Safer sleep for my baby

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As parents or caregivers, you make many decisions every day to help keep your baby healthy and safe. When it comes to sleep, your baby’s sleep environment is always important – day or night. Some sleep practices are safer than others. This pamphlet shares information about how to help make your baby’s sleep environment as safe as possible – so every sleep is a safer sleep. Share this pamphlet with everyone who will be looking after your baby.

You and your health care provider can also discuss your infant’s sleep plan. For more information, see the resources at the end of this document.

Sleep-related infant death includes:

Sudden Infant Death Syndrome (SIDS) is a sudden and unexpected infant death without an explanation
Accidental Death can be the result of a fall from a sleep surface or of suffocation as a result of items in the bed, the baby lying face down, or the parent or another child rolling onto the baby

Make every sleep a safer sleep

Place baby on their back to sleep
Put your baby to sleep on their back for every sleep, whether it's naptime or nighttime. Babies can breathe well on their back, and will not choke on their spit-up or saliva.

Use a firm mattress free of hazards
Use a firm mattress made for babies, with no bumper pads, pillows, heavy blankets, comforters, quilts or toys. This will help keep their sleep space safe.

Use a crib or bassinet
For many babies, the safest place to sleep is in their own Health Canada-approved crib, cradle or bassinet when at home or traveling. Plan ahead when traveling, and make sure there is a safe sleep surface for your baby. Check out this Health Canada link for more information: www.canada.ca/en/health-canada/services/safe-sleep/cribs-cradles-bassinets.html. To learn more about safer bedsharing explore the bedsharing questions to ask yourself on the next page.

Breastfeed or chestfeed as much as possible
One way to help prevent sleep-related infant death is by breastfeeding or chestfeeding – which helps boost a baby’s immune system. The more you breastfeed or chestfeed, the greater the protection. Any amount of human milk will help keep your baby healthy.

Share your room
Have your baby sleep on a separate sleep surface in the same room as you for the first six months.

Be smoke-free
Smoking increases your baby’s risk of sleep-related death. Keeping your home smoke-free before and after birth, as well as being smoke-free during pregnancy, can help prevent sleep-related infant death.

Avoid exposing your baby to cannabis, vaping and e-cigarettes during pregnancy and after birth. For more information to help you or someone in your home to quit smoking, please visit www.quitnow.ca.

Be alcohol/drug free
Drinking alcohol, using drugs or taking some medicines can make you drowsy and cause you to sleep more heavily. Heavy sleep increases the risk that you will roll over onto your baby if you are bedsharing. Have another adult on hand to help with your baby if you have consumed anything that makes you less alert.

If you would like support for any kind of substance use (including alcohol or other drugs), free, confidential information and telephone support is available from the Alcohol and Drug Information and Referral Service. Call 1-800-663-1441 (toll-free in B.C.) or 604-660-9382 (in the Lower Mainland). Support is available 24 hours a day, 7 days a week, in multiple languages.

Keep temperatures comfortable
Keep the room at a comfortable temperature and use a thin, lightweight sleep sack or cotton baby blanket so that your baby does not overheat. If the temperature is comfortable for you, then it is comfortable for your baby. If using a sleep sack, it should fit well around baby’s shoulders so that your baby’s head does not slip down into the bag. Extra bedding or hats indoors are not needed.

What about swaddling?
Swaddling is not needed and can be unsafe. Tight swaddling can make it hard for your baby to breathe, and can lead to pneumonia. Swaddling can also cause your baby to overheat and increase the risk of sleep-related infant death. It can also cause hip problems. In addition, swaddled babies can get stuck on their stomachs and be unable to move into a safer position if they roll over.

If you choose to swaddle, ensure that:

Baby is placed on their back to sleep
Only swaddle from the shoulder down – not over the face, and ensure hands and arms are free
Swaddle not too tightly or loosely. Make sure you can fit 2 fingers between the blanket and the baby’s chest, and that baby can bend and move their legs
Use a light cotton blanket
Avoid swaddling past 2-3 months or once your baby can make strong movements on their own

Are adult beds safe?
Adult beds are not designed to keep babies safe. Often they are too soft, and blankets and pillows can increase the risk of suffocation or entrapment. It is not safe to leave your baby unattended on an adult bed. Sleeping on a raised bed also increases the risk of falls.

Tips on car seats, carriers and strollers
It is not safe to leave your baby asleep in a car seat. Once you have reached your destination, place your baby on a safe sleep surface – even if they are only napping. It is not safe to leave babies unattended in carriers or strollers.

Are sofas, recliners or couches safe?
It is never safe for a baby to sleep on a couch or chair – either alone or with a caregiver. Your baby can fall to the floor or slip between your body and the cushions, leaving them unable to breathe. Have a bassinet or crib ready, or ask someone else to take the baby when you need to rest.

Bedsharing

The safest place for many babies to sleep for the first 6 months is on their own safe sleep surface in your room. Some families may prefer to bedshare for cultural or personal reasons, and some families might end up bedsharing even if they hadn't planned to. If you think you might ever share a bed with your baby, or even if you don’t plan to do so, here are some questions to ask yourself to make bedsharing as safe as possible for your baby.

Definition of bedsharing:

Bedsharing happens when a baby shares an adult bed or mattress with a parent or caregiver.

Questions to ask yourself…

Was your baby full term (born after 37 weeks) and did they weigh more than 2.5 kg or 5.5 lbs at birth?
Premature and small-at-birth babies have an increased risk of sleep-related death. This risk increases if baby is also bedsharing.
Were you and anyone else you were living with smoke-free while pregnant?
Exposure to smoke during pregnancy increases your baby’s risk of sleep-related death. This risk increases if baby is also bedsharing.
Is your baby’s environment smoke-free?
Exposure to smoke, including second-hand smoke from any parent or caregiver, increases baby’s risk of sleep-related death. This risk increases if baby is also bedsharing. For support to quit smoking, visit www.quitnow.ca.
Are you, and anyone else who shares the bed, alcohol and drug-free, and free of any substance that might make you sleep more heavily?
Heavy sleep increases the risk that you will roll over onto your baby, which can cause suffocation. It’s best to have another adult on hand to help with your baby if you have consumed any alcohol, drugs or medicines that make you less alert.
Is your baby breastfeeding or chestfeeding?
If you are not breastfeeding, chestfeeding or feeding human milk it is safest to not bedshare with your baby.

If you answered NO to ANY of these questions, then bedsharing may not be a safe option for your baby and is not recommended. Your health care provider can help you develop a safer sleep plan for your baby.

If you answered YES to ALL of these questions, review the checklist below.

Bedsharing and breastfeeding or chestfeeding

It is normal for babies to feed often during the night, and as a result some parents find themselves bedsharing. Most parents who breastfeed or chestfeed their baby in bed will naturally sleep in a “C” shape – facing their baby with their knees drawn up under the baby’s feet and their arm above the baby’s head. This protects the baby from moving down under the covers or up under the pillow.

Breastfeed or chestfeed your baby at night in a safe bed rather than on a couch or in a chair if you feel like you will fall asleep during the feed. You and your health care provider may wish to discuss sleep positions that can help you rest and keep your baby safe.

Caring for a baby takes a lot of energy and is tiring. Ask your support people for help, take naps when you can, and eat healthy food.

Checklist: additional ways to help keep baby safer if bedsharing

Baby is put to sleep on their back.
It is safest for babies to sleep on their back.

Mattress is on the floor.
To reduce the risk of falls, the mattress should be on the floor and away from walls. Ensure there is space around the bed so your baby cannot get trapped between the mattress and the wall or bedside table. Make sure the mattress is firm and clean (no waterbeds, pillow tops, feather beds, air mattresses or sagging mattresses).

Baby is far away from any pillows, duvets and heavy blankets.
Pillows, duvets and heavy blankets may increase baby’s chance of suffocation and entanglement. Use only a lightweight sleep sack or cotton baby blanket on your baby.

Baby is able to move freely and is not swaddled.
Baby should be able to move freely. Swaddling can restrict baby’s movements, and put them at increased risk. Swaddled babies can get stuck on their stomachs and be unable to move into a safer position if they roll over.

Baby sleeps on the outside of the bed, instead of between adults.
If there are two adults in the bed, ensure that baby sleeps on the outside of the bed, instead of between adults. Both adults need to be aware that baby is in the bed and be comfortable with this decision.

Baby and adult(s) are the only people on the sleep surface.
Ensure that no other children or pets share the baby's sleep surface.

Ensure that baby is not left alone in an adult bed.
Adult beds aren't designed to keep babies safe.

Checklist and image adapted from: Maximizing the chances of Safe Infant Sleep in the Solitary and Cosleeping (Specifically, Bed-sharing) Contexts, by James J. McKenna, Ph.D. Professor of Biological Anthropology, Director, Mother-Baby Sleep Laboratory, University of Notre Dame.

Alternative safer sleep surfaces

If using an alternative sleep surface, ensure it is firm, flat and placed on the floor. Keep the surface dry, pest-free, and away from pets and electrical cords. Ensure nothing can fall in and it won’t be tripped on. The sleep surface needs minimal padding – you can use a lightweight blanket wrapped around and taped to the bottom of a sturdy piece of cardboard as a mattress.