Bed safety rails (cotsides)

Bed safety rails (cotsides)

Bed safety rails (cotsides) are designed to help stop people rolling out of bed accidentally. They are not designed or intended to limit the freedom of people by preventing them from intentionally leaving their beds; nor are they intended to restrain people.

It is essential that bed rails are suitable for the people who are using them and compatible with the particular beds being used. Most bed rails for domestic beds have bars which run across and between the bed and mattress for greater security. Bed grab handles are unsafe to be used as bed rails as they are designed only to aid people getting in and out of bed and move around whilst in bed.

Serious injuries have occurred from the use of bed rails. The prescribing, selecting, fitting and maintenance of bed rails needs considerable care to avoid injury. The Medicines and Healthcare Products Regulatory Agency (MHRA) have issued a document : 'Safe Use of Bed Rails'.

The document recommends that alternative methods of care / management should be considered first, such as:


  • Tucked in sheets and blankets.
  • Variable height beds used in the lowered position (there are beds with an extra low height as a feature).
  • Soft cushioning on the floor to break a person's fall.
  • Alarm systems (person, movement or pressure operated) to alert carers that a person has moved from his/her normal position.
  • Body positioning devices (these help to position people with specific clinical needs, e.g. someone who has contractures).
  • The person sleeping on a mattress on the floor. However, it is very difficult to care for a person at this level. The risks from moving and handling and the loss of independence need to be balanced against the perceived benefits.

It is important to remember that:


  • Bed rails should never be used to restrain people who may attempt to climb over them. They risk falling from a greater height.

  • The bed rail is suitable for the size of the occupant. Standard bed rails usually suit someone over the size of an average 12-year-old and are unsuitable for a smaller adult, young child or baby.

  • The maximum allowed gap between the side rails for adults is no more than 12cm. For children under 12 years of age and adults of a similar proportion, the maximum allowed gap is 6cm.

  • Care should be taken that people do not injure themselves on hard metal frames and that heads or limbs do no become trapped by them. Limbs, for example, can be trapped in large spaces between bars, in the gap between the end of rail and headboard, between the mattress and lowest rail of the device or in the gap as a result of the weight of a patient compressing the mattress. Profiling beds need checking for dangerous gaps in all positions.

  • Some bed rails are provided with net sides to reduce the risk of impact injury. Some companies supply padding to go over rails. Do not assume the netting or padding will reduce the risk of being trapped. Also, some covers are not air-permeable and may present a risk of suffocation.
  • Care needs to be taken if a mattress overlay is used, or the mattress changed. If the bed rail is too low (because of the extra height) the occupant can fall over the top; softer surfaces can increase the risk of entrapment between mattress edge and rail; and some mattresses are too light to hold the bed rail in place. Check whether manufacturers and suppliers can provide secure fastenings and extra height bed rails.

All advice is either supported by references (cited in the text) or is based upon peer reviewed professional opinion. Our advice is impartial and not influenced by sponsors or product suppliers listed on the site.
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