Further recommendations for safe sleep in babies
Infant swaddling or wrapping
Swaddling or wrapping your baby is a useful strategy to calm them and promote back sleeping. There is no evidence to recommend swaddling or wrapping as a strategy to reduce the risk of SUDI.
- Use only lightweight wraps such as cotton or muslin (bunny rugs and blankets are not safe as they may cause overheating). The wrap should be firm, to prevent loose wrapping becoming loose bedding, which could cover your baby’s face. However, the wrap should not be too tight and must allow for hip and chest wall movement.
- If babies are swaddled or wrapped, they must always be placed on their back. There is a greatly increased risk of SUDI if a swaddled baby is placed, or rolls onto their tummy.
- As soon as baby shows signs of beginning to roll, wrapping should be stopped for sleep periods.
- An alternative to wrapping is to use a safe infant sleeping bag; one with a fitted neck and armholes that is the right size for the baby’s weight. However, there is no current evidence that sleeping bags are protective against SUDI.
- There are a wide range of products designed as infant swaddles, wraps and wearable blankets on the market. It is important to be aware that there is very limited evidence to support the use of these products as devices to promote infant settling, back sleeping and no evidence to support these products as a strategy to reduce the risk of SUDI.
- Devices which use Velcro to securely wrap the baby are not recommended as there is a risk that if the infant turns onto their tummy or their face becomes covered in bedding, they will not be able to move to escape potentially suffocating positions.
Dummy (pacifier) use is protective
Studies have reported a reduced risk of SUDI associated with dummy use.
- A dummy can be offered after breast feeding is established and should be used consistently for every sleep.
- Dummies can be offered to bottle-fed infants from birth.
- The mechanism by which dummies might reduce the risk of SUDI is not fully understood. Several mechanisms have been suggested including avoidance of sleeping on the tummy, protection of the airway and keeping the nose clear of bedding.
Immunisation is protective
No study has demonstrated an increased risk of SUDI with immunisation. In fact, studies have found that SUDI rate is nearly halved in immunised babies compared with those not immunised. Similarly, no study has shown an increase in autism with immunisation. Immunisation is a simple, safe and effective way of protecting against a number of infective diseases.
Home monitoring does not prevent SUDI
Baby breathing monitors are not necessary for healthy babies and toddlers. There is no scientific evidence that using any type of monitor will prevent SUDI, despite claims from some manufacturers.
- Monitor use is disruptive for most families and unnecessary for most babies.
- In a small number of cases, health professionals may recommend the use of home monitors, where their use can be helpful for babies and families.
Safe use of baby carriers and slings
Baby carriers and slings can be a risk for SUDI if not used appropriately.
- Adult worn slings and baby carriers are usually made of soft fabric and allow an adult to carry an infant hands-free. The sling straps around the adult’s neck, allowing the infant to lie in front of the adult, curved in a C-shape position.
- Strap on carriers allow the infant to be in an upright position with the infant’s head facing that of the carrier.
- Slings and strap on carriers are becoming increasingly popular.
- Babies can suffocate lying with a curved back with the chin resting on the chest or the face pressed against the fabric of the sling or wearer’s body.
- Parents should follow the T.I.C.K.S. guide to safe carrying of their infant in a sling (http://babyslingsafety.co.uk/).
Bed sharing or sharing a sleep surface with your baby
Sharing a sleep surface with your baby can increase the risk of SUDI even if the baby is breastfed and the parents do not smoke.
- More than half of all SUDI cases occur whilst the baby is bed sharing.
- Bed sharing increases the risk of SUDI particularly if the baby is under 3 months of age or has been born prematurely or small for their age.
- Bed sharing presents an even greater risk of SUDI if either parent smokes, drinks alcohol or takes illicit drugs.
- There is no increased risk of SUDI whilst sharing a sleep surface with a baby during feeding, cuddling and playing providing the baby is returned to a cot or their own safe sleeping surface before the parent goes back to sleep.
- Falling asleep on a sofa or couch is a particular risk. Often parents/carers will fall asleep unintentionally on a sofa or couch and there is a very high risk of a sleeping accident in this situation as the baby may become wedged into cushions or the back of the sofa, or even fall onto the floor injuring themselves.
- Sleeping your baby on their tummy on your chest, is an excellent strategy for settling, and helping them to self-regulate, as long as the baby and their airway are being observed. A parent falling asleep with a baby on the tummy on the parent’s chest and unobserved can be a risk, as sleeping on the tummy reduces the mechanisms that protect baby’s airway. In addition, the baby’s nose may become blocked by clothing, or the parent’s body or breast, or the baby may become positioned with his/her chin to chest, which will also block the baby’s airway.
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