As parents, you make many decisions every day to help keep your child healthy and safe. When it comes to sleep, your baby’s sleep environment is always important – day or night. Some sleep practices are safer than others. This page shares information about how to help make your baby’s sleep environment as safe as possible – so every sleep is a safer sleep.

You and your health care provider can also discuss your infant’s sleep plan. For more information, see the resources at the end of this document.

Make Every Sleep a Safer Sleep

Place baby on their back to sleep
Put your baby to sleep on their back for every sleep, whether it's naptime or nighttime.

Use a firm mattress free of hazards
Use a firm mattress made for babies with no bumper pads, pillows, heavy blankets, comforters quilts or toys. This will help keep their sleep space safe.

Use a crib or bassinet
The safest place for your baby to sleep is in their own Health Canada approved crib, cradle or bassinet when at home or traveling. Plan ahead when traveling, and make sure there is a safe sleep surface for your baby. Examples of other safe sleep surfaces are on the next page. Check out this Health Canada link for more information https://www.canada.ca/en/health-canada/services/safe-sleep/cribs-cradles-bassinets.html.

Breastfeed as much as possible
One way to help prevent sleep-related infant death is breastfeeding – which helps boost a baby’s immune system. The more you breastfeed the greater the protection. Any amount of breast milk will help keep your baby healthy.

Share your Room
Have your baby sleep on a separate sleep surface in the same room as you for the first six months.

Be smoke-free
Smoking increases your baby’s risk of sleep-related death. Quitting can be hard, but being smoke-free during pregnancy and keeping your home smoke-free before and after birth can help prevent sleep-related infant death.

To be extra careful, avoid exposing your baby to cannabis, vaping and e-cigarettes during pregnancy and after birth. For more information on how to quit smoking, please visit www.quitnow.ca.

Be alcohol/drug free
Drinking alcohol, using drugs or taking some medicines can make you drowsy and cause you to sleep more heavily. Heavy sleep increases the risk that you will roll over onto your baby if you are bedsharing. Have another adult on hand to help with your baby if you have consumed anything that makes you less alert.

If you would like support for any kind of substance use (including alcohol or other drugs), free, confidential information and telephone support is available from the Alcohol and Drug Information and Referral Service. Call 1-800-663-1441 (toll-free in B.C.) or 604-660-9382 (in the Lower Mainland). Support is available 24 hours a day, 7 days a week, in multiple languages.

Keep temperature comfortable
Keep the room at a comfortable temperature and use a thin, light-weight blanket so that your baby does not overheat. If the temperature is comfortable for you, then it is comfortable for your baby. If using a sleep sack, it should fit callout around baby’s shoulders so that your baby’s head does not slip down into the bag. Extra bedding or hats indoors are not needed.

What about swaddling?
Swaddling is not needed, and it can be risky. It is safest for your baby not to be swaddled. Tight swaddling can make it hard for your baby to breathe, and can lead to pneumonia. Swaddling can also cause your baby to overheat and increase the risk of SIDS. Swaddled babies can also get stuck on their stomachs and be unable to move into a safer position if they roll over.

If you choose to swaddle, ensure that:

• Baby is placed on their back to sleep
• Only swaddle from the shoulder down – not over the face, and ensure hands and arms are free
• Swaddle not too tightly or loosely. Make sure you can fit 2 fingers between the blanket and the baby’s chest, and that baby can bend and move their legs
• Use a light cotton blanket
• It is especially risky to swaddle past 2-3 months or once your baby can make strong movements on their own

Are adult beds safe?
Adult beds are not designed to keep babies safe. Often they are too soft, and blankets and pillows can increase the risk of suffocation or entrapment. It is not safe to leave your baby unattended on an adult bed. Sleeping on a raised bed also increases the risk of falls.

Tips on car seats, carriers and strollers
It is not safe to leave your baby asleep in a car seat. Once you have reached your destination, place your baby on a safe sleep surface – even if they are only napping. It is not safe to leave babies unattended in carriers or strollers.

Are sofas, recliners or couches safe?
It is never safe for a baby to sleep on a couch or chair – either alone or with a caregiver. Your baby can fall to the floor or slip between your body and the cushions and leave them unable to breathe. Have a bassinet or crib ready, or someone else to take the baby when you need to rest.

Bedsharing

Sharing a bed with your baby can be risky. The safest place for your baby to sleep for the first 6 months is on their own safe sleep surface in your room. Some families may prefer to bedshare for cultural or personal reasons, and some families might end up bedsharing even if they hadn't planned to. If you think you might ever share a bed with your baby, or even if you don’t plan to do so, here are some questions to ask yourself to make bedsharing as safe as possible for your baby.

Questions to ask yourself…

1. Was your baby full term (37-40 weeks) and did they weigh more than 2.5 kg or 5.5 lbs at birth?
   Premature and small-at-birth babies have an increased risk of sleep-related death. This risk increases if baby is also bedsharing.

2. Were you and/or your partner smoke-free while pregnant?
   Exposure to smoke during pregnancy increases your baby’s risk of sleep-related death. This risk increases if baby is also bedsharing.

3. Is your baby’s environment smoke-free?
   Exposure to smoke, including second hand smoke, increases baby’s risk of sleeprelated death. This risk increases if baby is also bedsharing. For support to quit smoking, visit www.quitnow.ca.

4. Are you and/or your partner alcohol and drug-free, and free of any substance that might make you sleep more heavily?
   Heavy sleep increases the risk that you or your partner will roll over onto your baby, which can cause suffocation. It’s best to have another adult on hand to help with your baby if you have consumed any alcohol, drugs or medicines that make you less alert.

If you answered NO to ANY if these questions then bedsharing is especially risky for your baby and is not recommended. Your health-care provider can help you develop a safer sleep plan for your baby.

If you answered YES to ALL of these questions, review the checklist below.

Bedsharing and Breastfeeding

It is normal for babies to feed often during the night, and as a result some parents find themselves bedsharing. Most parents who breastfeed their baby in bed will naturally sleep in a "C" shape – facing their baby with their knees drawn up under the baby’s feet and their arm above the baby’s head. This protects the baby from moving down under the covers or up under the pillow.

You and your healthcare provider may wish to discuss sleep positions that can help you rest and minimize risk to your baby. If you do not naturally sleep in a "C" position with your baby, it is safer for your baby to sleep on their own sleep surface in your room.

Checklist: Additional ways to help keep baby safe if bedsharing

Baby is put to sleep on their back.
It is safest for babies to sleep on their back. If your baby rolls onto their tummy while sleeping, gently place them back on their back.

Mattress is on the floor.
To reduce the risk of falls, the mattress should be on the floor and away from walls. Ensure there is space around the bed so your baby cannot get trapped between the mattress and the wall or bedside table. Make sure the mattress is firm and clean (no waterbeds, pillow tops, feather beds, air mattresses or sagging mattresses).

Baby is far away from any pillows, duvets and heavy blankets.
Pillows, duvets and heavy blankets can increase baby’s chance of suffocation and entanglement. Use only a light weight cotton baby blanket on your baby. If either adult has long hair, ensure it is tied back so that it can’t get tangled around the baby’s neck.

Baby is able to move freely and is not swaddled.
Baby should be able to move freely. Swaddling can restrict baby’s movements, and put them at increased risk. Swaddled babies can get stuck on their stomachs and be unable to move into a safer position if they roll over.

Baby sleeps on the outside of the bed, instead of between adults.
If there are two adults in the bed, ensure that baby sleeps on the outside of the bed, instead of between adults. Both adults need to be aware that baby is in the bed and be comfortable with this decision.

Baby and adult(s) are the only people on the sleep surface.
Ensure that no other children or pets share the baby's sleep surface.

Ensure that baby is not left alone in an adult bed.
Adult beds aren't designed to keep babies safe.

Checklist and image adapted from: Maximizing the chances of Safe Infant Sleep in the Solitary and Cosleeping (Specifically, Bed-sharing) Contexts, by James J. McKenna, Ph.D. Professor of Biological Anthropology, Director, Mother-Baby Sleep Laboratory, University of Notre Dame.