What can be described as a comforter? Is it a soft toy or a cloth/blanket? Does it have loose stitching that could present a choking or strangulation hazard? What is the individual child’s developmental stage and what are their needs?
This is a somewhat complex question, but one that needs more discussion both here and in our role as educators.
Have you engaged with the infant's parent to discuss safe sleeping recommendations or your Centre’s Safe Sleeping and Rest Policy? Do you document the use of comforters in the child’s records?
To determine the risks, we need to:
look at the research and understand why soft toys or a cloth/blanket may be beneficial and why they may create a potential hazard.
· It is recommended to "sleep all children with their head and face uncovered and airways clear (no puffy bedding, i.e. doonas, loose bedding, pillows, bumpers, soft toys etc.)”.
· Soft toys and padded objects or loose bedding in the cot can lead to complete airway obstruction, suffocation by rebreathing (hypercapnia) and/or overheating.
· Loose bedding may also cause a potential strangulation hazard when an infant can roll over and becomes more mobile.
· An infant under the age of 6 months is at an increased risk of SUDI (including SIDS and fatal sleeping accidents) than older babies, particularly in that period of their development when they first start to roll over and have not learnt to roll back. Their neck muscles readily fatigue and baby eventually rests face down in the bedding. Therefore, it is recommended that the sleeping environment is clear of items or products which may obstruct their face and cause asphyxiation or lead to hypercapnia.
· Babies under six months of age do not engage in exploring objects in their sleeping environment and are developmentally too young to take comfort from a toy or object to help them manage any separation from the mother/father.
· For older infants if a soft toy is a large one, then they can be used as a step up for little ones to climb over the rail of the cot creating a potential fall injury.
· On balance of the current evidence, the risk of suffocation and hyperthermia posed by the presence of soft toys or soft objects or loose bedding in the baby’s sleeping environment outweighs any benefit to the baby from the presence of a transitional object in the cot. It is therefore advised not to place soft toys and other soft objects in the cot for babies under seven months of age.
· As stated by Red Nose in their information statement on ‘Soft Toys in the Cot’, “Younger babies are more likely to self sooth with a dummy or pacifier, and older babies are more likely to use a soft object. Seven-month-old babies are more likely to explore objects in their sleeping environments than younger babies. Some babies over seven months of age may appreciate a small object such as a soft toy to provide comfort and connection (transitional object) during times of separation from their parent”. However, for older infants -over 7 months we also need to think about what can this little individual do at their particular developmental stage. They may vary with their behavioural response when faced with a potential hazard, e.g. face covered with loose bedding. Some questions to ask yourself are:
¨ Is it possible for them to become trapped against the soft product?
¨ Can they roll both ways and get themselves out of danger?
¨ Is there a possibility they can place the material over their face?
¨ Are they able to actively remove the material/comforter?
¨ How big is the soft toy?
¨ Can they use it to stand and climb?
¨ Will it be safe if used unsupervised?
¨ What are parents practising at home?
undertake a risk assessment of the individual and document. It is important to ascertain the following factors:
· How old is the infant?
· What are they able to do at their stage of development?
· What sort of comforter product is being introduced? ie Soft toy or loose bedding
· What are the potential benefits and potential hazards?
· Why has the comforter been introduced and at what age?
· By whom and is it best practice for this infant?
ensure as an educator that what we do in our practice, and what we role model to parents, can be safely done in the home environment. We may be able to supervise the infant, take away the comforter when they fall asleep; however, at home parents cannot supervise and be there next to the cot all the time. Supervise constantly – even if we check every 10 minutes, it is too long an interval if an infant’s head and face are covered – suffocation, overheating and death can occur very quickly.
If you would like further information, please contact us at education@soteriasafesleepingadvice.com.au
We offer in-service training and you can find more on our website https://www.soteriasafesleepingadvice.com.au/education OR
join one of our webinars for more on Sleeping your baby Safely
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