Safe Sleep for Babies: How to Reduce the Risk of SIDS

Safe sleep advice can feel like a lot to remember, especially when you are already tired. The main principles are reassuringly simple: put your baby on their back for every sleep, use a clear cot or Moses basket with a firm, flat mattress, keep their sleep space free from pillows and other unnecessary items, and have them sleep in the same room as you for at least the first 6 months.

These steps cannot remove the risk of sudden infant death syndrome, or SIDS, completely. However, NHS guidance and The Lullaby Trust recommend them because they can reduce the risk.

The same safer sleep principles matter for naps as well as overnight sleep, and they should be followed wherever your baby is sleeping.

What is SIDS?

Sudden infant death syndrome is the sudden and unexplained death of an apparently healthy baby under 1 year old. It was previously known as cot death.

SIDS is rare, and its exact cause is not known.

According to the NHS, certain factors are known to increase the risk. These include exposure to cigarette smoke and sleeping with a baby on a sofa or chair.

Babies who were born prematurely or had a low birth weight are also at higher risk.

SIDS is more likely during the first 6 months, although it can affect babies up to 12 months old. It can happen during daytime or night-time sleep.

This is why safer sleep guidance applies to every sleep rather than only bedtime.

Always put your baby on their back to sleep

The safest sleeping position for a baby is on their back.

Place your baby on their back at the beginning of every nap and night-time sleep unless a medical professional has specifically advised a different position for your baby.

Do not routinely place a baby on their front or side to sleep.

The NHS advises moving your baby back onto their back if they roll over until they are able to roll from their front to their back and back again by themselves.

Once your baby can roll both ways independently, you do not need to keep turning them back throughout the night. Continue placing them on their back at the start of every sleep.

Use a separate, clear sleep space

For the first 6 months, the safest place for your baby to sleep is in their own cot or Moses basket in the same room as you.

Their sleep surface should be firm, flat and waterproof.

A simple sleep space is safer than one filled with accessories.

Keep the cot clear of anything that could cover your baby’s face or head.

The NHS advises against using:

pillows
duvets
cot bumpers
loose bedding
soft toys
pods or nests
sleep positioners

Products marketed as cosy or supportive are not automatically suitable for unsupervised sleep.

The Lullaby Trust advises parents to be cautious about products claiming to reduce the risk of SIDS. No product can replace evidence-based safer sleep practices.

Choose a firm, flat mattress

Your baby’s mattress should be firm, flat and waterproof.

The mattress should fit the cot or Moses basket appropriately and should not allow your baby’s head to sink significantly into it.

Soft sleeping surfaces can increase the risk of a baby’s head becoming covered or their airway becoming restricted.

Avoid using pillows, folded blankets or other soft materials underneath your baby to make the mattress feel more comfortable.

If you are buying or reusing a mattress, follow current NHS advice and the manufacturer’s instructions for the sleep product you are using.

Keep your baby’s cot clear

It is easy to assume that a cot needs blankets, cushions and toys to feel comfortable. Babies do not need these extras for safe sleep.

A clear cot means fewer things around your baby’s face and airway.

Keep toys, cushions, pillows and other loose objects outside the sleep space.

Avoid cot bumpers. They can create additional hazards and are not recommended by the NHS.

Do not use products designed to hold your baby in a particular sleeping position unless they have been specifically recommended by an appropriate healthcare professional for your baby’s medical needs.

Simple is safer.

The NHS and The Lullaby Trust recommend that your baby sleeps in the same room as you for at least the first 6 months, both during the day and at night.

This is known as room sharing.

Room sharing does not mean that your baby needs to sleep in your bed. Their safest place is their own separate sleep space, such as a cot or Moses basket, positioned in the same room.

You can still leave the room briefly while your baby sleeps. The guidance means that, for most of their sleep during these early months, having them close by is safer than routinely placing them in another room.

Keep your baby from getting too hot

Overheating is associated with an increased risk of SIDS.

The Lullaby Trust recommends a room temperature of around 16°C to 20°C as a guide for babies.

A room thermometer can help you keep track of the temperature.

Keep your baby’s cot away from radiators, heaters and direct sunlight.

Avoid adding extra layers simply because your baby’s hands or feet feel cool. To check whether your baby is too warm, The Lullaby Trust advises feeling their chest or the back of their neck.

If their skin feels hot or sweaty, remove a layer.

Different sleeping bags and clothing have different thermal properties, so follow the manufacturer’s guidance for the specific products you use rather than relying on a single clothing formula.

Keep your baby’s head uncovered

Your baby’s head should remain uncovered during sleep.

Do not put your baby to sleep indoors wearing a hat.

Make sure bedding cannot ride up over their face or head.

If you use blankets in line with current NHS safer sleep guidance, follow the recommended setup carefully. Baby sleeping bags can also be used when they are appropriate for your baby’s size and fitted according to the manufacturer’s instructions.

Whichever option you choose, your baby’s face and head should remain clear.

Keep your baby smoke-free

Smoking during pregnancy and exposing a baby to cigarette smoke after birth increase the risk of SIDS.

Keep your baby’s home and sleeping environment smoke-free.

If you or your partner smokes, support is available through NHS stop smoking services.

This is also important when considering bed sharing. NHS and Lullaby Trust guidance advises against co-sleeping if you or anyone else in the bed smokes, even if you never smoke in bed.

The safest place for your baby to sleep is in their own separate cot or Moses basket.

However, many parents will bring their baby into bed to feed or comfort them, and some families choose to bed share. It is useful to understand the risks before tiredness makes the decision for you.

If you share a bed with your baby, the NHS advises keeping pillows, sheets and blankets away from them, making sure they lie on their back on a firm, flat mattress, and ensuring there is nowhere they can become trapped.

Do not leave a baby alone in an adult bed.

Do not have other children or pets sharing the bed with your baby.

There are also circumstances in which co-sleeping carries particular risks and should be avoided.

When should you not co-sleep?

The NHS and The Lullaby Trust advise against co-sleeping in several higher-risk situations.

Do not share a bed with your baby if you or anyone else in the bed:

has been drinking alcohol
smokes
has taken recreational drugs
has taken medicine that causes drowsiness

Co-sleeping is also particularly risky if your baby was born prematurely or had a low birth weight.

If any of these circumstances apply, place your baby in their own safe sleep space.

If you are unsure how your medication affects co-sleeping safety, speak to a pharmacist, GP or another qualified healthcare professional.

Never sleep with your baby on a sofa or armchair

Falling asleep with a baby on a sofa or armchair is particularly dangerous.

If you are feeding or comforting your baby and feel that you may fall asleep, move to a safer situation rather than remaining on a sofa or chair.

Tiredness can arrive quickly, particularly during night feeds.

Thinking about this before you are exhausted can help. Keep your baby’s cot or Moses basket ready so you can return them to their own sleep space before you go to sleep.

What if your baby falls asleep in a car seat, swing or bouncer?

Car seats are essential for safe travel, but they are not intended to replace a baby’s normal sleep space at home.

The Lullaby Trust advises that if your baby falls asleep in a swing or bouncer, you should move them to their own separate, firm and flat sleep space and place them on their back.

The same principle applies when you arrive home after travelling. Move your baby from their car seat to their normal safe sleeping space when practical.

Follow the manufacturer’s instructions for any baby product you use.

Breastfeeding and SIDS

The NHS and The Lullaby Trust state that breastfeeding is associated with a lower risk of SIDS.

Any amount of breastfeeding can be beneficial.

Not every parent can or chooses to breastfeed, and safer sleep guidance still applies regardless of how your baby is fed.

If you formula feed, you can still reduce your baby’s risk by following the other safer sleep recommendations, including back sleeping, using a clear cot, avoiding smoke exposure and keeping your baby from overheating.

Feeding choices should not become a source of guilt in a conversation about safe sleep.

What about dummies?

The NHS says some research suggests that using a dummy to settle a baby to sleep may help reduce the risk of SIDS.

If you are considering using one, check current NHS or Lullaby Trust guidance, particularly around breastfeeding and when to introduce or stop using a dummy.

There is no need to force your baby to take a dummy if they do not want one.

If it falls out once your baby is asleep, you do not need to repeatedly put it back in.

Routine vaccinations matter too

The NHS recommends keeping babies up to date with routine vaccinations.

Vaccinations protect against childhood illnesses, some of which may increase the risk associated with serious illness in infancy.

Follow the NHS vaccination schedule and speak to your health visitor, GP or vaccination team if you have questions about your baby’s appointments.

Does a baby monitor prevent SIDS?

A baby monitor can be useful for hearing or seeing your baby, but it does not replace safer sleep practices.

The Lullaby Trust states that there are no products that can reduce the risk of SIDS.

That means monitors, movement sensors and other consumer sleep devices should not give parents a false sense that other safer sleep recommendations can be ignored.

Follow the same safe sleep setup whether or not you use a monitor.

If your baby has a medical condition and a healthcare professional recommends specific monitoring, follow their individual advice.

Safe sleep away from home

Safer sleep principles still apply when visiting family, staying in a hotel or travelling.

Before a trip, think about where your baby will sleep rather than assuming a suitable sleep space will be available.

Wherever your baby sleeps, aim for:

a separate sleep space
a firm, flat mattress
a clear sleeping area
back sleeping
an appropriate room temperature
a smoke-free environment

Avoid improvising with soft surfaces, cushions, nests or unsuitable furniture.

If you are borrowing travel equipment, check that it is suitable, in good condition and used according to the manufacturer’s instructions.

A simple safe sleep checklist

For every nap and night-time sleep, check that:

your baby is placed on their back
they have their own clear sleep space
the mattress is firm, flat and waterproof
their face and head are uncovered
pillows, duvets, bumpers, toys and positioners are not in the cot
they are not getting too hot
their environment is smoke-free
they sleep in the same room as you for at least the first 6 months
nobody falls asleep with them on a sofa or armchair

You do not need an elaborate nursery or expensive sleep equipment to follow safer sleep guidance. A simple, clear sleeping space is exactly what is recommended.

When to get professional advice

Speak to your midwife, health visitor, GP or paediatrician if you are unsure how safer sleep guidance applies to your baby, particularly if they were born prematurely, had a low birth weight or have a medical condition that affects their sleeping position, breathing or feeding.

Do not change your baby’s sleeping position because of reflux or another health concern without discussing it with an appropriate healthcare professional.

If a doctor has given your baby individual medical sleep advice, follow that advice rather than general guidance.

Call 999 if your baby is unresponsive, is not breathing normally, is struggling to breathe, or has blue, grey or unusually pale colouring and appears seriously unwell.

Safe sleep advice is designed to reduce risk, not to make parents frightened of sleep. Focus on the core habits you can repeat every time: back to sleep, a clear cot, a firm flat mattress, a comfortable temperature and a separate sleep space close to you during the first 6 months.