will your baby choke from back sleeping

Will Your Baby Choke From Back-Sleeping?

Babies are safer on their backs. When a baby is on his back, the air tube (trachea) is on top of the esophagus (the tube that carries food) if a baby spits up while on his back, the food and fluid run back into the stomach and not to the lungs.

When a baby is on his stomach, the esophagus (or food tube) is on top of the trachea. Any food or fluid that is regurgitated or refluxed can more easily pool at the opening of the trachea, making it possible for the baby to aspirate or choke.

You may worry that if your baby spits up while on her back, she will choke. This is a genuine concern. However, your baby has natural ways to prevent spit-up from going down the windpipe (also called the airway). This special protection even exists when she is on her back.

Sometimes, your baby may cough or gag if she spits up. Her face may even turn red. Those reactions are her body’s normal and natural responses. It does not mean something is “going down the wrong pipe.” Since doctors have been recommending that babies sleep on their backs, research has shown no increase in babies having true choking events.

Do not elevate the head of a baby’s crib, even if your baby spits up frequently (also known as reflux). If the head of the crib is elevated, she may slide to the foot of the crib and no longer be in a safe sleep position.

You may have heard from friends or family that if your baby sleeps on her back, she will not sleep as soundly. You may have even noticed that while your baby is on her back, she may wake up or stir at times. This does not mean your baby is uncomfortable or a “bad sleeper.” It is important that babies can awake easily from sleep and probably helps protect against SIDS.

When a baby is on her belly, she is less likely to wake up, even if she is getting into trouble with her breathing. So actually, the same reasons that make belly sleepers seem to rest more soundly may be the same reasons belly sleepers are more likely to die from SIDS.

When a baby sleeps on her belly, she does not get a good supply of nice, fresh air with a good supply of oxygen. If a baby is on her belly, the old, stale air she just breathed out is more likely to be the same air she will breathe in.

The brain needs a good supply of oxygen, and rebreathing old air does not provide good amounts of oxygen. If the brain doesn’t get enough oxygen, it could cause your baby to be extra sleepy. She may appear to be getting “better rest” on her belly. But in reality, what seems like a more sound sleep can be a dangerous situation.

Some parents have heard that the back of a baby’s head may get flat from sleeping on the back. This is true. But a flat head is usually avoidable and not serious when it occurs.

Remember to turn your baby’s head to the side when you put her to sleep. Sometimes turn her head to the left, and other times, she turns it to the right.

You can also turn her around in the crib, so her head is at the foot of the crib sometimes. This can help if she usually looks in the same direction as the room. If her head does become a bit flat in the back, it usually is not serious. Having awake, supervised “tummy time” will also help prevent the back of her head from getting flat.

“Tummy time” means giving your baby some time on her belly while she is awake and you are watching her. In addition to helping avoid the baby’s head becoming flat, tummy time helps in other important ways.

Tummy time helps your baby develop the muscles in her chest and shoulders. It also gives your baby a chance to see and explore the world around her. At first, your newborn may not like being on her belly and will only tolerate tummy time for a few seconds without crying.

That’s OK. Over time, she will become more used to being on her belly when awake and will probably even start to like it. Make sure to give her some tummy time every day, and always supervise her during these special times.

These sleep tips are intended for babies up to one year. As your baby gets older and can roll from her back to her belly, you do not have to wake her to reposition if you find she has rolled to her belly. This is a natural part of her development and will probably occur around six months.

As your baby’s strength and coordination increase, her brain develops. These things help lower the chance of SIDS as she gets older. However, SIDS can still occur, so keep following safe sleep advice until her first birthday. That means to place her on her back to go to sleep until age 1, but don’t wake her to reposition her if she rolls onto her belly.

Baby Nursery FAQs

Remember to turn your baby's head to the side when you put her to sleep. Sometimes turn her head to the left, and other times, she turns it to the right. You can also turn her around in the crib, so her head is at the foot of the crib sometimes. This can help if she usually looks in the same direction as the room.

If your child coughs or frequently chokes while asleep, she may have sleep apnea. Sleep apnea is a serious sleep disorder sometimes caused by enlarged tonsils and adenoids (glands in the throat just behind the nose) blocking the upper airway passages during the night, making it difficult to breathe.

When a baby is on his back, the air tube (trachea) is on top of the esophagus (the tube that carries food). If a baby spits up while on his back, the food and fluid run back into the stomach and not to the lungs.

Babies protect their airways by swallowing. Regurgitated milk from the oesophagus lies at the lowest level and can be easily swallowed. It is difficult to work against gravity and be pushed up and into the respiratory tract. Hence, choking is reduced when the baby is sleeping on the back.

It's normal for a baby or young child to choke and cough from time to time. When it happens frequently, there could be cause for concern. These episodes are typically due to aspiration, food or liquid accidentally entering the airway.

Baby Choke If They vomit While Sleeping on the Back

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If your baby is sleeping on his back without any pillows restricting his head, it's unlikely he can choke on his vomit.

When a baby is lying on his back, his head will naturally fall to one side. So even if your baby spits up milk or vomits, it will flow out of his mouth onto the bed and not stay trapped in his mouth.

It's not safe to use a horseshoe-shaped pillow to keep his head straight. This will keep his mouth facing the ceiling and make it harder for fluids to flow out of his mouth.

Keep in mind that till your baby is a year old, pillows and stuffed toys pose a suffocation risk. They are said to raise the risk of SIDS, also known as cot death.

If you're worried about your baby's head getting round, know that this will happen on its own, gradually, as soon as your baby spends less time lying on his back and starts doing more tummy time in the day.

Lying flat on the back is the safest sleeping position for babies. Research shows that even if they've been vomiting, it's safe for a baby to lie on their back because it has reflexes like head-turning, coughing, and swallowing that prevent fluids from entering the airway.

Lying on the back also helps keep a baby's airway clear of fluid because of how his trachea (windpipe) and oesophagus (the tube from the throat to the stomach) are placed in his body.

Multiple SIDS (Sudden Infant Death Syndrome) studies show no evidence that babies who sleep on their back are more likely to choke on vomit than babies who sleep on their stomachs. 

There are some cases where you do need to be more careful:

  • In babies with certain health conditions, choking on vomit is possible because they may not be able to keep their airways clear when sleeping.
  • If your baby has a congenital disability that could cause food and liquid to pass into the windpipe (like a cleft palate or a laryngeal cleft), your baby's paediatrician may ask you to put your baby to sleep on his stomach or side, so he doesn't choke.
  • You should also follow any additional recommendations from your doctor if your baby was premature, born with low birth weight, or if he has reflux.

In these cases, your doctor will show you how to correctly position your baby to keep him safe while he sleeps.

  • When a baby sleeps on the back, the upper respiratory airways are positioned above the oesophagus (food pipe: the tube that carries food from the mouth to the stomach). Babies protect their airways by swallowing. Regurgitated milk from the oesophagus lies at the lowest level and can be easily swallowed. It is difficult to work against gravity and be pushed up and into the respiratory tract. Hence, choking is reduced when the baby is sleeping on the back.
  • When a baby sleeps on the tummy, the oesophagus sits above the baby’s upper airways. Babies sleep more deeply on their tummy and swallow less frequently. If a baby regurgitates or vomits milk or fluid, these substances will pool at the opening of the airways and are more likely to be inhaled into the baby’s airway and lungs.
  • When a baby sleeps on the side, there is still an increased risk of breathing fluid into their airway and lungs. Hence choking is less likely when a baby sleeps on the back. Babies swallow and clear fluids better when lying on their back.

4 Common Myths About Safe Sleeping Positions For Infants

Every year more than 2,300 healthy infants die in the United States from Sudden Infant Death Syndrome (SIDS). This number is half of what it used to be before the 1994 “Back to Sleep'' campaign started teaching parents to use supine (on the back) sleep positioning for all infants. 

However, even one SIDS death has devastating consequences for families and communities, and ongoing research and education efforts are working to decrease this number. We are still learning what exactly causes SIDS. 

As shown below, the risk of SIDS peaks around three months of age and declines after that. After age six months, the risk is much lower, but it can still occur.

In 2011 the American Academy of Pediatrics released an updated policy with even more specific recommendations about safe sleeping environments for babies. 

Even now, three years after these new guidelines, we still frequently see families misinformed about the safest way for their baby to sleep. Here are some common myths about infant sleeping that seem to confuse many families: 

Myth #1 – Side-sleeping is a safe position for babies 

Many parents reason that as long as their baby is not sleeping on her stomach, they are in a safe sleep position. However, recent studies have shown that SIDS risk is similar to side and stomach positioning, and some evidence suggests the risk may be even higher inside positioning! 

Side positioning is unstable, and babies are likely to roll to their stomachs. Many parents may use pillows, rolled cloths, or other objects to prevent their baby from rolling onto her stomach, but they can increase the risk of entanglement or suffocation. 

Myth #2 – My baby may choke on her spit up if she’s sleeping on her back 

Babies often spit up during the first few months of life, and parents are concerned they may choke when lying on their backs. However, numerous studies in different countries found no difference in the rate of aspiration or choking before and after the change to the recommended “Back to Sleep” position. 

Myth #3 – Sleeping on their back in a car seat or swing is ok 

The trouble with sleeping in these devices is that the babies often recline into a position that worsens reflux or may block their airway. Also, there is the risk of overturning or falling from the seat. 

Myth #4 – Many cultures practice bed-sharing; therefore, it must be safe 

There are some cultures for which bed-sharing is the norm and SIDS rates are low, but these cultures tend to have different sleeping practices from the United States (with firm mats on the floor, a separate mat for the infant, and no soft bedding). 

Studies here have shown that bed-sharing more than doubles SIDS risk. The risk is even higher in certain circumstances:

When one or both parents are smokers when the infant is younger than three mos when the parent has consumed alcohol, when soft bedding such as pillows or blankets are used, or when an excessively soft surface is used (such as a waterbed, a sofa, or an armchair). 

There are many “co-sleeper” products marketed to improve bed-sharing safety, but none of these has been proven to prevent SIDS. The AAP policy statement includes many other recommendations, including avoiding bumper pads, wedges, and other devices. 

You can read all of their recommendations here. A pediatrician friend who is also a mom once jokingly summarised the new AAP SIDS prevention policy statement like this: “Any condition which may be conducive to the infant sleeping is dangerous and should be avoided.” 

As a mother myself, I fully appreciate the difficulty in following some of these guidelines, especially when you are exhausted and your baby won’t stay asleep!  

However, SIDS remains the most common cause of death in infants after the newborn period, and we are sure all parents will sleep easier knowing that they are doing everything they can to decrease their child’s risk.

No Evidence of Babies Choking in Their Sleep

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It can be tempting to put a baby on their stomach while sleeping, especially if they seem to sleep better that way or if they spit up a lot and you worry about choking. Family members and friends can also be a source of pressure.

Since parenting is an open-ended experience with many different paths, it can be easy to brush off lots of what experts say. Don't give in to this temptation for your baby's safety. (Babies do need "tummy time" while they are awake and supervised.)

"Healthy babies automatically swallow or cough up fluids. There has been no increase in choking or other problems for babies who sleep on their backs," notes the National Institutes of Health Safe to Sleep campaign. 

The American Academy of Pediatrics states, "Despite common beliefs, there is no evidence that choking is more frequent among infants lying on their backs (the supine position) compared to other positions, nor is there evidence that sleeping on the back is harmful to healthy babies.

Babies on their stomachs tend to rebreathe their air. This can lead to increased carbon dioxide levels and decreased oxygen. Babies also stay warmer and sleep more deeply on their bellies. These are all risk factors for SIDS. Being in a deeper sleep state can make it harder for vulnerable infants to rouse themselves.

Research has also revealed that babies used to sleeping on their backs are at even higher risk of SIDS if put to sleep on their stomach at other times (like during a nap or by an unknowing relative or caregiver).

Babies put to sleep on their sides don't stay in that position for very long and are likely to roll over onto their stomachs. Wedges and other items used to prop babies on their sides don't prevent babies from rolling onto their bellies and can pose a suffocation risk (just like stuffed animals, pillows, thick blankets, and bumpers) and should not be in your baby's crib.

Nobody likes to hear that the way they painted their kids back in the day was somehow wrong. But just like using car seats and not letting toddlers eat whole hot dogs, new information and better parenting practices prevent deaths every day.

Put your baby on their back to sleep, and don't worry about choking. The risk of SIDS is just too high. Sleep is the biggest risk to a baby's life. Following the "safe to sleep" guidelines are a parent's best chance at ensuring that their child wakes up after each sleep.


Putting your newborn baby to sleep on their back is considered one of the best things you can do to help prevent sudden infant death syndrome (SIDS). This is recommended by the Canadian Paediatric Society, the American Academy of Pediatrics, and many other paediatric societies worldwide. 

Although you may be concerned about putting your newborn baby to sleep on their back if they are prone to spitting up, there is no need to worry. There is no increase in choking in newborn babies put to sleep on their backs.

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