Baby says “For the first six months, the safest place for me to sleep is in my cot in your room for night time and in the same room as you for all my sleep times, even short naps.”
These simple messages have a simple reason for being included. It’s all about being aware of any extra soft objects and loose materials in baby’s sleeping space. By reducing these unneeded extras, we can reduce the chance of impeding baby’s breathing in any way.
You should never place a baby to sleep on a pillow, beanbag, water bed/pillow, and you shouldn’t use hot water bottles or electric blankets.
Pillows, duvets, bumpers, comforters, positioners or soft toys in a baby’s sleep environment are potential suffocation and strangulation hazards. Additional items in a baby’s sleep space increase rebreathing of air the baby has exhaled.
As well as the increased risk of an unexplained SUDI, there is a risk of accidental suffocation if additional objects are in a baby’s sleep environment.
There is no need to use cot bumpers. They were introduced years ago when there was no regulation about the distance between cot bars. Bumpers were used to prevent a baby’s head from becoming trapped in the bars. Cots now have a minimum distance between bars as part of infant cot safety standards. The need to use cot bumpers is now obsolete.
Having a clear sleep space is especially important when infants begin to roll as they may roll onto or against an object before they are developed enough to free roll away from the hazard. Many babies who die from SUDI are found to have their head covered with loose bedding.
Specific baby sleep spaces, such as a cot, crib or Moses basket have a firmer surface for sleeping compared to when a baby may share a different surface such as an adult bed. In these cases, a baby is more likely to lie on a softer surface which can affect the temperature of their sleep space, as well as the potential of the surface affecting their airways. Revisit the section on infant anatomy (link) to learn why infants require a firm flat surface for every sleep.
Loose bedding increases the risk of SUDI and is greatly increased if an infant is lying on their tummy. Parents and caregivers should bear this in mind when babies start to move around their sleep space.
It can be confusing when retailers use images of babies lying on soft objects or advertise infant sleep spaces with bumpers, duvets, pillows or comfort aids. None of these items belong in an infant sleep space. Sometimes parents use particular bedding or pillows to protect a baby from falling or rolling against something hard. Whilst this choice is made to prevent one type of harm the reality is that it is likely to increase the risk of accidental suffocation.
Pillows and anything else propped underneath a baby’s head can tilt their head into a chin tucked down position. This can affect their breathing by slowing it down or limiting the amount of air they can breathe in.
A pillow is a very soft surface and if a baby rolls over on one it is a suffocation hazard. Many other objects act in the same way as a traditional pillow so parents and caregivers must be aware if anything that can cause the same effect as a pillow in a baby’s sleep space. Any item which is soft, can change shape around a baby’s face or is unstable and can roll into baby’s sleep space is a potential hazard
Baby’s do not require anything underneath their head to make them more comfortable. Their own head shape ensures that their airways remain open when sleeping on their back.
Anything that can move against a baby’s face, covering their mouth or nose is a risk to their breathing when they are asleep.
Evidence For Our Clear Cot Message
Bedding in a baby’s sleep environment can increase their risk of SUDI by 5 times. This risk increases to over 20 times when a baby is lying on their tummy, so older more mobile infants are more at risk from additional items in their sleep space.