Safe sleep: the Red Nose guidelines

Newborn · Health · Reviewed 12 June 2026 · All articles

Losing a baby to a sudden unexpected death is every parent's deepest fear. The reassuring news is that following a small number of practical, evidence-based steps significantly reduces that risk. In Australia, the organisation that leads this work is Red Nose Australia, formerly known as SIDS and Kids. Their six safe sleeping recommendations are the foundation of safe sleep guidance across the country, and this article explains each one in plain language, including what they mean for day-to-day life with a newborn in an Australian home.

What is SUDI and what is Red Nose Australia's role?

In Australia, the term used by health professionals and Red Nose is SUDI: Sudden Unexpected Death in Infancy. SUDI is a broader term than SIDS (Sudden Infant Death Syndrome). It covers all sudden and unexpected deaths of a baby, including SIDS, as well as cases where a cause is identified after investigation, such as accidental suffocation or an underlying medical condition. Using SUDI reflects current medical understanding and ensures that all preventable sudden infant deaths are captured in research and prevention efforts.

Red Nose Australia is the peak body for SUDI prevention in Australia. The organisation funds research, runs the national Safe Sleeping education program, operates a 24-hour support line for bereaved families, and works with hospitals and maternity services to ensure parents receive consistent, evidence-based safe sleep information from birth. Their six safe sleeping recommendations are equivalent in authority to the guidance from the Lullaby Trust in the UK or the American Academy of Pediatrics in the United States, and are endorsed by the Australian healthcare system.

Australia has made substantial progress over the past three decades. The rate of SUDI has fallen dramatically since the Back to Sleep campaign began in the early 1990s, but around 100 babies still die suddenly and unexpectedly in Australia each year. Red Nose's ongoing work focuses on reaching every family, particularly those in communities where risk factors are higher.

The six safe sleeping guidelines from Red Nose Australia

Red Nose Australia has developed six recommendations based on the best available evidence. Together, they address the main risk factors for SUDI.

1. Always place baby on their back to sleep

Placing your baby on their back for every sleep is the single most important thing you can do to reduce the risk of SUDI. This applies from birth and for every sleep, day and night, not just for the first few weeks. Babies who roll onto their side or tummy during the night do not need to be repositioned once they can roll back independently, but they should always be placed on their back to start.

Some parents worry that a baby who vomits while on their back might choke, but there is no evidence that the back position increases this risk. Babies have a natural airway protection reflex. The risk of SUDI on the back is far lower than on the front or side.

2. Keep baby's face and head uncovered

An uncovered face and head allows your baby to breathe freely and to release heat through their head, which is one of the main ways babies regulate their body temperature. Red Nose advises that babies should not wear hats or hoods indoors during sleep, even in cooler weather.

If you use blankets rather than a sleeping bag, tuck them in firmly under the mattress and no higher than your baby's shoulders. Your baby's feet should be at the foot of the cot (the "feet to foot" position) so there is no risk of them wriggling down under the covers. A sleeping bag that fits correctly removes this risk entirely by keeping the bedding away from the face.

3. Keep baby smoke free before and after birth

Exposure to tobacco smoke is one of the strongest modifiable risk factors for SUDI. The risk applies both to smoking during pregnancy and to exposure to secondhand smoke after birth. Red Nose's guidance is clear: no one should smoke anywhere near your baby, including in the car, in the home, or in outdoor areas where your baby is present.

A parent or carer who smokes and then shares a bed with a baby increases the SUDI risk significantly, even if they did not smoke immediately before going to bed. This is true regardless of where the smoking took place. If either parent smokes, bed-sharing is in the highest-risk category (see below). Quitting smoking is one of the most impactful things a parent can do for their baby's safety and long-term health.

4. Provide a safe sleeping environment night and day

The surface and space your baby sleeps on matters as much as position. Red Nose Australia recommends:

• A firm, flat, non-tilted surface. Soft, padded, or sagging mattresses are not safe. Inclined sleep products (such as rockers, bouncers, and wedge-shaped inserts) should not be used for unsupervised sleep.
• A fitted sheet that covers the mattress snugly with no excess fabric.
• Nothing else in the sleep space. No pillows, duvets, loose blankets, bumper pads, soft toys, or positioners. Each of these creates a suffocation or entrapment risk.
• A cot, bassinet, or portable cot that meets Australian Standards. Look for the compliance mark to AS/NZS 2172 (full-size cots) or AS/NZS 2195 (folding cots and portable cots). Second-hand cots should be carefully checked for damage, missing parts, or slat spacing that does not meet current standards.

This guideline applies to every sleep, including naps. A baby who falls asleep in a pram, car seat, bouncer, or swing should be moved to a safe flat sleep surface as soon as practical.

5. Sleep baby in their own safe sleeping place in the same room as you

Red Nose Australia recommends that your baby sleeps in their own safe sleep space in the same room as you for the first six to twelve months of life. Room sharing, where the baby is in a cot or bassinet next to the parents' bed, is associated with a lower risk of SUDI compared to the baby sleeping alone in a separate room. Parental presence allows for rapid response if a baby has any difficulty.

The baby's sleep space should meet the safe environment criteria described above: firm flat surface, fitted sheet, nothing else in the cot. A sidecar cot that attaches safely to the adult bed can be a practical option that keeps baby close while maintaining a separate sleep surface.

6. Breastfeed your baby if you can

Research consistently shows that breastfeeding has a protective effect against SUDI. Red Nose Australia supports and encourages breastfeeding as part of their safe sleep guidance. Even partial breastfeeding, alongside formula, has been shown to offer some protection. The mechanisms are not fully understood, but breastfed babies tend to have different arousal patterns and immune responses than formula-fed babies.

Red Nose's position is clear: breastfeed if you can, for as long as you can. They also acknowledge that breastfeeding is not always possible and that formula feeding parents can still follow all other safe sleep guidelines to protect their baby.

Safe sleep environment in Australian homes

Setting up a safe sleep environment in an Australian home involves a few practical decisions. The most important is the cot or bassinet itself.

Choosing a compliant cot

In Australia, cots must meet either AS/NZS 2172 (standard cots) or AS/NZS 2195 (portable and folding cots, including travel cots). These standards cover slat spacing, structural stability, finish materials, and hardware. When buying a new cot, look for a compliance statement from the manufacturer. When using a second-hand cot, check that the model is still compliant and that no recalls have been issued, and inspect it carefully for damage, missing screws, or cracked slats.

The mattress should fit the cot with no gap larger than 25mm on any side. A gap large enough for a baby's head to fit into is a suffocation risk.

Sleeping bags versus blankets in the Australian climate

A well-fitted baby sleeping bag is generally preferable to blankets for Australian conditions. Sleeping bags remove the risk of blankets covering the face and stay in place throughout the night. They also make it easier to manage your baby's temperature, because you can select a bag with a TOG rating appropriate for the season and room temperature.

In much of Australia, particularly in warmer states and during summer, a low-TOG sleeping bag (0.2 TOG or 0.5 TOG) is appropriate for most sleeping temperatures. In cooler southern states or during winter, a 1.0 TOG bag may be suitable. Heavy blankets and sleeping bags above 2.5 TOG are rarely appropriate in Australian conditions and carry a real overheating risk.

If you do use blankets, follow the "feet to foot" position: baby's feet at the bottom of the cot, blanket tucked firmly under the mattress and reaching no higher than the shoulders. Check your baby regularly to ensure the blanket has not moved up over the face.

No bumpers, pillows or soft toys

Cot bumpers, including mesh "breathable" bumpers, are not recommended by Red Nose Australia. Research has not shown them to reduce the risk of bumping or limb entrapment, and they introduce a suffocation and strangulation risk. The same applies to pillows and soft toys inside the cot. A bare cot with a fitted sheet and an appropriate sleeping bag is a safe cot.

Bed-sharing: Red Nose Australia's position

Red Nose Australia's guidance on bed-sharing is more detailed and nuanced than a simple "do not do it." They acknowledge that many families do share a bed with their baby, and they provide guidance aimed at reducing risk in those situations. However, they are clear that no bed-sharing situation is entirely without risk, and that a separate safe sleep space is always the safest option.

When bed-sharing carries the highest risk

Red Nose identifies specific situations where bed-sharing significantly increases the risk of SUDI and should be avoided:

• The baby is premature or low birth weight
• Either parent or carer smokes, regardless of whether they have smoked recently or smoke outdoors
• Either parent or carer has consumed alcohol
• Either parent or carer has taken drugs (illicit or prescription) or sedating medications that affect alertness
• The baby is under three months old

If any of these factors are present, Red Nose's guidance is that the baby should sleep in their own safe sleep space. The combination of maternal smoking and bed-sharing is associated with a particularly significant increase in SUDI risk.

Harm reduction for families who do share a bed

For families who choose to bed-share and do not have the highest-risk factors listed above, Red Nose recommends steps to reduce (though not eliminate) the risk. These include ensuring the mattress is firm and flat, keeping pillows and adult bedding away from the baby, never bed-sharing on a sofa or armchair (which is the most dangerous sleep surface of all), and ensuring the baby cannot fall off the bed or become trapped between the mattress and the wall.

It is also important to plan for safe sleep from the start of a night feed. Many bed-sharing incidents occur when a parent who did not intend to fall asleep in bed with their baby does so anyway during a night feed. Having a plan, such as feeding in a chair and then returning the baby to their cot, reduces the risk of an unintentional unsafe sleep situation.

Breastfeeding and safe sleep

Breastfeeding is protective against SUDI, and Red Nose Australia supports it strongly. But night feeding, particularly in the early weeks when feeds are frequent, creates situations where parents are exhausted and the risk of falling asleep while feeding in an unsafe position is real.

A few practical approaches can help you maintain both breastfeeding and safe sleep:

• Feed in a chair or supported sitting position rather than lying in bed, and return your baby to their cot or bassinet when the feed is complete.
• If you think there is a chance you might fall asleep during a feed, it is safer to do so in bed than on a sofa or armchair, where the risk of suffocation from cushions and the gap between seat and armrest is much higher. If this happens, move your baby to their cot as soon as you wake.
• Keep your baby's cot or bassinet right next to your bed so you can pick them up and put them down with minimal movement and disruption.
• Share night feeding with your partner where possible so each of you gets longer stretches of sleep. Expressing and offering a bottle for some feeds can make this easier.

Breastfeeding support is available from lactation consultants, the Australian Breastfeeding Association (1800 686 268), and many maternity hospitals. Getting breastfeeding established well reduces stress and exhaustion, which in turn makes it easier to maintain safe sleep habits.

Australian climate considerations

Australia's warm climate means that overheating is a more significant concern for many Australian families than it is for families in cooler climates. Overheating during sleep is a known risk factor for SUDI, and it is important to dress your baby appropriately for the temperature of the room rather than for how cool the air feels to an adult.

Room temperature

The recommended room temperature for a baby's sleep environment is between 16 and 20 degrees Celsius. In warmer parts of Australia, this may require air conditioning or a fan during summer months. A fan (not blowing directly on the baby) can help circulate air in a warm room and has been associated in some studies with a modest protective effect, though it is not a substitute for following the safe sleeping guidelines.

Checking for overheating

A baby who is too warm will often look flushed, feel hot to the touch on the chest or back of the neck, and may be sweating. A baby who is at a comfortable temperature should feel warm but not hot. Hands and feet are often cooler than the rest of the body and are not a reliable guide to core temperature. If your baby feels hot, remove a layer and check again in a few minutes.

Dressing your baby for sleep

As a guide for warmer Australian conditions:

• In a room above 24 degrees: a nappy and a 0.2 TOG sleeping bag, or a nappy and a light onesie
• In a room between 20 and 24 degrees: a singlet or short-sleeve onesie under a 0.5 TOG sleeping bag
• In a room between 16 and 20 degrees: a long-sleeve onesie under a 1.0 TOG sleeping bag

Always remove hats and outdoor layers before putting your baby down to sleep, even in cool weather.

When to call an ambulance

If your baby is not breathing or is unresponsive, call triple zero (000) immediately. Do not wait. The 000 emergency number connects you to ambulance services anywhere in Australia, including in rural and remote areas.

While waiting for the ambulance, if your baby is not breathing and you have first aid training, begin infant CPR. If you do not have training, the 000 operator can guide you through the steps. Red Nose Australia recommends that all parents learn infant CPR before their baby is born. Many hospitals, maternal and child health centres, and community organisations offer infant CPR classes across Australia.

If your baby is breathing but you are concerned, contact your GP, maternal and child health nurse, or call the Health Direct helpline on 1800 022 222 for advice 24 hours a day, seven days a week.

Frequently asked questions

What does SUDI mean?

SUDI stands for Sudden Unexpected Death in Infancy. It is the term used in Australia for any sudden and unexpected death of a baby where the cause is not immediately apparent. It covers what was previously called SIDS (Sudden Infant Death Syndrome) as well as cases where a cause is identified after investigation, such as accidental suffocation or an underlying medical condition. Red Nose Australia uses SUDI because it reflects current medical understanding and captures the full scope of sudden infant deaths that prevention efforts address.

Is it safe for my baby to sleep in my bed in Australia?

Red Nose Australia recommends a separate safe sleep space as the safest option. Bed-sharing carries the highest risk when a baby is premature or low birth weight, either parent smokes, either parent has consumed alcohol or drugs or sedating medication, or the baby is under three months old. If none of these factors are present, Red Nose provides harm-reduction guidance for families who do choose to bed-share, including using a firm flat surface and keeping adult bedding away from the baby. Bed-sharing on a sofa or armchair is always the most dangerous option and should be avoided entirely.

What cot mattress does Red Nose recommend?

Red Nose Australia recommends a firm, flat, non-tilted mattress that fits the cot snugly with no gap larger than 25mm on any side. The mattress should be covered with a fitted sheet only, with no extra padding, overlays, or positioners. The cot or bassinet itself should meet Australian Standard AS/NZS 2172 (for standard cots) or AS/NZS 2195 (for portable or folding cots). Soft, sagging, or padded mattresses are not safe.

Should my baby wear a hat indoors to sleep?

No. Red Nose Australia advises that babies should not wear hats or hoods during indoor sleep. The head is one of the main ways babies release heat and regulate their body temperature. Covering the head during sleep risks overheating, which is a known risk factor for SUDI. Any hat worn outdoors for sun protection should be removed before your baby is put down to sleep.

How does Red Nose Australia differ from the UK Lullaby Trust?

The core recommendations are very similar: back to sleep, clear sleep space, smoke free, room sharing, and breastfeeding if possible. The main differences are in terminology and bed-sharing guidance. Red Nose uses SUDI rather than SIDS, and their bed-sharing guidance takes a more detailed harm-reduction approach for lower-risk situations, compared to the UK guidance which is more uniformly cautionary. Australian guidance also places greater emphasis on overheating in warm climates, and recommends lower-TOG sleeping bags suited to Australian temperatures.

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• Newborn sleep: what is normal
• Baby sleep by age: what to expect from newborn to 12 months