Safe Sleep - Red Nose

The Supporting Children’s Health Workshop was delivered by the NSW Department of Education in partnership with health professionals from the Sydney Children’s Hospitals Network, Red Nose Australia and CPR Kids.

The Red Nose Safe Sleep video is the first of five presentations from the Workshop. This video provides practical information and guidance on the importance of safe sleeping practices, National Quality Framework requirements relating to sleep and rest, and the Red Nose six safe sleep recommendations.

By viewing this video and the upcoming presentations you will be able to:

  • Improve your responses to health incidents in your service.
  • Improve your understanding of and compliance with a range of health-related National Regulations, and Elements 2.1.1 and 2.1.2 of Quality Area 2 of the National Quality Standard.
  • Make practical improvements to your existing policies and procedures on health, injury, illness, infectious diseases and medical conditions.
  • Understand where to seek additional information and assistance, including contacts to children’s health units and organisations.
  • Provide guidance and help parents and families to support children’s health.
Video on safe sleep. Presented by Lorraine Harrison from Red Nose.

 

Lorraine Harrison

My name's Lorraine. I work as an educator for Red Nose. You may have known of us previously as SIDS and Kids. A couple of years ago, we changed our name to reflect some of the things that we do.

So what I'm here to talk to you about today is about safe sleeping. So the predominant area where safe sleeping is relevant is for babies less than one year of age. Now I know some of you may have the babies in and some may not have in your services, but it's also some of the stuff is quite relevant for the older child too particularly when we're talking about supervision and sleeping accidents. So we're going to do all that. Like Sarah, before me, I come from an emergency nursing background. Although it's a long time since I've worked in ED and I now refer to myself as across the old ED nurse because it's about 14 years since I worked in ED. So some of the things that we're going to look at today is looking at what your role is in terms of working with children and babies.

I want to tell you a little bit about Red Nose and who we are and what we do as well and looking at the ways you can then make use of the services we provide which hopefully you won't need to you make use of but some of the things that may be helpful for you as well.

Okay, so Red Nose, we're a not-for-profit charity organisation and we basically have a couple of major roles that we work in.

One of them is we work in education and that's what I'm hopefully doing here today. Is that rolling education, but we also do provide education in the whole area of bereavement as well so we can provide education and support to people maybe in the workplace in any areas where they may have had an employee whose baby has died and we can go and help and educate the work place around how do they support that family.

But most of the education is what I do, which is around safe sleeping. And we also are involved in advocacy and research we've put millions and millions of dollars into research into infant death and stillbirth. And we also do provide support to families who have had a baby that's died. Whether that's been from miscarriage, stillbirth, death of an infant, older child. Mainly where the death is sudden and unexpected. We have a great team of counsellors who work across the country that can support families on the phone, online, face-to-face.

Okay, but the good news about infant death, is that since we have the safe sleeping guidelines have been around it's actually reduced the infant death rate dramatically. There has actually been a reduction of 85% of the infant death rate by simply placing the babies to sleep a bit differently to what my generation and that would have done many years ago. And you can see how much that reflects that drop in the infant death rates quite dramatic. And look, that's something that all of you have and will continue to contribute to as well.

Okay, so why are the practices so important? We know that babies spend a huge amount of their time asleep. So it's important that we're sleeping them safely. We have a duty of care no matter where we work what we do. We all have a duty of care to the people that we work with. And even though we've had a massive reduction in the infant death rate, it's still the largest cause of death for babies less than one year of age. That's leaving aside congenital abnormalities and acute large prematurity that sort of thing. Once you take those out S.U.D.I. or Sudden Unexpected Death in Infancy is the largest cause of death. We also have a professional responsibility. And of course that comes for you from your national authority body ACECQA. And of course part of education or training as well.

Okay, it's important you have an idea of some of your safe sleeping practices. I'm not going to put you on the spot and say have you read your safe sleep and rest policy or do you know where the sleep and rest policy is kept. But it'll be a good idea if you were able to answer those to yourself and if you can't answer them. Yes. Yes. Go find out. Just Red Nose has been given the great responsibility of being the educating body for in terms of sleep and rest for all child care services.

So for child care services and family day care services. I know that we're also involved in looking at some of the safety with OSHC services as well. But not that many kids go to sleep at OSHC. They're usually so hyped up aren't they, before and after school, although you got school holidays. So it's important, we're really thankful that and felt quite privileged to be able to do this on behalf of ACECQA as well. And just gives you an idea of some of the areas within you the quality standards and the framework where the information about safe sleeping and safety for children and toddlers fits into what we talked about as well. And you can see there the different regulations, where safe sleeping and safety related to sleep is involved.

Okay, why did everything suddenly change? Well, nothing really changed a lot except some of the ways that child care services are asked to promote and practice safe sleeping and what to do, why it's important. So that all came as the result tragically of a little five-year-old bubby who died back in 2012 and in a care service and Red Nose was involved in part of the information that was gleaned then from the coroner's inquest and one of those recommendations was that it was really important to make sure that all babies and children were supervised appropriately when sleeping. As you would if they were out playing, as you would if they were eating, you know, Sarah has just given us a great talk about how to prevent choking, and supervision was one of the big things as well.

Okay, so what do you need to know how to implement the guidelines and to understand that your sleep and rest policy is based on the safe sleeping guidelines that Red Nose promotes. And you know, child care has not been singled out in this area. New South Wales Health, all employees nurses and midwives throughout New South Wales Health hospitals and community services are mandated to teach and model safe sleeping guidelines as well. So it's really important... important part of your care as well. We're going to do a little bit of science physiology here. And because I firmly believe that it's not my role to get up here and say you must do this and you must do that and you must do that.

My role here is to give you a little bit of a deeper understanding about why it's important that you place babies for sleep and supervise babies and young children when they're sleeping to help prevent and reduce the risk of infant sudden infant death.

So we talked about sudden unexpected death in infancy or as I refer to it now as SUDI. So SUDI is simply an umbrella term. So it's a term that encompasses all of the sudden and unexpected deaths. All of SUDI to classify in that area is where the death of an infant less than 12 months of age because definitionally infancy ends at 12 months. So it's a sudden unexpected death of an infant less than 12 months of age where, at the time of death, the cause of death is not obvious or unknown. So if you have a six-year-old who... sorry six month old who falls over or is pushed over really hard and falls a great height and died. That would not be classified as a SUDI.

Okay, it might be unexpected but it would be pretty obvious why, why that child had died. So SUDI, as I said is the umbrella term and if we look at the two areas underneath that, SUDI encompasses fatal sleeping accidents, so that might be any accident that occurs while the baby is asleep. That can be falling off a bed. It can be getting tangled up in bedding that might get caught round the baby's neck that might be getting the baby's head becoming covered and they're not not able to breathe. So it's like a suffocation. Or it may be a totally unexplained death, and that's what we would then refer to as SIDS. Another acronym or Sudden Infant Death Syndrome, and you may have heard of that one before. Now we're going to talk about the brain.

Okay, as I said before there's been a lot of money has been put into research particularly in in trying to find out what's happening, what causes you know, there's not many things that can be more tragic than a little baby or a six-month-old baby being placed for sleep and never wake up.

Okay, so there's it's been quite extensive, the research, and this model that I'm just going to briefly go through with you is what is probably the most accepted model in terms of looking at why these babies are, why these babies die. Why is it that just because I place the baby on the tummy to sleep? Why could that contribute to a baby's death? So the first thing we look at is what's referred to in this model as the vulnerable infant. Now what they found with a lot of the research is that these babies have had, the majority of these babies, seem to have had an abnormality within the brain particularly in the brain stem.

Now again, Sarah was also talking about how the brain controls so many things that that happen within the body and so if there is an abnormality in that area of the brain, called the brain stem, that can cause the whole body functions to have a problem with them as well. So say for example in that brain stem area, it's like a control box. Someone explain to me at one stage, you know, it's like you have the electricity comes in the big huge oval overhead power lines the high-tension power lines and it goes through a control box before it becomes the power that comes down the wires to your house. The brain works a little bit like that in the brain stem. So the brain stem is like that relay box that takes the messages from the main control to the body. That area of the brain controls breathing, heart rate, blood pressure, the ability to go to sleep and to wake up, and many many other vital functions. So you can imagine if there was something wrong there, it wouldn't take much for that person to die. And that's what we feel believe happens with these babies. Unfortunately, there is nothing we can do, no way that we could find that out prior to death.

Okay, and that that's a vital piece of information for what we'll look at in a moment. That vulnerable infant that abnormality is probably made worse when the baby is premature or pre-term and it's certainly exaggerated when mum smokes during pregnancy.

Okay, so that gives you a little bit more of a hint as to where we're going with the safe sleeping guidelines. So these babies are vulnerable. We can't identify them. We can't modify that part of the model. We know that the majority of the deaths occur in babies less than six months of age, but can occur up to 12 months. But ninety percent of the deaths occur in babies less than six months of age. So we refer to that as a critical developmental period, okay. So it's a critical time in that little bubby's life. So that then becomes the second part of the model, but again, it becomes a part of the model that we can't do anything about.

Now when that vulnerable infant under 6 months of age, but could be up to 12 months, is exposed to things from outside of their body, and they're called exogenous - exogenous means outside of - so exogenous stress, something that creates stress on that baby, it's body like, you know, pressure, internal pressure something that's causing the body not to work properly. Then that is probably the third part of this model that explains to us what happens to these babies. So what we're saying is, if little babies are placed on their tummy to sleep, okay, if little babies get their head and face covered, and that can happen in a number of areas if these babies are exposed to tobacco smoke, then that can be the third part of the model that contributes to that baby's death. Get it now? There's only one thing in there that we can modify... that we can change or we can do something about. And that's the outside stressors or what we now know, or we can now stop by placing the baby safely for sleep.

Okay, so the vulnerabilities not modifiable. The critical developmental periods, not modifiable... But the outside stressors on the baby or the way babies are placed to sleep, is modifiable. So that's what's been used to really push the importance of how we place babies for sleep. Now I know probably half of you are sitting there thinking, yeah, but when my baby was about five months of age or six months of age or four months of age, they started rolling over and they wanted to sleep on their tummy and nothing I could do would make any difference that's where they would stay. Now, that is very normal. But think about the difference between a little baby placed on their tummy to sleep, compared to the older baby who gets themselves to their tummy. These babies can lift their head up, turn it around, change position, roll back, roll over. So it's very very different. Now I have a number of grandmothers who say to me and I am now mother of 4 grandmother of eight and a half, sorry. No, I did that on purpose I promise... grandmother's will say to me, you don't need to listen about all that stuff, you know, all you, all my children were placed on their tummy to sleep and they were fine. I put my hand up. Yes all mine were placed on their tummy to sleep and survived. However, 85% more babies died then. You can't argue with that.

So because we don't know which babies are vulnerable we have to treat and manage and place for sleep all babies, so that we know then the ones that are vulnerable will be okay. It's a little bit like, you know, you hear of babies that are born with a hole in the heart. That's similar to what we're talking about only in a different part of the body in the brain and that often those little... some small degree of abnormalities disappear with age and development and that's probably what's happening here. But we know that particularly in that first six months it is really really important. Any questions about that or we're totally lost everybody? Are you going to sleep? Good. For me, when I first learnt this model, it really helped me understand why most babies don't die. But some do. And why do those 'some', die when most babies don't, regardless of how they're placed to sleep? What are we going to talk look at so these are the six safe sleep recommendations. You should all have a brochure on your table.

Okay, so the message is, sleep baby on the back from birth. Well I still think that should read 'place baby on the back for sleep from birth'. Sleep baby without head keep baby's head and face uncovered, keep babies smoke-free, provide a safe environment for day and night sleeps, but day as well. A lot of families don't think the day sleepers is a problem, but that is, needs to be safe sleeping provided there as well. And the two that are probably more applicable in the home than in services is to room share at night and breastfeed baby. We know that they are will add to the protectiveness of the other four guidelines.

Okay, the other thing that that people will say to me. Yeah, but if you place babies on their back to sleep, aren't they going to choke? You know when we do first aid, we're always tol, Sarah said it as well, we're always told to put people on their left side. Well what we're talking about in terms of placing people on their left side to protect their airway is an unconscious adult. Not a well healthy, baby who's asleep. Sarah also showed you the sizes of the straws and showed you the sizes of adult child and infant's airways. They are very different and particularly that little baby's airway is very different. So anatomically we're actually the same in many ways. So you can feel your trachea there in the front, that's that one, its bony. It's not bony in a little baby, but it certainly is an adult. That's the trachea or the air pipe. Directly behind that, and that's why it's so easy for people to actually choke or inhale something that they put in their mouth because the openings of the two are in exactly the same spot and one goes to the lungs, one goes to the tummy. So when we're looking, if you look at this particular diagram, you can see that when a baby is on their back, okay, at the bottom, on your back, the bottom is the oesophagus or the food pipe, on top of that is the trachea or the windpipe. So if a little baby is on their back, they burp up a bit of have a little bit of reflux of milk. You can see that it's quite difficult for that to get up hill into their trachea, into the airway. Whereas when the baby is lying on their tummy or their side, and they do a bit of a burp

My kids used to call them wet burps, you know what I'm talking about - then it's very easy for that to trickle over into the airway and for the baby to inhale that so that in actual fact, it's babies just preventing something happening with the airway because of regurgitation from the tummy, they are actually safer on their back than in any other position.

Now as they get older the shape of their airways change and it becomes very different. So like we can't compare an unconscious adult's airways to a little well healthy baby's airways, we can't compare the airways of a little well baby, to an unconscious adult because they're different. And so that's always the example that we use in trying to help people to understand.

The other thing with babies in the back position, they have in the back of their throat some little receptors that help the baby to swallow and that having those receptors there and having that baby on the back, those receptors work a lot better with them being on their back.

So they're swallowing reflexes are much better on their back than they are on their side or their tummy. Haven't lost you? Good. I just want to mention that one of the criticisms and complaints that people will make is about the fact oh, because you said I have to sleep my baby on their back, they've got a flat head. Really? Okay. Look one in five babies will get a little bit of a flat spot on the back of their head, you know, but it's important to look at ways that we can prevent that happening and becoming troublesome. Most flat spots or balding spots will disappear by the time the baby's about two. but it is quite common. It can be prevented by tummy time when baby's awake changing the position of babies, you know when you're holding baby and if you're feeding babies formula feeding or breast milk from a bottle when they're in your care rather than just have them on the same position all the time change their position.

Okay, holding the baby up for a little while after feeds particularly that really really small baby. Anything that takes the pressure off the baby's back of the baby's head. Tummy time, lots of ways to do tummy time. We got a beautiful photo of, I think it's a dad, who's lying on the floor with bub, doing tummy time. And you know, what a great way for either parent, grandparent, whoever to do tummy time, you know to actually get down on the floor with the baby at the same level and practice tummy time with them.

Okay. Second part of the message is to keep baby's head and face uncovered and that will reduce the risk of overheating, suffocation and asphyxiation. Why overheating you might say? Babies less than six months of age have a fairly poor method of controlling their body temperature, you know, if we if we get really hot, take some clothes off or we'll fan ourselves or will do whatever we need to do to make ourselves cooler, we perspire. That doesn't tend to happen with babies.

Okay, they aren't able to change their position. They aren't able to kick all those extra covers off and little babies will lose body heat through their head and their face. That's how they lose it. We lose it under our pits and all sorts of places. Babies lose their body heat through their head and their face.

So if a baby has got way too much clothing on, too many blankets on, and they've got something on their head while they're sleeping, they are at risk of not being able to control their body temperature. But also they are at risk of that hat or whatever coming down over their head and face and may be contributing to suffocation and if it's you know, something like a nice hat that's got nice ties that can go underneath it, they could get strangled in that as well, there's a potential for that. So really important to keep babies head and face uncovered.

When we look at how asphyxia can occur this is three ways, so again, if you think of the baby's airway as being like a very soft friable straw, if you cover the baby's face, head and face, with something, it's like putting your hand or finger over the top of the tube. The air can't get in and out. Pinching, so I know we don't go around pitching babies noses, but you know, little babies, if they, and Sarah also referred to the under three-month-old, if fever is really significant in that age group, so is a blocked nose significant in that age group, because babies up to about six months of age, are what we call obligate nose breathers, and I could say it's an O and B, but I wouldn't want to use the acronym. Obligate nose breathers.

They only know how to breathe through their nose, and that's because, you know, all of their feeding is done via the mouth but through sucking and so the mouth is completely covered when they're feeding. They still have to be able to breathe when they're feeding. So it's important to keep that nose uncovered. If the baby is in any sort of product, object, position that causes the chin to slip on the chest - and I hope I don't bash the mic - I'll do it gently... like that... that can cause, it's what we call the chin to chest position and that can actually, if the babies are in that position for a long period of time and they're sleeping that can actually cause problems to that baby and there have been a couple of tragic deaths of babies being left to sleep for long periods of time in bounce nets, car capsules, particularly with the good old cover on the top. And those babies have been sleeping in that position for long periods. So it is risky.

And the other thing can be the fourth one there that if it's, if the baby is, if say mom or dad or whoever is lying down baby is on their chest - apart from the fact at that stage the baby is sleeping in a prone position or on their tummy, which can be risky - but they can get pressure on the airways as well that can make it hard for babies to breathe properly also. I'm not trying to say all this to scare everybody witless about how we treat our own children and grandchildren. A lot of this all comes down to longer periods and unsupervised.

Okay, so again, I'm coming back to all children sleeping in services should be supervised. I'm not saying we shouldn't be allowing four year olds to sleep on their tummy if that's how they want to sleep or nine ten-month-old who get themselves to their tummy and want to sleep. I'm not talking about that. It's very different. It's the little babies who are placed in that position and can't move or change their position.

Okay, here's the popular one with child care services. Babies wearing necklaces, toddlers wearing necklaces, older children playing and wearing necklaces. Okay, there was actually, because, it's sort of any, I mean, this is not new, baby wearing things around their neck, children wearing things around their neck. What is the problem is that it's blown out of all proportion and the number of babies that are coming to your day care services with amber necklaces or other types of necklaces around their neck . It is risky. I had to do an interview with one of the newspapers one time, but the story was it was about an incident, this baby was okay, this toddler was okay, but it was a two-year-old, who mum had placed for afternoon sleep, baby had an amber necklace on, mum had placed the baby for sleep and the baby had slept for an...the toddler had slept for an unusual length of time. So after about two and a half hours mum went in and thought oh my goodness, he doesn't usually sleep this long, you know, and went in, this baby was fine, but went in and the baby was quite pale and difficult to arouse. And mum sort of got her up and shook her and everything was alright, but what she noticed was that the baby had put its toddler put it hand up between the necklace and the neck.

Okay. Now we all know that kids of around two don't know that if it goes in it's got to come out the same way if it's so small. So baby clenched his fist was trying to wriggle around and turn it to get to get it out. And of course it was just creating more, was becoming more and more tight around the baby's neck. And I've seen the pictures of the back of that baby's neck, is quite an obvious imprint of something tight with little beads on it around their neck. So the baby was fine, but it's important, you know, it's important, that's why we talk about nothing around the neck for sleep.

Okay, now that also it's not only isolated to amber necklaces, it's anything around the neck. So we're looking at, there's a lot of cultural necklaces that we need to have discussions with these families about why that needs to be removed prior to sleep. I had a service that rang me not long ago and it was a it was an eight month old had been just started with the service, and that baby had a very very highly expensive heirloom necklace that they sent the child along to daycare with. And she said I'm not I'm too scared to take it off, because what if we lose it, what if it goes missing, what if what if what if. I said and what if it gets tight around the baby's neck and the baby has trouble breathing. So I said I suggest you have a really good discussion with the family and please ask them not to send the child along to day care not only because of the cost of the necklace but because of the risk to bubby. That's why we talk about things like not allowing children to sleep with hoodies on. Particularly if the hoodies have got cords around them.

That's why we talked about making sure that all the blind cords and everything are away from children's sleeping environment and playing areas as well. So it's to do and how easily these things can happen. Wrapping is one that people often get asked about particular with the small babies. How many of you would have babies under currently under 12 months of age? Or will have them? So a few of you, yeah.

Babies may be wrapped parents may wrap them so few and that's fine or they may not wrap them. That's fine as well. Babies don't have to be wrapped. It's not compulsory. However, if babies come to your service or your family day care with, and they are used to being wrapped while they're sleeping, again, it's important that that you do the same for that baby. However, if that baby is starting to roll, this is what we tell parents, once that baby is starting to roll and looks like they might be successful, the wrap should be removed. Babies need their arms and that upper body strength to keep in a safe position.

Now the other side of that is that if a baby is not being used to wrap wrapped at home and they come to your service, and they are a bit unsettled, and you think oh they used to wrap that baby, I'll try, I'll wrap them again. Wrapping a baby who is naive or not used to being wrapped is quite dangerous because they're not used to having that tightness around their body and it actually does help babies to settle more and they may sleep safer. So particularly up to about 12 months of age, 18 months of age really important that these babies should not be wrapped and wrapping should not be introduced if it's already been ceased. You know, it was really important that we find other ways of settling babies. It can be quite risky potentially risky for babies who are rolling to be wrapped and babies who are not used to being wrapped being wrapped. I don't think there's any argument about keeping babies smoke-free before birth and after. And I think we all have a pretty good understanding, cigarette smoke is dangerous to baby and unborn baby the young baby and to every human being basically. And so it's important that we continue to promote that. Having said that, the risk to the baby is dose-related. So the greater the exposure, the greater the risk. Provide a safe environment day and night.

Okay, the only requirements we would say for where a baby should sleep is in a cot or a portable cot that meets the mandatory Australian standards. Now there's nothing wrong with using portable cots - porta cots - except that there's a couple of things you need to keep in mind, particularly for family day care often that's appropriate, you know, but it's up to what your individual regulating policymakers decide. If you're using a portable cot, again, it needs to meet, there are specific mandatory standards for portable cots.

A couple of things you need to remember, it may only be suitable and you need to look at the individual information with each cot. It may, there will be different weight ranges. Generally speaking, most of the cots will say not to be used for babies over 15 kilos of weight.

Okay, but there are some of them out there and I was quite alarmed when I heard about it, cots that actually meet the standards, but only up to a baby who's eight kilos in weight. So you need to be really careful and look about that. The other thing about portable cots that you need to be really careful about, is you only ever use the mattress that comes with the portable cot. Never add any softening to it extra padding. That bubby who died as a result, which was the one I was talking about in 2012, and there was one in Victoria around a similar time frame. Both of those babies were in a portable cot where extra padding had been put there. They were sleeping on loose blankets because you can't let a baby sleep on that hard mattress that comes with the portable cot... well you can. And they had all this loose soft bedding and it was uneven and the baby had become entrapped. So really really important. Plus the fact once there's any wear and tear, so the mesh starts to become a bit torn things like that. Then they shouldn't be used anymore it becomes a safety issue as well.

Okay, that just is looking at, and you can see this this cot's a good example. I have people who say to me, well, I'm a bit worried about the cot that I'm using because it's got solid ends. Aren't they just supposed to have slats all the way around. No, you're not. If it meets the mandatory Australian standards. it's okay. And so it doesn't matter if one or both ends are solid. Unsafe sleeping environment, lots of them and I'm sure if I was to put a heap of others up that some of those that you would recognise. Anything that may potentially cause a baby to fall or allow a baby to fall, cause a baby's head and face to become covered, cause a baby to be in the chin on chest position, anything like that, carries risks for that baby's sleep environment. Now, I'm not saying when I was talking before about not leaving a baby to sleep for long periods in a car seat or a car capsule, I am not inferring that little babies shouldn't be either allowed to sleep in a car capsule.

Try to stop them - or be that they then they better not be in a car capsule. It is very important that safety of safety standards of approved safety devices in any vehicle for babies and children so really important. However where it's good enough people say, oh, yeah, but we're going away on holidays and we're going to be driving for hours. What do we do with the baby then if they go to sleep. Well if it's good enough for a baby, sorry for the driver, and passenger to stop and drive after two hours, stop driving after two hours and have a break, it's good enough for the sleeping baby as well. You get the baby up, oh my goodness, but they might wake up. That's good. Get them out. Let them be upright or flat so that you know, they're not in that chin on chest position for long periods of time. One of the areas where that you'll get lots of good information about products and whether or not products have standards is from product safety. And the website is simply productsafety.gov.au. They have an excellent book called keeping baby safe. And it's you can download it for free and it's got some great information great information about cots and what makes the standards mandatory what they're looking for, great information also about some products that aren't don't have mandatory standards like bassinets, some good information about what would make a bassinet safe and what would be helpful in that area.

Last thing looking at supervision of sleeping children. This is I guess it's been the big area that there's been a huge change. Now the ideal absolutely perfect practice would be that all babies and all children would be eyeballed every second they're asleep. We know that's totally not possible, okay. So it's about adequate and appropriate supervision for sleeping babies and children in your services. As we say about you know, when kids, three, four-year-olds are outside playing, I doubt that they would be left for very long without an educator with them. But supervision is really important. So it needs to be active, effective and diligent. Active monitoring and supervision simply means the ability to see and hear babies and children when they're sleeping.

Okay, and this is straight from ACECQA's regulations, this information, and so it but it is really really important. So performing regular checks is the other thing that seems to have got a lot of people a bit up in arms about, so whereas with parents the most common question I get called about is about, as soon as they start saying, oh my baby's five months of age or four months of age, I know what you're going to tell me you're going to tell me your baby is rolling over in preferring to sleep on their tummy and 99.9% of times I'm right. The most frequently asked questions I get from child care services is around supervision and how often should we check? I can't give you the answer to that because there isn't an answer. It should be regular and frequent and diligent.

Now most services will check, perform a check, every 5, 10 or 15 minutes. Now remember that the most important thing about doing the checks is how that baby has been placed to sleep prior to you to even having to do checks. Because if babies are placed unsafely in an unsafe environment, 5-minutely checks may not be okay.

Okay, so it is important, these are all things that become combined together. So, you need to, and your people in your services who develop the policies, need to develop those policies and it may need to be for each individual child, but generally speaking it's a general guideline, but obviously if there's an issue with, with the baby, I'm finding more and more families are sending babies along to child care centres and family day care with significant congenital problems and sometimes that affects breathing. And you know, I think that's really difficult and then it becomes very unfair. If you don't have an idea of what that family's medical management plan is. So if you've got babies and children that come into your care that have issues that may affect their breathing, then you need to have some form of documentation from the physician, paediatrician, whoever is looking after the care of that baby and it needs to be, include, you know, they do it pretty well for things like anaphylaxis. You know, this is what you have to look for this what you have to do. Asthma we're doing it pretty well. But if it's related to sleep position, it doesn't seem to happen as much people don't want to really talk about that. So it's important that when there's any change in the sleep position that's recommended for a baby, that you have a management plan around that. You have a documented information from that child's paediatrician to say this is what should happen. And then you may need to develop an individual policy around that.

Okay what are you looking for? If you go and look at a baby. You check on a baby, oh yeah, what are you looking for, yeah, it's a baby. What am I looking for? You're looking particularly, firstly you're looking to what position is that baby been placed into. If it's got ,baby's got over on its tummy, is it still being wrapped? Things like that. Thinking at all of the things we've talked about, about sleep position. But if you're looking at you got to look at the skin colour. Now it's no point saying a baby is in danger if they're pale. Some babies are pale, period.

Okay. So it's important to know what is the normal skin colour for that baby. If they are normally pale or if they're not pale, breathing rate and effort, you know is they, are they breathing normally for that baby or is it noisy the breathing? Is it intermittent? Now, some little babies will breathe very regularly, but usually by the time they get to that sort of 6 to 12 months of age, their breathing is quite regular. You notice they have a whistling sound when they breathe in or breathe out. Are their nostrils flaring? Little babies when they get into respiratory distress, they'll get what they call nasal flaring and their little nasals will flare out. So it's important to know what you're looking for and in an emergency triple zero and your doctors ABCD is incredibly important. I'm not going to go through that. That one we'll finish up there. Any questions. Okay. So the question was what about babies sleeping in a rocker? What position is that baby in? Curved. Chin on the chest. Not a good place for babies to sleep. Bouncing nets, that's exactly the same. Yep. Pram... prams. Sleeping baby in a pram. Yeah that... the problem is prams are not designed as a baby's sleep environment. Particularly if that's overnight unsupervised sleeping.

Okay having said that, that's not what they're designed for. They're designed as a transport mechanism. You may use them as a settling device, it's like hammocks and all sorts of things, great settling devices but not for permanent sleeping. Prams, some of the problems are on how high are the sides. It doesn't take long before a child can get up and look out over the side and has a potential for climbing out and falling out. The other thing with prams is they may have straps in them and some of the prams that where the babies are lying flat do have straps in them. If you strap the baby into the pram when they're sleeping, they may wriggle and squirm and become entangled. If you don't strap them into the pram when they're sleeping, they might wriggle and squirm and become entangled. It's too difficult to supervise.

Audience

Thank you.

Lorraine

Okay.

Audience

What about those hammocks that are kind of like a bassinet that the baby is lying flat. So I would talk about it well under six months and to use them to help them settle but they also sleep during the day. Would that be a safe environment to have a baby sleeping in?

Lorraine

I'm not aware of any hammock that they actually lie completely flat. Can you see the baby in the hammock?

Audience

Yeah, it looks like a bassinet except it's on like a strings like on the tripod.

Lorraine

Yeah, and they have the material around it

Audience

That that's just up to you can rip the material.

Lorraine

Yeah, but if but if then then your, the baby's at risk of falling out,

Audience

No, no, so it looks like a bassinet just think of a bassinet, it's got the high sides except it's on it's kind of like on a tripod so to speak with a large string.

Lorraine

Yeah, they're a hammock are they the bivvy hammocks?

Audience

When I used to work in the nurseries they have one and I have been sourcing for one for my current workplace. Because they're really great at settling really young.

Lorraine

They're ok for settling but baby shouldn't be placed for sleep in them. I'm not aware of any hammock that has a firm base as well as flat and and I think it becomes quite a risky environment. And if anyone is using it in any of your services or care, you'd really need to be careful how you're writing your policy around that. One last thing, just to let you know about our Red Nose grief and loss. That phone number is a 24/7 number that's available for anybody who's affected by the death of a baby or child. And that's it. Thank you.

Presenter website

Video resources

Video topics overview

  • 03:00 - the decrease in Sudden Unexpected Death in Infancy (SUDI) in Australia
  • 03:40 - Importance of safe sleeping practices, National Quality Framework requirements and your responsibilities
  • 08:10 - SUDI – explanation and risk factors
  • 18:40 - Red Nose six safe sleep recommendations and guidance on each
  • 46:38 - Q&A and contacts for additional support
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