The risk, stated plainly

The Lullaby Trust says that following safer sleep advice is especially important for babies born before 37 weeks or weighing less than 2.5kg at birth, because premature and low birth weight babies have a greater risk of sudden infant death syndrome. Bliss says the same thing in its own guidance for parents going home from a neonatal unit.

That is a frightening sentence and it comes with a genuinely useful one attached: the risk is reducible, and safer sleep advice is what reduces it.

Count from the due date, not the birthday

This is the single fact that makes this page different from general safer sleep advice. The Lullaby Trust states that safer sleep advice is usually for babies up to 12 months old, but that if your baby was born prematurely you should follow it for a year from their due date rather than from when they were born.

The same correction applies to room sharing. The Lullaby Trust advises keeping your baby's sleep space in your room for at least six months, or six months past the due date for premature babies.

Why the cot at home looks nothing like the incubator

The Lullaby Trust addresses this head on: how your baby sleeps in hospital can be different from how they should sleep at home, because on the unit they are under constant supervision and may be positioned in a particular way for medical reasons. Babies on units may wear hats and have rolled-up towels around them. At home, the safest way to sleep is on the back, with no hat, and with no rolled-up towels or other items, unless your team advises otherwise.

Your neonatal team should prepare your baby for this before discharge, including starting to sleep them on their backs. If nobody has mentioned it by the time discharge is being discussed, ask.

The essentials

On the back, for every sleep, day and night.
In their own sleep space — a cot or Moses basket — in your room.
A firm, flat, waterproof mattress with no raised sides or cot bumpers.
Nothing loose in the cot: no pillows, duvets, soft toys, towels or bedding that could cover the face.
No products that hold a baby in one position, such as wedges, straps, pods or nests.
Sheets or a blanket tucked in no higher than shoulder height, or a well-fitting baby sleeping bag.

The Lullaby Trust adds a specific point for small babies: a baby should be 4kg before you use a baby sleeping bag, and the bag must fit well enough that they cannot slip down inside it. Bag sizes are usually given by weight rather than age, which for a preterm baby is the number that matters.

Hats come off indoors

The Lullaby Trust is explicit that premature babies often wear hats on the neonatal unit, but that once home you should stop using hats indoors, because babies lose heat through their heads and a hat indoors can make them too hot. Overheating raises the risk of sudden infant death.

Room temperature

The Lullaby Trust advises keeping every room where your baby sleeps between 16 and 20°C, and notes that this is deliberately cooler than a neonatal unit, because babies on a unit find it harder to keep warm — and that your baby will not be discharged until they can maintain their own temperature. Check your baby by feeling the back of the neck or chest, not the hands or feet, which normally feel cooler.

Reflux, and oxygen at home

Two exceptions people assume exist, and do not. The Lullaby Trust states that babies with reflux should still sleep flat on their backs, and that if your baby needs oxygen at home it is still safest for them to sleep on their backs, with the team advising if the oxygen needs adjusting.

Car seats

The Lullaby Trust advises checking with neonatal unit staff that it is safe for your baby to travel home in a car seat, and notes that your baby may need a car seat check at the unit to make sure they fit properly. It also advises avoiding long journeys with preterm and young babies, because young babies may be at risk of breathing difficulties if they sleep upright in a seated position for too long, taking regular breaks on longer trips, and taking your baby out of the seat on arrival and putting them on a firm flat surface. If your baby slumps forward, stop and reposition them before continuing.

Co-sleeping

The Lullaby Trust says research shows premature or low birth weight babies have a much higher risk of sudden infant death if they share a bed, chair or sofa with a sleeping adult, and advises avoiding co-sleeping completely until a year from the due date. It also gives the realistic version: have a safe sleep space ready nearby when you are really tired, so that if you feel yourself drifting off you can put your baby down somewhere safer.

Twins and multiples

The Lullaby Trust notes that premature multiples are often slept close together on the unit to mimic the womb and support heart rate and breathing, and suggests co-bedding twins or triplets in the same cot at home so you can share a room with them, following the same safer sleep rules.

Sleep will look different, and that is expected

Bliss notes that premature babies often have lighter, more active sleep than babies born at term and can have more frequent sleep difficulties, including restlessness and pauses in breathing at night, and that patterns usually become more like those of term babies as they develop. NICE guideline NG72 lists patterns of sleeping among the things parents are likely to be anxious about at discharge and tells professionals to help with it. Raising it with your health visitor or GP is not making a fuss.

Safe Sleep for a Premature Baby