Safe Sleep Guidelines for Young Children

by: Dr. Pamela Miteman

by Dr. Nicky Cohen
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Establishing safe sleep habits is critical for young children of all ages. The majority of the time that we spend away from our children is while they are sleeping. Thus, ensuring that their sleep environment is safe is of utmost importance!

The following are some guidelines to help ensure that your child’s sleep environment is a safe one:

Practice the ABC’s of safe sleep for your baby: Babies should always sleep Alone, on their Backs, in a Crib. Place your baby on his or her back for every sleep, night time and nap time.

Sleep ALONE, avoid bed-sharing: Bed-sharing (sometimes referred to as co-sleeping) is not recommended due to evidence linking bed-sharing with accidental smothering and suffocation. Due to the same safety concerns, waterbeds, air mattresses, couches, rocking chairs, car seats, infant swings or baby carriers should also not replace the crib for sleep. However, room-sharing (having your child sleep in a crib in the parental room) until six months of age is associated with a reduced risk of Sudden Infant Death Syndrome (SIDS). Make sure that your child’s crib meets Health Canada’s current safety standards.

Place on BACK to sleep: Until your baby can roll or move to another position on her own, the ‘back to sleep’ position is recommended by the Canadian Paediatric Society and Health Canada as it has been shown to significantly reduce the risk of SIDS. However, according to these guidelines, once babies can move to another position independently, they do not need to be repositioned or kept on their back, unless there is a medical reason to do so.

Keep the CRIB environment safe: Canadian Paediatric Society and Health Canada guidelines recommend that babies sleep on a firm flat surface in their crib for all sleep periods – day and night. It is also recommended that soft materials in the crib, including blankets, bumper pads, comforters, stuffed animals, pillows, and other pillow-like items such as rolled up blankets and infant sleep positioners be avoided. These soft materials can prevent the circulation of air around a baby’s face and lead to suffocation.

Avoid overheating: To avoid overheating your child, keep the room temperature on the ‘cool side of comfortable’ and do not overdress your baby or child. Being overheated is a risk factor for SIDS and can also generally lead to restless sleep. A good rule of thumb is that if a temperature is comfortable for a lightly clothed adult, it is usually comfortable for a child. In the warmer months, a single light layer of clothing should be sufficient. In the cooler months, depending on the household temperature, if a second layer of dressing is needed, a sleep-sack is recommended rather than a loose blanket (which can cover a young child’s face). Do not use a heater in your child’s room.

Don’t transition to a bed too early: If the transition to a bed is made too soon, bedtime problems and night wakings can develop or worsen and then you have a child who is awake and mobile. This could be a safety concern as well as difficult to manage because many young children are not yet “mature” enough to understand the rules associated with staying in bed. Barring no safety concerns, it is recommended that a child continue to sleep in a crib until 3-3.5 years of age.

Transitioning to a bed

This is a milestone that commonly occurs during the toddler and preschool years. It is essential to provide your curious child with a safe sleep environment. Below are some guidelines to help you with this transition.

Toddler beds: Health Canada recommends that young children transition from a crib into a toddler bed, which can be used until approximately 5 years of age. Typically, toddler beds are equipped with built-in bedrails to prevent falling out.

Portable bedrails on an adult sized bed: Health Canada cautions against portable bedrails for a child under 2 years old due to safety concerns. Rather than having a young child sleep in an adult-sized bed, use of a mattress on the floor is instead recommended to ensure a young child’s safety. For children over 2 years old in an adult-sized bed, proper use of portable bed rails is recommended to keep children from falling out. Before every bedtime and naptime, check that the bedrails are securely in place and that there are no gaps between the mattress and bedrail. Pillows and toys should not be placed against the rail because a child can suffocate if his face is pressed up against the non-breathable items. Make sure that your child’s bedrails meet Health Canada’s current safety standards.

Bedroom environment: The Canadian Paediatric Society cautions against cords on window blinds, shades, and curtains as a strangulation hazard. Ensure that any cords are out of your child’s reach. Similarly, corded baby monitors and small objects should not be in or near your child’s sleep space. Heavy furniture needs to be safely and securely fixed to the wall.

Home environment: Ensure that your child does not have access to potential hazards such as windows, patio doors, lamps, candles, electrical plugs, and extension cords. If there are stairs in the home, ensure that they are blocked by a properly installed safety gate.

For more information on safe sleep practices for young children, see the following handouts for parents:

Pleasant Dreams!

by: Dr. Nicky Cohen, Ph.D., C.Psych. & Dr. Pamela Mitelman, Psy.D., OPQ

Disclaimer

The information provided by Dr. Cohen and Dr. Mitelman is not intended to be a substitute for professional advice. Individuals are encouraged to speak with a physician or other health care provider if they have concerns regarding their child’s sleep and before starting any treatment plan. The information provided by Dr. Cohen and Dr. Mitelman is provided with the understanding that Dr. Cohen and Dr. Mitelman are not rendering clinical, counselling, or other professional services or advice. Such information is intended solely as a general educational aid and not for any individual problem. It is also not intended as a substitute for professional advice and services from a qualified healthcare provider familiar with your unique facts.

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