Zara Smith, Coram PACEY Advisor & The Childcare Professional Editor and Writer
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 (3.86 on page 33 and 34) states that ‘‘Babies and children must be placed down to sleep safely. For children under 2 years old the following requirements apply:
- Children must be placed down on their back in their own separate sleep space on a firm flat surface such as a cot, bed or mattress on the floor. Babies aged 12 months and under must only be placed to sleep in a cot.
- Sleep spaces must only contain a firm, flat, waterproof mattress and lightweight bedding which is firmly tucked in around the child below their shoulders to prevent head covering. Alternatively, a well fitted baby sleep bag may be used. Check the manufacturer recommendations before using a baby sleep bag.
- Where blankets are used, the child must be placed feet-to-foot at the bottom of the cot, with blankets tucked in.
- Cots must not contain extra items such as toys, pillows, extra blankets, bumpers, wedges or straps.
- Children should not get too hot or cold. The recommended room temperature for babies is 16 – 20˚C.
- Children’s heads must not be covered.
- Babies under six months of age must always have an adult with them in the same room for every sleep. All children must be frequently checked when sleeping.
- Children must always be within sight and hearing of staff when sleeping.
It also states that practitioners must read NHS advice on Sudden infant death syndrome (SIDS) – NHS. More information on safer sleep guidance is available from The Lullaby Trust
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, let’s break down some of these elements, and explore 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? How do you manage sleep for children under 6 months of age who must always have an adult with them? If older children 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 not suitable sleep surfaces. Pushchairs and prams are not considered a suitable main sleeping space. Children who fall asleep in their pushchair when out on a walk should be transferred to an appropriate safe sleeping space as defined in the guidance on their return to the setting
Having decided upon an appropriate sleep area we then need to make sure it is clear of any unnecessary items such as pillows, duvets, cot bumpers, toys, loose bedding, sleep pods, sleep nest, sleep positioners and wedges 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 achievable and provides you with the peace of mind that you are keeping all the children you care for safe, even whilst they are sleeping.
