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Sleep Position for Young Infants

What is the safest sleep position for my baby?

The American Academy of Pediatrics (AAP) recommends that all healthy infants sleep on their backs the first 6 months of life. Studies have shown sleeping on the back reduces the risk of Sudden Infant Death Syndrome (SIDS). SIDS is the sudden unexplained death of a healthy infant. Thousands of babies die each year from SIDS. Typically, a baby dies from SIDS while sleeping.

The AAP started recommending that babies sleep on their backs in 1992. Eighty percent of parents now follow this advice and there has been a 40% drop in the rate of SIDS.

Why does sleeping on the stomach increase the risk of SIDS?

Laying a baby on his stomach puts pressure on his jaw bone. This causes the airway in the back of the mouth to become narrower. Also, if the baby sleeps on a soft surface, the nose and mouth may sink in so the child breathes from a small pocket of stale air.

If your baby sleeps on his stomach, the risk of SIDS is 3 to 9 times greater. Sleeping on the side is safer than the stomach but still has twice the risk of SIDS as the back position. If you use a child-care center or babysitter, be sure they know how important it is to put your baby on his back to sleep.

Are there other ways I can reduce the risk of SIDS?

You can also reduce the risk of SIDS by:

  • Using a firm mattress (avoid soft bedding). Young infants should never be placed on waterbeds, sheepskin, soft pillows, bean-filled pillows, or other soft, spongy surfaces. Also make sure that none of these surfaces are placed in the crib. Even if you place your child to sleep on the back, it is possible that your child will roll over during the night.
  • Not letting your baby sleep in your bed during the first 12 months. The mattresses in most adult beds are too soft for babies. Blankets and pillows in your bed also increase the risk. The rate for sudden death for infants is 20 times higher for babies sleeping in an adult bed compared to a crib.
  • Breast-feeding your baby, if possible.
  • Protecting your infant from exposure to cigarette, cigar, or pipe smoke.

When should a baby sleep on his stomach?

Your baby should only sleep on the stomach if recommended and supervised by your child's health care provider. The American Academy of Pediatrics recommends putting your baby to sleep on his stomach in the following cases:

  • Infants with complications of spitting up. These complications include recurrent pneumonia from aspiration, interruption of breathing (apnea), or acid damage to the lower esophagus (esophagitis), and choking. While spitting up is common, these complications are rare. Years ago, doctors recommended that babies sleep on their stomachs to decrease the chance of choking. But choking is extremely rare and it was never proven that the stomach position prevented choking better than any other position.
  • A birth defect of the upper airway that interferes with breathing. Examples are a large tongue, a very small mouth, or a large and floppy larynx.

Any baby who needs to sleep on his stomach must also be placed on a firm sleeping surface.

Are there any disadvantages of sleeping on the back?

There are 2 minor disadvantages. When lying on the back, young infants are more likely to have a startle reflex that awakens them. Swaddling your baby in a snug blanket can prevent this. To swaddle your baby use the 3-step "burrito-wrap" technique. Start with your baby lying on the blanket and the arms at the sides. Then pull the left side of the blanket over the body and tuck. Next, pull the bottom of the blanket up. Then pull the right side over and tuck.

The other disadvantage is that some babies get a flattening of the back of the head. You can prevent this by changing the baby's head position slightly during sleep.

Should I lay my baby on his stomach during playtime?

It is good for your baby to spend some time on his stomach when he is awake during the day. The back position is only recommended for bedtime and naps. Letting your baby play on his stomach helps strengthen his shoulder muscles. Changing positions also keeps your baby's head from becoming flattened from laying in the same position all of the time.

For more information:

Sudden Infant Death Syndrome Alliance
1314 Bedford Ave. Ste. 210
Baltimore, MD 21208

Written by B.D. Schmitt, M.D., author of "Your Child's Health," Bantam Books.
Published by McKesson Provider Technologies.
Last modified: 2005-10-29
Last reviewed: 2006-03-02
This content is reviewed periodically and is subject to change as new health information becomes available. The information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional.
Copyright 2006 McKesson Corporation and/or one of its subsidiaries. All Rights Reserved.
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