Purpose and scope
The purpose of this best practice guideline (BPG) is to address the question of how health-care providers can partner with families to promote safe sleep for infants 0-12 months of age to reduce known risk factors for injury and death.
It provides evidence-based recommendations for nurses and the interprofessional team who provide care, in all health-care settings, to parents/caregivers and families of infants. Working with families to promote safe sleep for infants 0-–12 months of age is an interprofessional endeavour. Effective care depends on a coordinated approach that fosters ongoing communication between health-care professionals, parents, families and other caregivers of infants. However, in the delivery of care, the beliefs and unique needs of each client, as well as their personal and environmental resources, must always be considered.
Registered Nurses’ Association of Ontario (2014). Working with Families to Promote Safe Sleep for Infants 0-12 Months of Age. Toronto, ON: Registered Nurses’ Association of Ontario.
Do you want to learn about and implement the most- up-to-date evidence-based recommendations on this topic with your colleagues? Download and share the full best practice guideline (BPG), Working with Families to Promote Safe Sleep for Infants 0-12 Months of Age.
See below for a snapshot of the recommendations from this BPG. We strongly suggest you review the full BPG before implementing the recommendations and good practice statements. The BPG also includes further resources to support implementation and evaluation.
Recommendation 1.1: At every encounter, assess pregnant women, parents, and other caregivers for factors associated with a higher risk of unexpected death or injury in infants while sleeping.
Recommendation 1.2: At every encounter, assess infants for factors associated with a higher risk for unexpected death while sleeping.
Recommendation 1.3: At every encounter, assess sleep position and the sleeping environment for factors associated with a higher risk for unexpected death in infants.
Recommendation 2.1: Collaborate with parent/caregiver, family, significant others and the inter-professional team to develop a mutually agreed upon plan to promote safe sleep in all environments.
Recommendation 3.1: Model safe sleep practices by placing infants on their back (supine position) for every sleep, unless medically contraindicated.
Recommendation 3.2: Educate parents/caregivers about safe sleep environments.
Recommendation 3.3: Encourage parents/caregivers to place infants to sleep on a firm mattress and in an age appropriate crib, cradle or bassinet that meets current Canadian safety regulations.
Recommendation 3.4: Educate parents/caregivers about the benefits of sharing the same room with their infants for at least the first six months of life.
Recommendation 3.5: Educate parents/caregivers about the risks of sharing a sleep surface with their infant.
Recommendation 3.6: Support parents/caregivers in making an informed decision regarding pacifier use.
Recommendation 3.7: Provide health education about the risk of smoking during pregnancy and SIDS.
Recommendation 3.8: Provide smoking cessation counseling before, during, and after pregnancy to women, family members and other caregivers identified as tobacco users.
Recommendation 3.9: Encourage women, family members and other caregivers to promote a smoke-free environment during and after pregnancy.
Recommendation 3.10: Provide health education about the risks associated with SIDS and alcohol and substance use and their potential effect during pregnancy and while caring for an infant.
Recommendation 3.11: Provide health education before, during, and after pregnancy to promote breastfeeding as a protective factor against SIDS.
Recommendation 3.12: Provide health education before, during, and after pregnancy about routine immunization of infants as a protective factor against SIDS.
Recommendation 4.1: Evaluate parents’/caregivers’ knowledge and implementation of safe sleep practices for infants.
Recommendation 5.1: Perform self-reflection on knowledge, judgment, perceptions, practices and beliefs regarding safe sleep environments to reduce barriers to health teaching and modeling of recommendations.
Recommendation 5.2: Include content about safe sleep practices for infants in all foundational nursing education programs.
Recommendation 5.3: Provide continuing education and educational resources regarding safe sleep practices for nursing staff of organizations involved in prenatal, postnatal, and community-based family care.
Recommendation 6.1: Advocate for education, training and resources for alternate caregivers regarding safe sleep practices for infants.
Recommendation 6.2: Participate in research regarding morbidity and mortality as it relates to infant sleep.
Recommendation 6.3: Advocate for improved systems for reporting and monitoring of morbidity and mortality related to infant sleep.
Recommendation 6.4: Develop policies that support the implementation of safe sleep practice recommendations in all organizations involved in prenatal, postnatal, and community-based family care.
Disclaimer: These guidelines are not binding for nurses, other health providers or the organizations that employ them. The use of these guidelines should be flexible and based on individual needs and local circumstances. They constitute neither a liability nor discharge from liability. While every effort has been made to ensure the accuracy of the contents at the time of publication, neither the authors nor the Registered Nurses’ Association of Ontario (RNAO) gives any guarantee as to the accuracy of the information contained in them or accepts any liability with respect to loss, damage, injury or expense arising from any such errors or omission in the contents of this work.