Baby Sleep Safety: A Practical Guide to Safe Sleep

Sudden infant death syndrome — SIDS — and other sleep-related infant deaths are among the most devastating outcomes a family can face. They are also, in many cases, preventable. The research that has accumulated over the past three decades has identified a clear set of modifiable risk factors, and the safe sleep guidelines developed from that research have contributed to a dramatic reduction in SIDS rates in Australia since the early 1990s.

Understanding why each recommendation exists — rather than just what it says — makes it considerably easier to follow consistently and to explain to the other caregivers, family members, and friends who will put your baby to sleep at various points.

This guide is based on Red Nose Australia's safe sleep recommendations, which represent the current best evidence on reducing the risk of SIDS and sleep-related infant death in Australia. The full guidelines and supporting research are available at rednose.org.au, which is worth bookmarking as your primary reference.

The six safe sleep recommendations

Red Nose Australia's safe sleep guidance is built around six core recommendations. Each one addresses a specific, evidence-identified risk factor.

1. Always place your baby on their back to sleep

Back sleeping is the single most important safe sleep recommendation and the one with the strongest evidence base. The risk of SIDS is significantly higher for babies placed to sleep on their tummy or side compared to babies placed on their back.

This recommendation applies to every sleep — nights, naps, and daytime rests — for the first twelve months of life. It applies regardless of whether the baby seems to prefer another position, and regardless of reflux concerns. For babies with reflux, the evidence still supports back sleeping as the safest position — speak with your GP or paediatrician about reflux management rather than changing sleep position.

Once your baby can roll from back to tummy independently — typically from around four to six months — you don't need to reposition them during the night if they roll onto their tummy. Always start them on their back. Their ability to roll means they have sufficient strength and motor control to manage their airway in this position.

2. Keep the face and head uncovered during sleep

Covering a baby's face and head during sleep increases the risk of overheating and rebreathing exhaled carbon dioxide — both of which are associated with increased SIDS risk.

In practice this means: no blankets that can ride up over your baby's face, no hoods or hats during indoor sleep, and no covers of any kind over the head. If using a blanket, it should be firmly tucked under the mattress at the sides and bottom with the top edge no higher than your baby's chest, leaving their arms free. A fitted sleeping bag or sleep sack eliminates this management entirely and is generally considered safer than loose blankets, particularly for babies who move during sleep.

Head coverings including hats are appropriate outdoors in cold weather but should be removed when you bring your baby inside or into a warm environment.

3. Keep your baby smoke-free before and after birth

Exposure to tobacco smoke is one of the most significant modifiable risk factors for SIDS. The risk applies both to smoking during pregnancy — which affects fetal development in ways that increase SIDS risk — and to exposure after birth, including in the home and car.

This recommendation applies to all smoke exposure, not just direct smoking by the parents. Visitors who smoke should not hold the baby while wearing clothes that smell of smoke, and the home and car should be smoke-free environments. The risk from passive smoke exposure in infants is not trivial and does not disappear with ventilation.

If you or your partner smoke and are finding it difficult to stop, Quitline on 13 7848 provides free, confidential support. Your GP can also provide pharmacological support for quitting.

4. Provide a safe sleeping environment day and night

The sleep surface is the single most practically significant element of safe sleep for most families, because it is the one that most often varies from the recommendations.

The mattress. The sleep surface must be firm and flat. A properly fitted mattress in a bassinet or cot that meets Australian safety standards is the appropriate sleep surface. Soft mattresses, memory foam, and any surface that allows your baby to sink or that moulds around their face increases the risk of suffocation and rebreathing.

The sleep space. The sleeping area should contain only your baby and their sleep surface — a firm, flat mattress with a fitted sheet. Nothing else. No pillows. No cushioning. No bumper pads. No loose bedding. No positional devices or sleep positioners. No soft toys. No comforters. Each of these items introduces the risk of covering the face, overheating, or suffocation.

Unsafe sleep surfaces. Car capsules, prams, bouncers, swings, rockers, baby pods, and infant loungers are not safe sleep surfaces. These products are designed for supervised awake time and transport. If your baby falls asleep in any of these, transfer them to their firm, flat sleep surface as soon as safely possible. The inclined positions of many of these products can compromise airway alignment in sleeping babies.

The temperature. Overheating is an independent risk factor for SIDS. The recommended room temperature for infant sleep is between 16 and 20 degrees Celsius. Signs that a baby is too warm include sweating, flushed skin, and damp hair. Dress your baby in one more layer than you would wear comfortably in the same environment, and avoid electric blankets, heated mattress pads, and excessive clothing.

5. Sleep the baby in their own safe sleeping space in the same room as parents

Room sharing — having your baby sleep in their own bassinet or cot in the same room as their parents — reduces the risk of SIDS compared to sleeping in a separate room. The recommended duration for room sharing is at least the first six months of life and ideally the first twelve months.

The protective mechanism of room sharing is not fully understood but is thought to involve parental awareness of the baby's breathing and arousal patterns, ambient noise and light, and the arousal-promoting effect of being in close proximity to other people.

Room sharing is different from bed sharing. A baby sleeping in a bassinet beside your bed satisfies this recommendation. A baby sleeping in the adult bed does not.

Bed sharing and the evidence

Bed sharing — also called co-sleeping — is one of the most nuanced topics in safe sleep because the evidence exists on a spectrum of risk rather than being uniformly prohibitive.

Red Nose Australia's position is that the safest sleeping environment for babies is their own firm, flat sleep surface in the same room as their parents. Sharing a sleep surface with a baby increases the risk of sleep-related death, and certain factors increase that risk substantially: if either parent smokes, has consumed alcohol or sedating medication, is extremely fatigued, or if the baby was premature or of low birth weight, the risk associated with bed sharing increases significantly.

Many families do bed share, and Red Nose Australia provides detailed guidance on safer practices for families who make this choice rather than simply prohibiting it. If bed sharing is something you are considering or already doing, reading Red Nose Australia's guidance at rednose.org.au is the most important thing you can do.

6. Breastfeeding reduces the risk of SIDS

Breastfeeding is associated with a reduced risk of SIDS, with longer and exclusive breastfeeding associated with greater protection. The mechanism is thought to involve immune factors in breast milk, differences in arousal thresholds between breastfed and formula-fed babies, and the frequent night waking associated with breastfeeding.

This does not mean formula-fed babies are at high risk — the absolute risk of SIDS is low for all babies when other safe sleep practices are followed. It means that if you are breastfeeding, continuing for as long as works for you and your baby provides an additional protective factor.

If breastfeeding is not possible or not your choice, following all other safe sleep recommendations provides strong protection independently.

Commonly asked questions about safe sleep products

Sleeping bags and sleep sacks. Fitted sleeping bags with a neck hole, armholes, and no hood are considered a safe alternative to blankets by Red Nose Australia. They eliminate the risk of blanket migration over the face and are suitable from birth. Choose an appropriate tog rating for the room temperature and season.

Swaddling. Swaddling can reduce the startle reflex that wakes some babies during sleep transitions. If you swaddle, always place a swaddled baby on their back, stop swaddling as soon as your baby shows signs of attempting to roll — typically around three to four months — and ensure the swaddle is not too tight around the chest. Red Nose Australia recommends a hip-healthy swaddle technique that allows the legs to move freely.

Dummies and pacifiers. Using a dummy or pacifier for sleep is associated with a reduced risk of SIDS in research. If your baby uses a dummy, offering it at sleep time is considered safe. You don't need to reinsert it if it falls out during sleep and you don't need to force it if your baby doesn't want it. For breastfeeding mothers, most lactation consultants recommend establishing breastfeeding before introducing a dummy.

Baby monitors. Movement monitors and breathing monitors provide reassurance to some parents but are not recommended by Red Nose Australia as a substitute for safe sleep practices. No monitor has been shown to reduce the risk of SIDS, and false alarms from movement monitors are common. Following the safe sleep recommendations is more protective than any monitoring technology.

Safe sleep away from home

Safe sleep practices need to follow your baby wherever they sleep — not just at home. This includes visits to grandparents, holidays, and childcare.

A travel cot with a firm, flat mattress is an appropriate sleep environment away from home. Soft mattress toppers added to travel cots are not safe. If grandparents or other regular caregivers will be putting your baby to sleep, walking them through the safe sleep recommendations directly — rather than assuming they know — is worth the conversation. Safe sleep guidance has changed significantly in the past two decades and practices that were considered acceptable a generation ago are no longer recommended.

Childcare services in Australia are regulated to follow safe sleep guidelines for all children in their care.

When to get more information or support

Red Nose Australia at rednose.org.au is the authoritative Australian resource for safe sleep information, including detailed guidance on specific situations including premature babies, babies with medical conditions, and families who bed share.

Red Nose also provides support for families who have experienced SIDS or pregnancy and infant loss. If you or someone you know has experienced a loss, Red Nose's bereavement support services are available on 1300 308 307.

Your child and family health nurse is a useful ongoing resource for safe sleep questions as your baby grows and circumstances change.