Is It Safe For My Baby To Sleep In A Pram?

By Megan Petchel & Julie Monson Jul 15, 2021

The convenience of letting your little one take a nap in their pram so that you do not have to rush home is helpful. It provides you with a sense of flexibility to be able to go out without interfering with your baby’s sleep. Sometimes placing your baby in their pram and rocking them or walking around is the only way you can get them to sleep. But is it actually a safe place for them to sleep?

A pram can be a back-up sleep space for day naps, if it can recline flat. This is especially important for infants who do not yet have sufficient head control, who require a bassinet (also known as a carry cot) in order to lie completely flat. The majority of medical professionals warn against letting your baby sleep in a pram overnight, and very few prams and bassinets are approved for overnight sleep. It is best to place your baby in their cot soon as possible to reduce their risk of SIDS and other potential injuries. If letting your baby sleep in their pram is unavoidable, it is important to check your baby’s temperature regularly, keep the hood pulled back, and remove the pram apron/footmuff especially in warmer weather. This is because the hood can trap more heat. Also, remove your little one’s outdoor clothing and hat when inside.

What are the risks if my baby sleeps in their pram?

According to Safe Sleep principles, the safest place for the first 12 months of your child's life is to sleep on a flat and firm surface. Whilst most prams are able to recline, very few of them are able to lie fully flat. This is also the case when babies are left to sleep in their car seat when clicked onto the pram as it increases the risk of positional asphyxiation. There is also a concern around the padding used in some of the seats as it is often soft and made for comfort. It is therefore recommended that babies under 6 months are safer sleeping in a bassinet/ carry cot on the pram, if the pram or car seat does not recline to a fully flat position. A bassinet/ carry cot provides a firm, flat surface for babies under 6 months to sleep in a safer position; flat on their backs. It is therefore recommended that you purchase a bassinet if you intend to let your baby sleep in the pram when you are out and about.

Allowing your baby to sleep in their pram that does not recline flat can potentially result in the following:

Suffocation
Positional Asphyxiation
Overheating
Increased chance of SIDS
Entrapment
Injuries associated with the pram tipping over

WHAT MAKES A PRAM UNSAFE TO SLEEP IN?

There are various aspects of sleeping in a pram which contribute to the risks mentioned above:

Reclined sleeping:

Sleeping at an angle (usually 45°) increases the chance of positional asphyxiation, suffocation and SIDS in babies younger than 6 months.
This is especially dangerous in younger babies as their heads are proportionally heavier and larger than their bodies. This, along with poor neck muscle strength and control, makes it easier for their heads to flop forward and block airflow.

Overheating:

Babies are unable to regulate their own body temperature which means that they can easily overheat especially if they are overdressed and in a warm environment. ·
A baby’s chance of overheating in their pram is increased if they are left in the sun to sleep or have a blanket, towel or muslin placed over the pram. This traps heat inside and restricting the flow of fresh air.

Space restrictions:

The size restrictions of the pram mean that it is easier for your baby's face to come into contact with the sides of the pram as well as the padding. This poses a potential suffocation risk if they were to shift to the side or turn their face into the soft surface. The sides or the padding would likely mould to your baby’s face and could cover their mouth and nose.

Harness:

A baby must always be correctly harnessed in their pram including if they are asleep to ensure they cannot fall out or flop forward.
However, harnesses can also result in arms or legs becoming trapped as well as strangulation and suffocation.
An older child who wriggles in their pram can cause it to tip over which can be potentially dangerous as it is unlikely they would be unable to free themselves. This means that they could get caught in the pram's folds and gaps causing injuries to your baby.

Loose items:

Things such as blankets, pillows and toys should not be in the pram or over your baby if they are sleeping. All of these items can be potential choking and suffocation hazards.

IF MY BABY FALLS ASLEEP IN THEIR PRAM, WHAT SHOULD I DO?

The best thing to do is to relocate them to their cot and place them on their back as soon as you get home, to continue sleeping. If that is not an option then, it is important that you supervise your child while they sleep in their pram to ensure:

They are in a safe sleeping position and their mouth or nose are not covered by any part of the pram
They are breathing consistently
They are correctly harnessed in the pram
They are not too hot and at risk of overheating. Fold the hood back, remove the apron/footmuff and remove outdoor clothing and hat when indoors. Do not cover the pram as this traps heat.
The pram is in the shade and out of direct sunlight
The pram is secure and the brakes are engaged

CAN A BABY SLEEP IN A PRAM BASSINET OVERNIGHT?

Evidence has shown that sharing a room with your baby, especially for the first 6 months, can dramatically decrease the risk of SIDS. However, it is not always practical to place their cot in your room and so many parents opt to use a bassinet or Moses basket alongside their bed.

It is important to note that there is a difference between pram bassinets and stand-alone bassinets. It would be safe to use a stand-alone bassinet if it is rigid and the sides are not likely to fold or collapse. It also needs to be wide enough to reduce the risk of your baby rolling or turning their head into the sides which could lead to suffocation.

The AAP has approved the use of standard sized carrycots, bassinets and Moses baskets for safe sleep. However, it is recommended that certain guidelines are followed to ensure your little one is safe and reduce the possible chance of suffocation, SIDS and entrapment. Babies should always be placed to sleep on their backs, including when sleeping in bassinets.

When using a standard sized bassinet always make sure of the following:

1. The sides of the bassinet are at least 30cm higher than the top of the mattress base.

2. The base of the bassinet is wide and stable and has a sturdy bottom which will not tip over.

3. The mattress in the bassinet must fit snuggly with no gaps around the sides.

4. Only the original mattress designed for your particular bassinet is used.

This ensures a snug fit and prevents a mattress which is too padded being used. A mattress which is too soft could allow your baby’s face to sink into it, leading to increased risk of suffocation.

5. The mattress must be well supported by the base so that it is strong enough to hold your baby when they stretch and move. It is also important that the mattress does not dip in the middle.

6. There are no blankets, pillows, toys or mobiles in the bassinet as they can be a choking and suffocation risk to your baby.

7. Make sure that there is only a fitted sheet over the mattress and that it fits without any folds.

8. The specified weight and age limits of the bassinet as indicated by the manufacturer are used correctly.

It is also important to remember that your baby may outgrow the bassinet from a developmental perspective before they reach the weight or age limit.
For example, it is not safe for your baby to sleep in a carry cot if they are able to roll as they may move into the side of it which could result in suffocation.

9. There should be no decorative pieces that could hook your baby’s clothing.

10. Always remember that if you place the bassinet on the floor that it is lower than the level of your bed.

CAN I PUT A BLANKET OR MUSLIN OVER THE PRAM?

One of the known contributing risk factors to SIDS is overheating. Unlike adults, babies are not able to regulate their own body temperature and so they rely on us to keep them comfortable.

Watch this video where they monitor the increase in temperature in a covered pram over an hour:

Various “home studies” about covering a pram with a blanket or muslin have been carried out and valuable information gained: ·

While covering a pram with a blanket on a hot day can be dangerous and possibly cause overheating, a child who does not have anything covering them is exposed to direct sunlight and can also overheat.
In addition, they are exposed to the sun’s rays which could cause UV damage to your baby's skin resulting in sunburn and an increased risk of skin cancer later on.
Not only does a blanket restrict air flow and ventilation in the pram, it also traps heat making it hotter.
The Lullaby Trust recommends using the appropriate pram shade cover which is made from mesh and is air-permeable.
Purchasing a pram with a large sun hood ensures your baby has shade and sufficient ventilation.
If your sun shade on the pram is not sufficient and you do not have a pram cover and are unable to find shade then covering the pram for a short period of time is better than direct exposure to the sun.

It is best to use a muslin or a cellulose blanket both which allow more air to flow through than a blanket.
Make sure that the muslin is securely attached to the shade cover of the pram so that your baby is unable to pull it off. This will ensure that it is not a suffocation risk to your baby.
By not clipping the sides of the muslin to the pram, air will be able to gently blow through.

In conclusion

The sole purpose of a stroller or pram is to make it easier and more convenient for you to move your baby around especially when you are out and about. Prams are not marketed as primary sleeping devices and are not a substitute for their cot so caution must be taken if your baby falls asleep in their pram.