In this section
Note: This guideline is currently under review.
Recommendations for the safe sleeping of infants during inpatient admission at the Royal Children’s Hospital. Including anticipatory guidance for parents preparing for infant discharge.
Sudden Unexpected Death in Infancy (SUDI) is a broad term that includes all sudden and unexpected deaths of infants less than 12 months old, who have died in their sleep with the cause of death not initially known. Sudden Infant Death Syndrome (SIDS) is “the sudden and unexpected death of an infant under one year of age, with onset of the lethal episode apparently occurring during sleep, which remains unexplained after a thorough investigation including performance of a complete autopsy and review of the circumstances of death and the clinical history.” SIDS and fatal sleep accidents account for the majority of SUDI deaths: incidence 0.4 per 1,000 births in 2014. Any infant who requires care in a neonatal unit is considered part of the infant population with increased vulnerability to SIDS. This guideline incorporates current Australian and International research on SIDS and is consistent with the public health campaign developed by SIDS and KIDS Australia and the American Academy of Pediatrics. It is imperative that nurses teach and model recommended infant sleep practices before discharge to reduce the incidence of SIDS and fatal sleep accidents. Parental home practices are influenced by what has been observed in the nursery and infants need time to accustom to the supine sleep position.
The aims of this guideline are to:
A medical consultation with the parents is required if a non supine position is to continue post discharge, with the aim being to return the infant to supine as soon as their condition allows, documenting on EMR as required.
The convalescing infant will require supervised prone play time to prevent the development of plagiocephaly and encourage gross motor skills. Rotating the infants head to alternate sides will also support the developing head shape.
Smoking remains the most important modifiable risk factor in reducing the risk of SIDS.
Educate parents on the association between the risk of cigarette smoking and SIDS.Refer parents and significant family members to smoking cessation programshttp://www.quit.org.au/Teach strategies to reduce the infant’s exposure to cigarette smoke:
A separate sleep space, proximal to parents is encouraged.
In the hospital:
The following links highlight how to discuss the risks and benefits of co-sleeping with parents:
Pacifier use has been suggested to protect against SIDS and is recommended by some authoritative bodies. However this has not been fully endorsed by all.The American Academy of Pediatrics and a review by the Johanna Brigg Institute, suggest that offering a pacifier at sleep time reduces the SIDS risk. Currently the mechanism of this intervention is unknown.
Use pacifier when putting the infant down to sleep:
Pacifier use maybe associated with an increased risk of otitis media, gastro intestinal infections and oral colonization with Candida species.
Respect family knowledge, values, beliefs and cultural backgrounds in the delivery of care.
Providing families with timely, accurate and complete information enables them to participate in care and decision making.
Anticipatory guidance provides parents with the knowledge to confidently sleep their infants according to the safe sleep recommendations and have their concerns addressed before discharge from hospital.The following resources can be utilized by families to help them make an informed choice around co-sleeping with their infant. There are many documented benefits as well as risks that families should be aware of.
The evidence table for this guideline can be viewed here.
Please remember to read the disclaimer
development of this nursing guideline was coordinated by Emma Lowe, Registered Midwife, Butterfly Ward,
and approved by the Nursing Clinical Effectiveness Committee. Updated December 2016.