SIDS: reducing the risk

by | Babies and Pregnancy

Research has found some important ways to reduce the risk of sudden infant death and create a safe sleeping environment for babies.

1. Sleep baby on the back from birth, not on the tummy or side

The chance of babies dying suddenly and unexpectedly is greater if they sleep on their tummies or sides.

Healthy babies placed to sleep on the back are less likely to choke on vomit than tummy sleeping babies. In fact, sleeping baby on the back actually provides airway protection.

Some babies, with rare medical conditions, might have to sleep on the tummy or side but only do this if the baby’s medical practitioner advises to do so in writing.

SIDS sleep baby on back

2. Sleep baby with head and face uncovered

Ensure that baby’s face and head stays uncovered during sleep. A good way to achieve this is to use a safe baby sleeping bag (a safe baby sleeping bag is designed especially for baby and has fitted neck and armholes and no hood). If you decide to use blankets, ensure that the baby’s feet are at the bottom of the cot to reduce the risk of baby slipping down under the blankets. Use lightweight blankets that can be tucked in securely.

Soft items in a baby’s sleeping environment can increase the risk of sudden unexpected infant death. Remove quilts, doonas, duvets, pillows, cot bumpers, lambswool and fluffy toys.

When baby is put to sleep, check that:

  • Baby’s feet are positioned at the bottom of the cot
  • Bedclothes are tucked in securely so bedding is not loose, or place baby in a safe sleeping bag
  • Head coverings are removed before baby is placed for sleep
  • There are no doonas, quilts, loose bedding or fabric, pillows, lambswool, bumpers or soft toys in the cot

3. Keep baby smoke free before birth and after

Babies who are exposed to tobacco toxins during pregnancy or after birth have a significantly higher risk of sudden infant death and the risk increases if a baby sleeps with a parent who is a smoker. These risks still remain even if parents smoke outside, away from their baby.

To reduce the risk of sudden unexpected infant death, don’t let anyone smoke near your baby – not in the house, the car or anywhere else that your baby spends time.

If you want to quit smoking and you’re not finding it easy, ask for help. Call the Quitline on 13 7848 or ask your doctor, midwife or child health nurse for information and advice.

4. Provide a safe sleeping environment night and day (safe cot, safe mattress, safe bedding)

Cots, mattresses and environments that are unsafe increase the risk of sudden unexpected infant death.

5. Sleep baby in their own safe sleeping place in the same room as an adult caregiver for the first six to twelve months

Research has shown that sleeping baby in the same room, but not in the same bed, with the parents in the first six to twelve months of life reduces baby’s risk of SUDI. The protective effect of room sharing can be partially explained by increased adult supervision and observation of the baby This protective effect does not work if the baby is in the room with other children, probably because the children do not know if the baby is safe or not. Research also shows that sharing the same room during baby’s daytime sleeps is protective.

A bassinette or portable cot which has been specifically designed as an infant sleeping environment can be used for daytime sleeps and moved from room to room for adult supervision. If this is not possible, safety of the baby’s sleep environment should be viewed as a priority over sharing the same room as baby for daytime sleeps.

6. Breastfeed baby

Breastfeeding is the optimal source of nutrition for a baby, with many benefits for both mother and baby. Breastfeeding has been shown to reduce the risk of Sudden Unexpected Death in Infancy (SUDI).

Red Nose recommends that babies are breastfed. Red Nose also supports parents who bottle feed their babies through the other five evidence-based strategies that they can use to reduce the risk of Sudden Unexpected Deaths in Infancy.

  • Breastfeeding is the optimal form of nutrition for babies
  • Breastfeeding has multiple benefits for both babies and mothers
  • Breastfeeding has been demonstrated to reduce the risk of Sudden Unexpected Deaths in Infancy
  • Breastfeeding a baby more than halves the odds of a baby dying suddenly and unexpectedly
  • The protective effect of breastfeeding is stronger for exclusive breastfeeding over a longer period of time
  • Babies should be exclusively breastfed for the first 6 months of life
  • Introduction of solid foods to healthy infants should commence at 6 months of age
  • Breastfeeding (and/or milk or breast milk substitutes, if used) should continue beyond the first six months and ideally to at least 2 years of age with appropriate intake of solid food
  • Parents should be informed of the benefits of breastfeeding and of the risks of not breastfeeding when a change from breastfeeding is being considered
  • Parents who feed their baby infant formula or supplementary feeds will reduce the risk of SUDI using the other five evidence based safe sleeping strategies

Since the Reducing the Risk of SIDS program was introduced in Australia in 1991, sudden infant deaths have been significantly reduced.

In Australia, between 1990 and 2015 there were 5,000 babies who died suddenly and unexpectedly. Baby deaths attributed to SUDI have fallen by 85% and it is estimated that 9,967 infant lives have been saved as a result of the infant safe sleeping campaigns.

The Safe Sleeping program is based on strong scientific evidence, has been developed in consultation with major health authorities, SUDI researchers and paediatric experts in Australia and overseas, and meets the National Health & Medical Research Council rules for strong evidence.


It may have been suggested by family and friends that you sleep baby in a bassinet in the first couple of months, before baby becomes active and starts to roll, for some sleep times. Here are some things to consider when weighing up this suggestion.

As there is no Australian Standard for bassinets, we are careful to keep up to date with reports of accidents associated with their use. To date, the most frequent accidents associated with bassinet use are falls and suffocation hazards. The Australian government draws on these reports and produces guidelines on ways to reduce these types of accidents, which are available on the Australian government’s product safety website here. Further information from the ACCC is also available in their publication ‘Keeping baby safe – a guide to infant and nursery products’ available here.

Baby bouncers or baby rockers

There’s lots of attention on the use of baby rockers or bouncers, with the Australian Competition and Consumer Commission issued a warning to parents following reports of products being linked to infants deaths in the United States.

But what actually makes these products unsafe, and why should they never be used for sleep?

“Rockers and bouncers are chairs that are designed to allow a baby to either bounce or rock in an inclined position”, explains Red Nose Chief Midwife Jane Wiggill.

“They keep a baby in an incline position, which can lead to a baby’s airway becoming blocked and reducing airflow.

When a baby falls asleep in a propped up device such as a rocker, their head can fall forwards, pushing the chin down towards the chest,” Jane explains.

“Babies are also at risk of rolling on to their tummy or side in a rocker, or becoming trapped, which is a suffocation risk.

These are just some of the reasons why Red Nose’s evidence-based recommendations are to always sleep your baby on their back, on a firm and flat surface, and in a safe cot.”

While parents and caregivers are always reminded to follow the safety warnings and instructions when using rockers and bouncers, Red Nose recommends only using them for supervised play time.

“Rockers and bouncers should never be used unsupervised, and they should never be used for sleeping, or as a substitute for a safe sleep space,” Jane says.

Why rockers and bouncers are unsafe

  • There are no Australian safety standards
  • The baby is put in an incline position – restricting airflow and blocking airways
  • Babies can roll on to their tummy or side
  • Babies can become trapped

Rocking cradles

Family and friends may have suggested you sleep baby in a rocking cradle for the first few months. There are some important things to consider as you weigh up this suggestion.

As there is no Australian Standard for rocking cradles, we are careful to keep up to date with reports of accidents associated with their use. Research has shown that babies can become trapped in a tilted rocking cot or cradle and suffocate.


There is no Australian standard covering the use and manufacture of hammocks for babies.

Red Nose recommends that a baby should sleep on a firm and flat surface. One safety concern with the hammock is that it holds the baby in a curved position, this may cause baby’s neck to flex forward which may block baby’s airway not allowing airflow. A baby needs to be placed to sleep flat (not elevated or curved with chin on chest) to maintain an open airway

There is also a risk of injury or death from falls.

We are aware of case and injury reports documenting a number of hospital admissions of babies following a fall from a hammock and tragically two deaths of infants sleeping in hammocks in separate incidences in the USA in 2009 and an infant death in Victoria, Australia in 2011.

Research into these deaths in particular and the use of hammocks in general for babies concluded that they are not suitable for a baby to sleep in while unsupervised.

The safest place to sleep baby from birth is in a safe cot, which complies with the AS/NZS mandatory standards for either household or folding (portable) cots, in the same room as an adult caregiver for the first six to 12 months of life.