Sleeping babies need to breathe. To stay alive oxygen must get through to their lungs. Babies need the people who care for them to make their sleeping places safe.
The sudden death of babies in unsafe sleeping situations is the main cause of preventable deaths in the first year of life. As we learn more about how to protect babies, the distribution of risks changes.
Knowledge is growing all the time. Parents need to keep updated on information about safe sleep and sudden infant death.
Face up, face clear, smokefree, own space, close by: together, these five principles protect babies while they sleep. Best care means:
- always placed for sleep on the back (no sleep aids are necessary)
- always smokefree (both during pregnancy and after)
- always having a clear face and head throughout sleep (with no chance of these becoming covered during sleep)
- always in a protected space set up for their safety. (This may be a baby bed designed for babies or you may need to create a safe space to protect them from potential risks for babies when they sleep in adult beds, couches, makeshift beds, gaps near walls, have children in their sleeping space or when smoking,alcohol, drugs or tiredness reduce a parent's awareness and ability to respond.)
- always in the same room as parents (for the first 4-6 months)
Causes of suffocation
If oxygen is blocked from reaching their lungs, babies will suffocate. Ways this happens:
- overlaying or being rolled on by others (for babies 0-3 months)
- a covered face or head (for babies 0-7 months)
- heads or faces getting wedged against or between things (for all ages)
- crushed chest (a heavy arm across a tiny chest can make breathing movements impossible)
- blocked airway (a young baby's floppy jaw may be pushed forward and block breathing, if sleeping in a crumpled position)
The sleeping environment is ever-changing. Hazards work together to influence the risk. Whether a baby is sharing a bed or not, these are the kinds of hazard that can lead to suffocation when a baby goes to sleep:
- Position: Back is best. Stretched out on the back, not propped on pillows. The back is twice as safe as the side and seven times safer than the front. The side is a risk when babies roll to the front, especially when it is the first time. The front position is the greatest risk to babes when they sleep. There has been widespread international agreement about this for many years now. The back is especially important for more vulnerable babies: premature, low birth weight and smoke-exposed
- Places: Babies can roll to face down on soft surfaces, bean bags, V- pillows, water beds, pillows, cushions and when propped up on any of these. They can get wedged against things or into gaps on couches, chairs or makeshift beds.
- Bedding: Loose bedding can bunch up or cover the face. Babies can slip down under blankets and duvets, especially if their bed is sloping. Their faces can become buried in soft toys, pillows or items left hanging over the sides of the cot.
- People: Sleeping adults who share a surface with babies risk rolling onto them if their awareness is blunted from smoking, drugs, alcohol or extreme tiredness. Other children are also a sleep hazard if they are sharing a sleep surface with a baby. Couches are an especially dangerous places for shared sleeping with a baby.
- Babies: Babies most at risk from sleep-related deaths are those born early (before 36 weeks), born small (weighing less than 2500 grams) or exposed to any smoking (during pregnancy and/or after). For these babies, a safe place to sleep is in a bed of their own with parents close by (see the photo opposite). Sharing sleeping surfaces needs to be avoided to protect these more vulnerable babies from sudden unexpected death.
Be close to your sleeping baby
Being close to parents is important for babies for their emotional security and their survival. The challenge is to find the balance between closeness and safety.
Babies who sleep in the same room as their parents are safer from sudden unexpected death in infancy (SUDI) than those in a separate room. For now, we do not understand why, only that this is a finding in all the major research studies of SUDI.
Each year about sixty New Zealand babies die in sleeping situations that are not safe. Most of these deaths are preventable. Too many people are not aware of what is a hazard for babies when they sleep.
A major hazard is falling asleep with a baby on a couch and sharing a sleeping surface with a baby after drinking alcohol, taking drugs or if you smoke. To protect your baby, avoid these situations. Either place your baby in a cot beside your bed, or in a 'co-sleeper' designed for babies if in your bed.
Note: The organisation behind Tender Shoot™ (Change for our Children) has had a contract with the New Zealand Ministry of Health since 1994 for education to prevent sudden unexpected deaths in infancy)