Is Your Child Safe? Sleep Time

Introduction

Likely the only time you will leave your baby or young child unattended is while he or she sleeps. The important thing is to make sure children are sleeping where they will be safe. For this, parents and caregivers must be aware of safe sleep practices. Health Canada has produced this guide to provide you with information to keep your child safe during sleep time.

The Canada Consumer Product Safety Act (CCPSA), which came into force on June 20, 2011, is administered by Health Canada. Its purpose is to protect the public by helping to address and prevent dangers to human health or safety that are posed by consumer products in Canada. The Act and its regulations define the safety requirements applicable to consumer products, several of which are covered in this guide.

The CCPSA and its regulations do not distinguish between new and used products. Any person who sells, distributes, or gives away products that do not comply with the legislative requirements would be contravening the CCPSA and be subject to compliance and enforcement actions.

General Sleep Safety Tips

The safest place for your baby to sleep is on his or her back, in a crib, cradle or bassinet. Health Canada recommends room sharing for the first six months of your baby's life.

Babies and young children should never be placed to sleep on standard beds, water beds, air mattresses, couches, futons or armchairs. A baby can suffocate when sleeping on these unsafe surfaces.

Health Canada has received reports of injuries and/or deaths related to the improper use of many products mentioned in this guide. Follow the safety tips provided to reduce the risk of injury or death related to the use of these products.

• Put your baby on his or her back to sleep, both at nap time and at bedtime.
• Your baby's crib should be completely empty, except for the crib's mattress and fitted sheet.
• Avoid the use of loose bedding or soft objects in your baby's sleeping area. Products like these can be suffocation hazards and should not be placed where your baby sleeps:
  • comforters, heavy blankets and quilts
  • infant or adult pillows
  • foam padding
  • stuffed toys
  • bumper pads
  • sleep positioners
• Blankets can be dangerous if a baby's head gets covered when he or she sleeps and may cause suffocation. Instead of a blanket, consider dressing your baby in light sleep clothing, like a one-piece sleeper. If a blanket is needed, infants are safest with a thin, lightweight, and breathable blanket.
• Overheating is a risk factor for Sudden Infant Death Syndrome (SIDS). If the room temperature is comfortable for you, it is also comfortable for your baby.
• Keep your home completely smoke free. Cigarette smoke is harmful to babies and increases the risk of SIDS. No one should smoke near your baby.
• It is not safe for a baby to sleep for long periods of time in products such as strollers, car seats, swings, bouncers, slings or baby carriers, that keep him or her in a seated or semi-reclined position. Move your baby to a crib, cradle or bassinet for naps or overnight sleep, or once you have reached your destination.
• Cords on window blinds, shades and curtains are a strangulation hazard. Tie the cords out of your child's reach or install a tension device for looped cords. Whether the blind is up or down, make sure your child cannot reach the cords.
• Place your baby's sleeping area so that hazards like windows, patio doors, lamps, candles, electrical plugs, corded baby monitors, extension cords and small objects are out of your child's reach.
• Not everyone will take the same care you do in making sure their home is safe for children. When visiting family and friends, scan your surroundings for potential hazards and supervise your children closely.
• Check regularly for recalls of children's toys, clothing, furniture and equipment by contacting the manufacturer or by visiting Health Canada's Consumer Product Recalls web page: www.healthcanada.gc.ca/cps-recalls.

Safe Places for a Baby to Sleep

Room Sharing

Health Canada and the Public Health Agency of Canada recommend room sharing for the first six months of your baby's life. Room sharing is when you place your baby to sleep in a crib, cradle or bassinet that is within arm's reach of where you sleep. Research has shown that it is good for babies to share a room with one or more caregivers, and that it may reduce the risk of Sudden Infant Death Syndrome (SIDS).

Remember that room sharing is not sufficient to ensure a safe sleep for your baby. You should follow all applicable safety tips, including the general sleep safety tips provided in the previous section. In particular:

• Place your baby on his or her back to sleep, both at naptime and at bedtime.
• Avoid using bedside sleeping products with the sides lowered.
• Cords on window blinds, shades and curtains are a strangulation hazard. Tie the cords high and out of your child's reach or install a tension device for looped cords. Whether the blind is up or down, make sure your child cannot reach the cords.
• Place your baby's sleeping area so that hazards like windows, patio doors, lamps, candles, electrical plugs, corded baby monitors, extension cords and small objects are out of your child's reach.

• Always follow the manufacturer's instructions for setting up and using the bassinet. Only use parts provided by the manufacturer. Your baby's bassinet should not be modified in any way.
• Check often to make sure the bassinet's hardware is secure and not damaged.
• Check that there are no small parts on the bassinet that could be a choking hazard. Make sure there are no sharp points on the bassinet.
• Check that the mattress is firm. Mattresses that are too soft or worn down in any area could create a gap where a baby's face could become stuck, causing them to suffocate.
  • The bassinet mattress must not be thicker than 3.8 cm (1 1/2 in).
  • There must not be a gap of more than 3 cm (1 3/16 in) between the mattress and any part of the bassinet's sides. Push the mattress firmly against the sides of the bassinet to test this.
• If the bassinet has removable fabric over the frame, check often to make sure the fabric is securely attached to the frame.
• Avoid the use of loose bedding or soft objects in your baby's bassinet. Things like comforters, quilts, heavy blankets, infant pillows, adult pillows, foam padding, stuffed toys, bumper pads and sleep positioners should not be in your baby's sleeping area.
• A blanket should not be draped over the bassinet to keep light out. This could restrict air flow, or the blanket could fall on a baby's face, causing them to suffocate.
• Use a fitted bottom sheet made specifically for a bassinet mattress of the same size.
• Place your baby's bassinet so that hazards like windows, patio doors, lamps, candles, electrical plugs, corded baby monitors, extension cords and small objects are out of your child's reach.

Cradles

A cradle that meets today's Canadian safety regulations is an appropriate place for your baby to sleep until he or she reaches the maximum weight recommended by the manufacturer OR until your baby can push up on his or her hands and knees, whichever comes first. When your baby reaches this milestone, you should put him or her to sleep in a crib.

• Always follow the manufacturer's instructions for setting up and using the cradle. Only use parts provided by the manufacturer. Your baby's cradle should not be modified in any way.
• Check often to make sure that the cradle's hardware is securely fastened and not damaged.
• Do not use cradles with decorative cut-outs, corner posts that are more than 1.5 mm (1/16 in) in height or large spaces between the bars (spacing should be no more than 6 cm [2 3/8 in]).
• Check that there are no small parts on the cradle that could be a choking hazard. Make sure there are no sharp points on the cradle.
• Check that the mattress is firm. Mattresses that are too soft or worn down in any area could create a gap where a baby's face could become stuck, causing them to suffocate.
  • The cradle mattress must not be thicker than 3.8 cm (1 1/2 in).
  • There must not be a gap of more than 3 cm (1 3/16 in) between the mattress and any part of the cradle's sides. Push the mattress firmly against the sides of the cradle to test this.
• Avoid the use of loose bedding or soft objects in your baby's cradle. Things like comforters, quilts, heavy blankets, infant pillows, adult pillows, foam padding, stuffed toys and sleep positioners should not be in your baby's sleeping area.
• Use a fitted bottom sheet made specifically for a cradle mattress of the same size.
• Place your baby's cradle so that hazards like windows, patio doors, lamps, candles, electrical plugs, corded baby monitors, extension cords and small objects are out of your child's reach.

• Do not use a crib made before September 1986 as it does not meet current safety regulations. Also, cribs older than ten years are more likely to have broken, worn, loose or missing parts, and to be missing warnings or instructions.
• As of December 29, 2016, the sale, importation, manufacture or advertisement of traditional drop-side cribs is prohibited.
• While traditional drop-side cribs are mostly unavailable in the Canadian marketplace, they may still be found as remaining inventory in some new and second hand stores, and at garage sales.
• Always follow the manufacturer's instructions for putting together and using the crib. Only use parts provided by the manufacturer. Your baby's crib should not be modified in any way.
• Check often to make sure that the crib's hardware is securely fastened and not damaged.
• Make sure the crib, cradle or bassinet posts are no more than than 1.5 mm (1/16 in) high.
• Make sure the crib, cradle or bassinet bars are no more than 6 cm (2 3/8 in) apart.
• Check that the mattress is firm. Mattresses that are too soft or worn down in any area could create a gap where a baby's face could become stuck, causing them to suffocate.
• The crib mattress must not be thicker than 15 cm (6 in).
• There must not be a gap of more than 3 cm (1 3/16 in) between the mattress and any part of the crib's sides. Push the mattress firmly against the sides of the crib to test this.
• Check often that the crib's mattress support system is secure. Shake the crib from side to side, thump the mattress from the top and push up hard on the mattress support from underneath the crib. The mattress support system should hold the mattress firmly in place.
• Avoid the use of loose bedding or soft objects in your baby's crib. Things like comforters, quilts, blankets, infant pillows, adult pillows, foam padding, stuffed toys, bumper pads and sleep positioners should not be in your baby's sleeping area.
• Use a fitted bottom sheet made specifically for a crib mattress of the same size.
• Remove mobiles and toy bars as soon as your baby begins to push up on his or her hands and knees.
• Place the mattress support in its lowest position as soon as your baby can push up on his or her hands and knees.

Never harness or tie your baby in a crib. Your baby should not be left in a crib with a necklace, elastic band, scarf or pacifier on a long cord. These items could cause strangulation.

Other Places a Baby Might Fall Asleep

Bed Sharing

Bed sharing is when an adult or another child sleeps on the same surface as a baby, like a bed, couch, chair, futon or armchair. Health Canada does not recommend bed sharing.

Bed sharing is not safe because of the following potential hazards:

• A baby can suffocate if:
  • He or she becomes trapped between objects like the sleeping surface, the body of the adult or another child, the wall and other objects.
  • The adult or another child rolls over onto the baby.
  • There are soft bedding materials, like pillows or comforters, in the bed.
• Babies sleeping on a high surface can fall off and be seriously hurt.

Some people believe that bed sharing will reduce the risk of Sudden Infant Death Syndrome (SIDS), but there is no evidence to support this view. In fact, research shows that the risk of SIDS is higher if the baby is sharing a bed with a person who is a smoker, very tired, or under the influence of drugs or alcohol. For more information about SIDS, contact the Public Health Agency of Canada (see Other Resources).

On the other hand, Health Canada and the Public Health Agency of Canada recommend room sharing as a safe alternative to bed sharing (see Room Sharing). Research has shown that it is good for babies to share a room with one or more caregivers, and that it may reduce the risk of Sudden Infant Death Syndrome (SIDS).

Bedside Sleeping Products

A bedside sleeping product looks like a bassinet or a crib, and usually has three closed sides and one open side. Some may have four sides with one that can be lowered so an opening is created above the mattress support. The open side is meant to be placed next to an adult bed. Health Canada does not recommend using these products with a side lowered. Room sharing is a safer sleeping choice for babies (see Room Sharing).

The use of a bedside sleeping product with a side lowered can lead to the following hazards:

• If the space between the bed and the product is too wide, a baby can become trapped. It may seem like there is no gap, but one might be created when the adult lies down.
• If the fabric over the frame is not securely attached, it can bunch up when the side is folded down, creating an opening between the fabric and the product's frame. This opening can cause a baby to suffocate or fall.

Hammocks

Health Canada does not recommend using baby hammocks because:

• Hammocks can become unstable causing the product to tip forward, causing a baby to become wedged into one corner or side and suffocate.
• Hammocks intended to be used by infants and young children can suddenly twist around a child's neck, causing them to strangle.
• Babies placed on soft bedding (including hammocks) can become wedged in positions where they cannot breathe.
• Babies and young children using hammocks can fall from the high surface, causing injuries.

• If a change table or bassinet comes as an attachment for the playpen, always follow the manufacturer's instructions for putting it together and using it.
• Never place a baby in a playpen while the change table or bassinet attachment is still in place. A baby's head can become trapped in the gap between the attachment and the playpen and can strangle or suffocate.
• Your baby should not be placed to sleep on the change table attachment.
• Avoid adding blankets, pillows, extra padding or an extra mattress to a playpen. Using these items could cause a baby to suffocate.
• When you are using your playpen, keep the sides securely locked in place. Never leave your baby in a playpen with any side down. A baby can roll into the space between the mattress and the mesh side and suffocate.
• Check that the mattress pad is firm. Mattress pads that are worn down in any area could create a suffocation hazard.
• Large toys or stuffed toys that can be used to climb out of the playpen should not be placed in a playpen with your baby.
• Check for tears in vinyl rail coverings, mesh panels or the mattress pad of the playpen. Your baby could bite off small pieces and choke.

Other Products (Baby Carriers, Bouncers, Car Seats, Slings, Strollers and Swings)

Sleep Accessories Unsafe for Babies

Bumper Pads

Health Canada does not recommend bumper pads because:

• Babies can suffocate if their faces become pressed against the fabric of a bumper pad.
• A baby's head can get trapped between the bumper pad and the side of the crib.
• Long ribbons, strings or ties can cause a baby to become tangled or to strangle.
• Children can use bumper pads to climb out of their crib once they are able to pull themselves up into a standing position. They could fall from the crib and be seriously hurt.

Sleep Positioners

Sleep positioners are meant to keep babies on their backs to sleep. They are often made of two pieces of foam that are attached together by a piece of fabric that the baby sleeps on. Health Canada does not recommend using these products because babies can suffocate on them. Using make-shift sleep positioners, like rolled up towels, is not recommended either. When babies are able to turn over on their own, do not force them to stay on their back.

Other Accessories

Pacifiers/Soothers

There are many ways to soothe a baby and many babies never use a pacifier. If you decide to use a pacifier, please follow these safety tips:

• Inspect pacifiers daily. Check the nipple for changes in texture, tears, or holes. These can appear with age or exposure to heat, certain foods, or sunlight.
• Check that the nipple and any ring or handle remains firmly attached when it is pulled upon forcefully.
• Never tie or hang a pacifier or any other object around the neck of a baby or a young child. This can result in strangulation.
• Replace pacifiers at least every two months rather than waiting for signs of breakdown.
• Throw out any pacifier displaying signs of breakdown right away because the broken or loose pieces are choking hazards.
• Plastic covers for pacifiers can be suffocation hazards.
• Choose a teething ring as a safer alternative to chewing on a pacifier for children who are teething.
• Health Canada does not recommend using necklaces to prevent or reduce teething pains.

Sleepwear

Cotton, cotton-blend and rayon fabrics catch fire and burn more quickly than most synthetic materials. Nylon and polyester are harder to catch fire and burn more slowly.

Loose-fitting sleepwear includes nightgowns, bathrobes and loose pyjamas. They are more likely to catch fire than tight-fitting sleepwear and should be made of slower burning fabrics.

Tight-fitting sleepwear, like polo pyjamas or sleepers, is less likely to catch fire than pyjamas or nightgowns with flowing skirts, wide sleeves or large ruffles.

Other safety tips for children's clothing:

• Dress your children in actual sleepwear when putting them to bed, instead of T-shirts or other day clothes. Most day clothes do not meet the flammability requirements for sleepwear.
• Make sure belts, ties and sashes on your children's bathrobes are stitched firmly to the centre back. Children can strangle on any type of cord that can be removed from their clothing.
• Check for loose buttons or other small parts, which can be a choking hazard.
• Check blankets and sleepwear regularly for loose threads and fix them right away. Threads can wrap around your baby's arms, legs or neck and cause injury.
• Teach your children about the dangers of fire. Tell them to "STOP, DROP and ROLL" if their clothes catch fire.

Toys

• Your children should not take battery-operated toys to bed. Batteries can leak or overheat and cause burns or other injuries.
• Infants can suffocate on stuffed toys. Also, toddlers can use large stuffed toys as steps to climb out of their crib or playpen.
• Make sure any toys your child plays with do not have loose or small parts they can choke on.

Sleep Products for Toddlers and School-Age Children

Portable Bed Rails

Portable bed rails are often installed on standard adult beds to keep children from falling out, but they can cause your child to become trapped if not used properly.

• Never place a child who is under two years old on a bed fitted with portable bed rails.
  • To keep younger children safe if they fall out of bed, keep the floor area around the bed clear, or use a crib mattress on the floor beside the bed.
• Use portable bed rails only on a bed that has both a box spring and mattress, unless otherwise instructed by the manufacturer.
• Before each bedtime and naptime, check that the portable bed rails are securely in place and that there are no gaps between the mattress and the bed rail.
• Pillows and toys should not be placed against the bed rail because a child can suffocate on them if their face becomes pressed up against them.
• Health Canada recommends buying only portable bed rails that meet the latest ASTM International standard. Ask before you buy.

Toddler Beds

Toddler beds are often used when a child has outgrown a crib, but he or she is not yet big enough to use a standard bed. These beds are meant to be used until a child turns about five years old. Toddler beds usually come with guardrails on each side of the mattress.

• Read and follow the manufacturer's instructions for putting the bed together, and read the warning labels.
• Follow the age and weight restrictions recommended by the manufacturer.
• Many crib mattresses fit toddler beds:
  • Know what your crib mattress dimensions are before shopping for a toddler bed and make sure both are compatible.
  • Make sure that your crib mattress is in good condition before using it on a toddler bed.
  • Make sure there is no large gap between the mattress and the guardrails, headboard or footboard.
• The bed should be low to the ground. The guardrails are meant to remind your child that they are getting close to the edge, but they do not actually prevent your child from falling out of the bed or climbing over the rail.
• Openings in guardrails or other parts of the bed that are above the mattress support system should be less than 8.4 cm (3.3 in) apart.
• Check often to make sure the bed frame is sturdy.

Bunk Beds

Children under six years of age should never use the upper bunk of bunk beds.

• Only buy bunk beds meeting the latest ASTM International standard. Ask before you buy.
• Only allow one person at a time on the top bunk.
• Teach your children to use the ladder to get up or down. The ladder should always be securely attached to the bed. It should not be removed for any reason.
• Children should not be allowed to play on the top bunk. They should also not be allowed to play under the top bunk, unless the area under the bed is designed as a play area by the manufacturer.
• Never tie ropes or cords (like bathrobe belts or skipping ropes) to any part of the bed. These can be a strangulation hazard.
• Check often to make sure the frame of the bunk bed is sturdy and in good condition.
• Make sure the top bunk has guard rails on all four sides of the bed, even if the bed is pushed up against a wall.
• Make sure all parts of the bed, like corner posts or ladder uprights, do not extend more than 0.5 cm (0.2 in) above the upper edge (usually the guardrails) of the bed.
• Mattresses should fit snugly on all sides, leaving no gaps between the mattress and the sides of the bed. The sleeping surface should be at least 12.7 cm (5 in) below the top of the guardrails.
• Do not allow children younger than six years of age on the top bunk. If the manufacturer allows for this option, consider removing and storing the top bunk, or setting it next to the lower bunk until the child is old enough to use it. If the top bunk is used on the floor for a child under the age of six years, the guard rails should not be used. These guardrails have been designed to be used with a child of at least six years of age. Using guardrails with a younger child could cause them to become trapped.

Resources

Recalls

To check for consumer product recalls, go to: www.healthcanada.gc.ca/cps-recalls

If you want to know when new information, advisories and warnings, consumer product recalls and consultation documents about consumer product safety are posted on the Health Canada website, subscribe to Consumer Product Safety News: www.hc-sc.gc.ca/cps-spc/advisories-avis/_subscribe-abonnement/index-eng.php

Incident reporting

To submit a complaint or report a problem about a consumer product, go to: www.healthcanada.gc.ca/reportaproduct

Contact

For inquiries and complaints about consumer products, please contact your nearest Product Safety office by calling the toll-free number 1-866-662-0666 (calls will be routed to the nearest Product Safety office).

Other Resources

 Baby's Breath

www.babysbreathcanada.ca

1-800-363-7437

 Canadian Paediatric Society

www.cps.ca

613-526-9397

 Public Health Agency of Canada

www.publichealth.gc.ca

Tobacco Control Programme, Health Canada

www.GoSmokefree.gc.ca

1-866-318-1116

 Transport Canada

www.tc.gc.ca

1-800-333-0371

Consumer Product Safety, Health Canada

For more information on injury prevention, please contact:

Consumer Product Safety Directorate
PDB - External Relations
Health Canada
Address Locator: 4909A Ottawa, Ontario K1A 0K9

Email: CPS-SPC@hc-sc.gc.ca
Toll-free: 1-866-662-0666

For inquiries and complaints about consumer products, please contact your nearest Product Safety office by calling the toll-free number above.