SAFE SLEEP ADVICE: THEN VS NOW
In Hong Kong’s heat and humidity, it’s still common to see babies wrapped in blankets, dressed in layers, or sleeping in cots lined with bumpers and pillows. While these choices often come from love and a desire to keep baby cosy, they can increase the risk of overheating, suffocation, and other sleep‑related dangers.
Safe sleep guidance has changed a lot over the past few decades, and what felt normal a generation ago isn’t always what we now know is safest. In this blog, we’ll look at some of the most common “old‑school” sleep advice you may have heard from parents, grandparents, or well‑meaning relatives—and what current evidence says instead.
1. "Put them on their tummy so they don't choke."
Then: From the 1950s to the 1980s, popular advice recommended tummy sleeping to prevent babies choking on their own vomit.
Now: Babies should sleep on their backs, because their airway reflexes protect them if they spit up. Since the Back to Sleep campaigns began (1991 in the UK, 1994 in the US), SIDS rates have fallen by around 80% in the UK and by about half in the US.
2. "Make the cot cosy with pillows, quilts and bumpers."
Then: A soft, padded, well-wrapped cot was seen as comfortable and protective.
Now: The cot should have a firm, flat mattress and nothing else in it: no pillows, duvets, bumpers or soft toys. Soft bedding raises the risk of suffocation, and overheating is a recognised risk factor for SIDS. Current advice is a fitted sheet, a baby sleeping bag or light, firmly tucked blankets, and a room temperature of about 16–20°C. The US banned the sale of cot bumpers and inclined sleepers in 2022 but are still readily available (and used!) in Hong Kong.
3. "Have the baby in bed with you. We always did."
Then: For most of human history, babies slept with their mothers, and bed-sharing is still common in many households, particularly across Asia. In the mid-20th century, Western advice swung firmly against it. In practice, many families did it anyway, often without safety guidance.
Now: The safest place for a baby to sleep is on their separate sleep space on a flat, firm mattress in the parents' room. The American Academy of Pediatrics advises against bed-sharing. UK guidance from the NHS, UNICEF UK and the Lullaby Trust recognises that many parents do bed-share, and focuses on making it safer. Bed-sharing risk rises sharply if a parent smokes, has had alcohol or sedating medication, or if the baby was premature. Falling asleep with a baby on a sofa or armchair is the most dangerous arrangement. The Lullaby Trust estimates it raises the risk of SIDS by up to 50 times.
4. "Put a pillow under the mattress to help reflux."
Then: Raising the head of the cot with pillows, wedges or positioners was standard advice for babies who brought up milk. Later, inclined sleepers were sold for the same purpose.
Now: Babies should sleep flat on their backs, even with reflux. The AAP and the UK's NICE guidelines both advise against raising the head of the mattress. It does little to reduce reflux, and babies can slide down into a curled position that restricts their airway. The US FDA has warned against sleep positioners since 2010.
Make sure you are up to speed with the full safe sleep guidelines here:
