Sunday, July 14, 2024

Safe Sleeping

This is an INFORMATION page, verified by physician

There is lots written on safe sleeping, but advice has changed over the years too. We’ll be sharing professionally recommended practices to keep your new baby as safe as can be.

We monitor studies to ensure that we keep these guidelines up to date. We hope you find them useful and reassuring.

The Importance of Safe Sleeping

In the early weeks of life, babies can sleep for about 16 hours in a day. Planning where your baby can sleep safely is important. The sleep environment is an important part of establishing good sleep habits. Creating a safe sleep environment for baby will also reduce the risk of Sudden Infant Death Syndrome, SIDS.

SIDS (Sudden Infant Death Syndrome) or cot death is the leading cause of death in children between one month and one year of age. The risk of SIDS is highest in infants between one and four months of age.

It is not known why some babies die suddenly and for no apparent reason from SIDS. But we do know how to reduce this risk by providing a safe environment for your baby to sleep in.

Following our safe sleep guidelines for baby means you too can sleep without worry.

Back to Sleep

Always place your baby on his or her back to sleep. A baby sleeping on its back is better able to keep its airway open and clear. Assuming he or she is otherwise healthy, they are not at risk of choking in this position. Since we began sleeping babies on their backs, the rate of SIDS reduced by 70%.

Sleep your baby on his or her back from the very beginning. But once your baby learns to roll on its own, it is okay to leave baby on its tummy.

If your baby falls asleep on its tummy during the day, you may leave baby this way, as long as you are with baby at all times. Do not leave your baby asleep on its side or stomach if unsupervised.

Tummy time, while babies are awake, is very important for their development. It can be done from the newborn period. It is important to prevent baby from getting a flat head.

Rooming In

Your baby should have his or her own bassinet or cot/crib and share your bedroom for at least the first 6 months of life. Ideally for up to one year.

The reality is for some parents, it may be difficult to sleep if your baby is wakes often in the night or is a noisy sleeper. If you choose to sleep your baby in his or her own nursery, a monitor can help you hear your baby. And you can still follow the other safe sleep guidelines.

No Soft Bedding

There should be nothing loose or soft in the sleeping area that could cover your baby’s face. This includes cot bumpers, soft toys, pillows or loose blankets. If you are staying somewhere cold and your baby needs a blanket or sheet, make sure the top edge of the blanket stops at the upper chest. Tuck it in at the bottom of the mattress with the baby positioned with their feet down the end of the cot. 

Sleep sacks are now recommended by the American Academy of Paediatrics. They are available in different sizes (including from 0-3 months) and different fabric weights. If you are using a sleep sack it should be the right fit or size for the age of your baby.

Some countries still swaddle newborn babies with a thin cloth or muslin for the first few weeks of life. The UK guidelines do not recommend swaddling. But the AAP support swaddling for soothing and for sleep. Providing it is done correctly. Baby is put on their back for sleep and you stop swaddling baby when they start to roll. Ask your paediatrician or midwife to show you how to swaddle correctly.

Sleep aids such as Dock-a-tots and other pods or nests have become popular with parents in recent times. But these are classed as soft sleep surfaces and carry a risk of suffocation. They should never be used for unsupervised sleeping.

Avoid Overheating

Overheating is a risk factor for SIDS.

With the warm climate all year round in Cayman it is often difficult for first time parents to know what temperature to set their baby’s bedroom. The UK guidelines for safe sleep state that parents should avoid overheating the room. Keep room temperature to 18 degrees Celsius or 65 degrees Fahrenheit. This is hard to achieve here in Cayman without expensive air conditioning bills and a freezing home! It could also cause baby to be overcooled, which is also a risk factor for SIDS.

So, for your little Caribbean baby, we recommend the temperature of the home or bedroom should be at a comfortable temperature for you. If the room is comfortable for you, then it will be comfortable for baby. Most homes are kept around 78 to 80 degrees Fahrenheit.

In general, babies may need one extra layer if you are feeling cool. Babies heads often feel hot and their hands and feet cool. Feel baby’s temperature, by placing your fingers on his or her chest rather than head. If your baby feels sweaty or hot, remove a layer.

The best sleep sacks to use here in Cayman are made of light weight fabric such as muslin cloth, cotton or bamboo. Look for the lowest “TOG”rating possible on the sleep sack, typically 0.5. Baby will usually wear one layer under this, typically a onesie with long arms and short or long legs.

Never use a hat for sleep. If your baby gets too hot during sleep, the only way for heat to escape is from his or her head.

Smoke Free Home

Any smoke exposure both during pregnancy and afterwards, places baby at a significantly higher risk for SIDS. A smoke free womb and a smoke free home is best for baby. Speak with your obstetrician or GP to learn more about becoming smoke free. It is never too late to stop. This goes for partners and other family members too.

Breast Feed Your Baby

Breast feeding, if you are able, is the preferred way to feed your baby. Along with its many benefits, also helps lower the risk of SIDS. If your baby requires formula, you can still follow the other safe sleep guidelines.


The use of a pacifier or dummy may help reduce the risk of SIDS. But these should be used cautiously in the first month of life. Especially while establishing breast feeding. There is no evidence to support if the pacifier should be replaced in the mouth if it falls out while baby is sleeping.

Risks of Co-sleeping

Co-sleeping with your baby is generally not recommended. And in some cases, may carry significant increased risk for your baby. Especially if your baby is born premature or of low birth weight.

Sharing your bed with baby is also unsafe if you smoke, use alcohol or drugs, or take other medications. You should also avoid co-sleeping if you are very tired or are a heavy sleeper.

Please feel free to speak openly about sleep practice in your home. Especially, if co-sleeping is part of your culture. We will listen without judgement and can help you make a fully informed decision. If you do choose to co-sleep you do, we can help you do so as safely as possible.

More Advice on Safe Sleeping

It’s also worth checking out help, advice, and any safe sleeping posts in our Baby Facebook Group. It allows you to ask questions, gain access to basic advice and share experiences with others facing the same new experiences. You can join here:

For further information, please see our Early Days Course. This course is free for you to attend during your pregnancy. Safe sleeping will also be discussed at baby’s routine check-ups.

about the author

Dr Sarah Newton
Dr Sarah Newton
SPECIALIST GENERAL PAEDIATRICIAN & NEWBORN CARE - Dr Sarah Newton (MMBChB, FRACP (paeds), DCH) is a general paediatrician with the Royal Australasian College of Physicians, tertiary level trained in highly respected paediatric and neonatal centres in Australia, New Zealand and Singapore. Her specific interests include neonatal care, complex diagnoses and developmental follow up.

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