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Coronavirus (COVID-19): what you need to know 

New Scottish Government and NHS Safer Sleep for Babies resources developed in partnership with the Lullaby Trust, UNICEF Baby Friendly Initiative and BASIS the Baby Sleep Information Source based at Durham University.

Although sudden infant death syndrome (SIDS) is now very rare, over 200 babies still die every year. Yet we now have accurate information about how and where babies die and research that tells us how to prevent them dying. The organisations listed in this guide have come together to improve messages and take new action to tackle this. Your role is crucial - by talking to families, and supporting them with understanding how to avoid the specific risks for their baby, we can help to reduce the number of babies dying.

Where the term parent is used, this includes anyone involved in the care of a baby.

The number of babies who die of SIDS could be reduced dramatically if families followed three key pieces of advice:

Put them on their BACK for every sleep

In a CLEAR, FLAT SLEEP SPACE

Keep them SMOKE-FREE day and night

The big drop in the number of SIDS deaths has been largely attributed to the success of the message to sleep babies on their back - never their front or their side.

Despite this clear message being in place for many years, around 10% of families still do not adhere to the message, and sleep their baby in another position.

Back to sleep, for every sleep

Back sleeping needs to be consistent from day one. The odd night that a baby is slept differently, for whatever reason, is the one where the risk of SIDS peaks. Premature babies may have been slept differently whilst on a neonatal unit for health reasons, but when they go home they should be slept on their backs unless there is different medical advice.

Side sleeping is not safe

A baby sleeping on their side is not in a stable position, and should never be propped to stay in this position.

Babies with reflux do not need to be on their front

Families should seek medical advice if they feel the position their baby is sleeping in is having a detrimental effect on their health. This decision should not be made by families alone.

Longer, deeper sleep is not safer sleep

Babies sleeping on their front sometimes seem to sleep longer and deeper. Their risk of SIDS is also much higher, probably for these same reasons. Parents and grandparents may have been slept this way themselves before the Back to Sleep campaign, but remind families that SIDS rates were significantly higher then. Babies need to be on their back.

This piece of advice needs discussing with families to understand their circumstances and ensure they have planned for every eventuality.

Babies should be kept smoke-free both before and after birth.

SIDS risk is halved in babies who are breastfed for at least two months.

In these scenarios, it is always best to put baby in their own safe sleep space, such as a cot or a Moses basket. Keeping the cot or Moses basket next to the bed might make it easier to do this. Anytime parents are under the influence of drugs or alcohol, a sober adult should be in charge of the baby.

Place baby at the bottom of the cot so that baby cannot wriggle under covers – this is called ‘feet to foot’

SIDS rates are higher than they need to be - many sudden infant deaths occur with multiple risk factors.

Since safer sleep messages were introduced with the “Back to Sleep” campaign of the early 1990s, rates of SIDS have fallen dramatically. About half of the decline happened immediately after Back to Sleep, and the remainder has occurred more slowly over the last two decades due to additional infant care changes such as reduction in tobacco smoke exposure and increased breastfeeding.

We therefore know that following the available advice could significantly reduce the number of babies dying. This booklet, and the linked card and leaflet for families, focusses the messages to parents on those risk factors most closely linked to how babies are dying in the UK today. This is no longer the task of one group of professionals – we all need to focus on raising awareness of these messages and the reasons why they are important.

Safer sleep must be discussed with all families, regardless of their circumstances. These conversations will not always be easy, so we have produced two key documents to share with the families you work with

Discussions around some areas of safer sleep advice can be challenging. There are no magic answers to making these conversations easier, but we must have them, and we know they make a difference. For each of the three main pieces of advice we provide more information and discussion tips.

Creating an environment where families can discuss their situations and concerns without fear of judgement is crucial. We must acknowledge that young babies wake and feed frequently in the night and reassure families this is normal, self-limiting, and that there is no need to find a ‘solution’ to this that might go against the safer sleep messages.

Bedsharing needs to be discussed with all parents and carers who have young babies as any of them might fall asleep with their baby accidentally, even if they don’t intend to. Babies can and do die in highrisk bed sharing situations. It could be just as dangerous to say never bed share as it is to say that all bedsharing is fine. We know from talking to parents that if they are told not to bed share they will then feel they cannot discuss what actually happens and will not therefore get the right advice. Neither approach has been successful at reducing high-risk bed sharing deaths.

2. For families where SIDS risk is high, advise against bedsharing, and support with planning solutions for times when they might do so accidentally

For families where SIDS risk is low, make aware of the highrisk situations that anyone can get into on any given night (e.g. drinking alcohol), and refer to sources of information on making bedsharing safer: Basis, The Lullaby Trust and The UK Committee for Unicef (UNICEF UK) for your baby at night

4. Tell all families never to sleep on a sofa or armchair with their baby. Support with planning solutions for times when they might do so accidentally (e.g. moses basket next to the sofa, partner takes baby to cot)

5. Request for health visitors to be shown where baby sleeps

6. Consider families where parents live apart. It is important that all parents are aware of safer sleep information.

Bedsharing is not a risk-free activity, and parents must take responsibility for ensuring their baby’s safety. No studies have found that the parents' bed is safer than a cot beside the parents' bed.

Please use these links for further information on the following:

When babies start to roll The best sleeping position for your baby

Scotland’s Baby Box All about the Baby Box

Premature babies Reducing the risk of SIDS for premature babies

Slings What are baby slings and are they safe for your baby?

For guidance on safe sleep for twins, triplets or more, visit: How to keep all babies safe when sleeping

Remember: If parents think their baby is showing signs of being unwell, they should always seek medical advice. The Lullaby Trust Baby Check app can help parents or carers determine how ill their baby is. Available free from Google Play or the App Store.

E: bfi@unicef.org.uk

The baby sleep info source

E: basis.online@dur.ac.uk

Email: louise.mccue@gov.scot

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