Safe sleep and sudden unexpected death prevention — formative SAQs

SAQ 1 (10 marks)

Parents of a 3-week-old term infant ask how to keep their baby safe at night. They currently put the baby on the side “so he does not choke,” use a pillow in the bassinet, and sometimes feed on the sofa at 2 am. [1]

1. Correct the three unsafe practices with a clear rationale for each. (4) [1]
2. List the core safe-sleep environment rules you will teach for every sleep. (4) [1] [2]
3. When should swaddling stop, and why? (2) [11]

Model answer

Side sleep is not a safe compromise because infants more easily roll to prone; use supine every sleep. Pillows and soft objects increase rebreathing and suffocation risk — use a bare firm flat surface with fitted sheet only. Sofa feeding sleep is a high-risk shared-sleep setting; plan feeds so the adult does not fall asleep on a sofa with the infant. [1] [10]

Core rules: back every sleep; firm flat non-inclined approved surface; bare cot; room-share without routine bed-sharing (ideally ≥6 months); smoke-free; avoid overheating/head covering; support breastfeeding; optional pacifier once feeding established if family chooses. [1] [2]

Stop swaddling as soon as the infant can roll; swaddling with prone position is particularly hazardous. [11]

SAQ 2 (10 marks)

A 10-week-old ex-preterm infant (born 30 weeks) is ready for NICU discharge. Parents plan to bed-share “so we can breastfeed easily.” Mother smokes outside the home. [14]

1. Why is this infant’s risk profile different from a healthy term newborn? (3) [1] [14]
2. Outline your bed-sharing and smoke counselling for this family. (4) [1] [8] [10]
3. What discharge modelling and transition steps should the NICU complete? (3) [14]

Model answer

Prematurity and low birth weight increase vulnerability within the triple-risk framework; environmental hazards therefore carry higher stakes after discharge. [3] [14]

Do not recommend routine bed-sharing. Prefer room-sharing with a separate safe surface. Risk of shared sleep rises with smoke exposure and in preterm infants; sofas and alcohol/drugs are additional high-risk contexts. Support a smoke-free plan for home and car, not only “outside.” [1] [8] [10]

Transition to a home-safe sleep environment before discharge: model supine bare firm flat sleep, teach caregivers with teach-back, remove therapeutic positioning devices that will not be used at home, and document the plan. [14]