Safe sleep for babies

Many parents feel anxious about making sure their baby is sleeping safely because of the risk of Sudden infant death syndrome (SIDS). This is the sudden, unexpected and unexplained death of an apparently healthy baby. This usually happens in their sleep. 

Reading about SIDS can be scary. But try to remember that SIDS is rare and the risk to your baby is low. There are also lots of things you can do that will significantly reduce this risk.

The safest place for your new baby to sleep is in their own cot, in the same room as you, whether it’s during the night or at nap time in the day for the first 6 months. 

The Lullaby Trust promotes the ABCs of safer sleep: 

• ALWAYS sleep your baby on their BACK in a CLEAR cot or sleep space (free of bumpers, toys and pillows).

If your baby was premature

Babies who are born prematurely are at a higher risk of SIDS. It is even more important that safer sleep advice is followed if your baby was born prematurely (before 37 weeks) or was a low birth weight (2.5kg or 5½ lbs or less). Most twins and triplets are born early so this advice also applies to them. 

Some babies who were born very prematurely and spent some time in a neonatal unit may have been sleeping on their fronts for medical reasons and would have been under constant monitoring. Babies may find it hard to get used to a new sleeping position at first but keep putting your baby onto their back and speak to your health visitor, the community healthcare team or GP if you have any questions about this. 

You should not place your baby on their front or use any type of equipment or rolled up blankets to keep them in one position when you get home, unless you have been told to do so by your baby’s doctor or paediatrician because of a medical condition. 

Babies who need to be given oxygen at home should be sleeping on their backs. You may have been told to increase the amount of oxygen if they are on their back instead of their front, but this is still the safest way for them to sleep. 

Find out more about caring for your baby at home. 

DOs for safer sleep  

• Always place your baby on their back to sleep (not on their front or side).
• Keep your baby smoke-free during pregnancy and after birth.
• Place your baby to sleep in a separate cot or Moses basket in the same room as you for the first 6 months.
• Use a firm, flat, waterproof mattress that is in good condition.
• Keep your baby’s head uncovered – if they have a blanket, it should be tucked in no higher than their shoulders.
• Place your baby in the ‘feet to foot’ position, with their feet at the end of the cot or Moses basket.

Breastfeeding can also protect your baby. Breastfeeding for at least 2 months halves the risk of SIDS, but the longer you can continue the more protection it will give your baby.

Breastfeeding may come easily to some, but not others. If you’re finding it difficult, there is support available. 

DO NOTS for safer sleep  

• Never sleep on a sofa or in an armchair with your baby.
• Don’t sleep in the same bed as your baby if you or a partner smoke, drink or have taken drugs or medications that make you drowsy, are extremely tired, if your baby was born prematurely (before 37 weeks) or had a low birth weight (2.5kg or 5½ lbs or less).
• Avoid letting your baby get too hot or too cold – keeping the room temperature around 16-20 degrees is ideal. You can check your baby’s temperature by feeling their chest, tummy or the back of their neck (your baby’s hands and feet will usually be cooler, which is normal). 
• Don’t cover your baby’s face or head while sleeping (babies should not wear hats indoors) or use loose bedding.
• Remove all pillows, soft bedding, cot bumpers and soft toys from the cot.
• Don't smoke during pregnancy or while you are breastfeeding, and don't let anyone smoke in the same room as your baby.

Common questions about safer sleep

What do I need to buy for my baby?

You don’t need to buy lots of expensive products to make sure your baby sleeps safely. There are just a few items that you need:

• a cot or Moses basket
• mattress (waterproof, clean and new if possible)
• a baby sleeping bag (or sheets and a blanket)
• a room thermometer.

If you do use a sleeping bag it is important that it fits well around the shoulders so that your baby’s head cannot slip down into the bag. Make sure your baby is at the minimum height and weight for each sized bag as some babies are smaller than others. Do not use any other coverings, such as a blanket.

The Lullaby Trust has a helpful safer sleep product guide that they produced with Public Health England. It explains what you do and don’t need, and what to look out for choosing products. 

Can I swaddle my baby?

If you choose to swaddle your baby, it is important to follow this advice for all day and night-time sleep:

• use thin cotton materials
• don’t swaddle above the shoulders
• don’t swaddle too tight (you need to allow the legs to move to help your baby’s hip development)
• check your baby’s temperature to make sure they do not get too hot. 

Can I use a baby sling or carrier?

If you want to wear a baby sling or carrier, it’s important to be aware of the safety guidelines. Find one that supports the development of your baby’s spine, neck and hips. Your baby’s weight should be evenly distributed across your shoulders, hips and back. You should be able to see your baby, and they should be held tightly against your body, with their chin free to breathe easily. 

When wearing a sling or baby carrier, keep in mind the TICKS guidelines:

• Tight
• In view at all times
• Close enough to kiss
• Keep chin off the chest
• Supported back 

Can a dummy reduce the risk of SIDS?

Some experts think that using a dummy when you settle your baby to sleep may reduce the risk of SIDS. But not all experts agree as the evidence isn’t strong enough. 

If you decide to use a dummy, experts advise waiting until breastfeeding is established. This is usually by the time your baby is about a month old. 

Regular dummy use is the best way to use a dummy. This means offering your baby a dummy each time you put them down for a sleep, day or night. You and your baby will also find it easier to have a regular sleep routine. If the dummy falls out of your baby’s mouth during sleep, you don’t need to put it back in. 

Can I co-sleep with my baby?

Co-sleeping is very much a personal choice, so we would advise you to read all the information on safer co-sleeping so you can make an informed decision. 

Even if you decide not to co-sleep, it’s worth reading this information so you can make your bed a safer place for your baby just in case you doze off accidentally. 

It is important to know that co-sleeping with your baby can be very dangerous in some circumstances. You shouldn’t co-sleep with your baby if: 

• either you or your partner smokes (even if you don’t smoke in the bedroom)
• either you or your partner has drunk alcohol, taken drugs or taken medications that may make you sleepy
• you are extremely tired.

You should not co-sleep your baby for the first year if they were born prematurely (before 37 weeks) or born at a low weight (2.5kg or 5½ lbs or less).

You should never sleep on a sofa or armchair with your baby. This is very dangerous and can increase the risk of SIDS by 50 times.  

If you do choose to co-sleep with your baby, the safest place is a clear space on a firm, flat mattress. You should follow this safety advice:  

• make sure your baby can’t fall out of bed or become trapped between the mattress and wall
• don’t put your baby between 2 people
• make sure the pillow, sheets and bedclothes can’t cover your baby’s face or head
• don’t leave your baby alone in the bed, as even very young babies can wriggle into a dangerous position
• avoid letting pets or other children in the bed
• don’t use a sleep pod, positioner or nest
• avoid using loose bedding – a baby sleeping bag is much better. 

Can I use a sleep positioner, nest or pod?

Pods or nests are a softer type of sleep surface with raised or cushioned areas. They are sometimes used instead of a mattress, or as well as a mattress. It’s important to remember that when babies are asleep, they shouldn’t lie on or having anything soft around then, especially their heads. This can cause them to overheat and increase the risk of SIDS.  
It’s also important to know that unlike the British Standard cot mattresses, there is no standard for pods or nests and they are not safe sleeping environments. 

"Although there is a huge array of baby products on the market, a firm flat surface and some bedding is all that is necessary to keep your baby safe. Place your baby on their back and ensure that their heads are not covered. This reduces the risk of SIDS. There is no need for a positioner or rolled blankets to keep your baby in this safe position. Cover your baby with sheets and blankets, only up to their shoulders, and this will help ensure that the baby doesn’t overheat."
Amanda, Tommy’s midwife

My baby is developing a flattened head. Should I still put them on their back?

A young baby's skull is still relatively soft and some babies develop a flattened head when they're a few months old.

A slightly flattened head isn't usually anything to worry about, but it's a good idea to get advice early on so you can take steps to stop it getting any worse. Talk to your health visitor or GP. 
Your baby should still go to sleep on their back as this is the safest position for them. But to take pressure off the flattened part of your baby's head you can:

• give your baby play time on their tummy during the day (just make sure you are watching them carefully)
• change the position of toys and mobiles in their cot – this will encourage your baby to turn their head on to the non-flattened side
• alternate the side you hold your baby when feeding and carrying
• reduce the time your baby spends lying on a firm flat surface, such as car seats and prams – try using a sling or front carrier sometimes. 

What if my baby is sick – is it safe they are on their back?

Parents sometimes worry that if their baby is asleep on their back, it might be dangerous if they vomit. But babies sleeping on their backs have no difficulty turning their heads if they're sick.

Reflux is when a baby brings up milk, or is sick, during or shortly after feeding. It's very common and usually gets better on its own.

If your baby is poorly or has reflux, you should still make sure that they sleep flat on their back. Do not raise the head of their cot. Ask your GP or health visitor for more advice if this is something that happens to your baby.

What happens if my baby turns on their side during their sleep? 

The best way to make sure your baby sleeps on their back is to place them on their back from day 1. It is also important that you keep the same routine for your baby. Babies that sometimes sleep on their fronts are at a greater risk of SIDS. 

Parents are often worried when their baby learns to roll and finds a comfortable sleeping position on their side or front. Once a baby can move themselves from their back to their front and back again by themselves, they will be able to find their own sleeping position. The first few times they roll onto their tummy, you might like to gently turn them back, but do not feel you have to get up all night to check. 

More information and support

For lots of useful information about safe sleep for babies and SIDS, go to the Lullaby Trust website or call their information line on 0808 802 6869 (Monday-Friday, 10am-5pm). They have a series of online videos about safer sleep, which you can watch online for free. They also have useful fact sheets about many areas of safer sleep such as temperature, dummies and sleeping position, which you might find useful.