Safe Sleep

Safe SleepFor all newborns a safe environment for their sleeping is extremely important. A safe sleeping position is even more important for preterm or low birth weight babies.

Before parents take their baby home, the health care team will explain parents everything about the optimal positioning of the baby. The team can explain everything about safe sleep. Some hospital units offer written information or special counselling on safe sleeping positions.

Parents should be (made) aware that the sleeping position they may have seen and practiced in the neonatal intensive care unit (NICU) may differ completely from the positioning they should practice at home: in the NICU the baby might be placed predominantly on the tummy (prone position), particularly when the baby has breathing difficulties. But the more the baby is nearing discharge, the more the baby will be placed on the back (supine position). Unless parents have received special instructions regarding the sleep position of their child at home, the following recommendations are important:

Parents of preterm babies should always consult their healthcare team on specific individual sleeping suggestions.



SIDS (Sudden Infant Death Syndrome) was first defined in the late 1960s and was refined in 1991 as “the sudden death of an infant under one year of age which remains unexplained after a thorough case investigation, including performance of a complete autopsy, examination of the death scene, and review of the clinical history”. (Willinger et al, 1991).


Safe Sleep – European Guidelines



Do not Smoke – Do not expose your baby to cigarette smoke before or after birth.

Do not Bed-Share – Never fall asleep with your baby in your bed or in a chair or sofa.

Place in Bare Crib – The baby should be placed in a crib with no cover, pillows, bumper pads or positioning devices.

Place on Back to SleepAlways place your baby, day or night on his back to sleep. Gently turn your baby‘s head left, then right every hour or so to help prevent „flat-head syndrome“ (Positional Plagiocephaly)




  1. Get good early prenatal care. A healthy full-term baby is more likely to live past infancy.
  2. Do not use cocaine or heroin during pregnancy or prescription drugs not prescribed by your doctor.
  3. Do not smoke cigarettes during pregnancy.
  4. Do not become pregnant during your teen years.
  5. If you are a teen and already have one child, wait until adulthood to have another. A second infant born to a teen mother is especially at high risk.



  1. Do not fall asleep with your baby in your bed. If you breastfeed, be sure to place baby back in his crib before dozing off.
  2. Do not allow the baby to sleep with other children. Babies should never bed-share with children or adults.
  3. Use a bare crib with a firm mattress. Put nothing in the bed but the baby and the clothes needed to stay warm but not too warm. Do not use pillows, positioning devices, blankets or other cover. Remove bumper pads from baby’s crib. Make sure nothing can ever get close to his face. There is evidence that re-breathing (inhaling the air that was breathed out) can affect the infant’s arousal.
  4. Keep your baby’s crib in the parents’ room until he is at least 6 months of age and has learned to easily roll both ways on his own.
  5. Babies should be safely put in a bare crib on their backs even when they are fretful, have a cold, or otherwise need extra comfort.Gently turn your baby‘s head left, then right every hour or so to help prevent „flat-head syndrome“ (Positional Plagiocephaly). Just keep the crib close to you and you will both be comforted. Babies with colds are at higher risk for sudden infant death.
  6. Do not allow anyone to smoke around the baby. Do not have your baby in a room or car where people have recently been smoking.
  7. Offer your baby a pacifier. For breastfeeding mothers, introduce the pacifier after the baby has learned to feed. Do not attach the pacifier to the baby or crib since it can cause a choking hazard. Several studies have found a lower risk of sleep-related death when babies use a pacifier.
  8. Breast-feed your baby. This can lead to an overall healthy baby and may help soothe a fretful baby.
  9. Some mothers learn that putting babies on their stomachs may make them cry less. And while that is true for many, if not most babies, it is dangerous and puts babies at higher risk for sleep-related deaths.
  10. Give your baby plenty of interactive tummy play-time. This should never be in a bed. A good place for this is on a play mat on the floor. Never leave him on his stomach unattended. Play with him as he does his baby push-ups.
  11. When you travel with your baby, be sure to plan a safe place for him to sleep. Call ahead to the hotel to make sure they have safe cribs available or take your own portable crib.
  12. Do not put too many clothes on the baby or keep him/her in a room that is too hot. If the baby is sweating, remove some of the clothing.
  13. If your baby has periods of not breathing, going limp or turning blue, tell your pediatrician at once. And if your baby stops breathing or gags excessively after spitting up, discuss this with your pediatrician immediately.
  14. Thoroughly discuss each of the above points with all caregivers.
  15. If you take your baby to daycare or leave him with a sitter, provide a copy of this list to them. Make sure they follow all recommendations.