Safe Sleep for Your Baby

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Organization: Public Health Agency of Canada

Published: 2021-10-xx

Please take a few minutes to read this important information on steps you can take to help your baby sleep safely.

Please share this important information with everyone who takes care of your baby: grandparents, family members, childcare providers/babysitters and friends.

There are steps that you can take to lower the risk of Sudden Infant Death Syndrome (SIDS) and other infant deaths that happen during sleep time:

  • Always place your baby on their back to sleep, for every sleep.
  • Be smoke-free, before and after your baby is born.
  • Breastfeed your baby.
  • Give your baby a safe sleep space that has:
    • a firm, flat surface with a tightly fitted sheet
    • no gaps between the mattress and sides
    • no loose, soft bedding, bumper pads, pillows or toys.
    The safest place for your baby to sleep is in a crib, cradle or bassinet.
  • Room share - Place your baby to sleep in a crib, cradle or bassinet in the same room as you sleep for the first 6 months.

SIDS is when a baby that seems healthy dies suddenly in their sleep, and the cause of death cannot be explained. We do not know what causes SIDS, so it cannot be prevented. But there are things you can do to help lower the risk.

Other infant deaths that happen during sleep time can be prevented. These deaths happen when babies accidentally suffocate because of their sleep space.

Many of the steps in this booklet will help decrease your baby’s risk of both types of sleep-related deaths.

Back to Sleep

 Babies who always sleep on their backs have a lower risk of SIDS.

Placing your baby on their back for every sleep is one of the most important things you can do to reduce the risk of SIDS.

Even babies who spit up a lot are safer sleeping on their backs. Healthy babies will naturally swallow or cough up fluids.

Babies who usually sleep on their backs and are then placed on their tummies to sleep are at a much higher risk of SIDS. That is why it is important to let everyone know to always put your baby on their back for every sleep – naptime and night time, at home, in child care settings and when travelling.

Once your baby is older and can roll over on their own – around 5 months old – you do not have to move your baby onto their back if they roll on to their side or tummy while sleeping.

Sleep positioners or rolled up blankets should not be used to try to keep your baby on their back, as they increase your baby’s risk of suffocation.

Preventing flat head

You can help prevent your baby from developing plagiocephaly, also known as flat head:

  • Babies usually turn their heads to look into the middle of the room. Help your baby lie equally on both sides of their head by changing the direction you lay them in the crib every day: One day lay your baby with their head pointing to the head of the crib, the next day with their head pointing to the foot of the crib.
  • Supervised tummy time when your baby is awake will help them develop healthy muscles. Place your baby on their tummy 2-3 times a day. Start with a few minutes and work your way up to longer ‘tummy times’ of 10-15 minutes each.

Smoke-Free

 Being smoke-free, before and after birth, decreases your baby’s risk of SIDS.

Smoking during pregnancy is one of the biggest risk factors for SIDS. One out of three SIDS deaths could be prevented if pregnant women did not smoke. Not smoking at all is best for your baby, but reducing the amount you smoke can also lower the risk of SIDS.

Second-hand smoke also increases the risk of SIDS after your baby is born. Do not let anyone smoke around your baby - in the house, in the car or anywhere your baby spends time. If you, your partner, family or friends smoke, do it outside and far away from your baby.

Cannabis smoke contains many of the same harmful chemicals as cigarette smoke. Take the same steps to protect your baby from cannabis smoke before and after birth.

Vaping products can also expose your baby to nicotine and other harmful chemicals. It is best to not vape while pregnant. After birth, make sure that no one vapes around your baby.

For help to quit smoking, talk to your doctor, visit Canada.ca [search “quit smoking”] or call the pan-Canadian toll-free quit line at 1-866-366-3667.

Breastfeeding

 Breastfeeding lowers your baby’s risk of SIDS.

There are lots of reasons to breastfeed. One important reason is that breastfeeding can help protect your baby from SIDS. Breastfeeding for at least 2 months is needed to lower the risk of SIDS – by about half. The longer you can breastfeed, the more protection your baby will have.

Breastfeeding is the only food or drink your baby needs for their first 6 months. Many babies continue to breastfeed through their toddler years. For more info on breastfeeding, visit Canada.ca

Reminder: Young babies feed often - including during the night. If you bring your baby into bed to breastfeed, make sure you know about the situations that put babies at greatest risk when bed sharing so that you can avoid them. Putting your baby back in their crib, cradle or bassinet to sleep after the feeding will minimize any risk. Room sharing makes that easier!

Vaccinations are safe and provide important health benefits for your baby throughout their life. Vaccines do not increase the risk of SIDS – in fact, they may even lower the risk. Talk to your baby’s health care provider or local public health to be sure your baby gets their vaccinations according to the schedule in your province/territory. For more information, visit Canada.ca/vaccines

Safe Sleep Spaces

 The safest place for your baby to sleep or nap is in a crib, cradle or bassinet (including a bassinet that attaches to a playpen) that meets current Canadian safety regulations.

A safe infant sleep surface has:

  • A firm, flat mattress with a tightly fitted sheet
  • No gaps between the mattress and sides
  • No loose, soft items – including blankets, quilts, pillows, bumper pads, mattress toppers, sleep positioners or toys

Safe crib, cradle or bassinet

  • Check for a label that shows the date it was made. If it does not have a label, it may not be safe. Health Canada recommends using a crib no more than 10 years old. Never use a crib made before September 1986.
  • Always follow the manufacturer’s instructions when putting together and using the crib, cradle or bassinet. Be sure to follow the manufacturer’s guidance on the baby’s age, weight limit and development milestones.
  • Check regularly to make sure that the hardware is tight and not damaged.
  • Never use a drop-side crib. The hardware can break and the drop-side can detach, making a space between the side and the crib mattress. Babies have been killed and injured from being trapped in the space. It is illegal to sell or give away a drop-side crib in Canada.

To learn more, please visit Canada.ca [search: “cribs, cradles and bassinets”].

Safe sleep when travelling

Make sure your baby has a safe sleep space when sleeping away from home, like at a grandparent’s house.

  • Place your baby to sleep in a crib, cradle or bassinet if possible.
  • Bassinet attachments for playpens are an option when travelling. They are safe for sleep until your baby starts rolling over or reaches the attachment’s weight limit – whichever comes first.

Playpens themselves are not recommended for unsupervised sleep because they are not made to be as durable and safe as cribs. If you use a playpen for your baby to sleep in while travelling:

  • Be sure to set it up according to the manufacturer’s instructions
  • Position it away from blind/curtain cords and electrical cords - which babies can strangle on
  • To prevent suffocation, never add an extra mattress or padding to a playpen
  • Keep it free of soft items, bedding and toys while your baby is sleeping

Not recommended for sleep

  •  Bed-side sleepers that attach to an adult bed are not recommended. Babies can get trapped in the space between the bed and the bed-side sleeper.
  •  Baby nests or pods (small, portable pads with soft, padded sides) and other soft products like nursing pillows are not recommended for sleep. These products increase a baby’s risk of suffocation. They should never be used in a crib, cradle or bassinet, or on an adult bed for a baby to sleep in.
  •  Products with a sleep surface that is not flat, like inclined sleepers, baby hammocks and crib wedges, should not be used – even for babies who spit up a lot. These products can cause your baby to move into a position where they cannot breathe.
  •  High chairs, baby swings, bouncers, strollers and car seats are made for babies, but not for sleep. Sleeping in a sitting position can cause your baby's head to fall forward, which can make it hard to breathe. Babies have suffocated when sleeping in these products. If your baby falls asleep in a high chair, bouncer or swing, be sure to move them to a crib, cradle or bassinet.
    If your baby falls asleep while travelling in a car seat or stroller, move your baby to a crib, cradle or bassinet when you arrive at your destination. Take off your baby’s snowsuit, raincoat, jacket and other outerwear once indoors to reduce the risk of suffocation or overheating.
  •  Sofas or arm chairs, air mattresses and adult beds are not made for babies to sleep on. They increase a baby’s risk of falling or being trapped and suffocated. The risk is even higher if the baby shares the surface with an adult or other child.

Using baby slings and carriers (babywearing) is popular, and babies often fall asleep while being carried in them. If you use one, be sure to use it safely. Babies, especially who are less than 4 months old, or who were born prematurely or with a medical condition, have poor neck control and are at a higher risk of suffocation.

Keep your baby visible at all times. Make sure your baby is in an upright position. You should be able to see your baby’s face – make sure it is not pressed into your body, your clothes or the carrier. Check your baby often and watch for overheating. For more information, visit Canada.ca [search: “baby sling and carrier safety”].

Overheating increases your baby’s risk of SIDS

  • Your baby is safest when they sleep in simple, fitted sleepwear – like a sleeper. It should keep your baby comfortable at room temperature, so they do not get too hot.
  • Keep the room at a comfortable temperature. If it is comfortable for you, it will be comfortable for your baby too.
  • Babies do not need a hat when indoors, as it can make them too hot.
  • Babies do not need blankets when they sleep. When babies move their arms and legs, they can make the blanket cover their head. This can cause them to overheat or suffocate. If you use a blanket for your baby, make sure it is thin and lightweight.
  • Many parents use sleep sacks instead of a blanket. If you use one, make sure it is the right size for your baby. If it is too big, your baby can slip down inside the sack, which can make your baby overheat or suffocate. If it is too tight, your baby may not be able to move their hips and legs freely, which can be dangerous, especially if they roll onto their tummy.

Swaddling is sometimes used to calm babies, but can also be a risk. Babies can get tangled or covered in the blanket if it comes loose, or can roll onto their tummy while still swaddled. These are risks for suffocation. If you swaddle your baby, be sure to do it safely:

  • Use a lightweight blanket. Make sure it stays well away from the baby’s nose and mouth.
  • Wrap your baby so they can still move their hips and legs.
  • Leave your baby’s hands free so they can show you when they are hungry.
  • It is very important to stop swaddling before your baby can roll. Swaddling is not safe for babies when they are on their tummies.

Room sharing

 Room sharing helps your baby sleep safely and lowers the risk of SIDS.

Room sharing means placing your baby to sleep in their own safe sleep space - a crib, cradle or bassinet – which is placed in your room next to your bed. Room sharing is recommended for your baby’s first 6 months – the time when the risk of SIDS is the highest.

Room sharing makes it easier to breastfeed and check on your baby at night.

Room sharing is not the same as bed sharing.

Bed sharing is when a baby sleeps with an adult or other child on the same sleep surface, such as an adult bed, sofa or armchair. Bed sharing increases a baby's risk of SIDS and suffocation.

Some parents end up bed sharing with their baby, even though they do not plan to. It is important to understand the risks and know the situations that make bed sharing especially unsafe for babies, so you can take steps to avoid them :

Understanding the risks of bed sharing

Babies that share a sleep surface with someone else have a higher risk of SIDS and suffocation because:

  • the baby can get trapped between the sleep surface and the wall/side, bedframe, or the body of the adult or other child
  • the adult or other child can roll over onto the baby
  • soft bedding (pillows, comforters, blankets) can cover the baby’s face or head, which can make them overheat or suffocate

In-bed sleeping products like baby nests or pods do not keep your baby safe when bed sharing. The padded sides increase the baby’s risk of suffocation.

These situations put babies at especially high risk when bed sharing:

  • The baby is less than 4 months old or was born preterm or with low birthweight
  • The person bed sharing with the baby has taken alcohol or drugs
  • The person bed sharing with the baby has taken medication that makes them tired or harder to wake up
  • The baby’s mother smoked during pregnancy, or the person bed sharing with the baby is a smoker, or if there is smoking in the household
  • The sleep surface is soft – sleeping with a baby on a sofa, armchair, air mattress, waterbed or bed with a mattress topper is very unsafe
  • There is more than one other person (or a pet) bed sharing with the baby
  • There is loose bedding, pillows, blankets and other objects near the baby

If you bed share (even if you did not plan to) be sure to follow the other steps for safe sleep, including:

  • Always put your baby on their back
  • Make sure the sleep surface is firm and flat, with no gaps where the baby can get trapped
  • Keep soft loose bedding or other objects well away from the baby
  • Dress your baby so they do not overheat

For more information, talk to your baby’s health care provider or your local public health department.

Parents and all caregivers – including grandparents, family members, childcare providers, babysitters and friends – can help keep babies safe by following the steps for safe sleep for every sleep – nap time and nighttime, at home, in childcare settings and when travelling.

For more information on SIDS and safe sleep, please visit Canada.ca. For more information on baby sleep products, search “Is Your Child Safe? series”.

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