Safe Sleep for Babies: Reducing the Risk of Sudden Infant Death

Safe Sleep at a Glance

Sudden infant death syndrome (SIDS), sometimes called cot death, is the sudden and unexplained death of a baby, usually during sleep. Most happen in the first six months, and most often between one and four months. Other sleep deaths happen when a baby's breathing is blocked by bedding, a pillow, or an adult's body. The advice below lowers the risk of both.

Always on the Back

Put your baby down to sleep on their back every time, for naps as well as at night, from the day they are born. Babies who usually sleep on their back but are put on their tummy or side once are at particular risk, so tell grandparents, nannies and anyone else who puts your baby down.

Parents often worry that a baby on their back will choke if they bring up milk. Healthy babies have a strong reflex that protects the airway, and choking is not more common on the back. Side sleeping is not safe either, because babies easily roll from the side onto the tummy.

Once your baby can roll from back to tummy and back again on their own, usually around five to six months, you can leave them in the position they choose. Keep putting them down on their back.

If your baby falls asleep in a car seat, bouncer, swing or a wrapper on your back, move them to a flat surface when you can. Sitting devices let the head fall forward, which can narrow the airway. When carrying a baby in a sling or wrapper, keep their face visible, their nose and mouth clear, and their chin off their chest.

Tummy time is for when your baby is awake and someone is watching. It strengthens the neck and helps prevent a flat patch on the back of the head.

A Flat, Clear Space in Your Room

The safest place for a baby to sleep is their own cot, crib or basket, in the same room as a parent, for at least the first six months. Being close lets you hear and respond to your baby, and it lowers the risk of SIDS.

• Firm and flat: a firm mattress that fits the cot without gaps at the sides. Soft mattresses, foam pads, and old or sagging mattresses can let a baby's face sink in.
• Nothing else in the cot: no pillows, duvets, quilts, thick wrappers, cot bumpers, soft toys, sleep positioners or rolled towels.
• Feet to foot: place your baby with their feet at the foot of the cot, so they cannot wriggle down under anything.
• No cot? A firm, flat mat on the floor beside your bed, or a sturdy basket or box with a firm base, is safer than an adult bed or sofa.
• Away from hazards: keep cords from blinds, curtains and phone chargers out of reach.

Sofas and Armchairs

Falling asleep with a baby on a sofa or armchair is one of the most dangerous situations of all. Babies can slip into the gap between an adult and the cushions and be unable to breathe. If you are feeding at night and feel you might fall asleep, feed in bed, with pillows and covers moved away from the baby, rather than on a sofa. Put the baby back in their own space when the feed is done.

Sharing a Bed with Your Baby

In many Nigerian homes, babies sleep with their mother, and in small rooms there may be no space for a cot. The safest choice is still a separate flat space next to your bed. If you do share, these rules lower the risk.

The risk is also highest in the first four months. If you do share a bed:

• Put your baby on their back, on a firm mattress, away from pillows and duvets.
• Keep your baby on the mother's side, not between two adults, and never next to other children or pets.
• Make sure the baby cannot fall out or get stuck between the mattress and the wall.
• Do not wrap or swaddle a baby who is sharing a bed; they need their arms free and must not overheat.
• Breastfeeding mothers naturally curl around the baby, facing them, with an arm above the head. This position protects the baby.

Heat and Wrapping

Overheating raises the risk of SIDS. In Abuja's heat, most babies need very little on at night.

• Dress your baby in no more than one light layer more than you would wear to be comfortable in the room. On a hot night that may be a nappy and a vest.
• Usually no covering is needed. On a cool harmattan night or in air conditioning, add a sleepsuit or use a baby sleeping bag that fits well at the neck. If you use a thin sheet, tuck it firmly under the mattress, no higher than the baby's chest, with the feet at the foot of the cot.
• Keep the head uncovered — no hats or caps in bed. Babies lose heat through the head.
• Check the chest or back of the neck. Sweating, damp hair or heat rash means remove a layer.
• A fan or air conditioner is fine, as long as it does not blow straight at the baby and the cot is away from the unit.

Using Nets Safely

Malaria is dangerous for babies, so a long-lasting insecticide-treated net over every sleep space is part of safe sleep in Nigeria. Treated nets are safe to use over babies.

• Hang the net from above and tuck it firmly under the mattress all the way round, so it is taut and not loose.
• The net goes over the cot, never lying on the baby or bunched up inside the cot where it could wrap around them.
• If your baby sleeps on a mat, hang the net over the mat and tuck it under the edges.
• Check for holes and mend them, and use the net for daytime naps too.
• Do not burn mosquito coils or spray insecticide in the room where the baby sleeps.

Smoke, Generators and Carbon Monoxide

Babies breathe faster than adults, so smoke and fumes affect them more.

Tobacco smoke is one of the strongest risks for SIDS. Keep your home and car smoke-free. If a parent smokes, the risk is higher even if they only smoke outside, which is why bed-sharing is never safe with a smoker.

Generators, charcoal stoves (coal pots) and kerosene heaters give off carbon monoxide, a gas you cannot see or smell. In a closed space it builds up while people sleep, and it can kill everyone in a room or house. Families in Nigeria are lost this way every year.

• Never run a generator indoors, in a garage, on an enclosed veranda, in a corridor or shop front, or near a window, door or air vent — even with them open.
• Place it outside and well away from the house, exhaust pointing away from any building.
• If it cannot be placed safely, switch it off before everyone sleeps.
• Never bring a charcoal stove indoors for heat or cooking, and never sleep in a room with one burning.
• A battery carbon monoxide alarm near the bedrooms gives an early warning.

Headache, dizziness, sickness, drowsiness or confusion in several people at once — or a baby who is unusually sleepy, floppy or vomiting — can be carbon monoxide poisoning. Get everyone into fresh air, switch off the source if it is safe to do so, and come to Limi now: babies and children to Limi Children's Hospital, adults to The Limi Hospital. If you cannot get there quickly, go to the nearest emergency department. If a baby or child is not breathing, start rescue breathing and chest compressions — see CPR — and shout for help.

How Much Sleep Children Need

These are the usual ranges in 24 hours, including naps, from international sleep experts. A child who is growing, happy and alert during the day is usually getting enough.

Routines and Night Waking

Newborns do not know day from night. Teach them from the start: keep daytime bright and sociable, and night feeds dim, quiet and brief, with no play. From about three months, a short bedtime routine done in the same order each night helps your baby learn that sleep is coming:

1. Wash or bath, then a clean nappy and night clothes.
2. A feed, in a dim room.
3. A quiet song, prayer or story. Keep it the same each night.
4. Into the cot on their back, drowsy but awake, so they learn to settle there.

For toddlers, keep screens off for at least an hour before bed, and keep the bedtime and wake-up time roughly the same every day.

Night waking is normal. Young babies wake because they need milk. Many babies still wake once or more at night at six months and beyond, especially when teething, unwell, or learning to crawl or stand. Around eight to ten months, many babies become upset when a parent leaves the room; a calm, brief response helps. Toddlers may wake with bad dreams — comfort them and settle them back in their own bed.

When to Talk to a Doctor About Sleep

Snoring with pauses is often caused by large tonsils or adenoids, and can affect growth, behaviour and learning. It can be treated: the ENT team at Limi assesses your child and treats the cause. If any of the "come in now" signs appear, come to Limi Children's Hospital now, day or night, and call 0813 408 5400 on the way so the team can prepare. If you cannot get here quickly, go to the nearest emergency department.

Questions Parents Ask