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SUDDEN UNEXPECTED DEATH IN INFANCY (SUDI) Frequently Asked

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					                       SUDDEN UNEXPECTED DEATH IN INFANCY (SUDI)
                             Frequently Asked Questions

Index
                                                    17. Can babies be put on the tummy to play?
1. How do I contact SIDS and Kids?
                                                    18. Can I prevent my baby getting a flat
2. What does Sudden Unexpected Death in                 pressure spot on the head?
   Infancy mean?
                                                    19. What do I do when baby starts to roll into
3. Can Sudden Unexpected Death in                       the tummy position?
   Infancy be prevented?
                                                    20. Do babies who sleep on the back roll over
4. What are the risk factors for Sudden                 onto the tummy later than babies who don’t
   Unexpected Death in Infancy?                         sleep on the back?

5. How can I reduce the risk of Sudden              21. What is the safest way to sleep twins?
   Unexpected Death in Infancy?
                                                    22. At what age can I introduce cot bumpers
6. Is it safe to sleep baby in a bassinette?            and pillows?

7. What is a safe cot?                              23. Are there specific baby care products that
                                                        reduce the risk of sudden unexpected death
8. What is a safe mattress?                             in infancy?

9. Is it safe to use a second hand mattress?        24. Does SIDS and Kids recommend or
                                                        endorse any baby care products or
10. Does SIDS and Kids recommend                        positional aids?
    mattress wrapping?
                                                    25. Does dummy use reduce the risk of sudden
11. What is a safe sleeping environment?                unexpected death in infancy?

12. Is it safe to wrap/swaddle my baby?             26. Is formula feeding linked with sudden
                                                        unexpected death in infancy?
13. What is a safe infant sleeping bag?
                                                    27. Is immunisation linked with sudden
14. How much clothing/bedding does baby                 unexpected death in infancy?
    need?
                                                    28. Do baby monitors reduce the risk of sudden
15. Is it safe to sleep with my baby?                   unexpected death in infancy?

16. Does sleeping baby on a sofa increase           29. How do I ensure that babysitters and
    the risk of sudden unexpected death in             childcare workers sleep my baby safely?
    infancy?
                                                    30. Check list for safe sleeping


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                         SUDDEN UNEXPECTED DEATH IN INFANCY (SUDI)
                               Frequently Asked Questions

                                                          •     Loose bedding and puffy bedding
1. How do I contact SIDS and Kids?                        •     Sleeping baby with face or head covered
•   Telephone SIDS and Kids in your state or              •     Exposing babies to tobacco smoke before birth
    territory on 1300 308 307;                                  or after
•   Fax 1300 308 317                                      •     Sleeping baby in an unsafe cot or in an unsafe
•   Write to PO Box 9914, in your capital city.                 environment
•   Email SIDS and Kids with your question and
    your area post code on                                5. What steps can I take to reduce the risk of
    librarian@sidsandkids.org                             Sudden Unexpected Death in Infancy?
                                                          The SIDS and Kids Safe Sleeping program teaches
2. What does Sudden Unexpected Death in                   parents how to create a safe sleeping environment
Infancy (SUDI) mean?                                      for babies and young children.
SUDI is a term used to describe the sudden and            1) Put baby on the back to sleep from birth
unexpected death of a baby. SUDI may be the               2) Sleep baby with head and face uncovered
result of a serious illness or a problem that baby        3) Avoid exposing babies to cigarette smoke
may have been born with, but most SUDI deaths                before birth and after
occur as a result of either SIDS (sudden infant           4) Sleep baby in a safe cot and in a safe
death syndrome) or a fatal sleep accident.                   environment
The only way to find out why a baby has died              5) Sleep baby in its own cot or bassinette in the
suddenly and unexpectedly is to perform an                   same room as the parents for the first 6-12
autopsy, review the clinical history and to                  months.
thoroughly investigate the circumstances of
death, including the death scene.                         1. Put baby on the back to sleep, from birth
When no cause can be found for the death it is
called SIDS.                                              The chance of babies dying suddenly and
                                                          unexpectedly is greater if they sleep on their
3. Can Sudden Unexpected Death in Infancy                 tummies or sides.
(SUDI) be prevented?
                                                          Healthy babies placed to sleep on the back are less
Babies who die suddenly and unexpectedly as a             likely to choke on vomit than tummy sleeping
result of a medical problem are probably not              babies. In fact, sleeping baby on the back
preventable. However, scientists have identified          actually provides airway protection.
similar risk factors that are present in SIDS,
SUDI and fatal sleep accidents. By removing               Some babies, with rare medical conditions, might
known risk factors and providing a safe sleeping          have to sleep on the tummy or side but only do this
environment most of these deaths are                      if the baby’s medical practitioner advises to do so in
preventable.                                              writing.

4. What are the risk factors for Sudden                   2. Sleep baby with face uncovered
Unexpected Death in Infancy (SUDI)?
                                                          Ensure that baby’s face and head stays uncovered
•   Sleeping baby on the tummy or side                    during sleep. The best way to achieve this is to use
•   Sleeping baby on a soft surface e.g. soft             a baby sleeping bag (see Q13). However, if you
    mattress, pillow, and waterbed                        decide to use blankets ensure that the baby’s feet
•   Sleeping baby on a sofa (with or without a            are at the bottom of the cot, so that baby can’t slip
    parent)
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                               Frequently Asked Questions

down under the blankets. Use lightweight                 the room with other children probably because the
blankets that can be tucked in securely.                 children do not know if the baby is safe or not.
                                                         Recent evidence from the UK indicates that sharing
Alert                                                    the same room during baby’s daytime sleeps is also
Puffy items in a baby’s sleeping environment can         protective.
increase the risk of sudden unexpected infant
death. It is best to remove quilts, doonas, duvets,      6. Is it safe to sleep baby in a bassinette?
pillows, cot bumpers, lambs wool and fluffy toys.        Although there is no reason why a baby cannot
                                                         sleep in a cot from birth, many parents choose to
                                                         use a bassinette. Unlike cots there is no Australian
3. Avoid exposing baby to tobacco smoke                  Standard for bassinettes. However, we are not
before birth and after.                                  aware of any evidence to show that sleeping a baby
                                                         in a bassinette is harmful, providing that the safe
Babies who are exposed to tobacco toxins during          sleeping guidelines are followed.
pregnancy or after birth have a significantly
                                                         When using a bassinette ensure that it has a wide
higher risk of SIDS and the risk increases if a
                                                         stable base, is placed on a stable surface, and that
baby sleeps with a parent who is a smoker.
                                                         a safe mattress is used (see Q8). Make sure baby
These risks still remain even if parents smoke
                                                         sleeps on the back with face uncovered. It may be
outside, away from their baby.
                                                         better to use an infant sleeping bag (see Q13) when
To reduce the risk of SIDS don’t let anyone              using a bassinette, as it may be difficult to tuck
smoke near your baby – not in the house, the car         blankets under the mattress (see Q5.2).
or anywhere else that your baby spends time.
                                                         7. What is a safe cot?
If you want to quit smoking and you’re not finding
it easy, ask for help. Call the Quit line on 131 848     A safe cot is one that meets the Australian Standard
or ask your doctor, midwife or child health nurse        for cots. All new and second-hand cots sold in
for information and advice.                              Australia must meet the Australian Standard for
                                                         Cots (AS 2172) and will carry a label to say so. If
4. Sleep baby in a safe cot, with a safe                 you are planning to use a second-hand cot, check
mattress and in a safe environment.                      that it meets those standards.
                                                         Alert
Cots, mattresses and environments that are               Old or second hand cots may be dangerous for the
unsafe increase the risk of sudden unexpected            following reasons:
infant death. For information about safe cots,           • Wobbly or broken parts that make the cot weak
mattresses and environments see Q 6 –10.
                                                         • Gaps where a toddler or baby may get caught in
                                                         • Knobs, corner posts or exposed bolts that can
5. Sleeping baby in a cot next to the parent’s                hook onto a toddler or baby’s clothing around
bed for the first six to twelve months.                       the neck
                                                         • Sides that are too low and can be climbed over
Research in New Zealand and the UK has                        by active little toddlers
shown that sleeping baby in the same room, but           • Sharp catches or holes in the wood that can
not in the same bed, with the parents in the first            hurt curious little fingers
six to twelve months of life is protective. This is
                                                         • Paint that might contain poisonous lead
thought to be because parents can see the baby
and easily check to see that baby is safe. This
protective effect does not work if the baby is in

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                               Frequently Asked Questions

Rocking cots                                             Remove plastic packaging from the mattress and
                                                         always make sure that the waterproof mattress
Babies can become trapped in a tilted rocking-
                                                         protector is strong and a tight fit. Never put soft
cot or cradle. If you have a cradle or cot that
                                                         bedding under the bottom sheet as this makes the
rocks and has a child-resistant locking pin, make
                                                         sleeping surface too soft.
sure you secure the locking pin firmly in place
whenever you leave your baby and double check            Alert
it to make sure the cradle cannot move when you          A pillow, cushion or sofa is not a safe mattress as
are not there to supervise.                              they are too soft and increase the risk of sudden
                                                         unexpected infant death.
Portable cots
Only use the firm, well-fitting mattress that is
supplied with the portacot. Never add a second           9. Is it safe to use a second hand mattress?
mattress or additional padding under or over the         There has been recent media attention in relation to
mattress, which has been specifically designed           a theory that there may be a link between SIDS and
for the portacot, as baby can get trapped face           a certain bacteria found in secondhand mattresses.
down in gaps between the mattress and the
sides. Portable cots have a different Australian         However, the bacteria in question are normally
Standard to cots. If you use a portable cot              found on the skin and in the nose and throats of
ensure that it meets Australian Standard AS              healthy adults and infants. There is no evidence to
2195 and that it carries a label to say so.              show that there is an increased risk of SIDS for
                                                         babies who sleep on a second hand mattress
For a guide to cot and nursery furniture safety,         providing that baby:
visit the Australian Competition and Consumer             • Sleeps on the back
Commission (ACCC) website at
                                                          • Sleeps on a firm, clean, well fitting mattress that
http://www.accc.gov.au/content/index.phtml/itemI
                                                             is in good condition
d/655340 for the publication 'Keeping Baby
Safe'. Alternatively, phone the ACCC Information          • Sleeps with no bedding covering the face or
centre on 1300 302 502 to order a copy which                 head
can be mailed to you.                                     • Is not exposed to tobacco toxins before birth or
                                                             after

8. What is a safe mattress?                              For more information on this topic, see the SIDS
                                                         and Kids Information Statement Bed Bugs-
A safe mattress is one that is the right size for        Secondhand mattresses. This statement can be
the cot, is firm, clean and in good condition. A         downloaded from the SIDS and Kids website.
soft mattress can increase the risk of sudden            Alternatively, call your nearest SIDS and Kids office
unexpected infant death if baby rolls over onto          on 1300 308 307 to request a copy to be sent in the
the tummy.                                               mail.
A baby or toddler can get stuck in gaps between
a poor fitting mattress and the cot sides. This is
especially dangerous if their face is trapped and        10. Does SIDS and Kids recommend polythene
covered, or their neck is restricted in any way.         mattress wrapping?
Make sure there is no more than a 25mm (1                NO. Wrapping a baby’s mattress with polythene has
inch) gap between the mattress and the cot               been suggested as means of preventing SIDS. The
sides.                                                   theory proposes that cot mattresses emit toxic


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                         SUDDEN UNEXPECTED DEATH IN INFANCY (SUDI)
                               Frequently Asked Questions

gases and that wrapping the mattress will               Research shows that one of the best ways to
prevent SIDS.                                           reduce the risk of SIDS and SUDI is to sleep baby
                                                        on the back. However, some babies have difficulty
This theory has been thoroughly investigated
                                                        settling and staying asleep whilst on their back. For
through rigorously conducted, scientifically based
                                                        these babies wrapping can be a useful method to
research and there is no evidence to support the
                                                        assist them to settle and stay asleep as wrapping
link between wrapping mattresses and the
                                                        has been shown to reduce crying time and episodes
prevention of SIDS.
                                                        of waking. Wrapping has also been shown to
                                                        provide stability, which may help to keep babies in
11. What is a safe sleeping environment?
                                                        the recommended back position.
A safe sleeping environment means that all
potential dangers have been removed and the             Alert
baby is sleeping in a safe place. The ideal place       Tummy sleeping increases the risk of SIDS and
for a baby to sleep is in a safe cot, with a safe       must be avoided. Wrapping a baby in the tummy
mattress, safe bedding and in a safe                    position is even more dangerous as it prevents
environment (see Q 6-9). Other things to look out       baby moving to a position of safety.
for include:
Dangling cords or string
Keep the cot away from any cords hanging from           When wrapping a baby:
blinds, curtains or electrical appliances as they       •     Ensure that baby is positioned on the back with
could get caught around baby’s neck. Keep                     the feet at the bottom of the cot.
decorative mobiles out of the reach of curious
                                                        •     Ensure that baby is wrapped from below the
little hands and mouths.
                                                              neck to avoid covering the face.
Heaters and electrical appliances                       •     Sleep baby with face uncovered (no doonas,
Keep heaters or any electrical appliances well                pillows, cot bumpers, lambs wool or soft toys in
away from the cot to avoid the risk of                        the sleeping environment).
overheating, burns and electrocution. A baby            •     Use only lightweight wraps such as cotton or
cannot escape from a heat source to cool down                 muslin (bunny rugs and blankets are not safe
and does not know how to remove bedclothes.                   alternatives as they may cause overheating)
                                                        •     The wrap should not be too tight as this may
Alert                                                         interfere with physical development
Never use electric blankets, hot water bottles or
                                                        •     Make sure that baby is not over dressed under
wheat bags for babies or young children.
                                                              the wrap. Use only nappy and Singlet in warmer
                                                              weather and add a lightweight grow suit in
Prams, strollers and bouncers where restraints                cooler weather.
are not done up
Always do up the restraints when baby is in a
                                                        Alert
pram, stroller, bouncer or any other baby/toddler
                                                        Babies must not be wrapped if sharing a sleep
equipment. It can be dangerous if baby becomes
                                                        surface with another person (see Q15).
tangled in loose restraints that are not fastened
correctly.
                                                        Most babies eventually resist being wrapped. This
Make sure the footrest on the stroller is strong        is usually around the age of six months. An
and secure. A weak footrest can give way and            alternative to wrapping is to use a safe infant
cause baby to become trapped.                           sleeping bag (see Q13).

12. Is it safe to wrap/swaddle my baby?

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                         SUDDEN UNEXPECTED DEATH IN INFANCY (SUDI)
                               Frequently Asked Questions

For more information on this topic, see the SIDS       according to the room temperature and which can
and Kids Information statement Wrapping                be tucked underneath the mattress.
Infants. This statement can be downloaded from         When dressing a baby you need to consider where
the SIDS and Kids website. Alternatively, call         you live, whether you have home heating or cooling
your nearest SIDS and Kids office on                   and whether it is summer or winter. A useful guide
1300 308 307 to request a copy to be sent in the       is to dress baby as you would dress yourself – to be
mail.                                                  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,
13. What is a safe infant sleeping bag?                but ensure that baby is dressed appropriately for
A safe infant sleeping bag is constructed in such      the room temperature.
a way that the baby cannot slip inside the bag         A good way to check baby’s temperature is to feel
and become completely covered. The sleeping            baby’s chest, which should feel warm (don’t worry if
bag should be the correct size for the baby with a     baby’s hands and feet feel cool, this is normal).
fitted neck, armholes (or sleeves) and no hood.
                                                       Another way to prevent overheating is to remove
When using a sleeping bag ensure that the baby         hats or bonnets from baby as soon as you come
is dressed according to the room temperature           indoors or enter a warm car, bus or train, even if it
and do not use blankets. Dress your baby in            means waking the baby.
layers of clothing within the sleeping bag to keep
baby warm (see Q14).                                   Alert
                                                       Never use electric blankets, wheat bags or hot
Benefits of sleeping bags                              water bottles for babies.
•   Evidence suggests that sleeping bags may
    assist in reducing the incidence of SUDI,
    SIDS and fatal sleep accidents, possibly           15. Is it safe to sleep with my baby?
    because they delay the baby rolling in to the      Sharing a sleep surface with a baby increases the
    high-risk tummy position and also because          risk of SUDI, SIDS and fatal sleep accidents in
    they eliminate the need for bedding.               some circumstances. SIDS and Kids recommends
•   Sleeping bags keep baby warm as there are          sleeping a baby in its own safe sleeping
    no blankets to kick off.                           environment next to the parents’ bed for the first six
•   Sleeping bags prevent legs from dangling out       to twelve months of life as this has been shown to
    or the cot rails.                                  be protective.
14. How much clothing/bedding does baby                There appears to be no increased risk of SUDI,
need?                                                  SIDS or fatal sleep accidents whilst sharing a sleep
                                                       surface with a baby during feeding, cuddling and
Babies control their temperature through the           playing, providing that the baby is returned to its
face. Sleeping baby on the back and ensuring           own safe sleeping surface before the parent goes to
that the face and head remains uncovered during        sleep.
sleep is the best way to protect baby from
overheating and suffocation.                           Babies who are most at risk of SUDI, SIDS or sleep
                                                       accidents whilst sharing a sleep surface, are babies
Sleeping baby in a sleeping bag will prevent           who are less than four months of age and babies
bedclothes covering the baby’s face (see Q13).         who are born pre-term or small for gestational age.
If blankets are being used instead of a sleeping       Most studies show that SUDI and SIDS deaths
bag, it is best to use layers of lightweight           attributable to sharing a sleep surface are
blankets that can be added or removed easily
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                         SUDDEN UNEXPECTED DEATH IN INFANCY (SUDI)
                               Frequently Asked Questions

predominantly amongst babies whose parents              •     Put baby on the back to sleep (not on the
smoke.                                                        tummy or side)
However, there is a slightly increased risk of          •     Make sure the mattress is firm
SIDS among babies of non-smoking mothers                •     Sleep baby in a baby sleeping bag to avoid
who bed share with infants less than 11 weeks of              bedclothes (see Q13)
age.                                                    •     Make sure that any bedding cannot cover the
                                                              baby’s face. Keep pillows, doonas and any
Sharing a sleep surface with a baby may also                  other soft bedding well away from the baby
increase the risk of a fatal sleep accident as          •     Do not wrap the baby (see Q12)
some sleeping environments contain hazards              •     Place the baby at the side of one parent - not in
that can be fatal for babies. These risks include             between two parents, as this would increase the
overlaying of the baby by another individual;                 likelihood of the baby becoming covered or
entrapment or wedging and suffocation from                    slipping underneath adult bedding
pillows and blankets.
                                                        •     Ensure that the baby is not close to the edge of
                                                              the bed where he/she can fall off. Do not place
Alert                                                         pillows at the side of the baby to prevent rolling
Never fall asleep with baby lying on its tummy on             off. A safer alternative is to place the adult
your chest.                                                   mattress on the floor.
                                                        •     Pushing the bed up against the wall can be
                                                              hazardous as baby may become trapped.
Do not share a sleep surface with a baby if:
•   You are a smoker                                    Alert
•   You are under the influence of alcohol or           Never sleep baby on a soft mattress, sofa,
    drugs that cause sedation                           beanbag, or waterbed with or without a parent as
•   You are excessively tired.                          there is a very high risk of a sleep accident.
•   Other children are sharing the bed with a
    baby                                                For more information on this topic, see the SIDS
•   The baby could slip under bedding e.g.              and Kids Information Statement Bed sharing. This
    pillows and duvets or doonas                        statement can be downloaded from the SIDS and
•   The bed is a waterbed or if the mattress is         Kids website. Alternatively, call your nearest SIDS
    too soft                                            and Kids office on 1300 308 307 to request a copy
•   The sleep surface is a sofa or chair                to be sent to you by mail.
•   Baby could become trapped between the bed
    and the wall or the bed rails                       16. Does sleeping with baby on a sofa increase
                                                        the risk of sudden unexpected death in infancy?
•   Baby may fall off the bed
                                                        Yes. There is a very high risk of a sleeping accident
Important considerations when choosing to               if an adult falls asleep with an infant on a sofa. This
share a sleep surface with a baby                       is because baby may become wedged into
                                                        cushions or the back of the sofa and the sleeping
When choosing to share a sleep surface with a           person would not notice. Put baby back into his or
baby it is important to consider the sleeping           her own sleeping place before you doze off on a
environment. Babies are at the greatest risk if         sofa.
they sleep on their tummies or sides and if their
faces become covered. Taking measures to
prevent these situations will reduce the risk of
SIDS and fatal sleeping accidents.
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                          SUDDEN UNEXPECTED DEATH IN INFANCY (SUDI)
                                Frequently Asked Questions

Alert                                                           Changing the position of the cot in the room
Never fall asleep with baby on your chest whilst                may also have the same effect.
lying down as this is the same as sleeping the            •     When the baby is awake, minimise the time that
baby in the tummy position.                                     baby spends lying down with pressure on the
                                                                same part of the head. Carry and cuddle baby in
17. Can babies be put on the tummy to play?                     upright positions.
Yes. Tummy play is safe and very important for
                                                          •     Avoid prolonged periods in car seats, strollers,
babies from birth, but only when they are awake                 swings and bouncers as this places additional
and an adult is present. Tummy play helps                       pressure on the back of the head.
muscle development in the arms, neck and back             •     From birth, give baby increasing amounts of
and prepares babies for crawling. Tummy play is                 side lying and tummy time to play when awake
also very good to help prevent a misshapen                      and being observed by an adult but never put
head (see Q18) but remember not to put baby on                  baby on the side or tummy to sleep.
the tummy to sleep.                                       •     Alternate the holding position when feeding
                                                                baby i.e. hold in left arm for one feed and the
18. Can I prevent my baby getting a flat                        right arm for the next feed.
pressure spot on the head?                                A small number of babies can develop positional
Flat ‘pressure’ spots can develop if a baby lies in       plagiocephaly as a result of tight muscles on one
one position on the head for long periods of time         side of the neck, a condition known as torticollis or
and are sometimes referred to as positional               wryneck. If the baby has a strong preference for
plagiocephaly. These flat spots tend to improve           turning the head to one side, or has difficulty turning
with age and most will disappear completely as            the head please consult a doctor who can then
baby’s head grows and when baby starts to sit             arrange physiotherapy treatment.
up and look around.                                       Remember, always put baby on the back to sleep
                                                          and keep baby off the back of the head as much as
However, in some babies these flat spots can              possible when awake.
persist. A small number of babies with severe
flattening require fitting with a specially designed
                                                          Alert
helmet to help reshape the head. This is very
rare.                                                     Positional devices that restrict the movement of a
                                                          baby or the baby’s head are not recommended.
Prevention and treatment
Positional plagiocephaly may be prevented or
treated by simple repositioning techniques and            For more information on this topic, see the SIDS and
                                                          Kids Information Statement Plagiocephaly. This
by minimising pressure on the head when baby
                                                          statement can be downloaded from the SIDS and Kids
is awake. It is best to implement these simple
                                                          website. Alternatively, call your nearest SIDS and Kids
measures from birth.
                                                          office on 1300 308 307 to request a copy to be sent
•   Always sleep baby on the back, not on the             to you by mail.
    tummy or side.
•   Alternate the head position each time baby
    goes down to sleep (left and right).                  19. What do I do when baby starts to roll into the
•   As babies become more alert and interested            tummy position?
    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.
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                         SUDDEN UNEXPECTED DEATH IN INFANCY (SUDI)
                               Frequently Asked Questions

Most SIDS occurs under 6 months of age so try           20. Do babies who sleep on the back roll over
not to have baby sleep on the tummy before this         onto the tummy later than babies who don’t
time.                                                   sleep on the back?
Most back-sleeping babies can’t actually roll onto      Yes. Babies who sleep on the back tend to roll over
the tummy by themselves until about 5-6 months          onto the tummy later than side sleeping infants.
of age although a few can roll from a younger           This is probably why the back sleeping position
age.                                                    reduces the risk of SIDS, because baby does not
                                                        roll in to the high-risk tummy position until most of
Babies who sleep on their back tend to roll onto
                                                        the risk of SIDS has passed. The delay in rolling is
their tummy later than side sleeping infants. This
                                                        normal and does not affect baby’s later
probably plays a part in why the back position is
                                                        development. For example, these babies show no
safer for babies as they do not roll into the high-
                                                        difference in their walking ability at 18 months of
risk tummy position during a vulnerable period of
                                                        age compared to babies who slept on the side or
development. The delay in rolling is normal and
                                                        tummy.
does not affect the baby’s later development.
                                                        It is very good to encourage babies to play on the
Steps to follow when babies start to roll on to the
                                                        tummy as it helps to develop their strength and
tummy
                                                        prepare them for crawling. But remember not to put
• Give baby extra tummy time to play when               baby on the tummy to sleep.
   awake and supervised as this helps baby to
   develop stronger neck and upper body                 21. What is the safest way to sleep twins?
   muscles which in turn enables them to roll
   back over. It is best to start giving baby           Research has not yet provided a conclusive answer
   supervised tummy time from birth (see Q17)           to the question, ‘should twins sleep in their own
• Consider using an infant sleeping bag as              separate cots or together in the one cot?’ Some
   these can delay rolling over (see Q13)               research on twins in Neonatal Intensive Care
• If you use blankets rather than a sleeping            suggests a weaker twin may benefit if slept with the
   bag, make sure that the baby’s feet are              stronger twin.
   touching the bottom of the cot to prevent            However, it would be dangerous if the arms of one
   baby wriggling under the blankets and tuck           twin were able to accidentally cover the face of the
   the blankets in securely.                            other, causing an interference with breathing.
• Make sure that baby is on a firm and well             The safest way to sleep twins is to place them in
   fitting mattress.                                    their own cot following the steps to safe sleeping
• Make sure that baby’s face and head                   (see Q5).
   remains uncovered (avoid lambs wool,
   duvets, pillows, cot bumpers and soft toys)          However, if you are planning to sleep twins in the
                                                        same cot, it is best to place each twin in a separate
As babies grow and develop they become very             sleeping bag at opposite ends of the cot (feet-to-
active and learn to roll around the cot. At this        feet) as this will minimise the risk of one twin
time still put them on the back in the cot but let      covering the face of the other and eliminates the
them find their own position of comfort. By this        need for blankets (see Q13).
stage it is not necessary to wake during the night
to turn baby over to the back position.                 When the babies are able to move freely around the
Remember to reduce the risks in other ways (see         cot, put them to sleep in separate cots.
Q5).




                                                                                                               9
                                               October 2006
                            SUDDEN UNEXPECTED DEATH IN INFANCY (SUDI)
                                  Frequently Asked Questions

22. At what age can I introduce cot bumpers                   25. Does dummy use reduce the risk of sudden
and pillows?                                                  unexpected death in infancy?
Soft, puffy bedding such as pillows quilts duvets             Research suggests that dummy (pacifier) use may
and bumpers increase the risk of sudden                       have a protective effect against SIDS.
unexpected infant death. They may cover the
                                                              However, other research shows that dummy use
baby’s face and obstruct breathing or cause
                                                              can interfere with breastfeeding and increase the
overheating. Older babies in a cot can be at an
                                                              risk of ear infections. Parents are advised to weigh
increased risk of a sleeping accident by using
                                                              up these issues before deciding about dummy use
pillows and bumpers as a step to climb up and
                                                              for their baby.
fall out of the cot. It is safer to wait until the child
starts to sleep in a bed before introducing a                 While there are questions still being asked about
pillow or puffy bedding.                                      the pros and cons of dummy use, there is no
                                                              question about the effectiveness of the Safe
                                                              Sleeping program.
23. Are there specific baby care products that
reduce the risk of sudden unexpected death                    Sleeping a baby on the back, with face uncovered,
in infancy?                                                   and in a smoke free environment is the best way to
                                                              protect a baby from sudden and unexpected infant
There is no scientific research evidence that has
                                                              death.
convinced SIDS and Kids that any specific baby
care product reduces the risk of SIDS.                        Until there is more conclusive evidence about the
                                                              protective effect of dummies, SIDS and Kids makes
24. Does SIDS and Kids recommend or                           no recommendation about dummy use at this stage.
endorse any baby products or positional
aids?                                                         For more information on this topic, see the SIDS
NO. SIDS and Kids does not recommend or                       and Kids Information Statement Pacifier/dummy
endorse any baby care products. This includes                 use. This statement can be downloaded from the
positional aids for babies such as anti-roll                  SIDS and Kids website. Alternatively, call your
devices and items that fasten a baby in position.             nearest SIDS and Kids office on 1300 308 307 to
However, SIDS and Kids may license some                       request a copy to be sent to you by mail.
products for fundraising purposes only. SIDS and
kids only promotes and encourages practices
that are based on strong scientific evidence and              26. Is formula feeding linked with sudden
where effectiveness and safety have been                      unexpected death in infancy?
proven.                                                       There is no consistent evidence that formula
There is strong scientific evidence to show that              feeding increases the risk of SIDS or that
the best way to reduce the risk of SIDS and                   breastfeeding reduces the risk of SIDS. However,
sleep accidents is to sleep babies on their back              SIDS and Kids recommends breastfeeding as there
with face and head uncovered, to avoid exposing               is strong evidence to show that breastfed babies
babies to tobacco toxins and to provide a safe                have fewer infections and that breastfeeding lowers
sleeping environment.                                         infant mortality.




                                                                                                                  10
                                                     October 2006
                          SUDDEN UNEXPECTED DEATH IN INFANCY (SUDI)
                                Frequently Asked Questions

27. Is immunisation linked with sudden                    31. Checklist for safe sleeping
unexpected death in infancy?
No. The peak age of SIDS is the same age that             1. Has baby been placed on the back to sleep?
babies are most often immunised (two to four              2. Is baby sleeping in a safe bassinette or cot, and
months of age), so by chance they can occur at                away from hazards?
the same time.                                            3. Does the cot meet Australian Standard for cots?
                                                          4. Is the mattress firm?
However, there is strong evidence to show that            5. Does the mattress fit the cot /bassinette well?
immunisation is not associated with SIDS and              6. Is the mattress clean and in good condition?
that immunised babies are actually at a lower             7. Is baby’s face and head uncovered?
risk, so immunise your baby on time.                      8. Have any pillows, duvets, lambs wool, cot
                                                              bumpers and soft toys been removed?
28. Do baby monitors reduce the risk of                   9. If using a baby sleeping bag, does it have a
sudden unexpected death in infancy?                           fitted neck, armholes or sleeves and no hood?
There is no scientific evidence that electronic           10. If using blankets rather than a sleeping bag, has
baby monitors are of any assistance in                        baby been placed to sleep with feet touching the
preventing SIDS and have played no part in the                bottom of the cot /bassinette with blankets
dramatic reduction in SIDS deaths in Australia.               securely tucked in?
                                                          11. Is baby having tummy time to play when awake
The reduction in the number of babies dying of                and supervised?
SIDS has come about because parents have                  12. If you are a smoker have you stopped smoking
been made aware of ways to sleep baby safely                  or contacted your doctor or Quit line for help?
such as placing baby on the back to sleep from            13. Remember never to sleep baby on a sofa,
birth, sleeping baby with face uncovered, not                 beanbag, waterbed or pillow?
smoking during pregnancy or after the birth, and          14. Are other family members aware of how to sleep
by providing a safe sleeping environment.                     baby safely?

29. How do I ensure that babysitters and                  Keeping the FAQ up to date
childcare workers sleep my baby safely?                   The Safe Sleeping program is based on strong
                                                          scientific evidence using the recommendations laid
If babies are ever placed on their tummy to sleep
                                                          down by the National Health and Medical Research
they are at a significantly higher risk of SIDS.
                                                          Council of Australia, and was developed by
When ever you leave your child in the care of
                                                          Australian SIDS researchers, paediatricians,
someone else, it is very important to make sure
                                                          pathologists, and child health experts with input
that the carer knows to place your baby on the
                                                          from overseas researchers and clinical experts.
back to sleep, with no soft bedding (such as
pillows, doonas or soft toys), to avoid smoking in        The FAQ sheet is subject to change by SIDS and
your child’s presence and to make sure that baby          Kids as new research comes to light. To ensure that
is sleeping in a safe cot or bassinette.                  you have the latest edition of the FAQ sheet check
                                                          the SIDS and Kids web site www.sidsandkids.org
If your child is in a childcare facility ask about
their safe sleeping policy, the safety of the cots in     While every effort will be made to keep the FAQ up
use and insist that they avoid using unsafe               to date and to ensure that the information contained
sleeping practices.                                       in it is accurate, SIDS and Kids cannot be held
                                                          responsible for how readers make use of or
                                                          understand the information contained in the FAQ.



                                                                                                            11
                                                 October 2006

				
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Description: SUDDEN UNEXPECTED DEATH IN INFANCY (SUDI) Frequently Asked