Newborn Safe Sleep: Cot Setup, Wrapping, Temperature and Common Mistakes

The short version of safe sleep

Safe sleep is mostly about what you leave out. Australia's Red Nose has six core messages, and the UK's NHS and Lullaby Trust and the US American Academy of Pediatrics (AAP) say much the same: baby on their back, a clear flat cot, in your room, smoke-free, and nothing that covers the face. The details that differ between countries are in the comparison table further down.

Advice for sudden infant death syndrome (SIDS) and sudden unexpected death in infancy (SUDI) applies to every sleep, including naps. The Lullaby Trust says to follow it until your baby is 12 months old, counted from the due date if your baby was premature.

Setting up the cot

• The cot. In Australia, Starting Blocks says to use a cot that meets the Australian Standard for household cots (AS/NZS 2172), including a second-hand one, and portable cots have their own standard (AS/NZS 2195). A standard label doesn't make a damaged cot or an ill-fitting mattress safe, so check the condition too. Elsewhere, look for your own country's standard. The AAP, for example, refers to cots that meet the US Consumer Product Safety Commission rules.
• The mattress. Firm, flat, clean, and fitting the cot without gaps. The AAP says to use only a fitted sheet.
• The bedding. Starting Blocks and the NHS say to keep pillows, doonas, lambswool, bumpers and soft toys out.
• The surroundings. Keep the cot away from curtain, blind and electrical cords.
• Feet to foot. The NHS says to place your baby with their feet at the bottom of the cot so they can't wriggle down under covers. If you use a blanket instead of a sleeping bag, Red Nose says to tuck it firmly along three sides, up to chest level.

Back to sleep, tummy time awake

Back sleeping applies to naps and night. Always start on the back. The AAP recommends supervised tummy time while your baby is awake, building up gradually, because it helps development. Tummy time is for waking hours only.

Where your baby sleeps: room, bed, sofa, car seat

In your room. The cot goes in your room for the early months. Red Nose advises a safe sleep space in the same room for at least the first 6 months, and the NHS and AAP say the same. Starting Blocks, an Australian Government resource, describes 6 to 12 months. Follow the current advice from your local health authority.

In your bed. Red Nose says the safest place is their own safe sleep space and does not recommend co-sleeping, while acknowledging some families do it by choice or fall asleep by accident. It lists situations of increased risk: a parent who is overly tired, has had alcohol or drowsy-making drugs or medicines, or smokes, or a baby who is premature or small. The AAP is firmer and advises against bed-sharing altogether, and the NHS lists similar risk situations. If it will happen, Red Nose says to keep the baby on their back on a firm flat mattress, beside one parent and never between two adults or next to other children or pets, with pillows and bedding clear of their face.

On the sofa or armchair. Never. The NHS and Starting Blocks both say not to sleep with a baby on a sofa or armchair, so if you feel drowsy, put the baby in their cot first.

In a car seat, capsule or pram. Red Nose says never to leave a baby to sleep in a car seat, because the curved upright position can let the chin drop to the chest and block the airway. Take your baby out as soon as you arrive. See our guides to newborn car seats and prams and strollers.

Wrapping and sleeping bags

• Wrapping. Red Nose allows it for newborns, but you must stop as soon as your baby shows signs of rolling, when the arms need to be free. Never wrap a baby inside a sleeping bag. The AAP adds that a wrap should be loose enough for the hips to move, and that you should stop as soon as your baby shows any sign of trying to roll.
• Sleeping bags. Choose one with a snug neck and armholes, no hood, and the right size for your baby. Red Nose says arms should stay free to move, and the bag's warmth rating should suit the room, with a lower rating for warmer weather.
• Check the fit. A bag that is too big can let a baby slip down inside.

Temperature: not too hot

Overheating is a risk, and babies lose heat through their head and face, so keep them uncovered. Red Nose says to feel your baby's chest or back, not hands and feet, which are often cool. The NHS and Lullaby Trust give a UK room range of 16 to 20°C, while Red Nose gives no set temperature because no evidence links one to preventing SUDI. No single temperature guarantees safety, so keep checking your baby. The AAP says to avoid hats indoors and to dress your baby in one more layer than an adult would be comfortable in. Keep cots away from heaters and direct sun.

Inclined sleepers, nests, pods and rockers

Many baby products tilt or cradle a baby. Red Nose says an incline can let the head fall forward and block the airway, that a rolling baby on an incline can suffocate against a soft or padded surface, and that harnessed products carry a risk of entrapment. They are fine for watched, awake time, never for sleep. The Lullaby Trust says to avoid pods and nests, and the AAP says to skip inclined sleepers and any product not made for infant sleep. Reflux is a common reason for using a wedge, but Red Nose says there is little evidence it helps. The ACCC advises placing infants to sleep only on a flat, firm surface.

Common mistakes, and what to do instead

1. Letting a baby sleep in the car seat after the trip. Move them to a flat surface, even if it means waking them.
2. Falling asleep with the baby on the sofa during night feeds. Plan where you'll feed, and put your baby back in the cot if you feel drowsy.
3. Adding soft items to the cot. A cot that looks bare is a cot that is safe.
4. Continuing to wrap once rolling starts. Switch to a sleeping bag with the arms out.
5. Overdressing. Check the chest, and use fewer layers.
6. Using a second-hand mattress or cot of unknown history. Check the standard, condition and fit.
7. Relying on a monitor. The AAP says home heart rate or oxygen monitors don't reduce SIDS and shouldn't replace safe sleep practices. A simple audio monitor can help you hear your baby, but it doesn't replace a safe setup.
8. Letting people smoke near the baby. Keep the home and car smoke-free.

Premature or small babies

Premature and low birth weight babies are more vulnerable, so keep following safe sleep advice for 12 months from the due date, not the birth date, according to the NHS and Lullaby Trust. The NHS also says not to bed-share if your baby was born before 37 weeks or weighed under 2.5 kg.

Dummies and breastfeeding

Red Nose says a dummy used at every sleep is associated with lower SIDS risk. Breastfed babies should wait until feeding is established, usually around 4 to 6 weeks, and you shouldn't force a dummy on a baby who refuses it. If it falls out during sleep, don't put it back in. Breastfeeding at any amount is linked with lower risk, according to the Lullaby Trust. Our soothing guide covers dummies in more detail.

How the advice differs around the world

The core message is the same everywhere. These are the points where the official sources we checked differ.

If you live elsewhere, check your own country's health authority.

Frequently Asked Questions