Safe Sleep: What Preemie Parents Need to Know

By Heather Cresswell, Neonatal Nurse Practitioner

Following safe sleep guidelines is of utmost importance, especially for premature babies. Read on to learn how to give your baby the safest sleep possible and why safe sleep is extra-important for preemies.  

Why safe sleep is so important 

The reasons we need safe sleeping guidelines are difficult to think about yet crucial for parents to understand. Following safe sleep guidelines reduces the risk of sudden infant death syndrome (SIDS) and accidental death due to suffocation or entrapment.  

Babies who were born prematurely are more at risk of SIDS than babies born at term. Although experts don’t know the exact cause of SIDS, the good news is that research does tell us that there are many ways we can reduce the risk for babies.

Safe Sleep Guidelines 

The Canadian Pediatric Society (CPS), The Public Health Agency of Canada and Baby’s Breath Canada have put together the best research-based practices for safe sleep. Let’s look at each element of these guidelines. 

1. Babies should sleep on their backs.  

Babies who are placed on their backs to sleep have a reduced risk of SIDS. In fact, between 1999 and 2004 (the same time Canada launched education about the importance of babies sleeping on their backs), the SIDS rate in Canada dropped by 50%. 

Even babies who spit up (regurgitate) during sleep are safest on their backs.  

If you have spent time in the NICU, you probably have noticed that preemies love to sleep on their tummies. This is fine when they are hooked up to breathing and oxygen monitors. However, once an NICU baby is closer to being discharged home, they should follow the same safe-sleep guidelines as any other baby, including sleeping on their back. 

Once a baby is old enough to roll over onto their stomach during sleep, you don’t need to reposition them if they roll. Putting them down on their back and then letting them find their comfortable position is okay.  

Parents may worry that the back of their baby’s head may get flat from always sleeping on their back. You can prevent this by putting your baby’s heads at alternate ends of the crib with each sleep and giving them lots of tummy time. 

2. Babies should sleep in a crib, cradle or bassinet.  

Babies should only sleep on surfaces designed for safe sleep. Cribs, cradles, and bassinets are regulated in Canada to ensure they meet minimum safety standards. 

Your baby’s crib, cradle or bassinet should: 

• Have a firm, flat mattress 

• Have no bedding other than a tightly fitted sheet 

• Have no gaps between the mattress and sides 

• Be free of blankets, bumper pads, crib liners and toys 

• Not have sides that go down (bedside sleepers with a side that folds down are not recommended) 

Do not let your baby sleep in an infant seat or swing, especially unsupervised. Car seats are for travelling only, and babies should not be left to sleep in their car seats for long periods.  

Do not elevate the mattress in your baby’s crib or one end of the bassinet. Sleeping on a flat surface is safer, as babies who sleep on an incline may shift into an unsafe position, or their head may fall forward, blocking their airway.  

Do not use positioning devices (sometimes called nests or pods) that, unfortunately, are still sold in Canada. These devices often have soft sides and are a suffocation risk. Do not use a wedge or rolled blanket to prop your baby on their side as they may roll onto their stomach.

3. Do not bed share or sleep on a chair or sofa with your baby. 

Canadian data shows that many parents share a bed with their infant. About a third of parents reported sharing a bed frequently, while another 27% reported doing so occasionally. Whether parents intentionally choose to bedshare or do so out of exhaustion, it is essential to be aware of the risks.  

Some factors make babies particularly at risk of SIDS, suffocation or entrapment when sharing a sleep surface, including:  

• Babies less than 4 months of age 

• Babies who were born premature or at a low birth weight 

• Babies whose mothers smoked during pregnancy 

• Babies who are sharing a sleep space with an adult who has consumed alcohol or drugs 

• Babies who are sharing a sleep space with a very tired adult 

• Babies who are sharing a sleep surface with more than one person (including children) or pets  

• Babies who are sleeping on a soft surface such as a sofa, chair, waterbed or air mattress 

Even if your baby does not have any of the above risk factors, bed-sharing or sleeping on a chair or sofa with an infant increases the risk of SIDS or accidental death.  

There are some risk factors that you can’t change after your baby is born. For example, you can’t help if your baby was born prematurely, and you can’t go back if you smoked during pregnancy. The purpose of discussing these risk factors is not to cause stress or guilt but to empower parents with information so that they can optimize safe sleep for their babies.  

4. Room sharing 

The good news is that there is a safe way to co-sleep with your baby. Babies can co-sleep nearby in the same room (in their crib, cradle or bassinet).  

Experts recommend that babies sleep in the same room as their parents for the first six months. Room sharing helps parents respond to their baby’s cues, facilitates breastfeeding, and allows babies and parents to have frequent contact at night.  

5. Protect your baby from tobacco smoke exposure.  

If you are a smoker, quitting or reducing the amount of cigarettes smoked during pregnancy can reduce the risk of SIDS. Exposure to secondhand smoke is also associated with an increased risk of SIDS. Don’t let anyone smoke in your home or around your baby. 

Although there is not as much research, the CPS also warns against cannabis smoke and vaping products around babies, as both can expose them to harmful chemicals. 

6. Avoid overheating 

Dress your baby in fitted pajamas that are comfortable for room temperature. If needed, you can use a sleep sack for warmth (ensure it is appropriately sized and not too big), but it is essential not to overheat babies. There should never be loose blankets in your baby’s sleeping space.  

7. Safe swaddling 

If you swaddle your baby, ensure your baby’s mouth and nose are well above the blanket. Your baby should always have free movement of their legs and hips, so do not tightly swaddle their legs. It is very important to stop swaddling as soon as your baby shows signs of trying to roll over. Better yet, skip the swaddle and use a sleep sack instead.  

8. Breastfeed 

Research shows that babies who are breastfed have a lower risk of SIDS. The longer your baby is fed breast milk, the greater the protection.  

Real life  

Safe sleep guidelines are extremely important, especially when parents need to get some sleep or are not watching their baby.  

But of course, there will be times when your baby falls asleep in your arms, and you want to enjoy that closeness. If you are awake and attentive to your baby, there is no limit on how much you should hold and cuddle them, including when they are sleeping. If you start to feel drowsy, put your baby on its back in their crib, bassinet, or cradle. If you use a baby carrier, sling, or wrap, ensure you can see your baby’s face.  

If you unintentionally fall asleep with your baby, put them into a safe sleep situation as soon as you wake. Many exhausted parents have been there.  

The safest sleep is the best sleep of all. Check out the resources below to read more about safe sleep.  

Resources for Parents 

AboutKidsHealth (SickKids). Sleep time for newborns. 

Caring for Kids (CPS). Safe sleep for babies.  

Healthlink BC. Safer sleep for my baby.  

My Health Alberta. Safe sleep for baby’s first year.  

Sources 

Canadian Paediatric Society. (2021). Safe sleep for babies. https://caringforkids.cps.ca/handouts/pregnancy-and-babies/safe_sleep_for_babies [Accessed February 2025] 

Health Canada. (2024, October 9). Safe sleep tips. Canada.ca. https://www.canada.ca/en/health-canada/services/safe-sleep/safe-sleep-tips.html [Accessed February 2025] 

Health Canada. (2024, November 20). Cribs, cradles and bassinets. Canada.ca. https://www.canada.ca/en/health-canada/services/safe-sleep/cribs-cradles-bassinets.html [Accessed February 2025] 

Infant bed sharing in Canada. (2019, July 17). https://www150.statcan.gc.ca/n1/pub/82-003-x/2019007/article/00002-eng.htm [Accessed February 2025] 

Public Health Agency of Canada, Health Canada, Canadian Paediatric Society, & Baby’s Breath Canada. (2021). Joint Statement on Safe Sleep: Reducing Sudden Infant Deaths in Canada. https://www.canada.ca/content/dam/phac-aspc/documents/services/health-promotion/childhood-adolescence/stages-childhood/infancy-birth-two-years/safe-sleep/joint-statement-on-safe-sleep/joint-statement-on-safe-sleep-eng.pdf [Accessed February 2025] 

Public Health Agency of Canada. (2023, November 3). Joint Statement on Safe Sleep: Reducing Sudden Infant Deaths in Canada. Canada.ca. https://www.canada.ca/en/public-health/services/publications/healthy-living/joint-statement-on-safe-sleep.html [Accessed February 2025] 

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Heather Cresswell is a Neonatal Nurse Practitioner and health writer. As a nursing student in 1995, Heather discovered the NICU during a clinical placement and never looked back. She has spent her entire nursing career (more than 25 years and counting) caring for NICU patients (premature babies are her favourite!). When not caring for her tiny patients, Heather is also a health writer and is happy to contribute to the Canadian Premature Babies Foundation.

Heather lives with her family in Burlington, Ontario, and is a proud mom to one son.