How is safe sleep managed for infants in foster care?

Safe sleep for an infant in foster care is managed through a written, individualised plan that combines safer-sleep practice with the child’s health history, developmental needs and placement circumstances. The plan should be discussed with the fostering team and relevant health professionals, then kept under review as the infant grows or their needs change.

Before the infant arrives

Foster carers should receive the information needed to understand the infant’s usual sleep pattern and any factors affecting sleep, such as prematurity, low birth weight, breathing problems, reflux, prescribed medicines, developmental differences or previous changes in care. Where information is incomplete, carers should ask the social worker, supervising social worker, health visitor or other appropriate professional what is known and what should be monitored.

The sleeping arrangements should be prepared before the placement begins. An infant should have their own clear, flat and firm sleep surface, with a well-fitting mattress and appropriate bedding. The cot or crib should be free from pillows, duvets, quilts, cot bumpers, toys, loose blankets, sleep positioners and other items that could cover the face or obstruct breathing. Carers should check the equipment regularly and remove anything that becomes loose, damaged or unsuitable.

How the routine is followed

• Place the infant on their back for every sleep, including naps, unless a medical professional has given specific alternative instructions.
• Keep the infant’s head and face uncovered and avoid overheating by using suitable clothing and bedding for the room temperature.
• Position the infant with their feet near the bottom of the cot where appropriate, so they cannot gradually slip beneath the bedding.
• Keep the sleep space in the same room as the carer during the early months where this is advised and practical, while still using a separate sleep surface.
• Never leave an infant to sleep routinely on a sofa or armchair, where they can become trapped or covered.
• Do not use a car seat, bouncer, swing or other sitting device as the infant’s usual place for sleep. If the infant falls asleep in one, they should be moved to a suitable flat sleep surface when it is safe to do so.

Some infants are swaddled, but this should only be done if it is included in the agreed care guidance and the technique is understood. Swaddling must not be tight around the chest or hips, the infant must remain on their back, and it should stop as soon as they show signs of trying to roll. Weighted sleep products should not be used for an infant.

Managing bed-sharing risks

Foster carers should be given clear advice about avoiding bed-sharing, particularly if an adult has smoked, has consumed alcohol, has taken medication or substances that cause drowsiness, is extremely tired, or if the infant was premature or had a low birth weight. An infant should never share a bed with other children or pets. Falling asleep with an infant on a sofa or chair is especially hazardous, so carers should plan where to place the baby if they feel tired during a feed or comforting routine.

Responding to individual needs

Safer-sleep guidance does not replace medical advice. If an infant has a diagnosed condition, unusual breathing, feeding difficulties, prescribed treatment or another health concern, the fostering team should agree with the relevant clinician how sleep should be managed. Carers should not use a sleep positioner, incline, monitor or specialist product to address a concern without professional advice. A monitor may alert a carer to a sound or movement, but it does not make an unsafe sleep arrangement safe or prevent all sleep-related incidents.

Sleep information should be recorded as part of the infant’s day-to-day care where required. Carers may need to note changes in sleep, breathing, temperature, feeding, settling or behaviour and share concerns through the agreed reporting route. This helps professionals identify whether the routine remains appropriate and whether the infant needs a health assessment.

Safe sleep alongside contact and disrupted routines

Family contact, appointments and changes in the infant’s routine can affect settling. The safer approach is to keep the sleep arrangements consistent wherever the infant sleeps, including during travel or contact arrangements. Anyone caring for the infant should understand the basic routine and know that the infant must be placed on their back in a clear sleep space. Where another person’s care arrangement is involved, foster carers should raise any uncertainty with the social worker rather than making assumptions.

If an infant is found not breathing normally, is difficult to wake, has turned blue or grey, or appears seriously unwell, seek emergency medical help immediately. For less urgent concerns, contact the health professional or fostering team identified in the infant’s care plan. Foster carers are not expected to diagnose sleep-related problems; their role is to follow the agreed routine, observe the infant carefully and report concerns promptly.