Safe sleep: the current Australian guidelines

The Australian safe sleep guidelines — authored by Red Nose Australia and endorsed by the Royal Australasian College of Physicians — are the single most evidence-based component of early parenting advice. The guidelines exist because a decade of follow-through on them dropped the sudden infant death rate by over 80% across Australia and New Zealand.

This article covers every principle, the research that sits behind it, and the specific scenarios parents ask about (car seats, baby carriers, co-sleeping, bassinet attachments).

The six principles

1. 1Sleep baby on the back for every sleep, day and night.
2. 2Sleep baby with head and face uncovered.
3. 3Keep baby smoke-free before birth and after.
4. 4Provide a safe sleep environment: safe cot, safe mattress, safe bedding.
5. 5Sleep baby in their own safe sleeping place in the same room as an adult caregiver for the first 6–12 months.
6. 6Breastfeed baby, if possible.

1. Back sleeping

Back sleeping is the most important single intervention. Stomach sleeping has consistently been shown to increase the risk of sudden infant death fivefold across international data. Side sleeping is also unsafe — babies can roll onto their stomach from their side more easily than from their back.

Every sleep. Day and night. In every space — cot, pram, carrier, grandparents' house. Back, back, back.

If your baby rolls onto their tummy after independent rolling is established (usually 4–6 months), and they get themselves there, you do not need to flip them back. Put them down on their back; let them sleep where they end up.

2. Head and face uncovered

An uncovered head and face allow the baby to regulate their body temperature and avoid rebreathing exhaled air. Practical implementations:

• Feet-to-foot positioning — baby's feet at the foot of the cot, with light bedding tucked under the arms at chest level, so the bedding cannot ride up.
• Better still, a sleep sack / infant sleeping bag sized appropriately for the baby's weight and season. These eliminate the loose bedding question entirely.
• No hats indoors. Headgear overheats a baby and can slip over the face.
• No soft toys, no bumpers, no positioners, no pillows, no head-shaping devices in the cot.

3. Smoke-free

Cigarette smoke, both maternal and household, is one of the most consistent risk factors in SIDS research — independent of, and additive to, other risks. This includes:

• Smoking during pregnancy (the evidence is strongest here).
• Smoking in the household after birth, even if not in the same room as the baby.
• Vaping. There is emerging research that e-cigarette aerosols confer similar risk; the current cautious advice is to treat vaping as smoking for safe-sleep purposes.

If a parent smokes, the safest practical step is to quit. If quitting is not currently possible, smoking should never happen in the home, car, or presence of the baby; clothes should be changed after smoking before handling the baby; and co-sleeping should absolutely be avoided (combined smoking plus co-sleeping is one of the highest-risk combinations in the research).

4. Safe sleep environment

The cot

• An AS/NZS 2172-compliant cot (Australian/New Zealand Standard for household cots). Most cots sold new in Australia meet this — check the label.
• Mattress that fits the cot exactly (no more than a 20mm gap around the edges), firm, flat, not angled, not memory foam.
• A fitted sheet. Nothing else.

Bassinets and co-sleeper cots

Bassinets are fine for the first few months provided they meet Australian safety standards — firm flat mattress, ventilated, stable stand. Co-sleeper cots that attach to the adult bed are safe if they are designed for that purpose, rigid-walled, and deployed with manufacturer's specifications.

What is not a safe sleep surface

• Adult beds (for unsupervised sleep).
• Sofas and armchairs — sofa-sleeping with a baby is one of the highest-risk scenarios in SIDS research.
• Baby loungers, sleep positioners, nests, and pillows.
• Car seats for sleep outside the car — the angle is not safe for unsupervised sleep.
• Baby carriers for unsupervised sleep — fine for contact sleep while an awake adult is wearing them correctly.
• Inclined sleepers (the Fisher Price Rock 'n Play and similar products have been recalled globally after associated deaths).

5. Room-sharing, not bed-sharing

Red Nose Australia recommends babies sleep in the same room as an adult caregiver for at least the first 6 months, and ideally 12. Research shows room-sharing halves SIDS risk compared to the baby sleeping alone in a separate room.

Bed-sharing is a more contested area. The Australian position is that bed-sharing significantly increases risk, particularly when combined with other factors — smoking, alcohol or sedating medication, prematurity, a parent on soft bedding. Bed-sharing is never recommended in the presence of any of those.

If a family chooses to bed-share, safer practices (not safe, safer) include: firm flat mattress, no pillows or duvets near the baby, no other children or pets in the bed, no gaps between the mattress and wall/frame, baby on their back, and no parent who is smoking, drinking, or on sedating medication. Check the Red Nose website for the most current harm-reduction guidance.

6. Breastfeeding where possible

Breastfeeding is associated with a reduced SIDS risk; the protective effect appears dose-dependent (exclusive breastfeeding has the strongest association). This does not imply formula-feeding parents are doing wrong — it is one factor among several, and other safe sleep practices are what matter most.

What changed in the most recent guideline update

The current guidelines refresh, around 2024, tightened language on a few areas:

• Vaping is now explicitly grouped with smoking for risk purposes.
• Guidance on inclined and soft sleep surfaces tightened after the global recall wave.
• Stronger language around car-seat sleep — safe for the duration of a car trip with an awake adult driving, not safe as a substitute sleep surface.
• Pacifier language moved from 'consider' to 'encourage' after further research confirmed the protective association.

When in doubt

Red Nose runs a free advice line — 1300 998 698 — staffed by nurses, 7 days a week, for any safe sleep question from any parent, grandparent, or carer. It is the correct resource for specific product questions ('is this bassinet OK?', 'what about this carrier?') and for conversations that do not need to go through a GP.

The rules feel rigid. They are rigid because the cost of getting them wrong is too high and the cost of getting them right is negligible. An empty cot, a baby on their back, a smoke-free home, a room-shared first year — that is most of what matters.