Reduce the Risks of Cot Death

The following are the key things you can do to protect your baby from cot death. It is important to follow all of these guidelines, whenever possible. If you need more information, or are having trouble following one or more of these guidelines for any reason, feel free to contact us for support, guidance and advice.

The safest place for your baby to sleep at night is in its own cot, in your room, for the first 6 months of its life.

> Put your baby to sleep on their back.

This is the most important thing you can do to reduce cot death; it is not safe for babies to sleep on their front or side (unless specifically recommended by your doctor.)This is partially due to the fact that young babies who lack strength in their necks are unable to lift their heads up if they find it hard to breathe. Babies should be put on their back to sleep whenever they are put down to sleep. Babies are not more likely to choke on their back and you shouldn’t worry about them developing ‘flat head.’

> Place your baby in their cot in the "feet to foot" position.

Put your baby (on their back) at the bottom of their cot, with their feet at the end of the cot; don’t place them in the middle of the cot. This is to prevent them wriggling down under the covers.

> Keep your baby smoke free during pregnancy and after birth.

There is significant evidence that babies of smokers are 30% more likely to die from cot death than babies of non-smokers. It’s really important that you and your partner both give up smoking. Do not allow anyone else to smoke around your baby. Cigarette smoke limits the amount of oxygen circulating in your baby’s body. That means that your baby gets used to low levels of oxygen, and may not wake up if oxygen levels dip during sleep.

> Breastfeed your baby.

Breast feeding your baby provides them with the best possible start in life. As well as reducing the risk of cot death, breast milk gives your baby all the nutrients they need for the first six months of life, and helps protect them from infection. If you are finding it hard to breastfeed, speak to your Midwife about support available to you. If you find it easier to breastfeed your baby in your bed, remember that it is important to put them back in their own cot before falling asleep.

> Offer a dummy when your baby sleeps.

Some research suggests that using a dummy when putting a baby down to sleep might help to reduce the risk of cot death. If you choose to use a dummy, follow these guidelines.

> Make sure your baby doesn't get too hot or too cold.

Babies cannot regulate their temperature like adults can. The ideal room temperature for your baby is between 16°C and 20°C. Room thermometers are available here. This room temperature may feel cool; it is normal for your baby’s hands and feet to be cold. Keep the room well ventilated, and make sure that you use the right bedding. Never use duvets or pillows for infants under 12 months.

> Keep your baby's head uncovered while sleeping.

> Never fall asleep with your baby on a couch or armchair.

If you and your baby fall asleep on a couch or armchair, your baby can get trapped down the side or in the cushions. There is also the risk of you rolling over and suffocating your baby.

> Ensure any sheets and blankets in your baby’s cot are firmly tucked in at the bottom and sides of the cot, and are positioned no higher than the baby’s shoulders.

This is so your baby can’t wriggle down under the covers.

> Understand the risks of co-sleeping.

The safest place for your baby to sleep is in their own cot, in your room. In a four year study conducted by the Scottish Cot Death Trust, 68% of all cot deaths occurred when the baby was sleeping in bed with one or more adults. If you are considering co-sleeping, it is important to understand the risks. Adult beds are not designed for babies, so there is a risk that your baby can fall off the bed and be injured, or become trapped between the bed and the wall. Your baby is also likely to overheat because adult bedding is not suited to infants, and your baby will also be getting your body heat. Overheating is linked to cot death. There is also a high risk of suffocation: your baby could be trapped between a pillow and duvet, or you may roll over on to them, or you may cover their face or chest with a hand or arm while you are asleep. As your body creates slopes on the mattress, there is a high risk of your baby rolling over onto their front and being unable to breathe. Co-sleeping is also linked to cot death, for reasons we do not fully understand yet. You should never co-sleep if you have been drinking alcohol, smoking or taking (prescription or non-prescription) drugs, and it is safest to avoid co-sleeping entirely, even if you have not been doing these things.

> Learn to swaddle properly.

While swaddling provides some babies with a sense of comfort and safety, there is evidence that it can also increase the risk of cot death. If you want to swaddle, follow these guidelines: The most important thing is consistency. If you want to swaddle, swaddle consistently and remember to speak to other caregivers (your partner, parents or nursery) to tell them to swaddle your baby as well. It is safest to swaddle from birth, rather than deciding to change care practices and begin swaddling at a later age. It is particularly important not to begin swaddling at around 3 months of age, when the risk of cot death is highest. Don’t cover your baby’s head when you swaddle. Use thin materials, such as thin cotton or muslin cloth; this helps reduce the risk of overheating. NEVER place your baby on their tummy to sleep when they are swaddled. By the age of 3 or 4 months, most babies naturally start to wriggle; swaddling can be stopped at this age.

> Follow the 2 hour rule for car sear safety.

Car seats are designed for safety while travelling; they are not a main sleeping place for your baby. The maximum time advised for any baby in an infant car seat is two hours. Our advise regarding keeping your baby safe in their car seat can be found here.

Take frequent short breaks, even if it means waking the baby. Don’t use the seat for sitting or sleeping outside of the car. Ensure your baby is lying as flat as possible in their car seat, so that their head cannot fall forwards. When arriving home, take your baby out of their car seat and transfer them to a (safe) cot. Minimise the amount of time your baby spends in their car seat, and never exceed a maximum of two hours. Remember that cars can heat up very quickly, so consider the amount of clothing your baby is wearing. Try to remove outdoor clothing if possible, particularly hats and snow suits, as young babies cannot regulate their own temperature.

For more information and advice, see