In 1992 the (AAP) recommended that all infants be placed on their backs for sleep, which dramatically reduced the occurrence of Sudden Infant Death Syndrome (SIDS).
The AAP continues to publish guidelines to address safe sleep concerns for infants through age 1 to lower the risk of SIDS, suffocation or entrapment. Familiarising yourself with these guidelines will help to keep your baby safe and happy, not to mention give you greater peace of mind:
- Sleep on the back – place your baby on her back for sleep at night and for naps. You can practice tummy time during the day when your child is awake, and you are present to monitor her to strengthen her neck and shoulder muscles.
- Designated sleep space – your baby should have her own sleep space with a firm mattress and a tight-fitting sheet. Crib bumpers, blankets, loose bedding, toys or clothing should never be in your baby’s sleep environment. These items should stay out of the crib for older babies and toddlers, too, as more mobile toddlers can manipulate anything to climb out of the crib and risk falling.
- Breastfeed if possible – research indicates that breastfeeding for the first six months of your child’s life helps decrease the risk of SIDS.
- Pacifiers – gently offer your baby a pacifier as she falls asleep (not while she’s sleeping) at nighttime and during naps to reduce the risk of SIDS. But don’t force the pacifier if she’s not interested. For breastfeeding babies, please wait until after the first month to introduce a pacifier so that their breastfeeding habits are well-established. Room share – the AAP does not recommend bed-sharing but does recommend room sharing. Use a bassinet or bedside co-sleeper in your room to be near your infant as she sleeps but not share the same sleeping surface.
- No smoking – smoking in a baby’s environment can increase the risk for SIDS.
- Temperature control – our body temperatures naturally drop during sleep, and a cool room makes for the best sleep. Dressing your baby in breathable clothing for sleep will help prevent overheating. You can check your baby’s core temperature by placing two fingers down the back of her neck. Her skin should feel warm and dry.
Knowing about safe sleeping positions for babies is important in ensuring a safe sleep environment and preventing the risk of sudden infant death syndrome (SIDS).
SIDS falls under the category of sudden unexpected death in infancy (SUDI) and is majorly linked to the position in which the baby sleeps. Thus, knowing what positions are safe for your baby to sleep in is important to help prevent unexpected situations.
Also, knowing a few tips that will help reduce the risk of SIDS helps go a long way. One example of such a position of safe sleeping in babies is the supine position, in which the baby, who is less than a year old, is made to sleep on their back. Read on to know more about safe sleeping positions for babies and tips on sleep safety?
Baby Nursery FAQs
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.
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.
Your baby should not sleep on their stomach until one year old. They should always be placed on their back to sleep during the first 12 months to ensure a safe sleeping position.
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.
You can try to turn her face if you see her face down, but often, like rolling a tummy, babies will go back to the position of comfort. Always place the baby on its back to sleep. Increasing tummy time when awake is also helpful. If you are still wrapping her, this needs to be ceased - she needs her arms free.
Why Sleeping on the Back Is Safest for Babies
While research is still underway, studies suggest that babies get less oxygen and get rid of less carbon dioxide when they sleep on their bellies. In other words, while on their stomachs, an infant can only re-breath air from a small pocket of bedding pulled up around the nose.
Other findings point out that many babies who die from SIDS have underdeveloped regions of their brain, perhaps areas that prevent them from waking up to remove themselves from danger (like suffocation). And since it's impossible to figure out which babies won't arouse normally, it's better to be safe than sorry.
Since 1992, when the AAP began recommending that all newborn babies (from birth to age 1) be put to sleep on their backs, during naps, and at nighttime, the annual SIDS rate has declined more than 50 per cent. And there's been no increase in choking or aspiration since that time.
Sleep Habits to Reduce the Risk of SIDS
In addition to following the AAP's recommendation for baby sleeping positions, you can protect your infant from SIDS by following these simple sleep safety tips:
- Opt for a firm sleep surface. Purchase a safety-approved crib mattress, covered by a fitted sheet, and never place your baby down for sleep on soft surfaces, like pillows, quilts, and sheepskins.
- Keep the sleeping area clean and clear. This means no soft objects, toys, pillows, blankets, quilts, sheepskins or crib bumpers.
- Keep your baby’s sleep area near but separate. While your infant can sleep in the same room as you, he should not sleep in a bed or on a couch or armchair with adults or other children. Instead, your baby should sleep in a bassinet, crib, cradle or a bedside co-sleeper.
- Monitor the temperature in your baby’s room. In other words, not too hot or too cold. And never place your infant near air-conditioning or heating vents, open windows or other sources of drafts.
- Skip the blankets. Instead, invest in a one-piece sleeper or sleep sack as an alternative to blankets.
- Consider a pacifier. Pacifiers have been shown to reduce the risk of SIDS, but don't force it if your baby doesn't want it.
For healthy babies under one year of age, sleeping on the back is the ideal position. However, some extra measures would be helpful to ensure safe sleep for your baby.
- Avoid loose bedding: It is advisable to use a firm mattress rather than an overly soft mattress, waterbed, or sofa for your baby. Experts suggest against using bumper pads, pillows, fluffy bedding or stuffed animals around the baby in the crib. Anything that could cover a baby’s head or face during sleep is not recommended.
- Keep the crib simple: Do not use wedges, quilts, or comforters under an infant in the crib. Let the infant sleep with the 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 bedclothes securely. The sides or ends of the crib should be high enough to prevent the baby from climbing out or crawling out.
- Avoid covering the 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 preventing suffocation. The American Academy of Pediatrics recommends using ‘sleep sack’ or ‘baby sleep bag’ as 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 a baby in lightweight cotton or muslin also helps in preventing him from rolling onto the tummy during sleep.
- Avoid overheating: Infants should be clothed lightly for sleep. Avoid over-bundling and check if the baby is not hot to touch.
- Good sleep environment: It is important to maintain a considerably cool sleeping environment with a temperature of around 20oC for the baby.
- Vaccination: An investigation on diphtheria-tetanus-pertussis immunisation and potential SIDS association by the Berlin School of Public Health has concluded that increased DTP immunisation coverage is associated with decreased SIDS mortality (5). Current recommendations on timely DTP immunisation should be emphasised and followed to prevent not only specific infectious diseases but also potentially SIDS.
- Use a pacifier (at sleep times): The American Academy of Pediatrics considers pacifiers could prevent SIDS. However, do not force the baby if they do not 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 for the baby to get comfortable with breastfeeding.
- Use technology: If you are worried about the baby’s sleeping position, especially when they are in a separate room, use Wi-Fi baby monitors, app-powered thermostats, or small alarms to monitor the sleep position as well as vitals of your baby.
- Avoid the use of products that claim to prevent or reduce SIDS. This is crucial as, scientifically, there is no known way to prevent SIDS. The safety and efficacy of wedges, positioners, or other products claiming to prevent SIDS are not proven. On the contrary, various incidents have been reported where these products have been associated with injury and death when used in the baby’s sleep area.
- Share the same room: You may share the same room with the baby for convenient breastfeeding and contact. The crib in which the baby sleeps should be closer to the parents.
- Avoid sharing the bed: Experts suggest that infants ideally should not share the bed with parents, adults, siblings, or other children. Twins or multiples may be made to sleep separately. Do not share a bed with your baby, especially if you or your partner have been drinking, smoking, or taking medications or drugs that could induce deep sleep. Smoking and using a substance like drugs or alcohol significantly increase the risk of SIDS and suffocation in babies if the bed is shared.
The Good And Bad Positions For A Baby To Sleep
It is essential to learn about safe and unsafe sleeping positions to deal with the above risks.
Sleep On Back
Healthy babies born full-term should be placed on their backs for naps, short rest periods, and sleep at night.
- Sleep in the back position was found to lessen the risk of SIDS in babies, as it keeps airways open.
- The US National Institute of Child Health and Human Development (NICHD) labelled this as the best sleeping position for babies.
- 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’.
Risks Involved In ‘Sleep On Back’ Position
If infants are placed on the back for a long time, it may lead to ‘positional plagiocephaly,’ a case of flattened or distorted head and ‘brachycephaly,’ the flattening of the back the skull.
The shape will become normal by the time they turn one year and rarely requires any treatment. Simple repositioning techniques may 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 flat side.
- Cutting down the time spent by babies in carriers or car seats.
- Getting more ‘cuddle time’.
- Changing the baby's direction in the crib so that they do not always view the same things, and in one direction always.
Sleep On Stomach
Several theories discourage parents from making a baby sleep on the stomach because:
- It could pressure a baby’s jaw, reducing the airway and restricting breath.
- If the baby sleeps on the stomach, i.e., in the prone position, they may be lying with the face very close to the sheets and breathing the same air.
- The baby may suffocate while sleeping on the stomach if the mattress is very soft.
- The baby may also breathe in microbes present on the mattress.
When Can Babies 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.
- A few physicians believe that sleeping on the 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.
- The danger of vomiting was the most important argument for making the baby sleep on its stomach. This is because doctors believed that it would be dangerous if the baby vomits while sleeping on the back. They argued that babies might choke on their vomit due to a lack of strength to turn their heads. However, babies sleeping on their backs may not have as much difficulty turning their heads and vomiting the stomach's contents out.
- Also, you may make a baby with colic sleep on the stomach to relieve them of gas. However, please do not do it immediately after feeding them. Let there be some gap between the feed and the sleep time.
The sleep-on-stomach position for babies is highly unsafe for the following reasons:
- This position may put some pressure on the baby’s jaws and block the airways, making it difficult for the baby to breathe.
- Sleeping on the stomach makes the baby lie with his face very close to the sheet, making him breathe the same air. This may result in breathing in recycled air, which is low in oxygen.
- Sleeping on the stomach on a very soft mattress may cause suffocation in babies. The risk of rebreathing the exhaled air is higher while lying on a soft mattress because the baby’s face slacks deeper into the soft fabric of the mattress. This might block the baby’s airways from all sides.
- Also, because the nose is placed very close to the mattress in this position, the baby ends up breathing in the microbes present in the sheet covering the mattress, and this may lead to allergies.
Sometimes, in case of certain medical conditions, doctors may advise parents to put the baby in the sleep-on-stomach position. Usually, children with gastroesophageal reflux or certain upper-airway malformations like Pierre Robin Syndrome are advised to sleep in this position, but it may not work. Hence, it is advisable to consult the physician properly before putting the baby to sleep on his stomach.
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.
In addition to the good and bad sleeping positions, you must also know about the sleeping practices that could lead to sudden unexpected death in infants.
Sleeping on the side is not a recommended infant sleeping position, as infants tend to roll onto their tummy while asleep eventually. This increases the risk of SIDS due to one of the reasons mentioned above.
So then, which sleeping position is good for your baby? Well, the only option remaining now is the sleep-on-back position. Let’s take a closer look at it.
Risks Involved In The Sleep-On-Back Position
Children lying in the sleep-on-back position for a long time may suffer from ‘positional plagiocephaly’, a case of flattened head or the baby may also suffer from ‘brachycephaly’, a case of flattened back.
But, these are temporary conditions that normalise as soon as the baby turns one. There are some techniques that you can use to avoid these conditions altogether –
- More tummy time when the baby is awake.
- Turning the baby on the sides while he is not asleep.
- Reducing the time spent in carriers or car-seaters.
These techniques allow the baby to lie down in different positions instead of lying down on the back.
There are a few more things you can follow to ensure your baby sleeps safely. The tips provided below will help you manage or correct your baby’s sleep positions.
Getting your newborn in the habit of falling asleep on his back may seem near impossible, as many babies seem to fall asleep better on their stomach or side, especially when curled up on a parent's or caregiver's chest.
Rest assured, however, that in time your infant will get used to this safe baby sleeping position. Of course, once your child can roll over, he may reposition himself.