FAQ

The SIDS and Kids Frequently Asked Questions (FAQs) cover a number of topics related to Sudden Unexpected Deaths in Infancy (SUDI) in brief question and answer format. In the FAQs we define SUDI and offer advice on ways to provide a safe sleeping environment for baby. Our FAQs also provide information to allay any concerns parents and carers may have about issues such as immunization, safety in prams and strollers and bottle feeding, just to name a few.

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Alternatives to sleeping baby in a cot for the first few months: · Bassinettes · Rocking cradles · Hammocks
Mar. 26, 2010
· Bassinettes
There is no Australian Standard for bassinettes unlike cots. We are aware of reports of accidents associated with bassinette use. Australian and US governments’ guidelines on ways to reduce these types of accidents include:
· ensure that it has a wide stable base and that it is placed on a stable surface
· Remove all ribbons and ties to prevent strangulation
· The sides should be at least 300mm high measured from the top of the mattress base
· Use a firm mattress that is a snug fit and is not thicker than 75mm

Make sure baby sleeps on the back with face uncovered. It may be better to use an infant sleeping bag (see Q15) when using a bassinette. Only use a lightweight blanket for additional warmth if it is possible to tuck blankets under the mattress (see Q2 & 16).

Rocking cradles
If you are buying a rocking cradle, make sure that it complies with the safety requirements of the voluntary Australian standard AS/NZS 4385. Look for a label or sticker that says the rocking cradle complies with this voluntary standard. If there isn’t one, ask the retailer. If the retailer cannot verify that it complies, ask if there is an alternative that does comply. Babies can become trapped in a tilted rocking cot or cradle. If you have a cradle or cot that rocks and has a child-resistant locking pin, make sure that you secure the locking pin firmly in place whenever you leave your baby and double check it make sure the cradle cannot move when you are not there to supervise. Ensure the cradle has a tilt limiter to limit the angle of tilt to no more than 10 degrees from the horizontal.

Hammocks
There is no Australian standard covering the use and manufacture of hammocks for baby. While we are not aware of any research on the safety of hammocks or guidelines for their use for babies, we are aware of case and injury reports documenting a number of hospital admissions of infants following a fall from a hammock and tragically 2 deaths of infants sleeping in hammocks in separate incidences in the USA in 2009.Babies sleeping in hammocks are at risk of incurring a falling injury. Babies should not be left unsupervised in these devices as they are not designed as an infant sleeping place.

Are there recommendations for car seat or baby seat use?
Mar. 26, 2010
It is required by law that you place baby in a correctly fitted infant restraint that meets the Australian standard AS/NZS 1754 for every trip in the car.
· transport accidents are the leading cause of death for children once the infancy period has passed and
· child restraints supplied on the Australian market have key safety features that reduce the associated risks of injury to/death of a child while travelling in a motor vehicle.

Never leave your baby unattended in the car – not even for a short time.

Each child restraint must:
· be correctly installed
· have the Standards Australia mark
· suit your child’s weight and size

For more information on safe child restraint use, see the Australian government publication: A simple guide to child restraints : How you can protect your child. Click here to download a copy.

Once the car journey is over it is very important that you remove baby from the car seat or capsule, even if this means waking baby, because it is not safe for baby to spend long periods in car seats, capsules or infant seats. Research has shown that:
· car seats may cause baby’s neck to flex forward which may block baby’s airway not allowing airflow
· infants less than one month old left in a sitting position for a long period of time may be placed at increased risk for sudden infant death.
· falls from car seats used outside of the car as infant carriers are common, often involvechildren unbuckled in their car seats and represent a significant source of head injury that may be prevented with strategies such as warning families regarding leaving infants in carriers on shopping carts, counters, or other high locations

Are there specific baby care products that reduce the risk of sudden unexpected death in infancy?
Mar. 26, 2010
There is no scientific research evidence that has convinced SIDS and Kids that any specific baby care product reduces the risk of SIDS.

At what age can I introduce cot bumpers and pillows?
Mar. 26, 2010
Soft bedding such as pillows quilts duvets and bumpers increase the risk of sudden unexpected infant death. They may cover the baby’s face and obstruct breathing or cause overheating. Older babies in a cot can be at an increased risk of a sleeping accident by using pillows and bumpers as a step to climb up and fall out of the cot. It is safer to wait until the child starts to sleep in a bed before introducing a pillow or other soft bedding.

Bouncinettes
Mar. 26, 2010
A bouncinette (also known as a bouncer or rocker) is a chair that allows baby to either bounce or rock in a reclined position. There is no Australian standard for bouncinettes. Accidents can occur in bouncinettes:
Accidents have occurred where baby has become trapped in the restraining, when the bouncinette has fallen from a high surface or been placed where baby could get caught in curtain or blind cords. Deaths have occurred when baby has been left unsupervised to sleep in a bouncinette.

Alert
· Only use a bouncinette on the floor
· Never carry a baby in a bouncinette
· Never leave a baby unattended in a bouncinette

Can babies be put on the tummy to play?
Mar. 26, 2010
Yes. Tummy play is safe and very important for babies from birth, but only when they are awake and an adult is present. Tummy play helps muscle development in the arms, neck and back and prepares babies for crawling. Tummy play is also very good to help prevent a misshapen head (see Q20) but remember not to put baby on the tummy to sleep.

Can I prevent my baby getting a flat pressure spot on the head?
Mar. 26, 2010
Flat ‘pressure’ spots can develop if a baby lies in one position on the head for long periods of time and are sometimes referred to as positional plagiocephaly. These flat spots tend to improve with age and most will disappear completely as baby’s head grows and when baby starts to sit up and look around.

However, in some babies these flat spots can persist. A small number of babies with severe flattening require fitting with a specially designed helmet to help reshape the head. This is very rare. Prevention and treatment Positional plagiocephaly may be prevented or treated by simple repositioning techniques and by minimising pressure on the head when baby is awake. It is best to implement these simple measures from birth.
· Always sleep baby on the back, not on the tummy or side.
· Alternate the head position each time baby goes down to sleep (left and right).
· As babies become more alert and interested in the environment they like to look at certain objects before falling asleep. Sleeping baby at alternate ends of the cot will encourage him or her to look in different directions. Changing the position of the cot in the room may also have the same effect.
· When the baby is awake, minimise the time that baby spends lying down with pressure on the same part of the head. Carry and cuddle baby in upright positions.
· Avoid prolonged periods in car seats, strollers, swings and bouncers as this places additional pressure on the back of the head.
· From birth, give baby increasing amounts of side lying and tummy time to play when awake and being observed by an adult but never put baby on the side or tummy to sleep.
· Alternate the holding position when feeding baby i.e. hold in left arm for one feed and the right arm for the next feed.

A small number of babies can develop positional plagiocephaly as a result of tight muscles on one side of the neck, a condition known as torticollis or wryneck. If the baby has a strong preference for turning the head to one side, or has difficulty turning the head please consult a doctor who can then arrange physiotherapy treatment. Remember, always put baby on the back to sleep and keep baby off the back of the head as much as possible when awake.

Alert
Positional devices that restrict the movement of a baby or the baby’s head are not recommended.

For more information on this topic, see the SIDS and Kids Information Statement Baby’s Head Shape. This statement can be downloaded from the SIDS and Kids website under ‘Safe sleeping’. Alternatively, call your nearest SIDS and Kids office on 1300 308 307 to request a copy to be sent to you by mail.

Can Sudden Unexpected Death in Infancy (SUDI) be prevented?
Mar. 26, 2010
Babies who die suddenly and unexpectedly as a result of a medical problem are probably not preventable. However, scientists have identified similar risk factors that are present in SIDS, SUDI and fatal sleep accidents. By removing known risk factors and providing a safe sleeping environment most of these deaths are preventable.

Check list for safe sleeping.
Mar. 26, 2010
1. Has baby been placed on the back to sleep?
2. Is baby sleeping in a safe bassinette or cot, and away from hazards?
3. Does the cot meet Australian Standard for cots?
4. Is the mattress firm?
5. Does the mattress fit the cot /bassinette well?
6. Is the mattress clean and in good condition
and flat (not titled or elevated)?
7. Is baby’s face and head uncovered?
8. Have any pillows, duvets, lambs wool, cot bumpers and soft toys been removed?
9. If using a baby sleeping bag, does it have a fitted neck, armholes or sleeves and no hood?
10. If using blankets rather than a sleeping bag, has baby been placed to sleep with feet touching the bottom of the cot/bassinette with blankets securely tucked in?
11. Is baby having tummy time to play when awake and supervised?
12. If you are a smoker have you stopped smoking or contacted your doctor or Quit line for help?
13. Remember never to sleep baby on a sofa, beanbag, waterbed or pillow?
14. Are other family members aware of how to sleep baby safely?

Do babies who sleep on the back roll over onto the tummy later than babies who don’t sleep on the back?
Mar. 26, 2010
Yes. Babies who sleep on the back tend to roll over onto the tummy later than side sleeping infants. This is probably why the back sleeping position reduces the risk of SIDS, because baby does not roll in to the high-risk tummy position until most of the risk of SIDS has passed. The delay in rolling is normal and does not affect baby’s later development. For example, these babies show no difference in their walking ability at 18 months of age compared to babies who slept on the side or tummy.

It is very good to encourage babies to play on the tummy as it helps to develop their strength and prepare them for crawling. But remember not to put baby on the tummy to sleep.

Do baby monitors reduce the risk of sudden unexpected death in infancy?
Mar. 26, 2010
There is no scientific evidence that electronic baby monitors are of any assistance in preventing SIDS and have played no part in the dramatic reduction in SIDS deaths in Australia.

The reduction in the number of babies dying of SIDS has come about because parents have been made aware of ways to sleep baby safely such as placing baby on the back to sleep from birth, sleeping baby with face uncovered, not smoking during pregnancy or after the birth, and by providing a safe sleeping environment.

Does dummy use reduce the risk of sudden unexpected death in infancy?
Mar. 26, 2010
Research suggests that dummy (pacifier) use may have a protective effect against SIDS.
However, other research shows that dummy use can interfere with breastfeeding and increase the risk of ear infections. Parents are advised to weigh up these issues before deciding about dummy use for their baby. While there are questions still being asked about the pros and cons of dummy use, there is no
question about the effectiveness of the Safe Sleeping program.
Sleeping a baby on the back, with face uncovered, and in a smoke free environment is the best way to protect a baby from sudden and unexpected infant stage.

For more information on this topic, see the SIDS and Kids Information Statement Pacifier/dummy use. This statement can be downloaded from the
SIDS and Kids website under ‘Safe sleeping’. Alternatively, call your nearest SIDS and Kids office on 1300 308 307 to request a copy to be sent to you by mail.

Does SIDS and Kids recommend mattress wrapping?
Mar. 26, 2010
NO. Wrapping a baby’s mattress with polythene has been suggested as means of preventing SIDS. The theory proposes that cot mattresses emit toxic gases and that wrapping the mattress will prevent SIDS. This theory has been thoroughly investigated through rigorously conducted, scientifically based
research and there is no evidence to support the link between wrapping mattresses and the prevention of SIDS.

Does SIDS and Kids recommend or endorse any baby care products or positional aids?
Mar. 26, 2010
NO. SIDS and Kids does not recommend or endorse any baby care products. This includes positional aids for babies such as anti-roll devices and items that fasten a baby in position.

This is because some of these products have not been tested properly and some have been used incorrectly and resulted in tragedy.

However, SIDS and Kids may license some products for fundraising purposes only. SIDS and kids only promotes and encourages practices that are based on strong scientific evidence and where effectiveness and safety have been proven.

There is strong scientific evidence to show that the best way to reduce the risk of SIDS and sleep accidents is to sleep babies on their back with face and head uncovered, to avoid exposing babies to tobacco toxins and to provide a safe sleeping environment.

Does sleeping baby on a sofa increase the risk of sudden unexpected death in infancy?
Mar. 26, 2010
Yes. There is a very high risk of a sleeping accident if an adult falls asleep with an infant on a sofa. This is because baby may become wedged into cushions or the back of the sofa and the sleeping person would not notice. Put baby back into his or her own sleeping place before you doze off on a sofa.

Alert
Never fall asleep with baby on your chest whilst lying down as this is the same as sleeping the baby in the tummy position.

How do I carry baby safely in a sling?
Jan. 19, 2012
Slings are carriers that allow an adult to carry an infant hands-free. The sling straps around the adult's neck, allowing the infant to lie in front of the adult, curved in a C-shape position. If you choose to carry baby in a sling, at all times ensure that:
· baby’s airways are free at all times
· you can see baby’s face
Babies can suffocate lying with a curved back with the chin resting on the chest or the face pressed against the fabric of the sling or the wearer’s body.

At particular risk from these products are babies with a low birth weight, those that were born prematurely, or have breathing issues such as a cold. Injuries can also occur from the baby falling from the sling when the caregiver trips and falls; the product malfunctions or its hardware breaks; or the baby slips and falls over the side.

For more information, see the Australian Government safety alert Baby slings, which you can access from the Product Safety website at http://www.productsafety.gov.au/content/index.phtml/itemId/986870

How do I contact SIDS and Kids?
Mar. 26, 2010
· Telephone SIDS and Kids in your state or territory on 1300 308 307;
· Fax 1300 308 317
· Email SIDS and Kids with your question and your area post code on librarian@sidsandkids.org

How do I ensure that babysitters and childcare workers sleep my baby safely?
Mar. 26, 2010
If babies are ever placed on their tummy to sleep they are at a significantly higher risk of SIDS. When ever you leave your child in the care of someone else, it is very important to make sure that the carer knows to place your baby on the back to sleep, with no soft bedding (such as pillows, doonas or soft toys), to avoid smoking in your child’s presence and to make sure that baby is sleeping in a safe cot or bassinette. If your child is in a childcare facility ask about their safe sleeping policy, the safety of the cots in use and insist that they avoid using unsafe sleeping practices.

How much clothing/bedding does baby need?
Mar. 26, 2010
Babies control their temperature through the face. Sleeping baby on the back and ensuring that the face and head remains uncovered during sleep is the best way to protect baby from overheating and suffocation.

Sleeping baby in a sleeping bag will prevent bedclothes covering the baby’s face (see Q15). If blankets are being used instead of a sleeping bag, it is best to use layers of lightweight blankets that can be added or removed easily according to the room temperature and which can be tucked underneath the mattress.

When dressing a baby you need to consider where you live, whether you have home heating or cooling and whether it is summer or winter. A useful guide is to dress baby as you would dress yourself – to be comfortably warm, not hot or cold. It is not necessary to leave the heating on all night or to monitor the room temperature with
a thermometer, but ensure that baby is dressed appropriately for the room temperature.

A good way to check baby’s temperature is to feel baby’s chest, which should feel warm (don’t worry if baby’s hands and feet feel cool, this is normal). Another way to prevent overheating is to remove hats or bonnets from baby as soon as you come indoors or enter a warm car, bus or train, even if it means waking the baby.

Alert
Never use electric blankets, wheat bags or hot water bottles for babies.

For more information on this topic, see the SIDS and Kids Information Statement Room Temperature. This statement can be downloaded from the SIDS and Kids website under ‘Current topics’. Alternatively, call your nearest SIDS and Kids office on 1300 308 307 to request a copy to be sent in the mail.

Is formula feeding linked with sudden unexpected death in infancy?
Mar. 26, 2010
No. The peak age of SIDS is the same age that babies are most often immunised (two to four months of age), so by chance they can occur at the same time.

However, there is strong evidence to show that immunisation is not associated with SIDS and that immunised babies are actually at a lower risk, so immunise your baby on time.

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