Sleeping Positions For Babies: What Is Safe And What Is Not

Safe Sleeping Positions For Babies

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If you have a baby at home, it is essential to know about the safe sleeping positions and tips to reduce Sudden Infant Death Syndrome or SIDS risk (1), which claims nearly 2,500 lives every year in the US. Around 80% of sudden and unexpected infant deaths are caused due to SIDS and the most effective way to avoid the risk is to make a healthy baby, less than a year old, sleep on its back i.e., in the supine position.

Momjunction tells you the ideal positions in which a baby can sleep, and also gives tips on safe sleep for infants and babies.

Sleeping Practices That Could Lead To Sudden Unexpected Death In Infancy (SUDI)

SUDI includes both SIDS and fatal sleeping accidents. Here are a few practices that could lead to SUDI:

  • Making the baby sleep on the stomach or side.
  • Putting the baby to sleep on soft surfaces such as mattress, sofa, waterbed, pillow, or lamb’s wool, either with or without a parent.
  • Covering the baby’s head or face with bedding, which may cause accidental suffocation and overheating.
  • Smoking during pregnancy or after childbirth.

[ Read : How To Minimize The Risk Of SIDS ]

The Good And Bad Positions For A Baby To Sleep

It is essential to learn about the safe and unsafe sleeping positions for a baby to deal with the above risks.

1. Sleep-On-Back

Healthy babies born full-time should be placed on their backs for naps, short periods of rest, and sleep at night.

  • ‘Sleep on the back’ position was found to lessen the SIDS risk in babies as it keeps airways open.
  • The US National Institute of Child Health and Human Development (NICHD) labeled this as the best sleeping position for babies (2).
  • Since the American Academy of Pediatrics made the ‘back-to-sleep’ recommendation in 1992, the SIDS rate has dropped more than 50%. The ‘back-to-sleep’ recommendation was later campaigned as ‘safe to sleep’ (3).

Risks Involved In ‘Sleep On Back’ Position

If infants are placed on the back for a long time in the same position, it could lead to ‘positional plagiocephaly’, a case of flattened or misshapen head and ‘brachycephaly’, the flattening of the back of the skull. The shape will become normal by the time they turn one year and rarely requires any treatment.

Simple reposition techniques can be employed to avoid such conditions. They include:

  • Increasing ‘tummy time’ of the baby when awake
  • Making the baby rest on the other side of the head rather than the flattened side.
  • Cutting down the time spent by babies in carriers or car-seaters.
  • Getting more ‘cuddle time’.
  • Changing the direction of the baby in the crib so that he does not tend to view same things in one direction always.

[ Read : When To Do Tummy Time With Your Baby ]

2. Sleep On Stomach

Several theories discourage parents from making a baby sleep on the stomach because:

  • It could put pressure on a baby’s jaw reducing the airway and restricting breath.
  • If the baby sleeps on the stomach i.e., in the prone position, he may be lying with his face very close to the sheets and keeps breathing the same air.
  • The baby could suffocate if he sleeps on stomach on a very soft mattress.
  • He could breathe in microbes present on the mattress.

Are There Any Cases Where Babies Can Sleep On Stomach?

In rare cases, due to a medical condition, doctors may advise parents to make the baby sleep on the stomach rather than the back.

  • Few physicians believe that sleeping on stomach could be good for babies with severe gastroesophageal reflux or certain upper-airway malformations like Pierre Robin Syndrome, which lead to acute airway obstruction episodes. However, no recent study supported or refuted the benefits. Healthcare providers should consider the potential benefits and risks before recommending this position.

[ Read : Causes Of Acid Reflux In Babies ]

  • The danger of vomiting was the most important argument for making the baby to sleep on its stomach, as doctors used to believe that it would be dangerous if the baby vomit while made to sleep on its back. They used to think that babies may choke due to lack of sufficient strength to turn the head. However, babies sleeping on their backs have no difficulty turning their heads if they’re sick.

3. Sleep On The Side

It is unsafe for babies to sleep on the side because they may end up on the tummy, increasing the risk of SIDS.

10 Tips For Safe Baby Sleep

  1. Avoid Loose Bedding: It is advisable to use a firm mattress rather than an overly soft mattress, water-bed or sofa for your baby. Experts suggest against the usage of bumper pads, pillows, fluffy bedding or stuffed animals around the baby in the crib. In simple words, anything that could cover a baby’s head during sleep is not recommended.
  1. Keep The Crib Simple: Do not use wedges, quilts or comforters under an infant in the crib. Let the infant sleep with his feet touching the bottom of the crib so that he can’t wriggle down under the bedding. Use a firm, clean mattress that fits the cot well and tuck in the bed clothes securely. The sides or ends of the crib should be high enough to avoid the baby climb out or crawl.
  1. Avoid Covering Baby’s Head: Blankets should be covered only up to the chest of the baby with arms exposed, to avoid the shifting of the blanket onto the head and thereby avoiding suffocation. The American Academy of Pediatrics recommends using ‘sleep sack’ or ‘baby sleep bag’ as a type of bedding to keep him warm without covering the head. Sleeping bags with a fitted neck and armholes and no hood are considered the safest. Wrapping baby in lightweight cotton or muslin also helps in preventing him from rolling onto his tummy during sleep.
  1. Avoid Overheating: Infants should be light-clothed for sleep. Avoid over-bundling and check if the baby is not hot to touch.
  1. Good Sleep Environment: It is important to maintain a considerably cool sleeping environment with a temperature around 20 degrees centigrade for the baby.
  1. Vaccination: An investigation done on diphtheria-tetanus-pertussis immunization and potential SIDS association (4) by Berlin School of Public Health has concluded that “increased DTP immunization coverage is associated with decreased SIDS mortality. Current recommendations on timely DTP immunization should be emphasized to prevent not only specific infectious diseases but also potentially SIDS.” Make sure your baby is immunized.

[ Read : Tips To Ease Baby’s Pain After Vaccination ]

  1. Use A Pacifier (at sleep times): The American Academy of Pediatrics considers pacifiers to prevent SIDS. However, do not force the baby if he doesn’t want it or if it falls out of the mouth. If you are breastfeeding, wait until it is well established before beginning to use a pacifier. It usually takes around three to four weeks of age.
  1. Use Technology: For you to have a peaceful sleep, use one of the several Wi-Fi baby monitors, app-powered thermostats, or small alarms available to monitor the sleep position as well as vitals of your baby.
  1. Share Same Room: Parents should share the same room with the baby for convenient breastfeeding and contact. The crib in which the baby sleeps should be closer to parents.
  1. No Bed-Sharing: Infants should ideally not share the bed with parents, adults, siblings or other children. Twins or multiples should be made to sleep separately. Do not share a bed with your baby especially if you or your partner has been drinking, smoking or taking medications or drugs that could induce deep sleep. Smoking and the use of substance like drugs or alcohol significantly increase the risk of SIDS and suffocation in babies, if the bed is shared.

FAQs

1. What If The Baby Rolls Onto Stomach While Sleeping?

Around four to five months of age, babies begin to roll over onto their stomach from their back. This can be alright as the SIDS risk lowers by this time. Let the baby find his own comfortable sleeping position as he will be able to turn his face to the side to keep the mouth and nose free for breathing when sleeping on stomach. However, place him on his back at the start of the sleep.

Note that the SIDS risk is at a peak between one and four months of age, but it remains a threat until babies are 12 months old. So, follow other precautions to reduce the risk of SIDS all through your baby’s first year.

[ Read : When Do Babies Roll Over ]

2. Why does my baby sleep in fencing reflex while in the back-to-sleep position?

Babies exhibit many involuntary movements as they grow. One such thing is the Fencing Reflex or Tonic Neck Reflex. When placed on the back-to-sleep position, the baby’s head turns to one side with the arm and leg of that side extended, while the other arm and leg are flexed. This is called the fencing position, which helps prevent a baby from rolling over onto his stomach before his body gets ready for it. This is one more reason for putting your baby to sleep on his back. This involuntary movement will disappear anytime between three to six months of age.

3. When can the baby be on its stomach?

Baby can be put on the stomach, but under supervision, when he is awake. Giving tummy time for baby is a good way to strengthen his stomach, back and neck muscles.

According to Dr Karen Sokal-Gutierrez, clinical professor, community health and human development, University of California Berkeley-UCSF Joint Medical Program, SIDS risk is lowered with babies spending more tummy time when they are awake. Moreover, the baby would develop upper body strength needed to lift the head and roll over in sleep.

4. Can I use infant sleep positioners for my baby?

FDA has never approved infant sleep positioners to reduce or prevent the risk of SIDS in babies. In fact, using a sleep positioner to hold the baby sleep on his back is dangerous.

5. What if babies throw up when sleeping on the back?

The chances are fewer for healthy babies to choke on vomit when made to sleep on their backs than on their sides or tummies. Sleeping on the back does not increase choking risk in babies with gastroesophageal reflux disease too. But do not put the baby to bed with a bottle propped for feeding. This dangerous practice could lead to ear infections and choking.

6. What to do if my baby has difficulty in sleeping on the back?

A few infants may not have a deep sleep in the back-to-sleep position. Some may even turn fussy when placed on the back. But a lack of deep sleep would save the little one from SIDS. One of the reasons for discouraging sleep on the stomach is that infants tend to sleep deep in this position, experiencing fewer movements and being less reactive to noises. All these would put the infant at higher risk of SIDS.

The baby may not feel comfortable sleeping on the back even if he has a congested nose. In such a case, place a humidifier in the baby’s room to moisten the air and loosen congestion. Elevating his head slightly can minimize the discomfort from a stuffy nose.

7. What are the best sleeping positions for preterm babies?

According to recent research, pre-term infants are at a higher SIDS risk (5) and they are to be placed on the back-to-sleep position. However, in a highly monitored inpatient setting, sleep on stomach position may be appropriate in case of acute respiratory disease in pre-term infants.

Hope this information was helpful for you. If you have any questions or tips to share, feel free to comment below.

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