Safe Sleep Sweet Dreams

Protect Your Baby from Sleep-related Accidents and Sudden Infant Death Syndrome (SIDS)

We all wish our baby could sleep tight. It is essential to keep sleep safety in mind and create a safe sleeping environment for her, so that you both can share a sound sleep.

Taking appropriate precautions can reduce sleep-related accidents and the risk of SIDS.

I. Safe Sleeping Position

Place your baby on back for sleep

• Sleeping on the back (supine position) is the safest sleeping position for babies compared with sleeping on the stomach (prone position) and on the side.
  • Research showed that prone (sleeping on stomach) or side sleep position may increase the risk of breathing difficulty
  • Prone sleeping, compared with supine position (sleeping on the back), increases the risk of overheating
  • Infants on side sleep position are more likely to roll to prone position than those sleeping on their back. Both side sleep and prone sleep position may increase the risk of SIDS
• Make sure your baby's face and arms are not being covered during sleep.

Sleep-related accidents in infancy include:

1. Sudden Infant Death Syndrome (SIDS)
   • SIDS or cot death is the sudden, unexpected and unexplained death of a baby with unknown cause.
   • SIDS most commonly affects babies in the first 6 months with peak at 1 to 4 months of age. It is a major cause for sleep-related death in babies.
   • Sleeping on the back gives your baby the best protection from SIDS.
2. Other causes such as suffocation, fall from bed, etc.

II. Safe Sleeping Environment

1. Your baby should sleep with you in the same room on different beds

   For your baby's safety as well as for easy care, babies under one (particularly the first 6 months) is recommended to sleep in a cot by the side of your bed.

   If it is not possible to put a cot in your bedroom, you may place your baby in a cradle on your bed to separate him from you. The baby should have his own blanket. Make sure your bedding does not cover his head and face to prevent suffocation.

2. Avoid putting objects on your baby's bed

   Don't put soft objects and loose bedding at where your baby sleeps to protect her from suffocation. Examples are pillows, diapers, fluffy blankets or duvets, pillow-like bumpers, stuffed toys, etc. In summary, apart from a fitted sheet, caregivers should keep the baby’s sleep environment clear of everything.

3. Mattress and cot safety
   • Leave no gaps between the mattress and the sides of the cot.
   • Distance between the vertical bars of the cot should be less than 6 cm.
   • Pull up and lock the cot bars when baby is sleeping in the cot.
   • Use a firm and well fitted mattress. Never place baby on a quilt, pillow, sheepskin, bean bag or sofa, etc.
4. Maintain a smoke-free environment

   No smoking. There is evidence indicating that mothers smoke during pregnancy and babies exposed to secondhand smoke would increase the risk of SIDS.

5. Maintain comfortable temperature

   Light clothing is preferred for babies. Do not overdress or overheat your baby with the covers. Remember to keep the room well-ventilated with a comfortable temperature.

III. Breastfeeding

Breastfeed your baby

Research studies showed that breastfeeding is associated with a lower risk of SIDS. We strongly encourage breastfeeding which has many other health benefits for both the baby and the mother.

IV. Immunisation

Get your baby fully immunised

Get your baby fully immunised. Recent evidence has shown that immunisation can prevent infection and reduce the risk of SIDS.

The following circumstances can be particularly dangerous for your baby while bed-sharing:

• The baby sharing the same bed with you is premature, has low birth weight or younger than 4 months old
• The baby sleeps with a smoker or the mother smokes during pregnancy
• The carer sharing the bed with the baby has reduced alertness due to tiredness, alcohol or drugs
• Use of soft mattresses, loose bedding or fluffy objects like pillows on the bed, or placing your baby to sleep on soft sofa, waterbed, couch or armchair, etc. These may cover the baby's face or head, particularly when the baby rolls onto his front
• The baby shares a bed with someone other than his parents (e.g. other children or adults)

Our Recommendation

Let your baby sleep on his back in his cot!

You may also read the other related references:

• “Providing a safe environment for your baby”

  Some simple but important tips to help you set up a safe home environment for your baby

• “Is Your Newborn Baby Safe?”

  Complete this checklist to see whether you have a safe home environment for your newborn

• “Love Your Child, Prevent Injuries (0-1 year)”

  Provide home safety information for parents of infants so that they make their home childproof

• “Is Your Baby Safe at Home?”

  Provide tips for parents to check whether their home environment is childproof

Audio-visual resources:

• “Baby's safe sleeping position and environment You are the one to care”
• “Home Safety”

FAQs

(1) To make breastfeeding easier, should I sleep with my baby?

Some mothers may need to breastfeed frequently; the best way would be to place the baby's cot directly next to your own bed. In this way, whenever he needs, you can breastfeed the baby either sitting or lying on your bed. Put the baby back to his own cot after he is satisfied. By doing so, it is not only convenient but also brings the following benefits:

• You can sleep better and you don't need to worry about the baby's safety when he sleeps in his bed.
• It can reduce the risk of SIDS by avoiding sharing a bed with the baby.
• It helps the baby develop a healthy sleeping habit without the need to rely on suckling on the breast to fall asleep.

(2) Does my baby need a baby pillow?

• Babies usually sleep well without a pillow.
• Research shows that use of pillows, bumper pads, and loose bedding, etc increase the risk of SIDS and accidents during sleep. These items are not recommended for babies.

(3) Should my baby use a pacifier to reduce the risk of SIDS?

• Research has shown that babies who use a pacifier have a reduced risk of SIDS.
• Studies revealed that persistent use of pacifier till toddlerhood may increase the risk of otitis media while the incidence is lower in the first year after birth.
• Early use of pacifier may affect how your baby learn to suckle properly. If you are breastfeeding, you may consider giving your baby a pacifier after breastfeeding is well established.
• Consider using pacifier only when settling the baby to sleep, and there is no need to put it back once your baby drops the pacifier during sleep.
• Do not force your baby to use a pacifier.
• Do not coat the pacifier with any sweetened solutions. Clean it often and replace it regularly.

(4) How to reduce my baby spit up when I put her to bed?

Many newborn babies spit up a little after feeding, during burping, or when lying down because their digestive tracts are immature. To help decrease chances of spitting up, avoid overfeeding your baby. Stop feeding when the baby shows cues of fullness. Always burp your baby after feeding and when she takes a short break during the feed. Keep her in an upright position for 10 to 20 minutes before putting her down on bed helps to reduce spitting up. There is no need to raise the baby's head on bed. Putting your baby to bed on her back is considered one of the best things you can do to help prevent SIDS and will not increase choking in newborn babies. So you don't need to worry about this sleep position.

If your baby is unwell, please seek advice from your doctors.

Points to Note for Keeping Baby Safe during Sleep

• Put baby to bed on his back with his face and hands not covered
• Smoke-free environment
• Avoid putting objects at where your baby sleeps
• Baby sleeps in a cot with you in the same room
• Use firm mattress
• Comfortable temperature

Reference

Moon R, Carlin R, Hand I, et al. Evidence Base for 2022 Updated Recommendations for a Safe Infant Sleeping Environment to Reduce the Risk of Sleep-Related Infant Deaths. Pediatrics. 2022;150(1):e2022057991