Safe sleeping
Sudden infant death syndrome (SIDS)
Sudden infant death syndrome (SIDS) – sometimes known as "cot death" – is the sudden, unexpected and unexplained death of an apparently healthy baby.
In the UK, around 200 babies die suddenly and unexpectedly every year. This statistic may sound alarming, but SIDS is rare and the risk of your baby dying from it is low.
The Welsh Government have produced a leaflet with advice on safe sleeping for babies to reduce the risk of sudden infant death syndrome (cot death). Please click here
The Lullaby Trust provides expert advice on safer baby sleep and raises awareness of sudden infant death. Much of their information and videos have been included on this page, but additional information can be found on the Lullaby Trust website: Please click here
How to reduce the risk of SIDS
All your baby needs for a safer night’s sleep - The best sleeping position for your baby
Always put your baby on their back for every sleep, day and night, as the chance of SIDS is particularly high for babies who are sometimes placed on their front or side
The safest room temperature for babies
It is important to make sure that your baby’s room is a comfortable temperature – not too hot or too cold. The chance of SIDS is higher in babies who get too hot. Try to keep the room temperature between 16 -20°C.
Please click here for further information
How to co-sleep more safely
Some parents choose to share a bed (also known as co-sleeping) with their babies. It is important for you to know how to do this safely and that there are some circumstances in which bed-sharing with your baby can be very dangerous
Please click here for further information
When should you worry?
Newborn
NEWBORN
Contact your health visitor or GP if your baby is newborn and they…
- Feel very stiff, for example:
- Hold their arms and legs in the same position, such as always pulling their arm into their chest, or always crossing their legs
- Find it difficult to change their position on their own
- You may also find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
- Feel very floppy, or have floppy arms or legs when awake
- Move their arms and legs in repetitive jerky movements, or writhing movements
- Don’t have a Grasp Reflex (doesn’t grab your finger or small object when you put it in their hand)
- Are often startling and you cannot understand why
- Move one side of their body more than the other, for example:
- Rarely moves one of their arms compared to the other arm
- Rarely moves one leg compared to the other leg
- When your baby startles, one side moves or looks different from the other
6-8 weeks
6-8 WEEKS
Contact your health visitor or GP if your baby is 6-8 weeks and they…
- Feel very stiff, for example:
- Hold their arms and legs in the same position, such as always pulling their arm into their chest, or always crossing their legs
- Find it difficult to change their position on their own
- You may also find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
- Feel very floppy, or have floppy arms or legs when awake
- Move their arms and legs in repetitive jerky movements, or writhing movements
- Have not started to bring both their hands to their face, or do not move their arms much
- Keep their hands fisted, and you find it difficult to open their hands
- Can’t lift their head when lying on their tummy
- Move one side of their body more than the other, for example:
- Mostly moves one arm or mostly brings one hand to their face
- Rarely kicks or moves one leg compared to the other leg
2-3 months
2-3 MONTHS
Contact your health visitor or GP if your baby is 2-3 months and they…
- Feel very stiff, for example:
- Hold their arms and legs in the same position, such as always pulling their arm into their chest, or always crossing their legs
- Find it difficult to change their position on their own
- You may also find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
- Feel very floppy, or have floppy arms or legs when awake
- Move their arms and legs in repetitive jerky movements, or writhing movements
- Have not started to bring both their hands to their face, or do not move their arms much
- Keep their hands fisted, and you find it difficult to open their hands
- Can’t lift their head when lying on their tummy
- Move one side of their body more than the other, for example:
- Mostly moves one arm or mostly brings one hand to their face
- Rarely kicks or moves one leg compared to the other leg
3-4 months
3-4 MONTHS
Contact your health visitor or GP if your baby is 3-4 months and they…
- Have lost skills which they could do before
- Feel very stiff, for example:
- Hold their arms and legs in the same position, such as always pulling their arm to their chest, or always crossing their legs
- Find it difficult to change their position on their own
- You find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
- Feel very floppy when awake
- Prefer to keep their arms by their sides. For example, they do not reach for things, or do not bring their hands together over their face or tummy
- Move their arms or legs in repetitive, jerky, or strange ways
- Still need you to support their head, or can’t lift their head when lying on their tummy
- Have very tight fists and it’s hard to open their hand
- Move one side of their body more than the other, for example:
- Rarely use one of their arms to pick up toys
- Rarely kick one leg compared to the other
4-6 months
4-6 MONTHS
Contact your health visitor or GP if your baby is 4-6 months and they…
- Have lost skills which they could do before
- Feel very stiff, for example:
- Hold their arms and legs in the same position, such as always pulling their arm to their chest, or always crossing their legs
- Find it difficult to change their position on their own
- You find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
- Feel very floppy when they are awake
- Move their arms or legs in repetitive, jerky, or strange ways
- Move one side of their body more than the other, for example:
- Rarely use one of their arms to pick up toys
- Rarely kick one leg compared to the other
- Are unable to roll, or can roll in one direction but not the other
- Find it difficult to reach their arms out. For example, they do not reach for toys
- Still have their early reflexes, like the startle reflex and grasp reflex
- Keep their legs flat when lying on their back. For example, they do not bring their feet to their chest
- Still need you to support their head
6-9 months
6-9 MONTHS
Contact your health visitor or GP if your baby is 6-9 months and they…
- Have lost skills which they could do before
- Feel very stiff, for example:
- Hold their arms and legs in the same position, such as always pulling their arm to their chest, or always crossing their legs
- Find it difficult to change their position on their own
- You find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
- Feel very floppy when they are awake
- Move their arms or legs in repetitive, jerky or strange ways
- Move one side of their body more than the other, for example:
- Rarely use one of their arms to pick up toys, or eat and drink
- Rarely kick one leg compared to the other
- Can’t sit without support. For example, they lean on their hand, or, when they sit, their back is very curved
- Still have their early reflexes, like the startle reflex and grasp reflex
- Keep their legs flat when lying on their back, for example, do not bring their feet to their chest
- Still need you to support their head
- Still need you to help turn their head when lying on their back
- Can’t crawl, or find it hard, for example, drags one of their legs behind them
- Find it difficult to stand, for example:
- Can’t stand with support
- Doesn’t try to pull themselves up to stand
- Can’t move a toy from one hand to the other
- Doesn’t use both hands to hold larger things
9-12 months
9-12 MONTHS
Contact your health visitor or GP if your baby is 9-12 months and they…
- Have lost skills which they could do before
- Feel very stiff, for example:
- Hold their arms and legs in the same position, such as always pulling their arm to their chest, or always crossing their legs
- Find it difficult to change their position on their own
- You find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
- Feel very floppy when they are awake
- Move their arms and legs in repetitive, jerky, or strange ways
- Use one side of their body more than the other, for example:
- Lean to the side when they sit
- Use one arm to pull to stand more than the other
- Rarely use one of their arms to pick up toys, or eat and drink.
- Rarely kick one leg compared to the other
- Find it difficult to sit, for example:
- Only sit with support
- Lean on their hand when sitting
- When they sit their back is very curved
- Can’t move a toy from one hand to the other
- Don’t use both hands to hold larger things
- Don’t point to objects
- Can’t crawl, or find it hard, for example, drags one leg behind them
- Find it difficult to stand, for example:
- Can’t pull themselves up to stand
- Find it hard to pull themselves up. For example, they only use their arms and don’t push with their legs
- Can’t stand with support
2 months
Your Baby By Two Months
Social/Emotional Milestones
- Calms down when spoken to or picked up
- Looks at your face
- Seems happy to see you when you walk up to her
- Smiles when you talk to or smile at her
Language/Communication Milestones
- Makes sounds other than crying
- Reacts to loud sounds
Cognitive Milestones (learning, thinking, problem-solving)
- Watches you as you move
- Looks at a toy for several seconds
Movement/Physical Development Milestones
- Holds head up when on tummy
- Moves both arms and both legs
- Opens hands briefly
4 months
Your Baby By Four Months
Social/Emotional Milestones
- Smiles on his own to get your attention
- Chuckles (not yet a full laugh) when you try to make him laugh
- Looks at you, moves, or makes sounds to get or keep your attention
Language/Communication Milestones
- Makes sounds like “oooo”, “aahh” (cooing)
- Makes sounds back when you talk to him
- Turns head towards the sound of your voice
Cognitive Milestones (learning, thinking, problem-solving
- If hungry, opens mouth when he sees breast or bottle
- Looks at her hands with interest
Movement/Physical Development Milestones
- Holds head steady without support when you are holding him
- Holds a toy when you put it in his hand
- Uses his arm to swing at toys
- Brings hands to mouth
- Pushes up onto elbows/forearms when on tummy
6 months
Your Baby By Six Months
Social/Emotional Milestones
- Knows familiar people
- Likes to look at self in a mirror
- Laughs
Language/Communication Milestones
- Takes turns making sounds with you
- Blows “raspberries” (sticks tongue out and blows)
- Makes squealing noises
Cognitive Milestones (learning, thinking, problem-solving)
- Puts things in her mouth to explore them
- Reaches to grab a toy she wants
- Closes lips to show she doesn’t want more food
Movement/Physical Development Milestones
- Rolls from tummy to back
- Pushes up with straight arms when on tummy
- Leans on hands to support herself when sitting
9 months
Your Baby By Nine Months
Social/Emotional Milestones
- Is shy, clingy, or fearful around strangers
- Shows several facial expressions, like happy, sad, angry, and surprised
- Looks when you call her name
- Reacts when you leave (looks, reaches for you, or cries)
- Smiles or laughs when you play peek-a-boo
Language/Communication Milestones
- Makes a lot of different sounds like “mamamama” and “bababababa”
- Lifts arms up to be picked up
Cognitive Milestones (learning, thinking, problem-solving)
- Looks for objects when dropped out of sight (like his spoon or toy)
- Bangs two things together
Movement/Physical Development Milestones
- Gets to a sitting position by herself
- Moves things from one hand to her other hand
- Uses fingers to “rake” food towards himself
- Sits without support
1 year
Your Baby By One Year
Social/Emotional Milestones
- Plays games with you, like pat-a-cake
Language/Communication Milestones
- Waves “bye-bye”
- Calls a parent “mama” or “dada” or another special name
- Understands “no” (pauses briefly or stops when you say it)
Cognitive Milestones (learning, thinking, problem-solving)
- Puts something in a container, like a block in a cup
- Looks for things he sees you hide, like a toy under a blanket
Movement/Physical Development Milestones
- Pulls up to stand
- Walks, holding on to furniture
- Drinks from a cup without a lid, as you hold it
- Picks things up between thumb and pointer finger, like small bits of food
Advice and Guidance
Do & Don’t
Do
- place your baby in the "feet to foot" position – with their feet touching the end of the cot, Moses basket, or pram
- keep your baby's head uncovered – their blanket should be tucked in no higher than their shoulders
- let your baby sleep in a cot or Moses basket in the same room as you for the first 6 months
- use a mattress that's firm, flat, waterproof and in good condition
- breastfeed your baby, if you can – see benefits of breastfeeding for more information
- make sure you use a sling or baby-carrier safely – The Lullaby Trust has more information
Don’t
- do not smoke during pregnancy or let anyone smoke in the same room as your baby – both before and after birth
- do not sleep on a bed, sofa or armchair with your baby
- do not share a bed with your baby if you or your partner smoke or take drugs, have recently drunk alcohol or if your baby was born prematurely or weighed under 2.5kg when they were born
- do not let your baby get too hot or too cold – a room temperature of 16C to 20C, with light bedding or a lightweight baby sleeping bag, will provide a comfortable sleeping environment for your baby
Experts do know placing a baby to sleep on their back reduces the risk, and exposing a baby to cigarette smoke or allowing them to overheat increases the risk. It's also known there's an association between sleeping with your baby on a bed, sofa or chair (co-sleeping) and SIDS.
Follow the advice on this page to reduce the risks as much as possible.
How to reduce the risk of SIDS
To reduce the risk of SIDS:
- place your baby on their back to sleep, in a cot in the same room as you, for the first 6 months
- keep your baby's head uncovered – their blanket should be tucked in no higher than their shoulders
- if wearing your baby in a sling or carrier, do not cover their head with the sling material or with a muslin
- place your baby in the "feet to foot" position, with their feet at the end of the cot or moses basket
- do not let your baby get too hot or cold
- do not share a bed with your baby
- never sleep with your baby on a sofa or armchair
- do not smoke during pregnancy or breastfeeding, and do not let anyone smoke in the same room as your baby
Place your baby on their back to sleep
- Place your baby on their back to sleep from the very beginning for both day and night sleeps. This will reduce the risk of cot death.
- Do not put your baby to sleep on their side or tummy.
- Once your baby is old enough to roll over, there's no need to worry if they turn onto their tummy or side while sleeping
Do not let your baby's head become covered
Babies whose heads are covered with bedding are at an increased risk of SIDS.
To prevent your baby wriggling down under the covers, place them in the "feet to foot" position. This means their feet are at the end of the crib, cot or moses basket.
To put your baby in the feet to foot position:
- Tuck the covers in securely under your baby's arms so they cannot slip over their head – use 1 or more layers of lightweight blankets
- use a baby mattress that's firm, flat, well-fitting, clean and waterproof on the outside – cover the mattress with a single sheet
- do not use duvets, quilts, baby nests, wedges, bedding rolls or pillows
If you use a sling or carrier, make sure you use it safely.
The Lullaby Trust has more information and advice about swaddling your baby and using slings.
Do not let your baby get too hot or too cold
Overheating can increase the risk of SIDS. Babies can overheat because of too much bedding or clothing, or because the room is too hot.
- When you check your baby, make sure they're not too hot. If your baby is sweating or their tummy feels hot to the touch, take off some of the bedding. Do not worry if their hands or feet feel cool – this is normal.
- It's easier to adjust for the temperature by using layers of lightweight blankets. Remember, a folded blanket counts as 2 blankets. Lightweight, well-fitting baby sleeping bags are a good choice, too.
- Babies do not need hot rooms. All-night heating is rarely necessary. Keep the room at a temperature that's comfortable – about 16 to 20C is ideal.
- If it's very warm, your baby may not need any bedclothes other than a sheet.
- Even in winter, most babies who are unwell or feverish do not need extra clothes.
- Babies should never sleep with a hot water bottle or electric blanket, next to a radiator, heater or fire, or in direct sunshine.
- Babies lose excess heat through their heads, so make sure their heads cannot be covered by bedclothes, slings or carriers while they're asleep.
- Remove hats and extra clothing as soon as you come indoors or enter a warm car, bus or train, even if it means waking your baby.
Do not share a bed with your baby
The safest place for your baby to sleep for the first 6 months is in a cot in the same room as you.
It's especially important not to share a bed with your baby if you or your partner:
- smoke (no matter where or when you smoke and even if you never smoke in bed)
- have recently drunk alcohol
- have taken medicine or drugs that make you sleep more heavily
The risks of co-sleeping are also increased if your baby:
- was premature (born before 37 weeks), or
- had a low birthweight (less than 2.5kg or 5.5lb)
As well as a higher risk of SIDS, there's also a risk you might roll over in your sleep and suffocate your baby.
Your baby could also get caught between the wall and the bed, or roll out of an adult bed and be injured.
Never sleep with a baby on a sofa or armchair
It's lovely to have your baby with you for a cuddle or a feed, but sleeping with your baby on a sofa or armchair is linked to a higher risk of SIDS.
It's safest to put your baby back in their cot before you go to sleep.
Do not let anyone smoke near your baby
Babies exposed to cigarette smoke before and after birth are at an increased risk of SIDS. Do not let anyone smoke in the house, including visitors.
Ask anyone who needs to smoke to go outside. Do not take your baby into smoky places.
If you smoke, sharing a bed with your baby increases the risk of cot death.
Get help and support if you want to quit smoking.
Feeding, dummies and SIDS
Breastfeeding your baby reduces the risk of SIDS.
It's possible using a dummy at the start of a sleep also reduces the risk of SIDS. But the evidence is not strong and not all experts agree that dummies should be promoted.
If you do use a dummy, do not start until breastfeeding is well established. This is usually when your baby is around 1 month old.
Stop giving them the dummy when they're between 6 and 12 months old.
Get medical help quickly if your baby is unwell
Babies often have minor illnesses that you do not need to worry about.
Give your baby plenty of fluids to drink and do not let them get too hot. If your baby sleeps a lot, wake them up regularly for a drink.
It can be difficult to judge whether an illness is more serious and needs urgent medical attention.
See spotting the signs of serious illness for guidance on when to get help. Please click visit our New baby what's normal and what's not page.
The safest place for your baby to sleep is a separate cot or Moses basket in the same room as you for the first 6 months, even during the day.
Place your baby to sleep in a separate cot or Moses basket in the same room as you for the first 6 months, even during the day.
A large study of evidence from across Europe found that the risk of sudden infant death was significantly reduced when the infant slept in the same room, but not the same bed, as the parents.
The safest place for your baby to sleep for the first 6 months is in a separate cot or Moses basket in the same room as you
The chance of SIDS is lower when babies sleep in a separate cot in the same room as their parents
Never sleep on a sofa or in an armchair with your baby
Sleeping on a sofa or in an armchair with your baby is one of the most high-risk situations for them.
Studies have found that sharing a sofa or armchair with a baby whilst you both sleep is associated with an extremely high risk of SIDS. One study found that approximately one-sixth of infants in England and Wales who died of SIDS were found sleeping with an adult on a sofa.
Make sure that you do not accidentally fall asleep with your baby on a sofa. If you think you might fall asleep, put the baby down in a safe place to sleep.
If you are breastfeeding, have your partner stay up with you, breastfeed in a different position where you are confident you might not fall asleep, or feed the baby somewhere else.
Download Bed Sharing Fact sheet
Download Back to Sleep Fact sheet
It is essential for safety that babies travel in a car seat. However, it is recommended that you avoid travelling in cars with pre-term and young babies for long distances. Research into the link between car seats and SIDS found young babies may be at risk of breathing difficulties if they travel while sitting in an upright position for too long.
For more information on car seats and SIDS please visit, NHS website.
If you choose to swaddle your baby or use a sling it is very important to follow guidelines to reduce the risk of SIDS.
Swaddling your baby
Swaddling is a common practice used to help settle young babies and promote sleep. We recognise that in some parts of the world this is also referred to as wrapping, but in the UK is referred to as swaddling. Parents/carers who wish to swaddle should be informed how to do this correctly to reduce the chance of SIDS:
- Never put a swaddled baby to sleep on their front or side.
- Stop swaddling (with arms wrapped inside the material) when a baby shows signs of rolling as they could roll onto their tummy and won’t be able to roll back. Use materials such as a thin muslin or thin cotton sheet – DO NOT USE blankets or place any additional bedding over a swaddled baby, this could cause them to overheat
- Ensure baby is not overdressed under the swaddle, has their head uncovered and does not have an infection or fever
- Check baby’s temperature to ensure they do not get too hot – check the back of their neck. If baby’s skin is hot or sweaty, remove one or more layers of bedclothes.
- Baby should be swaddled securely to reduce the risk of face-covering by loose material.
- Swaddles should not be applied very tightly around the hips as this is strongly associated with developmental dysplasia of the hip. However, the swaddle should also be secure enough not to come apart, as loose soft bedding can increase the chance of SIDS if pulled over a baby’s head, causing a baby to over-heat or obstruct their breathing.
- There are various swaddle products on the market for example swaddle blankets, swaddle sacks and swaddle bags. We can’t comment on their safety but parents/carers need to ensure the products meets necessary safety standards. They should be well fitted.
- Parent/Carers should ensure they follow the product guidance. Some swaddle manufacturers recommend their product is used when a baby is a certain weight, rather than age so it is best to check on the swaddle product they choose to use.
- We do not advise on a specific tog rating for swaddle products, we advise parents/carers to use a lower tog rating/lightweight to reduce the chance of baby overheating.
Using slings and baby-carriers
Slings and baby-carriers are useful for holding a baby hands-free, however they are not always used safely. Although there is no reliable evidence that slings are directly associated with SIDS, there have been a number of deaths worldwide where infants have suffered a fatal accident from the use of a sling. These accidents are particularly due to suffocation, and particularly in young infants.
The risk appears to be greatest when a baby’s airway is obstructed either by their chin resting on their chest or their mouth and nose being covered by a parent’s skin or clothing.
The safest baby carrier to use will keep the infant firmly in an upright position where a parent can always see their baby’s face, and ensure their airways are free. Complete guidance is available by visiting The Royal Society for the Prevention of Accidents.
When wearing a sling or baby carrier, keep in mind the TICKS guidelines:
- Tight
- In view at all times
- Close enough to kiss
- Keep chin off the chest
- Supported back
Self care and Prevention
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