Health Canada’s safe sleep rules for babies, explained

Health Canada and the Public Health Agency of Canada say the safest way for a baby to sleep is alone, on their back, on a firm, flat surface in a crib, cradle or bassinet that meets Canadian regulations, for every sleep. The advice comes from the agencies’ safe sleep tips and the Joint Statement on Safe Sleep, which the Canadian Paediatric Society and Baby’s Breath Canada also signed.

The public health agency says sudden infant death syndrome, or SIDS, happens when a baby who seems healthy dies suddenly in their sleep and the cause cannot be explained. Risk peaks at two to four months of age. The agency said researchers do not know what causes SIDS, but parents can lower the risk by changing how and where a baby sleeps.

The joint statement says Canada saw a 50 per cent drop in the rate of SIDS between 1999 and 2004. The agency said the decline came mainly because most parents began placing babies on their backs to sleep. Back sleeping is still the first rule: on the back, for every sleep, including naps. Once a baby can roll over on their own, Health Canada said parents do not need to keep turning them back.

The sleep surface matters just as much. Health Canada recommends a firm, flat mattress with a tightly fitted sheet and no gaps between the mattress and the sides of the crib. Quilts, blankets, bumper pads, pillows, stuffed toys, nursing pillows and sleep positioners should stay out. The joint statement says positioners should not be used because they pose a suffocation risk. Health Canada also advises against letting a baby sleep on inclined sleepers, baby hammocks, crib wedges, baby nests and loungers, because the surface is not flat.

Not every baby product is meant for sleep. Health Canada said baby swings, bouncers, strollers, car seats and high chairs should not be used for sleep. If a baby falls asleep in a car seat, the guidance is to move them to a crib once the trip is over. Playpens are not regulated for infant sleep in Canada, though a bassinet attachment that meets current regulations is acceptable.

Sofas and armchairs are singled out as especially risky. The joint statement says babies are more likely to become trapped and suffocate on them, particularly when an adult is also sleeping there. Health Canada also warns against waterbeds, air mattresses, futons and any surface with a memory foam topper or extra padding.

On bed sharing, the guidance is direct. The joint statement says it is not advised, and the risk is particularly high for babies younger than four months, or babies born early or at a low birth weight. The risk rises further with smoking, alcohol, drugs, drowsiness, soft surfaces, loose bedding, or more than one person or pet in the bed. The agency noted that in recent Canadian data, a third of mothers reported sharing a bed with their infant every day or almost every day, and another 27 per cent reported doing so occasionally.

What Health Canada recommends instead is room sharing. A baby sleeping in the parents’ bedroom, in their own separate bed, for the first six months has a lower risk of SIDS, according to the joint statement.

Smoke exposure is another factor. The agencies recommend keeping a baby’s environment smoke-free before and after birth, and the joint statement says that includes vaping and cannabis. The public health agency estimates that one third of SIDS deaths could be prevented if maternal smoking were eliminated. Breastfeeding is also linked to a lower risk. The statement says at least two months of breastfeeding is needed for a protective effect, and it recommends exclusive breastfeeding for six months.

Dressing a baby for sleep is simpler than many parents expect. The agencies say overheating is a risk factor, and Health Canada said babies do not need hats or blankets indoors. Simple, fitted sleepwear or a properly sized sleep sack is enough. Swaddling carries its own caution: the joint statement says swaddled babies face an increased risk of death if they roll onto their stomachs, so swaddling should stop when a baby shows signs of rolling. For babies carried in a sling or carrier, Health Canada said their face should always be visible and they should be upright. It adds that parents should not zip a coat around a baby in a carrier.

The joint statement says pacifiers may have a protective effect, with the advice to wait until breastfeeding is well established. It also states that immunization does not increase the risk of SIDS and may even lower it, and that there is no evidence home sleep monitors reduce SIDS. Parents may want to read about the rotavirus vaccine schedule for babies by province and the federal advice on a whooping cough shot in every pregnancy.

Federal rules also cover the furniture itself. Health Canada said every new and used crib, cradle and bassinet sold in Canada must meet the Crib, Cradle and Bassinet Regulations. Since Dec. 29, 2016, it has been illegal to sell, import, manufacture or advertise traditional drop-side cribs. Cribs made before September 1986 should not be used. Crib slats can be no more than six centimetres apart, and the gap between the mattress and the sides can be no more than three centimetres. A crib mattress can be no thicker than 15 cm, while cradle and bassinet mattresses can be no thicker than 3.8 cm.

Health Canada also lays out when to move up. A baby should leave a bassinet once they can roll over, leave a cradle once they can push up on their hands and knees, and leave a crib once they can climb out or are taller than 90 cm. The department urges buyers to check that any crib, cradle or bassinet has not been recalled, including secondhand ones, using the federal recalls and safety alerts database.

Sources: Health Canada, Safe sleep tips; Health Canada, Cribs, cradles and bassinets; Health Canada, Is Your Child Safe? Sleep Time; Public Health Agency of Canada, Joint Statement on Safe Sleep; Public Health Agency of Canada, Sudden infant death syndrome.

This article is based on official guidance from Health Canada and the Public Health Agency of Canada and is provided for general public information. It’s not a substitute for medical advice, if you have questions about how this applies to you, talk to your doctor or pharmacist.

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