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Advice about safe sleep for babies is nothing new. But it sure has changed. Twenty-five years ago, doctors advised parents to put their infants down on their tummies to avoid the possibility of choking on milk or spit-up. Experts were starting to address crib safety issues, such as ensuring crib bars weren’t too far apart. But nobody had much advice for parents on how to prevent sudden infant death syndrome (SIDS), the tragic incidents where babies die mysteriously in their sleep.

         Today, over 20 years of studies have identified numerous risk factors for SIDS (see Understanding risk), resulting in a long list of safety guidelines for parents.

         

          Here is the current advice: Parents are told to place the baby on his back in a crib that meets Health Canada standards, preferably in the parents’ room until the baby is six months old. Sharing a bed with your baby is risky, some experts advise, but having the baby near you protects against SIDS. And, in contrast to the days when cribs were festooned with lush decorative duvets, bumper pads and a stuffed animal or two, today’s baby crib is supposed to be empty except for your baby and perhaps one light, tucked-in blanket. Some advice givers don’t even approve of the blanket. One Canadian parenting website illustrates its safe sleep article with a photo of an empty crib bearing the caption: “No toys, no blankets, no drapes, no bumper pads, no anything.”

Finally, the room should not be too warm, and baby’s environment should be smoke-free.

          Not much when you say it fast! Some of this advice has been well accepted (for example, most parents now put babies on their backs). But other advice, particularly advice against bed sharing, has been controversial.

Long lists of safety rules are not only complicated, they have the effect of making it seem as if all risks are equally important. That is not true in the world of safe sleep advice. According to paediatrician and SIDS researcher Aurore Côté, of McGill University in Montreal: “The most important risk factors are smoking during pregnancy, sleeping on the stomach (for the baby) and co-sleeping (bed sharing) in certain situations — on a sofa, if the parents have been drinking or using drugs, or on a makeshift bed with pillows and cushions. None of the other risk factors are nearly as important.”

           Here’s a guide to help you understand where today’s safe sleep instructions come from, why some are more important than others, and whether some lesser risk factors might be relevant to you.