Recommendations and tips for safe infant sleep

Infant sleep safety is a very important topic for parents and health professionals, as ensuring a safe sleep environment helps prevent the risk of infant cot death and other complications.

Sudden infant death during sleep in the first year of life can be caused by SIDS (Sudden Infant Death Syndrome), suffocation or unintentional strangulation, illness or injury.

Infants spend most of their first weeks and months sleeping, and ensuring that they do so safely is critical to their health and well-being.

The American Academic of Paediatrics (AAP), UNICEF and Italian Ministry of Health (to name a few) provide official recommendations for infant safe sleep which have been established to reduce the risk of ‘cot death’ and to create a safe sleeping environment for infants.

Here are some key recommendations for parents on infant sleep:

1) Sleep position: Always put your baby to sleep in a supine position (on its back), both at night and during the day. This position significantly reduces the risk of SIDS.

2) Safe sleeping surface: The child should sleep on a flat, sufficiently firm and well-protected surface, such as a cot approved for newborns. Use a firm mattress with a tight-fitting cover and do not add pillows or soft toys in the cot.

The AAP’s latest 2022 recommendations include the recommendation to avoid using inclined surfaces (maximum 10 degrees). If the child falls asleep on a reclined support such as a car seat, it should be supervised and moved to a flat surface as soon as possible.

3) Room conditions: Keep the room temperature comfortable and suitable for the child (not too hot). Dress him or her according to the climate of the room, and use a sleeping bag or sleepsuit instead of loose blankets (if you prefer to use a sheet with a blanket, they should be neatly arranged so that they cannot shift if the child moves).

4) Sharing a room: It is advisable for the child to sleep in the same room as the parents (at least until 6 months), but not in the same bed (see the section on this subject below). A cot placed close to the parents’ bed can reduce the risk of SIDS and allow constant monitoring.

5) Breastfeeding is associated with a reduced risk of SIDS. If possible, try to feed naturally.

6) Use of a dummy: Use of a dummy during sleep can help reduce the risk of SIDS, but should be introduced after breastfeeding is well established. If the baby does not want to use it, it should not be forced; if the baby loses it during sleep, it does not need to be replaced.

7) Avoid smoking: Exposure to smoke, both prenatally and postnatally, increases the risk of SIDS. Avoid smoking during pregnancy and keep the baby away from places where smoking occurs. If one of the parents smokes it is important that the baby is not exposed to smoke even from clothes/hands/breath.

8) Avoid overheating: Avoid overdressing the child or using too many blankets. Overheating can increase the risk of SIDS.

9) Beware of sleeping position: Avoid using car seats, prams or bouncers as places to sleep the baby for long periods. These can restrict the baby’s movement and increase the risk of suffocation.

By following these recommendations, you can help create a safe sleeping environment for your baby and reduce the risk of SIDS.

If you need further personalised advice and have any specific questions or concerns, please do not hesitate to contact me.

Insight into bed-sharing or ‘co-sleeping’: mums often fall asleep while breastfeeding

This topic deserves a point of deepening and reflection: as health workers, we know that it can happen to any mother that she falls asleep while breastfeeding, even when she starts out with the best of intentions.

UNICEF, for example, unlike the AAP, states that shared sleep between mother and baby is possible and sufficiently safe if parents are properly informed on how to manage night feeds.

Breastfed babies often want to stay at the breast for long periods during the night, and this is perfectly normal. Not providing information on how to breastfeed safely at night is much more risky because mothers, driven by the general prohibition of bed sharing, often sit on the sofa or an armchair and this leads to an increased risk of SIDS if they fall asleep in these positions. Other times, however, it can happen that, driven by fatigue, mothers take their babies to bed anyway (not knowing how to do this safely) or that they abandon breastfeeding (a factor now widely recognised as determining the health of babies and mothers).

“Given the profound effect on maternal and child health that breastfeeding can have, it is important that discussions with parents on night time care acknowledge and address the particular needs of breastfeeding mothers…When discussing night time care with parents it is important that health professionals consider safety issues as well as those related to SIDS. This relates to cots, beds, sofas and chairs.” (UNICEF UK)

UNICEF recommendations for bed sharing: let’s summarise further

Let’s look at how to share the bed safely according to UNICEF recommendations (always taking into account the general recommendations mentioned above):

• Keep your child away from pillows.
• If you use a duvet, replace it with cotton sheets and blankets but keep them under your arms. It is preferable to use a sleeping bag or sleepsuit for your baby to sleep in. Do not use hats at home.
• Make sure your child cannot fall out of bed or get trapped between the mattress and the wall.
• Get into a safe position (sideways ‘shell’ with folded arms and legs).
• Make sure that the sheets do not cover the child’s face or head.
• The child should never be between the two parents or in the presence of other older siblings.
• Do not leave the child alone in bed.

Elements to watch out for when mum and baby sleep:

• Avoid bed sharing if your child has a low birth weight or is preterm.
• Do not sleep with your child if you have been drinking alcohol or taking medicines or drugs that induce drowsiness.
• Avoid bed sharing if you feel unusually tired (e.g. after a difficult and long labour) to the extent that you find it difficult to respond to your newborn.
• Do not sleep with your baby if you or whoever sleeps with you is a smoker.
• If you feel sleepy, do not put yourself in a situation where you might doze off with your baby on a sofa or armchair.
• Do not let your child sleep on soft surfaces such as water mattresses, very soft old mattresses, sofas or armchairs.