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Safe sleeping position

Why is it important?

Safe sleeping position for young babies involves ensuring that they are always placed in a supine position when going to sleep (i.e. on their back). This is very important and can help reduce the risk of sudden unexpected death in infancy.
SUDI Scotland 

SUDI is defined as the sudden and unexpected death of an infant (a baby under the age of one year) that remains unexplained after thorough investigation. It is the leading cause of post-neonatal death in infancy in babies aged from one month to 12 months in the UK and in Scotland.   

Current situation

In Glasgow, about 93% of infants sleep in the supine position. However, there are differences between neighbourhoods. The percentage of infants who sleep in the supine position varies between 78% and 100% across Glasgow’s neighbourhoods.

Although SUDI rates are very low (0.4 per 1000 live births in 2015) they are still higher in Scotland than in other developed European countries.  

Are there inequalities to consider? 

Risk factors for the sudden and unexpected death of an infant include:

  • Age -  Babies under the age of one year are most at risk and having  a younger mother is associated with a higher risk of SUDI.
  • Birth weight -  Rates of SUDI are higher in low-birth-weight babies (less than 2,500g (5lb 5oz)).
  • Poverty - Deprivation has been linked to the occurrence of SUDI and higher risk is observed for babies from more deprived families.
  • Prematurity -  Babies born pre-term (less than 37 weeks gestation) are at much higher risk compared to babies born at full term.
  • Smoking - Babies are at greater risk when their mother smokes during pregnancy or if there is smoking in the home. An estimated one third of SUDI deaths could be prevented if mothers did not smoke while pregnant or following the birth of their baby.
  • Sleeping position - Greater risk is associated with placing a baby to sleep on the front or side or in a room alone. Bed sharing with a baby when a parent is a smoker or under the influence of drugs or alcohol may also increase risk.
  • Overcrowding has been identified as a factor affecting sleeping habits in the home. Unexpected infant deaths are also associated with overheating; overwrapping the baby or placing objects in the cot that may increase heat. 

Challenges and solutions

Numbers of babies recorded as sleeping in an unsafe sleeping position in Glasgow are higher in more deprived communities. Actions to prevent SUDI include:

  • Early (antenatal) education of  parents and carers on ‘safer sleeping positions’.
  • Ensuring that babies sleep in the supine position – ‘back to sleep’ for every sleep and on a firm flat surface.
  • Keeping the baby’s head uncovered by placing the baby in the ‘feet to foot’ position i.e. baby’s feet should be placed against the foot of the cot.
  • Avoiding the use of ‘sleep positioners’  which often feature bolsters attached to each side of a thin mat and wedges to elevate the baby’s head. This is dangerous practice as it increases the risk of the baby suffocating.
  • Avoiding sleeping on a sofa or couch with one’s baby as this is particularly hazardous and increases the risk greatly. 
  • Ensuring that babies (including twins) sleep in a separate cot.
  • Ensuring that young babies sleep in the same room as their parents up to six months of age.
  • Reducing smoking in pregnancy.
  • Avoiding exposure to tobacco smoke in the home and in cars.
  • Babies should not be left to sleep in infant carriers or car seats for prolonged periods of time. Some manufacturers recommend a two-hour maximum period.

Examples of positive action

1. The Scottish Cot Death Trust has produced a leaflet for parents/carers providing advice on how to avoid cot death which is issued to all new parents/carers in GGC.

2. Public Health England has published  a London Child Safety Update on Sudden Unexpected Deaths in Infancy: Advice for People Working with Children, Young People and Families.

4. The US Department of Health and Human Services and The Public Health Agency of Canada have published guidance and advice on safe sleeping and the importance of avoiding the use of sleep positioners. 

Links to other issues

Risk of SUDI can be reduced by ensuring that babies are not exposed to tobacco smoke in the home or in cars.  The proportion of newborn babies exposed to second hand smoke across Glasgow neighbourhoods during 2014/15 is presented on Understanding Glasgow. 

Links to other resources

See examples of positive action above.