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SAFE SLEEP FOR INFANTS. The Canadian Foundation for the Study of Infant Deaths National Office: 60 James Street, Suite 403, St. Catharines , Ontario L2R 7E7 Tel: 905-688-8884 Toll Free: 1-800-363-7437 Fax: 905-688-3300 Website: E-Mail:

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The Canadian Foundation for the Study of Infant Deaths

National Office: 60 James Street, Suite 403,

St. Catharines, Ontario L2R 7E7

Tel: 905-688-8884 Toll Free: 1-800-363-7437

Fax: 905-688-3300



In Canada, babies continue to die of Sudden Infant Death Syndrome (SIDS) and in unsafe sleep environments

Research suggests over half of these deaths could have been prevented

Many believe these deaths are the result of lack of education and awareness

Infant Deaths in Canada

Hear about SIDS and unsafe sleep practices from mothers that have lost a child

Be introduced to behaviors that increase the risk of SIDS and unsafe sleep accidents

Be introduced to practices and resources to help you reduce the risk of SIDS and unsafe sleep accidents for infants

Discuss your role in reducing infant deaths

Workshop Objectives

The CFSID is dedicated to reducing the rate of sudden and unexpected infant deaths and providing emotional support to those who are affected

The Canadian Foundation for the Study of Infant Deaths

to deliver infant health and safety education through an extensive network of volunteers in communities across Canada

to provide resources and services for all infant deaths including miscarriage and stillbirth with respect to peer support, public education and awareness

to support Sudden Infant Death Syndrome (SIDS) related research

CFSID Mandate

Who we are?

Why we are here?

Our mission and message?

Some of our successes so far!

The Ontario Safe Sleep Team

Sudden Infant Death Syndrome

ICD-9 Definition

The sudden death of an infant under one

year of age which remains unexplained

after the performance of a complete



mortem investigation including:


examination of the scene of death

review of the case history

It is a diagnosis of exclusion

Caused by external suffocation

Caused by vomiting and choking

Caused by immunizations

Child abuse or neglect



Predictable or completely preventable


Maternal smoking during pregnancy

Exposure to second hand smoke


Respiratory illness

Sleeping on a soft surface


Soft bedding or stuffed animals in bed

Increasing the Risk of SIDS

Tummy and side sleeping

Substance abuse during pregnancy

Teen mothers

Mothers with late or no prenatal care

Preterm infants

Low birth weight infants

Multiple births

Additional Risks

Triple Risk Model to Explain SIDS

First 6 months

Critical period of development

Prone/Side Sleep Position




Modifiable Pre- and Post-Natal










(Filiano and Kinney, modified)


Bed sharing

Risk factors don’t CAUSE SIDS, but are present in babies that die of SIDS

Even babies with no risk factors present can die of SIDS

SIDS cannot be completely prevented

SIDS is nobody’s fault

What You Should Know About These Risk Factors

Create a healthy lifestyle for you and your baby

Avoid smoking and alcohol during pregnancy and while breast feeding

Always provide a smoke free environment for your baby

Smoking increases the risk of SIDS

Healthy Lifestyle Choices

Mothers with late or no prenatal are at a greater risk of having a child die from SIDS or an unsafe sleep accident

Prenatal care is essential to the health of the mother and the infant during pregnancy and after birth

Prenatal Care

What is safe and

not safe sleep

for babies?

Safe Sleep for Babies

Risk of falling; out of bed or off sofa or chair

Risk of becoming trapped in bed or sofa

Risk of smothering or suffocation

Risk of entanglement

Risk of overheating

Unsafe Sleep

A total of 96 cases were reviewed this past year

• 40 of 96 deaths were classified as Undetermined

• 33 (75%) of the Undetermined cases involved unsafe sleeping environments

• 19 (58%) of these unsafe sleeping related cases involved bed-sharing



Sleep surfaces in 14 unsafe sleeping deaths that did not involve bed-sharing

11 of the infants were female; 22 were male

31 of the infants were 7 months of age or younger and 2 were 10 months old, stressing the increased risk of sharing a sleep surface with very young babies

33 unsafe sleeping related deaths in 2008

Where Should Infants Sleep?

Scheers, Rutherford, & Kemp, Pediatrics, October 2003

Based on Risk for SIDS:

Greatestif sharing a sleep surface

Intermediateif sleeping in another room

Leastif infant sleeps in same room as parent in own safe crib

Safest :

Place baby in their own safe

crib in the caregiver’s room

for the first 6 months

Always on my Back in my own Crib

  • The safest place for a baby to sleep is in their own crib in their caregivers’ room for at least the first six months.

  • Bed Sharing is not

    recommended anywhere, at anytime!

April 15, 1992

The American Academy of Pediatrics recommended that healthy infants:

“when being put down for sleep, be positioned on

their back ….”

Since 1992 accredited with 50% reduction in SIDS deaths

Back Sleeping

Babies have a tonic neck reflex, which causes them to turn their heads to the side when they are placed on their back

If the baby does spit up or vomit, the fluid runs out the nose and mouth to the side of the infant, thus avoiding choking

Choking Concern

Please see Health Canada’s website at www.hc-sc.gc.cafor the current regulations for cribs and cradles

Please have a firm fitted mattress

A crib purchased prior to September 1986 is not recommended

Please NEVER modify a crib or cradle

Follow the manufacturer’s instructions

Ensure the mattress support is secure

Cribs and Cradles

Cribs should be away from windows due to falling risks and drafts

Be sure to tie up all cords and curtain strings

Keep crib away from radiators due to overheating concerns

Place mobiles out of baby’s reach and remove when sitting up

Crib and Cradle Placement

Should be firm and tight fitting

If a second hand mattress is all that is available, check it for tears, rips, mould, and do not use it if any of these are present

Ensure that it meets current standards and that it fits the crib snugly


Soft worn or loose fitting mattresses can cause gaps and suffocation hazards

Ensure mattress is at lowest setting when baby can sit up

Remove mobiles and toy bars when baby starts reaching for them

Mattress Safety

Always on my Back in my own Crib

Twins if sleeping together should be placed one at each end of the crib, feet to the foot of the crib

When they can move freely, separate them into their own cribs


Bassinetsdo not have the same safety standard requirements as a crib

If this is your only alternative

It should be well ventilated

Remove padding

Have a firm and fitted mattress

Keep it clutter free


Playpens are not safe for sleeping.

Only use for supervised play

Ensure is a newer model with mesh sides for air flow

Never place baby in playpen with bassinet or change table insert attached

Keep play pen clutter free

Play Pens

NO comforters, quilts, sheepskins, pillows, positioners, bumper pads or stuffed animals in the crib

Just a light blanket tucked under the arms or the best is a wearable blanket or SleepSack



  • Often causes are too much bedding or clothing, or

  • because the room is too hot

  • Ideal room temperature is 68-72 degrees

  • Dress infant in sleeper and one

  • additional light layer-receiving

  • blanket or wearable blanket

Car Seats

Car Seats are not safe for sleeping.

80% of car seats are installed incorrectly!

  • They do not provide a flat firm sleeping surface

  • Avoid covers and blankets

  • If baby does fall a sleep move to a safe sleep surface ASAP

  • Attend a car seat safety and installation clinic


Strollers are not recommended for sleeping

  • ALWAYS supervise child in stroller

  • ALWAYS use safety belts

  • USE BRAKES when stopped

  • Avoid blankets, pillows and covers

  • Place in horizontal position when child is sleeping

Slings and Carriers

Serious injuries and deaths have resulted

due to sling and carrier use

  • Slings are not recommended

    at any time

  • Only a front facing carrier is suggested

Research has found that breast feeding your baby can reduce the risk of SIDS

When breastfeeding sit up in bed or a chair and be sure to place the baby on their back in their own crib when finished



A pacifier at sleep time has been found to decrease the risk


  • If breastfeeding introduce after 1 month

  • If refused-its okay

  • Replace with new one every 2 months

  • Never coat with anything sweet

  • Never add string or ribbon

Positional plagiocephaly is an uneven or misshapen head when the infant is born


pressure on the baby’s skull while in the uterus

or during birth and is often seen as a flat spot on the back or side of the head

may also develop during the first few months of life due to a baby preferring to lie in one position

Flat Head

If the resting position of the baby’s head is constantly the same, the effects of gravity on a soft, rapidly growing head may cause a flattening on one side

Positional plagiocephaly may be prevented or treated by repositioning techniques and by minimizing pressure on the head when the baby is awake. Tummy time!

Helmets have been used in some extreme cases


Tummy Time Play

  • Tummy time must be supervised by an adult. This tummy play helps develop good tone in the neck and back muscles and learn to roll over, crawl, sit, and stand

  • Tummy time can begin

    as soon as the cord falls off

  • All babies should be placed on their tummies to play

NO evidence that monitor use reduces SIDS

CAN NOT prevent SIDS

Even if using monitor MUST follow safe sleep practices


Be aware of what can be done to maintain a safe and healthy environment even when not at home

The best alternative is on the floor - no pillows around the infant if a safe crib is not available

When visiting family and friends, be aware that not everyone will take the same precautions you do for ensuring an area is free of hazards and safe for children

Supervise children closely

When Traveling with a Baby

Children spend time with people other than parents, sometimes for long periods; grandparents, other relatives, nannies, friends, childcare workers, even church “crying rooms” when you are attending a service

Children can and do die of SIDS and in unsafe sleep accidents in these settings

Alternate Childcare

CFSID recommends a formal written agreement for babysitters and childcare centres that clearly describes your expectations and instructions

CFSID recommends that you and all staff associated with infant care sign a back to sleep agreement


The ABC’s of Safe Sleep DVD and

Workshop Guide

18 minute chaptered video with bilingual guide for Educators

$10 donation to CFSID

Available now!

Safe Sleep DVD and Guidebook

The ABC’s of Safe Sleep

CFSID now offers:

The ABCs of Safe Sleep

Online Certificate Course

The ABCs of Safe Sleep course:

explores risk factors of SIDS

provides caregivers with information

to improve the health and safety of

infants and reduce the risk of SIDS

is designed for anyone providing care to an infant

Course Content

Online Certificate Course

Course Duration: 2 hours

Price: $49.99

Prerequisite(s): None

Language(s): English

ABC’s of Safe Sleep


The New Online Certification Course


Healthcare Professionals

Launch date and cost to be announced

Online Certification Course for Healthcare Professionals

The Canadian Foundation for the Study of Infant Deaths

National Office: 60 James Street, Suite 403, St. Catharines, Ontario L2R 7E7

Tel: 905-688-8884 Toll Free: 1-800-363-7437 Fax: 905-688-3300

Website: E-Mail:

Health Canada



Canadian Paediatric Society


2305 St. Laurent Blvd., Ottawa, Ont., K1G 4J8

Phone: 613 526 9397

Fax: 613 526 3332

Canadian Institute of Child Health


Suite 300, 384 Bank Street, Ottawa, ON K2P 1Y4Tel.: 613-230-8838Fax: 613-230-6654E-mail:

Additional Resources

Special Thanks

Special Thanks

to the

Ontario Trillium Foundation

for funding the Safe Sleep Campaign

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