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Is Side Sleeping Safe For My Baby?

You carefully put your baby down at bedtime, keeping in mind that “back is best.” However, your little one squirms in their sleep until they’ve managed to roll onto their side. Or maybe your baby refuses to fall asleep unless you put them on their side, to begin with.

That joy has turned you into a bundle of worry — and all the warnings about safe sleeping positions and SIDS aren’t helping.

Take a deep breath and look away from the baby monitor for a minute or two. You’re doing a great job even if your baby isn’t a natural-born or serene back sleeper.

It’s true: Back sleeping is best when it comes to babies. Side sleeping can also be safe as your baby grows and gets stronger. You’ll find your baby gets more active during sleep as they near their first birthday — which, thankfully, is also when a lot of these sleep-position worries go away. In the meantime, there are several ways to help keep your little sleeping beauty safe.

Here’s a look first at some of the reasoning behind back sleeping for babies — and when it’s safe to allow your little one to sleep. Spoiler alert: The risks we talk about below do pass, and both you and baby will be sleeping easier before you know it.

Baby Nursery FAQs

The main risk of putting a baby to sleep on their side is falling onto their stomach. When a baby is too young to support their head, this may mean that their face becomes stuck against the mattress, making it hard to breathe. Most babies can fully support and lift the head by four months.

Most parents know that the safest way to put their baby to sleep is on its back. Babies who sleep on their backs are much less likely to die of sudden infant death syndrome (SIDS). Babies who always sleep with their heads to the same side can develop flat spots.

Studies have found that the side sleep position is unstable and increases the chance infants will roll onto their stomachs7—the sleep position associated with the highest SIDS risk. The AAP Task Force recommends that infants be placed wholly on their backs to sleep—for naps and at night.

Although sleeping positions can cause a misshapen head to develop in little ones, some good practices can be adopted by parents to reduce the likelihood of a flattening development. These methods can also help a flattening improve if it has already developed.

Around 3 to 4 months of age, you may notice that your child can roll slightly, from their back to their side. Shortly after this — around 4 to 5 months into your child's life — the ability to roll over, often from their stomach to their back, may appear.

The most serious risk: SIDS

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Let’s get this beast out of the way from the get-go: Putting babies to sleep on their back is safer than sleeping on their tummy. Stomach sleeping increases the risk of sudden infant death syndrome (SIDS) and suffocation, and it’s an easy roll from side to stomach — gravity means very little effort on the baby's part.

SIDS is the leading cause of death in babies between 1 month and one year old. In the United States, about 3,500 babies die suddenly during sleep each year.

Tummy sleeping isn’t the only factor. The risk of SIDS also rises if:

  • mom smokes during pregnancy or baby is around secondhand smoke after birth
  • baby is born premature (four times the risk)
  • baby is sleeping in the same bed as the parent(s)
  • baby is sleeping in a car seat or on a sofa or couch
  • parents drink alcohol or misuse drugs
  • The baby is bottle-fed instead of breastfed
  • there are blankets or toys inside the crib or bassinet

Not all of these are within your control — and for the ones that aren’t, you should never feel guilty or let someone shame you for it. Most babies born prematurely do quite well, and a fed baby — breast or bottle — is a healthy baby.

But the good news is that some of these factors are within your control. First off, the safest place for your newborn to sleep is in your bedroom with you, but in a separate bassinet or crib.

Second, place the baby on their back to sleep. Early swaddling is fine — preferable, even, since it mimics the safety and security of the womb — until your little one can rollover. Then, they need to have their arms free to lower suffocation risk should they roll over onto their tummy.

It’s the risk of tummy sleeping that also makes placing your baby on their side to sleep a big no-no at this stage: It’s easier to accidentally roll from side to tummy, even for babies that aren’t yet rolling over intentionally, than it is to roll from back to tummy.

The risk for SIDS is highest for infants aged 2-4 months, but it can happen at any time up until the age of 1 year.

But side-sleeping prevents choking, right?

You may worry that your baby might choke if they spit up milk or vomit while sleeping on their back. But according to the National Institutes of Health (NIH) — a very reliable source with many years of research behind it — it’s a myth that side sleeping can prevent choking while sleeping.

NIH says that studies show back sleeping has a lower risk of choking. Babies are better able to clear their airways while sleeping on their backs. They have automatic reflexes that make them cough up or swallow any spit-up, even while sleeping.

Think about how easily your baby burps up spit-up. They’re naturally gifted to do this in their sleep, too!

Side sleeping and torticollis risk

Torti, what? It may sound unfamiliar, but if you’ve ever woken up with a sprain in your neck from sleeping funny, you already know what torticollis is. Unfortunately, newborns can also get a kind of torticollis (“wry neck”).

It most commonly happens from birth (due to positioning in the womb) but can develop up to 3 months later. When it develops after birth, it can be because your baby sleeps on their side, which is less supportive for the neck and head.

Torticollis in babies can be hard to miss because they don’t yet move their necks very much. But if your sweet little one has this neck condition, you may notice signs like:

  • tilting the head in one direction
  • preferring to breastfeed on one side only
  • moving their eyes to look over their shoulder at you rather than turning their head to follow you
  • being unable to turn the head completely

Torticollis can also affect how your baby sleeps. Your baby may prefer sleeping on one side or turning their head to the same side every night to be more comfortable. But this isn’t ideal. Continue to place your baby on its back.

Talk to your baby’s pediatrician if you notice any of the symptoms of torticollis. It can often be treated with neck-strengthening exercises with your baby at home. A physical therapist can also help. You’ll need follow-up appointments with your baby’s doctor.

Harlequin color change

About 10 per cent of healthy newborns have harlequin colour change when they sleep on their sides. This harmless condition causes half of the baby’s face and body to become pink or red. The colour change is temporary and goes away in less than 2 minutes.

Harlequin's colour change happens because blood pools in the smaller blood vessels on the side that the baby is lying on. It goes away as the baby grows.

Avoid letting your baby's side sleep to help prevent the colour change from happening. The colour change is harmless — but remember, there are more serious conditions you’ll be helping to prevent.

When is side sleeping safely for your baby?

As we’ve mentioned, putting your baby to sleep on their side may make it easier to roll over onto their stomachs accidentally. This isn’t always safe, especially if your little one is younger than four months. At this tender age, babies are often too small to change positions or even lift their heads.

If your baby only falls asleep on their side (under your supervision), gently nudge them onto their back — as soon as you can do so without waking them up!

If your acrobatically gifted baby rolls into a side-sleeping position after you put them down on their back, don’t worry. The American Academy of Pediatrics advises that it’s safe to let your baby sleep on their side if they can comfortably roll over on their own.

After about four months, your baby will be stronger and have better motor skills. This means that they can lift their head to explore — this will be fun for both of you! — and roll themselves over when you put them onto their tummy. At this age, it’s safer to let your baby sleep on their side, but only if they end up in that position on their own.

Bottom line: It’s still safest to lay the baby down on their back for nap time and bedtime. Putting your little one to bed on their stomach isn’t safe in the first year of life — and placing them in a side-sleeping position is, unfortunately, a quick way to get to the stomach. Tummy time is when your baby is wide awake and ready to exercise with you.

How to change baby sleeping positions 

Some babies sleep better on their stomachs or side. This is what can make these positions so dangerous. Babies enter deeper sleep for longer and may be more difficult to awaken. They may not wake up if they cannot breathe or need to move.

The simplest way to change a baby’s sleep position is to begin putting them to sleep on their back. Parents and caregivers may need to help the baby slowly adapt to this new position by nursing them to sleep before bed, gently rubbing their belly, singing to them while they fall asleep, or rocking them.

People should not use devices that hold a baby in position or prevent them from rolling. Infant sleep positioners increase the risk of SIDS because a baby may suffocate against the device. Restraining a baby’s movement may prevent them from rolling out of a dangerous position.

Instead, it is best to focus on putting the baby to sleep on their back.

Tips for improving sleep safety

is side sleeping safe for my baby

The following sleep safety tips can help keep a baby-safe, even if they roll onto their side or stomach:

  • Sleep in the same room as the baby: A bassinet or crib next to the bed allows people to check on the baby easily. Ensure that pillows or other objects from the bed cannot fall into the baby’s sleep space.
  • Do not smoke: People who smoke should never smoke in the house or around the baby.
  • Do not use weighted blankets: Avoid using these or similar devices.
  • Prevent the baby from overheating: Do not use space heaters or keep the room too warm. Dress the baby in light clothing rather than heavy fabrics or layers.
  • Use a swaddle: Make sure it is tight at the chest but loose at the hips and knees. However, only use a swaddle before the baby starts rolling onto their side.
  • Stop swaddling once the baby can roll over: It is important to stop using a swaddle as soon as they start moving on to their side.
  • Keep the crib empty: Do not put toys, blankets, pillows, or a bumper in the baby’s sleeping area.

Bed-sharing

Some parents and caregivers choose to bed share with their infants. This practise remains controversial. In some cultures, it is a common custom, but in the United States, most pediatricians advise against it. The AAP emphasises that bed-sharing before a baby is four months old, presents the greatest risk.

Advocacy group La Leche League advise people who wish to bed share to follow these tips:

  • Do not smoke or allow the baby to sleep near a smoker partner.
  • Do not bed share with a baby when intoxicated or otherwise impaired.
  • Bed share only if the baby breastfeeds.
  • Do not bed-share if the baby was born prematurely.
  • Put the baby to sleep on their back.
  • Dress the baby in light clothing, not heavy layers.
  • Sleep only on a safe surface, which means not using a couch, chair, or bed excessively soft or covered in blankets and pillows.

The Academy of Breastfeeding Medicine encourages pediatricians to discuss bedsharing risk reduction strategies with new parents and caregivers. They also argue that bed sharing may improve sleep for the mother or caregiver and facilitate breastfeeding.

Sleep alarms

Some people use sleep alarms to keep their babies safe. There is no evidence that these alarms work, but they are new, so there might eventually be research supporting their use.

The asleep alarm is not a substitute for safe sleeping. These devices may be dangerous if they give people a false sense of safety or encourage them to use unsafe sleep practices.

Preventing side sleeping before it’s safe

Your baby already has a mind of its own — and you wouldn’t want it any other way. But you want to prevent them from sleeping on their side before it is safe enough to do so. Try these tips:

  • Use a firm sleep surface. Make sure your baby’s crib, bassinet, or playpen has a firm mattress. This means that your baby shouldn’t leave an imprint on it. Avoid softer mattresses that allow your baby to sink in slightly. This makes it easier to roll to the side.
  • Use a video baby monitor. Don’t rely on just any kind of monitor; get a direct visual on your baby once they’re in their room. Monitors may help give you the heads-up that your baby is on the move to side sleeping.
  • Swaddle your baby until they can rollover. Wrapping your baby like a burrito may help them sleep more comfortably on their back. Make sure to swaddle loose enough that they can easily move their hips. And know when to stop — swaddling becomes a risk when your baby can roll.
  • Try a sleep sack. If your baby can’t stand being swaddled, try a sleep sack. It’s also a good intermediate step. These look like tiny little sleeping bags that your baby wears to sleep. You can find arms-free versions that are safer for babies that can roll, but the sack itself might help your baby stay asleep longer without moving over onto their side.

A safe crib should only have a firm mattress and a tightly fitted sheet. It might seem natural to use an extra pillow or baby positioners to keep your baby on their back while sleeping. After all, most baby car seats have built-in cushions to keep your baby’s head in place.

But the Consumer Product Safety Commission and the Food and Drug Administration advises that using baby positioners during sleep may not be safe. Baby positioners are padded or foam risers that help keep your baby’s head and body in one position. 

Some cases (12 reports in 13 years) of baby positioners causing suffocation while sleeping.

Similarly, avoid bulky or moveable things in the crib that might get caught between your sweet one and the crib. These include:

  • large teddy bears and stuffed toys
  • bumper pads
  • extra pillows
  • extra or bulky blankets
  • too much clothing or layers

Conclusion

During the first year of your little one's life, always place her on her back for every sleep. Back-sleeping is the safest sleeping position for your baby. Side-sleeping can increase the risk of SIDS. 

If your baby rolls onto his side or stomach during sleep and is under one year old, gently return him to the back position. Continue to do this until your baby can comfortably roll herself over in both directions.

Back sleeping is best for babies. This sleep position has been proven to prevent SIDS. Most of the other risks of side sleeping — like wry neck or colour change — are easily treated, but your precious little one is worth the world to you. Side sleeping isn’t worth the risk.

Side sleeping is usually safe once your baby is older than 4 to 6 months and rolls over on their own after being placed on their back. And always put your baby to sleep on their back until one year.

Tell your baby’s pediatrician if you notice a preference for side sleeping in the first three months. And also, make an appointment if you’re worried about a flat head — but rest assured, a temporary flat spot won’t take away from your baby’s cute appearance.

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