While there are clear recommendations surrounding safe sleep for babies to help reduce the risk of SIDS, most of the available information only guides you until they are 12 months old. Once they pass this age the risk of SIDS drops substantially. However this is not to say that there are no longer other sleep safety concerns you should be aware of.    

The focus of safe sleep for toddlers shifts away from preventing SIDS to rather creating a safe sleeping environment to prevent accidents such as falling. A safe sleeping environment for a toddler is one where they should not be able to climb out of their cot, fall off their bed or become entangled by any cords.    

Toddlers love to explore and are often adventurous in trying to learn more about how their world works. As parents, we need to make their environment as safe as possible to allow them to do this. This is especially important at night time while they are sleeping as they are likely to be alone in their room.  

When is it safe for my baby to move out of their cot and into a bed?

No two toddlers are the same and so the time at which they are ready to move from their cot to a bed will vary. Factors such as the height and development of your toddler will form the basis of this decision. On the whole, this transition tends to happen between the ages of 2 and 3.   

There is generally no hurry in moving your toddler from their cot to a bed. Ideally this should only happen when your toddler is emotionally ready to move out of their cot. During the first 12-24 months your baby has come to feel safe and secure within the four sides of their cot and so they need to be ready for the physical boundaries to go away. This generally happens closer to the age of 3 but once more ranges with each child. 

What are the risks of keeping my baby in a cot for too long instead of moving them to a bed?

The biggest and most concerning risk associated with allowing your baby to stay in their cot too long before moving them to a toddler bed is that of them falling out or getting stuck if they were try to climb out on their own. While it may seem cute that they are able to climb out on their own, there is also the chance that they could slip and bump their head on the floor or on the way down. This is not to say that every time your toddler climbs out of their cot they will fall or get hurt, however the risk does not disappear.   

This can be especially dangerous at night when it is dark and they are unable to see what they are doing as well as if they are wearing a sleep sack as this restricts their movement. The sides of a cot are very narrow and do not provide much support which makes it easier to slip over. There is also nothing below them once they do climb over for them to land which can make getting down safely more difficult.     

A toddler who has managed to get out of their cot at night is also at risk of injury should they roam the house unsupervised. 

How do I know if my toddler is ready to move to a bed?

What are the safest bed options for my toddler?

Are there specific things to look out for when buying bed rails?

Bed rails should be used from the age of 2 years to 5 years to prevent your toddler or child from falling out of their bed. You can choose from wooden, mesh or inflatable rails depending on your specific needs.  

When deciding on a bed rail, the following should be taken into consideration: 

• The size of the mattress: 
• In order to effectively prevent your toddler from falling out, the bed rail needs to be no lower than 16cm from the top of the mattress. 
• The length of the mattress: 
  
• The bed rail should be placed in the centre of the side of the bed with a 25cm gap on either side to make it safer for your toddler to get in and out. 
• The weight of the mattress: 
• If the mattress your toddler is using is too light or thin, it will not be able to securely and safely support a bed rail.  
• Placement of the mattress: 
• Should your child’s mattress be placed away from the wall then 2 bed rails will be needed. It is also crucial that the bed rail be securely attached so that your toddler is not able to get stuck between the mattress and the bed rail.

What other safety features should be in place?

With the focal point having moved from the position in which your baby sleeps to the environment around them, other safety concerns need to be addressed.   

For toddler still sleeping in a cot: 

• As long as your toddler remains in their cot, it should be empty with no blankets, pillows or toys. The concern is that some of these items can be used as a step to get over the side of the cot. 
• Avoid placing furniture nearby the cot or any other object which they could use to step on to help them climb out.   The mattress should be placed on the lowest setting to make it more difficult for them to climb out.  
• Make sure that there are no paintings, shelves, curtains, blind strings, mobiles, or items with strings and ties within their reach.   

For toddler sleeping on a toddler bed or single mattress:   

• Be careful when placing a bed against the wall as it is easy for toddlers and young children to become trapped or stuck between the mattress and the wall. It is suggested that the head of their bed rest against the wall. 
• Keep the area around their bed free from any other furniture, toys or hard objects which could injure your toddler should they fall out.  
• It is best to have a bed that is closer to the floor with soft items such as carpets, pillows or blankets around it to minimise any injury.  
• It is still important to make sure that any curtains, blind cords, objects with ties and strings and electrical cords are far out of your toddler's reach as they still pose strangulation risks.  
• Any heavy items of furniture such as bookcases or toy storage containers are securely attached and anchored to the wall to prevent them from falling onto your toddler especially if they decided to climb on it. 
• Cover any open plug points to prevent your toddler from placing their finger in one.  
• Make sure that any choking hazards such as batteries, coins, magnets and toys are not left in their room. 
• Similarly, any medicines or creams and oils must also be far out of their reach.  
• Consider placing a safety gate in the doorway of their room which will prevent them from being able to get out and roam around the house which has its own risks.

At what age can toddlers sleep with a pillow, blanket and stuffed toy?

Once they have moved to a toddler bed or a single mattress, blankets, pillows and stuffed animals no longer pose the same risk they did when they were younger. It is however still recommended that you wait until your toddler is at least 2 years old before introducing a pillow to prevent placing unnecessary strain on their necks. It is also advised that you introduce a small and flat pillow to your toddler and not an adult sized pillow. Similarly, it is best to start with thin and light blankets which are easier for them to manage rather than a big, thick and heavy blanket, duvet or quilt. 

Is it safe for my toddler to sleep in a bunk bed?

Bunk beds are a great way to save space in your child’s room and often add an element of fun. There are however some safety aspects which should be considered when deciding to use a bunk bed especially for toddlers. Firstly, it is not safe for a child under the age of 6 to sleep on the top bunk. This is because the guard rails which are used on the top bunk are designed to be used with children over the age of 6. Should your toddler sleep on the bottom bunk, bed rails must be used to prevent them from falling out. Careful attention should also be paid to the size of the gap between the side of the bunk bed and the wall to ensure that your toddler cannot get trapped or stuck.    

Another big safety concern is the ladder portion of the bunk bed. This should be securely attached to the bunk bed and must be the only way a child is able to get onto the top bunk. Ensure that your child is able to use the ladder safely to get onto and off of the top bunk. Great caution must be taken if there is a ladder to the top bunk and there is a child under the age of 6 on the bottom bunk as they pose a significant safety risk of slipping and falling should they attempt getting to the top bunk.    

Ropes, cords or ties should not be attached to any part of the bed. Also be cautious of leaving these items in your child’s bedroom as they are a strangulation hazard. 

Safe sleep for toddlers looks different to that of babies as the concern is no longer focussed on SIDS but other potential dangers in their room. When trying to identify possible hazards, get onto the level of your toddler so that you are able to see things from their perspective.

references

https://afmc.org/aces-news-and-notes/is-your-baby-or-toddler-sleeping-safely/

https://www.whattoexpect.com/toddler/sleep/toddler-safe-sleep-practices/ 

https://my.clevelandclinic.org/health/articles/14302-sleep-in-toddlers--preschoolers 

https://raisingchildren.net.au/toddlers/sleep/where-your-child-sleeps/cot-to-bed 

https://pediatrics.aappublications.org/content/128/2/e339 

https://www.parents.com/toddlers-preschoolers/sleep/101/toddler-sleep-101-what-you-need-to-know/ 

https://www.webmd.com/parenting/safe-for-toddler-to-use-pillow#1 

https://www.canada.ca/en/health-canada/services/consumer-product-safety/reports-publications/consumer-education/your-child-safe/sleep-time.html 

https://www.aappublications.org/content/aapnews/28/3/25.4.full.pdf 

https://www.healthyfamiliesbc.ca/home/articles/bed-safety-toddlers-age-three 

https://www.safetots.co.uk/safetots-blog/which-toddler-bed-rail/ 

https://rednose.org.au/downloads/RN3356_Cot_Bed_DL_Oct2018_web.pdf