Joint Statement on Safe Sleep

Sudden infant deaths that occur during sleep continue to be a significant public health concern in Canada, the Public Health Agency of Canada (PHAC) notes on their website.

The Joint Statement provides health care practitioners with up-to-date, evidence-based information on sudden infant deaths in Canada so that they can provide parents and caregivers with information on how to best mitigate risks and protect babies from sleep-related deaths. The statement is available as a downloadable fact sheet at: 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

Sleep-related sudden infant deaths occur unexpectedly in otherwise healthy infants. They include deaths due to Sudden Infant Death Syndrome (SIDS) as well as accidental deaths caused by suffocation or strangulation in bed. Large-scale epidemiological studies over the last two decades have increased the understanding of SIDS and identified certain modifiable risk factors. The most important modifiable risk factors for SIDS are infants sleeping in the prone position, and exposure to tobacco smoke prenatally and after birth.

The updated Safe Sleep for Your Baby booklet provides parents and caregivers with important information on how to keep baby safe while sleeping. It also provides important steps to take to ensure that baby is safe during every sleep whether it is during nighttime, nap time or while travelling and away from home.

The PHAC website notes that there has been a notable shift in reporting practice for infant deaths, in Canada as well as globally, which has made it challenging to assess the prevalence of SIDS. Since 2012, SIDS is no longer being used for the classification of infant deaths in most provinces and territories in Canada, with these deaths being classified as “undetermined” cause, which has an unsettling impact for bereaved families left without a diagnosis. There have been calls for clear SIDS definitions and guidance for death certifiers. The latest available data (2012) shows the highest rate of SIDS in Canada is in Nunavut, where the SIDS mortality has been found to be over 3 times the Canadian rate. Canadian research has identified differences in SIDS rate based on neighbourhood income, with SIDS rates ranging about twice as high in the lowest income areas compared to the highest. The website comments, “Alarming disparities persist among Canada’s Indigenous population, with a SIDS rate more than seven times higher than the non-Indigenous population.”

A safe infant sleep surface:

  • Has a firm, flat mattress with a tightly fitted sheet;

  • Has no gaps between the mattress and sides, where the infant could become trapped;

  • Is free of soft bedding, bumper pads, toys and sleep/head positions.

Alcohol and substance use: Alcohol and opiate use during pregnancy are associated with an increased risk of SIDS. Parental alcohol and substance use are also associated with a significantly higher risk of infant death when combined with bed sharing.

Immunization: Immunization does not increase the risk of SIDS and may even lower the risk. Infants should receive their vaccinations according to the schedule established in their province/territory.

Home monitors: Despite marketing claims, there is no evidence that home sleep monitors – used to detect infant breathing, heart rate or movement – reduce the incidence of SIDS. These products can provide a sense of false reassurance. Priority should be placed on the principles of safe sleep as the most effective way to decrease the risk of SIDS.

The most important modifiable factors that can lower the risk are:

  1. Placing infants on their backs to sleep for every sleep.

  2. Protecting infants from exposure to tobacco smoke, before and after birth.

  3. Providing a safe sleep environment for infants. The safest place for an infant to sleep is in a crib, cradle or bassinet, free of soft loose bedding, placed in the parent's room for the first 6 months.

  4. Breastfeeding - for at least 2 months, with greater protection provided with longer duration.

  5. Practicing the principles of safe sleep FOR EVERY SLEEP - at home, in childcare settings and when travelling.

Although bed sharing is not advised, parents/caregivers should be aware of the factors that put infants at greatest risk when bed sharing so they can take steps to avoid them.

Quick links for the Safe Sleep support information are available at:

Jessica Campbell