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The tragic death of 5 month old Sunshine Coast infant Indianna in a family day service serves as a very timely reminder of the importance of safe sleeping in early childhood education and care environments.
Sudden Infant death Syndrome (SIDS) is still the most common category of deaths for babies between one and twelve months of age and while all the causes of Sudden Unexpected Death in Infancy (SUDI) including SIDS and fatal sleeping accidents are unknown, what we do know is that some sleeping arrangements are safer than others.
SIDS and Kids is Australia's leading authority on safe sleeping practices for children, especially those in the high-risk 0-12 month age category. The steps in this article are recommended as best practice safe sleeping guidelines for early childhood education and care providers.
1. Put baby on the back to sleep, from birth
The chance of babies dying suddenly and unexpectedly is greater if they sleep on their tummies or sides. Healthy babies placed to sleep on the back are less likely to choke on vomit than tummy sleeping babies. In fact, sleeping baby on the back actually provides airway protection.
This is because in the back position, the upper respiratory airways are above the oesophagus (digestive tract) therefore regurgitated milk can easily be swallowed and aspiration into the respiratory tract avoided. When a baby is placed on its tummy the digestive tract sits above the baby's upper airways and if the baby regurgitates milk it is more likely to be inhaled into the baby's airways and lungs. Some babies, with rare medical conditions, might have to sleep on the tummy or side but only do this if the baby's medical practitioner advises to do so in writing.
Most babies over the age of four months can roll over in the cot. These babies can be placed in a safe sleeping bag (fitted neck and armholes and no hood).
2. Sleep baby with face uncovered
Ensure that baby's face and head stays uncovered during sleep, a good way to achieve this is to use a baby sleeping bag. However, if you use blankets ensure that the baby's feet are at the bottom of the cot, so that baby can't slip down under the blankets. Use lightweight blankets that can be tucked in securely. Ensure there are no doonas, bumpers, pillows, toys or loose bedding in the cot.
3. Avoid exposing baby to tobacco smoke
Babies who are exposed to tobacco toxins have a significantly higher risk of SIDS. These risks remain even if carers smoke outside, away from the babies. If possible, maintain a smoke free service. Ask all parents and employees who smoke to move away from the centre to do so and ask that they wash their hands when caring for infants. Encourage staff to quit smoking by offering supportive programs in the workplace.
4. Sleep baby in a safe cot, with a safe mattress and in a safe environment.
Safe cot: Do all the cots in your service meet the current mandatory Australian standard for Cots (AS/NZS 2172)? If they do then they should have a sticker saying they do. Avoid old and second hand cots as they probably won't meet current standards,
Safe mattress: Is the cot mattress the right size for the cot and is it firm, flat and clean? Babies can easily get wedged in gaps between the mattress and cot sides and this is especially dangerous if their face is trapped and covered or their neck is restricted. Make sure there is no more than 20mm gap between the mattress and the cot sides and ends and remove plastic packaging from the mattress. If you use waterproof mattress protectors make sure they are strong, not torn and a tight fit. Remember a pillow, cushion or beanbag is not a safe mattress.
If you use port-a-cots make sure they meet the required standard AS/NZS 2195 and have a label to say so. Use the supplied mattress and don't add additional padding, ensure the mattress is firm, clean and flat.
Safe bedding: Remove pillows, doonas, loose bedding, lambs wool, bumpers and soft toys. If you wrap babies consider the baby's stage of development. Leave arms free once the startle reflex disappears around three months and discontinue use of a wrap when the baby can roll from back to tummy and back again as the wrap may prevent an older baby who has turned onto their tummy from returning to the back position.
5. Sleep baby in their own safe sleeping place in the same room as an adult care giver for the first six-twelve months.
Room sharing has been shown to reduce the risk of SUDI. A care-giver in this instance can include any adult carer, babysitter, nanny or parent. Placing a baby on their back under supervision is equally important for daytime sleeps as nighttime sleeps.
Carers are not expected to observe the baby constantly but should check them regularly to ensure they remain on their back and their head and face are uncovered.
Older babies (beyond 5-6 months) will move around their cot and roll over, make sure you put them to sleep on their back but let them find a sleep position they feel comfortable in. Safe cot and sleep environments are still important for older babies.
For more information on safe sleeping in early childhood education and care visit the SIDS and Kids website or purchase their SIDS and Kids Infant Safe Sleeping Child Care Kit.
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