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Sleeping danger: Know the risk of SIDS

 
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Despite the best efforts of public health campaigners, about 1 in 3,000 Australian babies will die unexpectedly in their sleep this year.

The Red Nose charity has campaigned for decades to reduce preventable deaths due to Sudden Infant Death Syndrome (SIDS) and the broader category Sudden Unexpected Death in Infancy (SUDI), which includes sleep deaths due to suffocation.

Understand the risks

A recently published study conducted in Queensland found that 4 out of 5 early childhood education and care services attended by researchers did not follow at least one Red Nose safe-sleeping guideline.

Educators told researchers they knew their service’s policies and procedures on sleep and rest and understood how the National Law and National Regulations applied.

More than 70% of services had a copy of the safe-sleep guidelines on display in or near the infant sleep room.

Yet in almost half of the breaches of the safe-sleep guidelines, educators were observed placing babies on their sides or tummies to sleep—against the primary recommendation to sleep babies on their backs.

Dr Sally Staton, a development psychologist and research fellow at the University of Queensland, was one of the authors of the study.

Dr Staton said the researchers identified a gap between what educators reported knowing and what they were seen doing.

The statistic ‘1 in 3,000 Australian babies’ is hard to visualise.

According to Red Nose, it translates to about 130 Australian babies every year dying unexpectedly in their sleep.

Understand the importance of safe-sleep guidelines

The medical evidence from decades of SIDS research and coronial inquiries is clear: in many cases, educators and carers can help prevent SIDS by following the first 4 of the 6 Red Nose safe sleep recommendations in its Safe Sleeping brochure:

  • sleep baby on their back
  • keep baby’s head and face uncovered
  • do not smoke around baby
  • ensure a safe-sleeping environment

Ensuring centres equip their staff with high quality training in line with the Red Nose recommendations will help protect babies and children in care and reduce the risk of SIDS.

'The main thing is to make sure babies have adequate airflow and that their airways are extended, which allows them to breathe,' Dr Staton said.

'For this reason, it is important that babies are not left to sleep in car seats and rockers as they are not flat sleeping surfaces.'

Explain your service’s policies to parents

Services can expect that some parents will have personal or cultural preferences that may not align with the Red Nose recommendations. These preferences might include the use of an amber teething necklace or swaddling for older babies.

It is vital that educators remove any necklaces, ties or bows from around the neck of a sleeping baby as they could tighten during sleep and make breathing difficult.

Many parents will recognise that wrapping or swaddling is a useful way of helping baby settle and stay asleep. It has also been shown to improve the baby’s stability and may help them remain on their back.

But when choosing to wrap a baby, educators must consider the baby’s stage of development. It is very important to discontinue wrapping as soon as baby starts showing signs that they can begin to roll. This is usually when the baby is between 4 and 6 months of age but it can begin when they are younger. Educators must never wrap a baby who is also being placed in a safe-sleeping bag.

When showing new parents around the centre, take the time to explain your service’s policies and procedures around infant sleep—especially back sleeping—and assure them the babies will practice tummy time when they are awake.

Educators must be allowed to speak frankly with their leader or supervisor about any concerns surrounding sleep practices, especially any pressure from parents to deviate from procedures.

'It is very important that educators are supported by their service director or education leaders in their conversations with parents about sleep practices,' Dr Staton said.

Approved providers and educators must follow the Red Nose safe sleeping guidelines, even when a child’s parents request otherwise. The requirements under section 167 of the National Law cannot be avoided by an agreement with parents.

Approved providers, nominated supervisors and family day care educators have a legal responsibility to ensure every reasonable precaution is taken to protect children from harm and hazard under section 167 of the National Law. Following the safe sleeping guidelines developed by Red Nose will support compliance with that requirement.

The only situation in which safe sleeping practice may be modified is when the parents have a certificate from their doctor.

If a baby’s doctor recommends in writing that a baby sleep on their tummy or side, the service might consider conducting a risk assessment and formulating a risk minimisation plan for that baby.

Consider the physical environment

The physical design of the sleep environment plays a large part in educators’ ability to supervise and safeguard sleeping infants.

Can educators view sleeping babies through an unobstructed window or a convex mirror while they sleep? Is the room temperature warm enough for comfort yet cool enough to prevent overheating?

Babies must sleep in cots that meet Australian safety standards and that are regularly maintained and checked for damage. Mattresses must be firm, flat, clean and in good condition and, importantly, they must be the right size for the cot and not result in any gaps around the sides of the mattress/cot.

Red Nose recommends that portacots must meet the Australian Safety Standard, and must be used in accordance with the manufacturer’s instructions with no additional padding added. The use of portacots is also limited for use by a child of no more than 15kg in weight.

The Australian Competition and Consumer Commission has compiled some information about the use of portacots. Specifically, they advise that these cots are subject to more wear and tear due to folding and are generally less robust than permanent sleeping enclosures such as household cots. Educators must therefore be extra vigilant in checking that portacots are in good working order with no rips, tears or other damage before use. 

Educators must never put babies to sleep on mats or mattresses on the floor. Red Nose provides guidance around the transition of a child from a cot to a bed or a mattress on the floor. There are very specific circumstances and measures that need to be put in place for when children (not babies) are able to use a mattress on the floor. See the Red Nose brochure Cot to Bed Safety.

For more advice on building design and bedding, see the department’s webpage Sleep and rest physical environment considerations and the Australian Competition and Consumer Commission brochure Keeping baby safe (PDF, 4MB).

Read our excellent resources on sleep and rest

The department has a comprehensive collection of sleep learning resources for early childhood professionals, including fact sheets, practice examples and podcasts. This collection of resources was developed in co-operation with University of Queensland research fellow Dr Sally Staton.

It is essential for approved providers and educators to stay current about the latest findings in regard to safe sleep practices. You can do that by regularly accessing the Red Nose website.

Sources

  • Red Nose Education resources
  • Staton S., Pattinson C., Smith S., Pease A., Blair P., Young J., Irvine S. and Thorpe K, 2019, ‘Observed compliance with safe sleeping guidelines in licensed childcare services’, Archives of Disease in Childhood, published online first: 12 July 2019. doi: 10.1136/archdischild-2019-317000

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Last updated 13 December 2019