Zara Smith, PACEY Advisor

How do we ensure that we are still providing the best possible care to the children we look after whilst they are sleeping and what should we do to make sure that they are as safe as possible? 

The starting point is always to identify what the risks are.  Once we know what these are, we are then able to consider the steps we should take to minimise them and keep children safe.

For the purposes of this blog, we are referring to daytime sleeping children. If you provide overnight care, you might find our Overnight care factsheet useful.

Most of us will be aware that the most significant risk to small, sleeping children is Sudden Infant Death Syndrome (SIDS).  If we understand what SIDS is and recognise what the risks are, then we, as childcare professionals, are well placed to ensure that we are keeping children safe.  With the right knowledge, we can make informed choices to ensure that we are following best practice guidelines and fulfilling our responsibility to minimise the risk. 

Safety during sleep is referenced in national guidance. In England the EYFS (3.60 on page 36) states that ‘Sleeping children must be frequently checked to ensure that they are safe.  Being safe includes ensuring that cots/bedding are in good conditions and suited to the age of the child and that infants are placed down to sleep in line with latest government safety guidance’.  On the bottom of this page there are also a couple of links to latest NHS on SIDS and minimising risk.  In Wales the National Minimum Standards (24.9, on page 61) says ‘Sleeping babies are frequently checked by a member of staff. All persons providing care are made aware of guidance on sleeping babies.’

So, lets break this down, and explore the what you might need to consider.

Frequently checked

How will you carry out these checks?  Do children sleep in the same room as those who are still awake, or do they have a separate sleep area?  If they are in a separate area, how do you check them?  Do you do it in person, and if so, do you do a quick check or do you go close to the child and observe the rise and fall of their chest?  Or do you use a baby monitor?  If so, how frequently do you check that it is working and how do you ensure that there isn’t any interference that is impacting on the quality of sound?

Importantly, there is increasing evidence that where a young baby sleeps in the same room as their parent or carer, there is a significant decrease the risk of SIDS. 

Being safe

There are several considerations when reviewing safety.  First, we need to think about where the child or baby is sleeping.  The guidance states that children should be sleeping on a firm, flat, waterproof mattress that is in good condition, with a clean well fitted sheet that cannot become loose. 

This could be a Moses basket, cot, carry cot or a sleep mat.  Sleeping on beanbags, sofas, bouncy chairs, pods, cushions, and car seats significantly increase the risk of SIDS in babies and are therefore not suitable sleep surfaces.  Pushchairs and prams are only suitable if they can be fully reclined so that the child can lie flat, but cautioned should be used as having restraints such as straps can increase the risk of SIDS but may be essential in preventing a child from falling out. 

Having decided upon an appropriate sleep area we then need to make sure it is clear of pillows, duvets, cot bumpers, toys, loose bedding, sleep pods, sleep nest and sleep positioners as research has shown that these can also increase the risks.  If child use dummies, the advice is to provide these whilst they are sleeping but ensure that they are not on a chain or ribbon that could cause a strangulation hazard.

The environment around a sleeping child is also important.  The room should be at a comfortable temperature, ideally between 16 and 20 degrees, without too much or too little bedding.  Keep the air clean in the sleep area and make certain that children are not exposed to second hand smoke as this also significantly increases the risk of SIDS.

Safety guidance

In the NHS Reduce the risk of sudden infant death syndrome (SIDS) information it says babies should be placed on their back to sleep in the ‘feet to foot’ position at the end of the cot, ideally in the same room as their carer until they are 6 months old.  Their heads should not be covered and blankets, if used should be not higher than shoulder height.  Baby sleeping bags are a useful alternative as a baby cannot wriggle under the covers if they are well fitted but remember that if you are using a baby sleeping bag, then a blanket is not needed.

In addition to the NHS website, another particularly useful resource is the Lullaby Trust website.  It contains advice and guidance for both practitioners and parents, along with a range of downloadable resources, some of which are available in 25 different languages – helpful for supporting and strengthening those all-important parent partnerships! 

The following video is from the Lullaby Trust and is a useful quick guide to safer sleeping practices.

In conclusion there is a lot to consider when ensuring that children remain as safe as possible while sleeping such as:

• Sleep position
• Room temperature
• Suitable cots, clear of toys, pillows, and bumpers
• Appropriate mattresses and bedding
• Not letting children to sleep in inappropriate places such as car seats, pushchairs, baby bouncers and sofas
• Other hazards such as smoking around children and in areas where they are likely to sleep.
• Monitoring sleeping children

With a little thought and planning, all of these are easily achieved and provides you with the peace of mind that you are keeping all the children you care for safe, even whilst they are sleeping.

#Signposts

• Sudden infant death syndrome (SIDS) – NHS (www.nhs.uk)
• Reduce the risk of sudden infant death syndrome (SIDS) – NHS (www.nhs.uk)
• Lullaby Trust publications – The Lullaby Trust