeding is beneficial and should beencouraged as it promotes healthy outcomesfor infants and mothers, however it is notcurrently recommended as a specificstrategy to reduce the risk of suddeninfant death.