Safer sleeping & reducing the risk of sudden infant death – resources for practitioners to share

A significant safeguarding theme across the country and locally is the risk factors associated with Sudden Unexpected Death in Infancy (SUDI).

Despite public health campaigns and the involvement of universal services in parental education, the following risk factors are still identified in many cases:

It is important that all practitioners working with families promote ‘safe sleeping’ – there is a lot of good advice and resources on the Lullaby Trust website at www.lullabytrust.org.uk

Policy and  procedure
The  MFT Safer Sleeping Practice for Infants (October 2017) (PDF)  guidance on how to keep babies safe whilst sleeping should be read in conjunction with the relevant sections of the GMSP procedures.

The MSB has produced a seven minute briefing on safer sleeping which can be shared with front line practitioners and families.

Product Safety

In Manchester we believe that the safest place for a baby to sleep is on their back, in a Moses basket, or cot, in a room with the parent or carer, for the first six months.

To help define a suitable firm surface for babies to be put to sleep on, lying on their backs, for every sleep visit the website www.which.co.uk/smothering-risk-cot-mattress

We also encourage discussion with parents and carers and the provision of a link to the Lullaby Trust Product Guide to inform them further.

Health visitors will be providing these leaflets at the antenatal contact. Staff are asked to check the families’ understanding of firm, flat, clear mattress as the only surface that babies are left to sleep on.

Safer sleeping – reducing the risk

It is not known why some babies die suddenly and for no apparent reason from sudden infant death syndrome (SIDS) or cot death. Advice for parents and carers from NHS Choices states:

Experts do know placing a baby to sleep on their back reduces the risk; and exposing a baby to cigarette smoke or allowing them to overheat increases the risk. It is also known there is an association between co-sleeping (sleeping with your baby on a bed, sofa or chair) and SIDS.

SIDS is rare, so don’t let worrying about it stop you enjoying your baby’s first few months. Follow the advice below to reduce the risks as much as possible.”

How to reduce the risk of SIDS
The Lullaby Trust safer sleep advice gives simple steps to reduce the risk of sudden infant death syndrome (SIDS) which is commonly known as cot death.

The NHS advise that the safest place for a baby to sleep is on their back, in a Moses basket or cot in a room with their parent or carer for the first six months. This advice is the same for all times of the day and night as the chance of SIDS is particularly high for babies who are sometimes placed on their front or side

It is important to make sure that baby’s room is a comfortable temperature – not too hot or too cold. The chance of SIDS is higher in babies who get too hot, so try to keep the room temperature between 16-20°C.

Other advice to note:

  • do not leave baby to sleep unsupervised in a car seats or bouncer
  • do not smoke during pregnancy or when breastfeeding and do not let anyone smoke in the same room as baby
  • do not share a bed with a baby if you have been drinking alcohol, if you take drugs, or if you are a smoker
  • never sleep with a baby on a sofa or armchair
  • do not let baby get too hot or cold
  • keep baby’s head uncovered; their blanket should be tucked in no higher than their shoulders
  • place baby in the ‘feet to foot’ position (with their feet at the end of the cot or Moses basket).

Co-sleeping
Some parents choose to co-sleep with their babies. It is important for parents to know that there are some circumstances in which sharing a bed with their baby can be dangerous. Bed sharing may increase the chance of SIDS and is particularly dangerous if:

  • either parent /co-sleeper smokes (even if they do not smoke in the bedroom)
  • either parent / co-sleeper has drunk alcohol or taken drugs (including medications that may make them drowsy)
  • parent / co-sleeper is extremely tired
  • baby was born premature (37 weeks or less)
  • baby was born at a low weight (2.5kg or 5½ lbs or less)
  • never sleep on a sofa or on an armchair with a baby.

Parent or co-sleeper should never sleep with their baby if any of the above points apply.

Parents must be especially careful when giving baby a feed that they are not in a position where they could both fall asleep in the bed together.

For any questions about SIDS or safer sleep, call the Lullaby Trust information line on 0808 802 6869 (lines open Monday-Friday 10am to 5pm) or visit their website at www.lullabytrust.org.uk/safer-sleep-advice

Feeding, dummies and SIDS
Breastfeeding baby reduces the risk of SIDS. It is possible that using a dummy at the start of a sleep also reduces the risk however, the evidence is not strong and not all experts agree that dummies should be promoted.

  • if carers do use a dummy, do not start until breastfeeding is well established – this is usually at around one month old
  • stop giving the dummy when baby is between 6 and 12 months old
  • if baby is unwell, seek medical help promptly
  • babies often have minor illnesses, which carers don’t need to worry about – give baby plenty of fluids to drink and don’t let them get too hot
  • if baby sleeps a lot, wake them up regularly for a drink
  • it can be difficult to judge whether an illness is more serious and needs urgent medical attention.
  • visit the NHS website at www.nhs.uk/how-to-tell-if-your-baby-is-seriously-ill for guidance on when to get help.

Sleep Positioners

There has been a lot of coverage in the news about sleep positioners. Several UK retailers have stopped selling baby sleep positioners amid fears they can cause babies to suffocate. The US Food and Drug Administration (FDA) has linked the products to at least 12 baby deaths in America, in some of which babies had rolled from their side to their front and suffocated.

The Lullaby Trust does not recommend wedges and sleep positioners as evidence shows that the safest way for a baby to sleep is on a firm flat mattress, in a clear cot, free of pillows, toys, bumpers and sleep positioners.

Babies are at higher risk of sudden unexpected death if they have their heads covered and some items added to a cot may increase the risk of head-covering and can also increase the risk of accidents.

The Lullaby Trust recommends that as evidence on individual products is not widely available, parents do not take any chances and stick to scientifically proven safer sleep guidelines.

Advice for new parents on what they need to buy to sleep their baby safely is available on the Lullaby Trust website at www.lullabytrust.org.uk/safer-sleep-advice

Safer sleeping in car seats

A recent Serious Case Review served as a poignant reminder about safer sleeping arrangements for babies.

Wigan Safeguarding Children Board (WSCB) published a Serious Case Review following a case where a child tragically died at 10 weeks old.  The child died whilst in a car seat and the coroner ruled ‘it was not possible to ascertain the cause of death’.

Dr Paul Kingston, Independent Chair of WSCB, said: “The findings highlight the difficulties faced by families in sustaining safe sleep arrangements, amidst gaps in cohesive professional advice from many sources, not least in relation to sleeping in car carry seats which is not a unique issue to Wigan.”

Read the full report on the WSCB website at www.wiganlscb.com/Professionals/Serious-case-reviews

In car safety & car seats
Twelve children under 10 are killed or injured as passengers in cars every day. Car seats prevent deaths and serious injury.

  • adult seat belts are not designed for children as they don’t sit across the right parts of the body
    • if a child isn’t in the right booster or car seat, they can be injured by the seat belt in a crash
  • the law says that children under 3 are not allowed to travel anywhere in a car without an appropriate child restraint – usually a baby or child car seat
  • trying to hold a small baby in a car crash at 30mph would be like trying to lift 8 bags of cement at the same time
  • all children under 12 years old who are under 135cm in height have to use a child restraint – It is the law.

General car safety tips

  • a child can legally travel in the front of the car but it is always safest for them to travel in the back if possible
  • child car and booster seats must be used on every trip for children under 12 years old and less than 135cm tall
    • they are known to reduce the numbers of children seriously hurt in car accidents
    • buy new and buy the correct seat for your child’s weight, height
    • if given one by a family member or friend only use it if you are very sure that it has never been in an accident, is complete, fits your car properly and you have the fitting instructions
  • if a car is reversing in a car park or a driveway, the driver may not be able to spot small children if they are below the level visible from their rear or side windows -it is safest to hold a child’s hand in car parks just as when crossing the road
  • store car keys safely to reduce the risk of a child getting hold of them and starting the car.

More detailed information about car seats and in car safety can be found from the:

Warning over babies sleeping in car seats
The results of a small study suggest spending long periods of time in a car seat may lead to babies having breathing difficulties but, the researchers pointed out “we cannot be certain of the clinical significance or potential risks”. This novel study used a vehicle simulator to look at the effects of placing a newborn baby in a car seat at the 40⁰ angle required for travelling.

Researchers tested 40 newborns, who were a mix of pre-term and full-term. They found that while sat at this angle for 30 minutes – either stationary or when in motion – the babies’ heart and breathing rate increased and their blood oxygen levels were lower compared with lying flat in a cot.

Dr Renu Arya, consultant paediatrician at Great Western Hospitals NHS Foundation Trust, who led the research project, said “Parents should not stop using car safety seats to transport their infants. Infants must be protected in moving vehicles and UK law requires car seats be used whenever infants travel in cars.

It may be a good idea to rethink leaving a baby in a car seat for prolonged periods when they are not travelling. Taking regular breaks when driving long distances is also recommended. As well as giving a baby a chance to move out of their car seat, it will also help keep the driver alert and reduce the risk of accidents. RoSPA recommends taking at least a 15-minute break every two hours.

Find out more on the NHS website at www.nhs.uk/warning-over-babies-sleeping-in-car-seats/

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