How Can I Prevent Cot Death? The Complete Back to Sleep Guide

This is a big read - you'll need a coffee and a munchie. OK, here we go!

Firstly, we must give praise to the Lullaby Trust for their tremendous achievement in reducing cot deaths in the UK. They were formed in 1971 and were then called FSID (Foundation for the Study of Infant Deaths). The cot death rate was horrendous back then - several thousand per annum!

In 1991, FSID introduced the "Back To Sleep Campaign". In 2013, FSID was renamed "The Lullaby Trust" - you can see why it offered a kinder, warmer image.

The Back To Sleep Campaign has reduced the cot death rate from thousands a year to below 200. Yes, of course one death is too many, but what a wonderful contribution they have made.

The Back To Sleep Guidelines

Always Place Your Baby on Their Back to Sleep

Before this advice, babies were placed on their tummies. This was advocated by the famous paediatrician Dr Benjamin Spock in 1958 in his editions of Baby and Child Care. "Not many know that!"

The "Feet to Foot" Position

Always sleep your baby on its back with its feet touching the base end of their crib - whether they're in a Moses basket, crib, pram, or cot. The reason is that if you use blankets, your baby cannot slip under them. Most babies now sleep in sleep sacks, so blankets aren't as common. If you do use blankets, ensure the blanket is under their arms so it cannot ride up and cover their head.

Room Sharing

The overwhelming advice from the Lullaby Trust and the medical profession is to keep your baby in the same room as you while they're sleeping until they're at least 6 months old. Use a next-to-me crib, rocking crib, or Moses basket on a stand. No pillows, duvets, or toys in their beds.

Bed Sharing Advice

It's not advisable to share your bed with your baby - you could fall asleep and slip on top of them. If you do, keep other children, pets, and toys out of the bed.

Do not share a bed with your baby if you or your partner:

• Smokes
• Takes recreational drugs
• Has had two or more units of alcohol
• Has taken medicine that causes drowsiness

Also, don't share a bed with your baby if they weighed under 2.5kg (5.5lbs) when they were born.

No Smoking

You all know this, but we have to list it: don't smoke during pregnancy or let anyone smoke in the same room as your baby, both before and after birth - and this includes vaping. All the research shows vaping is as harmful to your baby as cigarettes.

For the same reasons, don't sleep on a sofa or armchair with your baby.

Room Temperature

Very important: 16°C to 20°C, with light bedding or a lightweight baby sleeping bag (sleep sack), will provide a comfortable sleeping environment. You can buy sleep sacks in different tog ratings.

Cot Bumpers Are Banned

Just a word on cots - they used to have lovely bumpers around them, supposedly to stop a baby's head from bashing against the bars and to act as a draught stopper. Now bumpers are banned because they stop air circulation and pose a suffocation risk if your baby's head gets underneath them.

Bumpers were also accused of being a climbing aid for some babies to escape from their cots! I can support that theory - one of mine used to get out and enjoyed the mountaineering group when he went to uni.

Breastfeeding

All the evidence points to breastfeeding reducing the risk of cot deaths.

Slings and Baby Carriers

Make sure you use a sling or baby carrier safely. They're all different shapes and sizes, and it's very personal - not something you can easily try when buying online. Seek out honest reviews from mums who have reviewed them after a few weeks, not when they first take it out of the packet.

The Mattress - Critically Important

In the first six months, your baby will spend approximately 2,500 hours on its mattress.

Your baby's mattress should be firm, flat, waterproof, comfortable, and in good condition. We'd also add breathability, temperature control, and durability - you don't want it to dent or sag after a few months' wear.

Why Firmness Matters

This is confusing, but please stick with me - I'll try to explain the Lullaby Trust recommendations.

The mattress must be firm and flat because if it sags, your baby's head dips down, the chin goes on the neck, and the airways aren't fully open.

Why Waterproofing Matters

The Lullaby Trust suggests your mattress should be waterproof to prevent urine or vomit getting to the mattress core. A waterproof protector should go over the mattress cover and under the top cotton sheet. Remember: "waterproof" - not "water resistant". Don't fall for that marketing nonsense!

When the Lullaby Trust came out with this regulation, most mattresses were made of foam. It was vital to protect the foam from body fluids, and here's why:

In 1988, the UK Government made a new law requiring all baby mattresses to be flame retardant, which meant the foam was infused with toxic flame retardant chemicals. What an absolute nonsense - "you couldn't make it up!"

It was then suggested by scientist Dr Barry Richardson that if sweat, urine, or vomit mixed with these flame retardant chemicals, it could produce poisonous gases - Stibine, Phosphine, or Arsine - which could cause cot deaths.

The way to prevent this gas forming was to put a barrier between your baby and the foam core. A waterproof sheet was the answer (not water resistant).

In October 2025, the UK Government realised what an insane decision it was to make baby mattresses flame retardant with toxic chemicals. Yes, it only took 37 years for them to realise British babies weren't smoking in their cots! They rescinded the rule.

Foam can now be made without flame retardant chemicals. However, it's still a good idea to keep body fluids away from the core to prevent bacterial growth, whether the mattress is made of fibre, foam, or natural coir.

Balancing Waterproof and Breathable

Putting a plastic waterproof cover over mattresses meant poor air circulation, which could contribute to your baby overheating.

A way to combat this is to put the waterproof protection under the mattress cover but over the mattress core. Have the cover made from a temperature-controlled fabric like CoolMax backed with a spacer fabric such as MaxiSpace or Spacetec. Then you get the best of both worlds: waterproof protection to the core and maximum breathability.

Not an easy topic to cover - I hope it answered all your questions!