Ensuring that children are safe while they sleep is just as important as caring for their wellbeing while they are awake – despite this, Ofsted frequently raises concerns around safer sleep practices in inspection reports.
Repeatedly nurseries have been deemed inadequate for practitioners not following the latest guidance when settling children for a nap, and poor staff deployment resulting in babies being left alone where practitioners are not able to see or hear them.
So what should settings be doing to ensure safe sleep practices? The EYFS (2021) states, ‘Sleeping children must be frequently checked to ensure that they are safe. Being safe includes ensuring that cots/bedding are in good condition and suited to the age of the child, and that infants are placed down to sleep safely in line with latest Government safety guidance [see Further information for references].’
It is vital that nursery sleep policies ensure that practitioners are aware of the risks of sudden infant death syndrome (SIDS) and of the steps that can be taken to help reduce them. Kate Holmes, head of support and information at The Lullaby Trust, gives the following advice for babies:
- Put them on their back for every sleep.
- Keep them smoke-free, day and night.
- Provide a clear, flat, separate sleep space.
‘Safer sleep advice should be followed for every sleep, day and night,’ she says. ‘This includes ensuring that every baby is put on their back to sleep and not on their front or side. Each baby should be provided with a separate sleep space that conforms to safer sleep guidance. For example, a Moses basket, cot, travel cot or carrycot that has a firm, flat mattress that is protected by a fitted waterproof cover.
‘Mattresses should be checked regularly to make sure they are still firm, flat and in good condition with no rips, tears or sagging. All mattresses should be inspected and replaced immediately if there are any signs of damage. It is also important that any equipment used for the babies’ sleep spaces has passed the necessary safety checks and that the manufacturer's guidance is followed for every product in use.’
Holmes says the surface of a mattress should be firm enough that when a baby is placed on it, their head does not sink in more than a few millimetres because this could be a risk for overheating and suffocation. It is also important to make sure that the mattress is the correct size for the sleep space.
‘All a baby needs to sleep is a sheet or lightweight blanket that is tucked under the mattress and not above shoulders, or a well-fitted baby sleep bag,’ she adds.
Regular checking
While there are no longer tight ratios when it comes to sleeping children, early years consultant Penny Tassoni urges settings to consider the worst-case scenario – what would they do if sleeping children need to be quickly evacuated? She recalls visiting a nursery where children slept in an attic room and staff left the premises for breaks during nap time. There would not have been enough staff to carry the sleeping children outside in an emergency.
The Lullaby Trust advises that babies under six months of age should be in the same room as an adult for all sleep periods. Other sleeping children should be regularly monitored. ‘Most settings that do this well either have somebody in the room with sleeping children or a person who checks every ten minutes,’ advises Tassoni. ‘There needs to be a balance because having people going in and out of the room can disturb children who are nearly asleep, but staff need to be available when children first wake up because they may otherwise be disorientated and wandering around.’
Holmes says sleeping children should be monitored for signs of overheating because the chance of SIDS is higher in babies who get too hot. ‘The best way to check baby's temperature is by putting a hand on the skin on their chest or the back of their neck,’ she advises. ‘If their skin feels hot, slightly clammy or sweaty, this is a sign they are overeating and a layer of bedclothes or bedding should be removed.’
The ideal temperature of the sleep room is 16-20°C, but Tassoni adds that staff should remember that if children are sleeping on mats, the floor will feel cooler than where the adult is standing. She also recommends having ventilation, such as an open window, to reduce the spread of infections.
Comfort and safety
Good sleep practice includes working with parents to ensure that children's individual routines are followed and they feel safe and comfortable. However, staff should not force children to stay awake against their will.
Tassoni says the aim is to enable a child to sleep without artificial props. ‘In fairness to the child and parents, you don't want to start routines that then become habits for children, such as stroking their heads until they go to sleep,’ she explains.
Sleep spaces should be kept as clear as possible. While being aware of potential dangers, such as blind cords, staff should also risk-assess resources in multipurpose areas that may prove a danger if a bored, wakeful child were to start playing with them. Care should be taken to ensure children are dressed appropriately for sleeping to avoid overheating and any items of clothing that may be a choking or strangulation risk.
Tassoni also says be mindful of the age and stage of children; when children of different ages sleep in the same area, a baby may not be able to reach a toy from their cot, but a three-year-old may pass it to them.
CASE STUDY: More2Nurseries in Greenwich, south east London
‘Safer sleep is so important because if you get it wrong, the consequences are devastating,’ says Kelly Salambasis, co-founder of the two nurseries which are graded Outstanding by Ofsted. ‘There's a danger that people just take it for granted that nurseries and practitioners know what they're doing and assume that the recent safer sleep messages have got through. But, for example, some people trained or were parents when advice was to put babies on their fronts to sleep.
‘Our sleep policy is based on the NDNA, policy which is comprehensive. We have carefully gone through it to make it specific to our nurseries. For example, we have transferred to using coracles in the baby rooms because we like that babies can be more independent when they are mobile.
‘We review all our policies annually and also when issues arise. We also conduct regular audits of our practice and feel it is important to work with external consultants to have a fresh pair of eyes and help us to reflect. Recently early years consultant Ruth Mercer pointed out to be careful with how we space the older children's sleep mats to ensure they are sufficiently away from each other. She also observed that some staff had got into the habit of patting children to get them to sleep rather than allowing them to self-soothe. She noted that one of our newer practitioners was doing this very functionally, rather than in a relaxing way.
‘We go into depth on our safe sleep routines in staff inductions but we revisited our policy in training recently to ensure that all staff were up to date with the current advice. We have produced a visual safe sleep pack that contains diagrams and key bullet points of our non-negotiables – such as babies laid on their backs, feet to the bottom of the coracles, blankets under the arms, mats being spaced out and the importance of 10-minute visual checks. We have also put these messages on posters in the rooms to remind staff and bank staff. Our managers are also actively visiting rooms and interacting with room leaders to make sure policies are being followed and working.’
FURTHER INFORMATION
The EYFS references:
- NHS advice on sudden infant death syndrome: https://www.nhs.uk/conditions/sudden-infant-death-syndrome-sids
- NHS advice on safe sleeping: https://www.nhs.uk/conditions/baby/caring-for-a-newborn/reduce-the-risk-of-sudden-infant-death-syndrome
- The Lullaby Trust: https://www.lullabytrust.org.uk
- Scottish Cot Death Trust: https://scottishcotdeathtrust.org
