For this week’s blog post, we’re going to look at sleep and, in particular, safe sleep practices.  We’re going to share information set out in the amazing Every Sleep Counts resources produced by the team at Hampshire Safeguarding Children’s Partnership to help you make the best and safest choices when it comes to your baby’s sleep.  We were fortunate to attend a really great training event from their team last month, which has inspired us to write this blog.

Before we get into the Every Sleep Counts message and advice, it’s really essential to remind ourselves why safe sleep practice is such an important consideration for all parents-to-be and new parents.

Sudden Infant Death Syndrome (SIDS)

Historically often called ‘cot death’, SIDS is the term used in relation to the sudden and unexpected death of an apparently healthy baby or infant where no cause can be found following a post-mortem.  With years of research on the subject, there are now a known number of key DOs and DON’Ts in relation to minimising the risk of SIDS, and we will be highlighting these throughout this blog post.  It’s worth remembering that this research – which is ongoing – means that some of the advice that (for example) your parents, grandparents, and friends might have been given and followed in relation to their babies has now changed.  Just because ‘We did that with you and nothing bad happened’ doesn’t mean that it is safe or recommended practice to do so now!

Probably the most crucial – and most well-known – piece of information for any new parent is that baby should always be placed on their BACK for sleep.

To show you the importance of following researched safe sleep practice, the ‘back-to-sleep’ message was launched in the UK in December 1991, and the impact on the rate of SIDS deaths was almost immediate.  Indeed, in 1989, 1,545 UK babies were recorded as having died as a result of SIDS; today, The Lullaby Trust reports that the figure is approximately 230 deaths a year, a reduction of over 80%.

Whilst this is clearly a huge improvement, the fact that around 4 babies per week are still dying due to SIDS means that more can and must be done to protect babies from the known risks.  We share with you this very powerful video from Anne Diamond, the TV personality who famously lost her third son to cot death in 1991, with the warning that you may find it upsetting to watch:

The Every Sleep Counts message

Taking on board all the various safe sleep information can be a little overwhelming as a new parent, so the Every Sleep Counts programme have produced a simple key message:

What we’re hoping to do in this blog post is not only reiterate this message to you but also to help you appreciate WHY this is the safest way for your baby to sleep, as well as helping you consider ways of minimising risk when this ‘best practice’ is either not possible or where you would like to deviate from it in some way.

The impact of baby’s development on sleep practices

Perhaps the best way to understand and appreciate the reasoning behind all the different aspects of safe sleep practice is to understand why they are important.  To do this, we need to look at some key elements of your baby’s physiological development which make their sleep needs and safe practice different from ours, as adults.

DEVELOPMENTAL POINT 1 – MOVEMENT: Young babies – depending on their age and development – are either not able to move and change their position at all, or are unable to move back to a safe position if they have managed to roll over.

RELEVANCE TO SAFE SLEEP: This all means that, if a baby is placed or ends up in a position where their airflow becomes restricted in some way, they will not be able to get themselves into a safe position, with a potentially tragic outcome.  As parents, we need to ensure that our tiny babies are always placed in the safest position possible.  We need to be alert to slightly older babies who may be able to roll a little, getting themselves out of a safe position, and take responsibility for returning them to that safe position ourselves (although, as The Lullaby Trust confirms, there’s no need to keep checking on this all night, especially if all other aspects of safe sleep practice are being maintained).  We also need to check that baby’s immediate sleep surroundings are not going to increase the risk of baby ending up in a dangerous position that he or she is unable to get out of and/or which could restrict their airflow.

KEY AREAS OF APPLICATION:

• DO ensure that your baby is placed safely to sleep in their own cot or Moses basket, with a firm, flat mattress which is in a good condition and which properly fits their sleep space.
• DON’T place or allow baby to sleep in a location where they are at risk of rolling, or getting wedged between surfaces. In particular, if using a sleep aid of some sort, ensure that it is (a) a branded and certified tested product which is appropriate to baby’s age/stage of development; (b) undamaged; and (c) has been assembled and is being used correctly, in accordance with the manufacturer’s instructions (ideally, then, you should avoid using any sort of sleep aid that you have acquired second-hand).  Baby’s cot/Moses basket should also ideally be kept clear of all additional items – such as soft toys, cot bumpers, loose bedding, pillows etc – which could increase the risk of baby’s head becoming covered and/or an accident occurring.

DEVELOPMENTAL POINT 2 – TEMPERATURE REGULATION: Babies’ nervous systems are still developing and this means that they will initially be unable to regulate their own body temperatures. Further, babies’ heads are the site of 40% of the heat that their bodies’ produce, and of up to 85% of their heat loss.

RELEVANCE TO SAFE SLEEP: This – combined with Point 1, above – means that, if baby becomes too hot (e.g. because the room temperature is too high and/or baby is inappropriately dressed/wrapped for sleep), they will be unable to sort the situation for themselves.  This means that their bodies run the risk of overheating which, again, can lead to a tragic outcome.

KEY AREAS OF APPLICATION:

• DO keep baby’s head uncovered when sleeping. Babies should never wear hats indoors and/or whilst sleeping, in order to avoid the risk of thermal imbalance occurring.  Further, keep baby’s cot free of loose bedding etc which could increase the risk of baby’s head becoming covered during sleep, and place them with their feet at the foot of the cot, to minimise the risk of them wriggling under the covers.
• DO dress baby in age- and season-appropriate sleepwear. Always look for labels which show that the clothing/bedding/etc has been safety-tested and is the right size etc for your baby.
• DO ensure that baby is not overdressed when in a car seat, as they are in danger of overheating quickly if they fall asleep in the car.  The best advice is to remove hats and other outer clothing (coats, snowsuits, etc) when placing baby in the car seat in the car, and to monitor their body temperature by checking how warm their chest or the back of their neck feels.  It’s also worth noting that the wearing of a coat etc can also reduce the effectiveness of baby’s car seat safety harness in the event of a crash (see RoSPA website for more information on car seat safety).
• DON’T let baby get too hot (or too cold – although overheating is the much bigger risk; as the Every Sleep Counts team reminded us, a baby that is feeling cold will wake up, cry and let you know, whereas a baby that’s overheated might not have that option…). In particular, baby should never sleep next to a radiator, fire or heater, with a hot water bottle or electric blanket, or in direct sunshine.  Ideally, place baby to sleep in a room with a temperature of between 16°-20°C; check baby’s temperature as suggested above, by feeling either the back of their neck or their chest, and remove a layer or two of clothing/bedding if they are feeling hot or sweaty.

DEVELOPMENTAL POINT 3 – BABIES HAVE NARROW, IMMATURE AIRWAYS: The British Lung Foundation tells us that, whereas adult lungs have somewhere in the region of 300 million air sacs, at birth, your baby will only have around 20-25 million air sacs, which are still developing.  These will increase dramatically during the first six months of your baby’s life, and will continue to grow steadily as your child develops.  Babies also have much narrower airways than we do, as fully-grown adults.

RELEVANCE TO SAFE SLEEP: This point also links with Developmental Point 1, and means that it is doubly-important to ensure that baby’s mouth and nose remains clear at all times, and that nothing should compromise baby’s ability to breathe.  Further, the air surrounding them should be kept as clean and clear as possible.

KEY AREAS OF APPLICATION:

• DO ensure that your baby is placed safely to sleep in their own cot or Moses basket, with a firm, flat mattress which is in a good condition and which properly fits their sleep space, to reduce the risk of their airway becoming blocked in some way. Further, keep baby’s cot free of loose bedding etc which could increase the risk of baby’s head becoming covered during sleep, and place them with their feet at the foot of the cot, to minimise the risk of them wriggling under the covers, all of which could again interfere with their ability to breathe.
• DON’T allow anyone – including both you and baby’s mum – to smoke in the same room as baby, both before and after birth. Ideally, both of you should quit smoking as soon as you start to plan for having a baby, or discover that you are pregnant.  If you will be hosting visitors who smoke to your house or have them close to your baby, you should ensure that key precautions are taken.  For example, smokers should wash their hands and change their clothes after smoking and before coming into contact with your baby. You should also never share a bed with your baby if either you or your partner smoke (even if you never smoke in the bedroom or the house).
• DON’T allow baby to sleep for long periods in a car seat, as they will not be in an ideal position for sleep and breathing. The Every Sleep Counts team recommend that, during a journey, babies under six weeks of age should be taken out of their car seat every 30 minutes for a stretch, and the same should be done every hour once they are over six weeks.  The Lullaby Trust website also suggests not leaving any baby in a car seat for more than two hours without a break.  Further, if baby has fallen asleep in the car seat whilst travelling, you should take them out of the seat and put them into a safe sleeping location (e.g. their cot) as soon as you arrive at your destination. The risk with the car seat is that, by having baby in a slightly upright position, it can cause breathing difficulties; further, you should be alert to the danger of baby’s head slumping forwards whilst in the seat, as this could again cause a restriction of their airways.  Ideally, have a second adult sitting in the back seat with baby, to keep an eye out for this.  If you can’t do this, think about having a special mirror fitted which enables you to monitor your baby’s position; if you see them slump forward, stop the car as soon as you can and reposition them.

DEVELOPMENTAL POINT 4 – YOUNG BABIES NEED TO WAKE FREQUENTLY TO BE FED AND CARED FOR: As we considered in our earlier blog post about sleep, it is 100% natural and normal for babies to wake every few hours – day and night – for food, care and comfort.  Because it is normal and natural, you should not seek to try and stop it in anyway (no matter what you’ll inevitably hear from someone else about their baby sleeping through the night from Day One, etc…).

RELEVANCE TO SAFE SLEEP: As all new parents know, a newborn baby’s sleeping-and-waking patterns will have a massive effect on our own ability to sleep at night, and sleep deprivation is a very real thing, especially in the early days.  This of course increases the danger of a parent falling asleep in a position that is unsafe, whilst holding and/or feeding baby.  Further, keeping baby too warm/tucked up in the hope that they won’t wake at night, or keeping them in a separate room, so they won’t disturb your sleep, all bring risks.

KEY AREAS OF APPLICATION:

• DO keep your baby sleeping in their own cot or Moses basket, in the same room as you, for the first six months. This allows you to be more quickly and easily able to respond to your baby’s needs.
• DO, if possible, encourage and support mum to breastfeed your baby, as this has been shown to reduce the risk of SIDS. In the early days, when sleep deprivation is an especial issue and mum is at highest risk of possibly falling asleep whilst feeding, putting baby at risk, a key role for dad is to stay up with mum as she feeds, chatting with her and keep her company.
• DON’T fall asleep on a sofa, bed or chair with your baby. A sofa is actually one of the most dangerous places to fall asleep with your baby, increasing the risk of SIDS by up to 50 times.  Aim to keep an eye on each other to prevent such a situation arising and, if you feel yourself at risk of ‘dipping off’ with baby in your arms, get up and #LiftTheBaby to a safe sleeping place – i.e. their cot or Moses basket.

Unusual situations

Obviously, in an ideal world, as new parents, we’d follow these rules every day, and keep our babies safe. However, the team at Hampshire realise that life isn’t perfect, and this isn’t always going to be possible.  Their key message, though, is to remember that every sleep counts – not just those which take place at home, at night.

For example, it’s important to follow the advice for all of baby’s daytime naps – and establishing a solid sleep-time routine for baby (whatever time of the day or night it is) will also help him or her learn how to settle and sleep.

If you are away from home when your baby needs to sleep – during the day or night, whether on purpose or inadvertently – it’s important to again follow the rules.  Remember that it takes just one ‘risky’ sleep to potentially turn to tragedy, so you should never take that risk and, wherever possible, plan ahead.  Have in mind the key dos and don’ts for safe sleep, alongside the developmental information in relation to you baby, to keep those risks to an absolute minimum.  The best place for baby to sleep when away from home is in a travel cot, using the mattress supplied – it may look thin, but it is perfectly designed for its purpose.  Adding any extra padding/layers to make it ‘comfier’ for baby is very dangerous and should always be avoided.

Another situation which clearly falls outside of the core Every Sleep Counts safe sleep message, but which many parents will at least consider, is co-sleeping.  If this is something that you still choose to do, as a family, then it’s important that you first of all read around the subject as much as possible, to reduce the risks – again, this includes familiarity with the dos and don’ts for reducing the risk of SIDS and the information on baby’s developmental stages.  The Lullaby Trust have a really excellent webpage which sets out their co-sleeping advice, which includes a list of situations when you should never co-sleep, some FAQs from parents, and also a useful video.  There’s also a link to the UNICEF ‘Caring for your baby at night – a guide for parents‘ leaflet, which has been endorsed by The Lullaby Trust, and their own bedsharing factsheet.

A key point with co-sleeping is never to share a bed with a baby when either you or your partner have been drinking alcohol or taking any drugs (legal or illegal, prescription or recreational) which could cause drowsiness, or if either of you is a smoker.

Sources of further advice and information:

The Hampshire Safeguarding Children Partnership website contains further information on the Every Sleep Counts programme, including a link to their support leaflet and poster, and their supporting video (shown above).

The Lullaby Trust website also contains lots of useful information, with advice, short videos and downloadable leaflets available on all aspects of safe sleep practice. You can download also a copy of their ‘Safer Sleep for babies – a guide for parents‘ leaflet.

The ‘Lift The Baby for safer sleeping’ campaign is a joint initiative between health care providers in Berkshire and the London Irish RFC, sharing safe sleep messages specifically aimed at dads.  You can see their video above, and visit their website for further information.