In this section
Note: This guideline is currently under review.
Definition of Terms
Strategies to promote safe sleeping
Infants are unable to control their sleeping environment.
Providing a safe sleeping environment is the best way to reduce the risk of Sudden
Unexpected Death in Infancy (SUDI). SUDI is a broad term that includes all
sudden and unexpected deaths of infants less than 12 months old – this current
definition includes sudden infant death syndrome (SIDS) and deaths caused by asphyxia or of an
undetermined cause after a thorough investigation including performance of an autopsy
and review of the circumstances of death and the clinical history. SUDI remains
the leading cause of infant death with the peak age being between two and four
months of age.
who require care in a neonatal unit are considered part of the infant
population with an increased vulnerability to SIDS. Parental home practices are
influenced by what has been observed in the neonatal unit. Infants who have had
altered sleeping positions, due to medical needs, need time to accustom to
sleeping supine. It is imperative that nurses teach and model recommended
infant sleep practices before discharge to reduce the incidence of SUDI.
The aims of this guideline are to:
This guideline applies to all neonates and infants receiving care at The Royal Children’s Hospital.
There are multiple areas that contribute to risks associated with SUDI:
Note: There may be certain medical conditions that require an infant to be slept in different positions however this must ONLY be done with the instruction of the treating medical team. The aim is always to have the infant sleep in a supine position as soon as able.
Note: In an intensive care environment there will be times where an elevated bed head and nests are used for infants that are sedated/require mechanical ventilation. These have been shown as developmentally supportive measures for periods of stress, to avoid energy expenditure, reduce unnecessary movements and assist in the weaning of analgesia. They must however be removed as soon as developmentally and medically appropriate for the infant and the infant should then be slept within the recommended safe sleeping guidelines.
Smoking remains one of the most important modifiable risk factor in reducing the risk of SUDI. Babies who are exposed to tobacco smoke before and after birth are at an increased risk of SUDI.
Discharge advice for parents is to have a separate sleep space for the child, proximal to them. There is currently no universal agreement in the difference between the terms co sleeping and bed sharing. Bed sharing, sleeping on the same surface, is not the recommended method of safe sleeping. Red Nose Australia and the America Academy of Pediatrics do not recommend bed sharing with infants however if parents choose to share the same sleeping surface with their infant, precautions should be taken. More information can be found on; https://rednose.org.au/article/Co-sleeping_with_your_baby
In an inpatient setting, consent from parents must be obtained prior to offering an infant a pacifier/dummy. This should be documented in the patients EMR. There is no consensus on the use of pacifiers/dummies and the interruption of breastfeeding. The general recommendation is to introduce a pacifier or dummy once breastfeeding has been established. The World Health Organisation recommends not using of pacifiers/dummies to encourage exclusive breastfeeding for the first 6 months of an infant’s life. Parents should be allowed to make an informed decision about the use of a pacifier/dummy for their child.
There has been increasing evidence to suggest that the use of pacifiers/dummies protect infants from SIDS however this has not been confirmed through randomised control trials. The American Academy of Pediatrics and a review by the Johanna Brigg Institute, suggest that offering a pacifier/dummy at sleep time reduces SIDS risk. Currently the reason of this intervention is unknown although, an increase in blood pressure and heart rate (cardiac control) with pacifier/dummy use has been suggested as a mechanism that lowers SIDS risks in preterm infants.
If using a pacifier/dummy when putting the infant down to sleep:
World Health Organization (2020) Breastfeeding Available: https://www.who.int/health-topics/breastfeeding#tab=tab_1.
The evidence table for this guideline can be viewed here.
Please remember to read the disclaimer
development of this nursing guideline was coordinated by Aaliya Fanham, RN, Butterfly Ward,
and approved by the Nursing Clinical Effectiveness Committee. Updated June 2020.