Red Nose recommends six key steps to help reduce the risk of sudden infant death and sleeping accidents:
1. Always place baby on their back to sleep, not on the tummy or side
2. Keep baby’s face and head uncovered
3. Keep baby smoke free, before birth and after
4. Safe sleeping environment night and day
5. Sleep baby in their own safe cot in the same room as an adult care-giver for the first six to twelve months
6. Breastfeed baby.
The term Sudden Unexpected Death in Infancy (SUDI) is now used as this term refers to all cases of sudden and unexpected death in infancy and includes deaths from the Sudden Infant Death Syndrome (SIDS) and fatal sleeping accidents. Safe sleeping recommendations target known risk factors associated with SUDI. Where studies specifically define the population as SIDS, this specific term will be used to describe the study findings.
It is important for parents when they are thinking of buying a product for their baby to be able to make the best informed decision based on evidence of product safety. This is crucial for preventing SUDI or other fatal sleeping accidents.
It is often assumed that all nursery products sold in retail stores must be safe, however many products have never been formally tested so it can be difficult to tell what is safe for your child.
Parents need to assess:
1. Is the product I am thinking of buying/using safe for my baby especially during sleep?
2. What are the potential benefits of using this product and what are the potential hazards?
3. Am I using the product in a safe way?
4. What is my baby/infant doing in this product, and does this create any potential hazards?
Product Safety groups and the Australian Competition and Consumer Commission (ACCC) in Australia also work to:
1. Monitor the safety of infant and nursery products.
2. Make laws that cover the safety of potentially dangerous infant/nursery products.
Keeping Baby Safe – A guide to infant and nursery products https://www.accc.gov.au/publications/keeping-baby-safe-a-guide-to-infant-and-nursery-products\ states that ‘most nursery products should be made to meet voluntary or mandatory Australian standards and carry labels that warn about possible hazards”.
The Government has developed mandatory standards for cots and portable cots (from March 2009) and all cots, new and second hand, sold in Australia must meet the Australian Standard for cots (AS/NZS 2172-2003). Safety requirements for cots regarding height and gaps around the mattress are currently mandatory, but the test method set out in the Australian Standard for ‘sleep surfaces – test for firmness’ is a voluntary standard (Australian/New Zealand standard AS/NZS 8811.1:2013 Sleep surfaces – test for firmness).
In addition, the voluntary mattress firmness test is only in place for mattresses supplied with the cot, not mattresses sold separately. There is no mandatory Australian standard to check for when buying many other nursery products.
Bassinettes and bassinet type products
Unlike cots, there is no Australian Standard for bassinets, so Red Nose is careful to keep up to date with reports of accidents associated with bassinet use. This research shows that the most frequent accidents associated with bassinet use are falls and suffocation hazards. Australian and US governments draw on these reports and produce guidelines on ways to reduce these types of accidents.
Finnish Baby Box
In Finland, since 1938, parents have been provided with a government funded maternity package or “baby box”, which includes clothing, bathing products, and a box with a mattress and bedding. Finland had a high infant mortality in the 1930s, 65 per 1000 live births, however mortality declined markedly in the decades that followed. Declines have been attributed to improved prenatal care, a national health insurance scheme, central hospital network and the baby box, which promotes safe sleeping and breastfeeding1. It appears that these boxes can be used as portable sleep spaces, in bed, or adjacent to the parent sleeping environment, however there are currently no published studies describing box use by parents. To receive the grant or box, parents must engage with doctors and nurses to receive safe infant sleeping information. Hence ante-natal and post-natal care for all women is improved with this engagement. Thus the success of the campaign and the low rates of SUDI in Finland are not due to the “baby box” alone, but are underpinned by the increased health care mothers and babies receive and the information provided to them for safe infant sleeping. All other Scandinavian countries also have very low rates of SUDI, despite parents not being supplied with a “baby box”.
Many cultures around the world have used devices or spaces to keep their infants close at all times, including during sleep. In New Zealand, the Wahakura is a flax woven portable infant sleeping basket, traditionally used in Maori culture. More recently, use of the Wahakura together with safe sleep messages has been promoted. A recent randomised study has shown that there were no significant differences in risk behaviours (head covering, side/prone sleeping position, or bed sharing) when infants slept in the Wahakura compared to when infants slept in a bassinet2. There was also no difference in maternal sleep or fatigue, but there was an increase in sustained breastfeeding. These findings suggest that the Wahakura is safe and can be promoted as an alternative to infant-adult bed-sharing.
Pēpi-Pod® Sleep Space and the Pēpi-Pod® Program New Zealand
Pēpi-Pod® Program sleep spaces started as a “Change for our Children” community program in Christchurch for vulnerable families and received national attention as emergency beds for vulnerable babies in Christchurch, New Zealand, following the 2011 earthquakes. The Pēpi-Pod® Program combines a safe sleep space with parent education about safe infant sleeping, and a family commitment to spread messages about safe infant sleeping through their social networks. A Pēpi-Pod® sleep space is a protected place for babies to sleep when they are in, or on, an adult bed, on a couch, in a makeshift setting, or away from home. These situations have a higher risk of accidental suffocation for babies. Pēpi means ‘baby’ in Maori and a pod is a symbol of protection in nature. The Pēpi-Pod® may be a safer and more convenient alternative to the “baby box” as it overcomes a number of the concerns raised about the “baby box”. The Pēpi-Pod® is made of transparent plastic so is rigid, easily cleaned and lightweight. The baby can be easily observed and the pod has ventilation slits to allow air flow. The mattress is made from polyurethane enviro-foam and contains no chlorofluorocarbons. It is custom-made to fit the pod which should only be used with the supplied mattress and a fitted sheet is provided. There are preliminary data to show that the Pēpi-Pod® is safe and that its use has decreased the number of infants in New Zealand dying from SUDI3.
Australian Pēpi-Pod® Program
A trial of the Pēpi-Pod® Program, based on original New Zealand Program, commenced in Queensland in 2013 with participating government and non-government health services providing care for Aboriginal and Torres Strait Islander families. Preliminary results report benefits relating to safety, convenience and portability and integration of the Pēpi-Pod® Program into several health services suggests that the Pēpi-Pod® Program is sustainable long-term. It is also similar to the Coolamon, a shallow, wooden vessel that many Aboriginal families used traditionally to sleep newborns next to their parents.
Considerations when purchasing baby safe sleeping products
When we look at products to buy for a new baby, we need to ascertain not only whether it is effective for the required purpose but also is it safe to use under all circumstances of use especially where the baby may be unsupervised. This is particularly important when selecting products which babies will use when asleep.
When assessing whether or not a product is safe for baby to sleep in parents need to ensure a number of things:
- Ensure that it has a wide stable base and that it is placed on a stable surface.
- Use a size and style to suit your baby’s weight and age (see manufacturer’s instructions).
- Remove all ribbons and ties to prevent strangulation.
- The sides should be at least 300 mm high, measured from the top of the mattress base, and preferably made of air-permeable material such as mesh (or breathable zones).
- Use a firm, clean, well-fitting mattress that is flat (not tilted or elevated) and is not thicker than 75mm.
- If the legs fold, ensure they can be locked and won’t collapse when used.
- A safe baby sleeping bag which reduces the need for extra bedding is a good alternative when using a bassinet. If baby’s chest feels cool to touch and additional warmth is necessary, a lightweight blanket can be used if it is possible to tuck the blanket under the mattress so that it cannot be pulled over baby’s head.
- It is recommended that a bassinet type product should be used for a short period only. Once baby becomes active and starts to roll, the baby should be moved into a safe cot.
- Products that are made from cardboard may not be suitable for all Australian climates. Such factors as humidity and dampness may make the box soft and likely to become less rigid and maybe even break when carried.
- Products that sit on the floor may increase the risk of pets sleeping in them or the danger of being tripped over.
- Anything that makes it hard to see the baby in a safe sleeping product (e.g. curtains, mobiles, high box sides) should be avoided.
In Australia, between 1990 and 2015 approximately 5,000 babies died suddenly and unexpectedly. Baby deaths attributed to SUDI have fallen by 85% and it is estimated that 9,967 infant lives have been saved as a result of the infant safe sleeping campaigns.
The Safe Sleeping program is based on strong scientific evidence, has been developed in consultation with major health authorities, SUDI researchers and paediatric experts in Australia and overseas, and meets the National Health & Medical Research Council rules for strong evidence.
For further information visit the Red Nose website at www.rednose.org.au or phone Red Nose on 1300 998 698.
View the references for this article here.
Red Nose National Scientific Advisory Group (NSAG). 2017. Information Statement: Baby Safe Sleeping Products. Melbourne, Red Nose. This information statement was first posted in August 2017.
Last modified: 7/1/21