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best sleeping position for baby - back

When Can Babies Sleep on Their Stomach?

Sep 22

As a new parent, you are constantly bombarded with a deluge of advice and information about everything from feeding schedules to stimulating toys. Simply scroll through your Facebook feed and you are sure to come across plenty of articles telling you exactly what you are doing wrong!

For the most part, a lot of this advice is a matter of opinion, but when it comes to matters of safety, it’s important to gather as much reliable information as you can. Knowing about official recommendations and guidelines is key for keeping your baby safe and healthy.

One area that is important to know a lot about is sleep. Many parents experience anxiety about how, when, and where their infants sleep, and for good reason. After all, you’ve likely heard of SIDS (sudden infant death syndrome) and the direct correlation between SIDS and the sleep environment. There’s also a risk of suffocation or strangulation in bed.

In fact, in 2017, out of the approximately 3600 sudden unexpected infant deaths in the United States:

  • About 1400 of the deaths were due to SIDS
  • About 900 of the deaths were due to suffocation or strangulation in bed.

Many parents wonder what they can do to help prevent such a tragedy from striking their family. While there are no set of precautions that guarantee this, there are several correlations researchers have found between the sleeping environment and SIDS.

One of these correlations, and the one we’re going to focus on today, has to do specifically with baby sleep positions. How important is proper sleeping position? What is the correct sleeping position for your newborn, and how long do they need to sleep that way?

A quick history of sleep positions

You’ve probably heard from a number of sources the phrase “Back to Sleep,” a campaign that was launched in 1994 and is still used today. But why might your mom and grandmother insist you should put your baby on his or her tummy to sleep? Because for a long time, doctors did not understand that sleeping in the supine position (on the back) was safest for babies.

In 1944, a pathologist from New York noticed that about 66% of infants who died from suffocation during the night were face down. These findings launched a short-lived campaign against face-down sleeping positions.

However, this campaign didn’t last. In 1945 a pediatrician (Woolley) vocally rejected these findings through some faulty research of his own. He attributed the face-down sleeping deaths to infection, choking on vomit, and a hypersensitivity to inhaled milk. He also thought the suffocation explanation caused unnecessary guilt for parents over their child’s death. While noble in his intentions, he set parents on the wrong path for the next 50 years.

(By the way, the idea that babies will choke if they spit up or vomit while sleeping on their backs is a myth: studies show that babies who sleep on their backs are not necessarily more likely to choke while sleeping.)

From the late 1960s to the early 1990s, scientists conducted more research around what is now called SIDS (Sudden Infant Death Syndrome). As early as 1988, scientists began to recommend putting babies to sleep on their backs to reduce the risk of SIDS. Further studies made in New Zealand, Australia, and the United Kingdom supported this new suggestion.

Despite the growing amount of scientific evidence proving otherwise, experts still promoted face-down sleep positions. The first text that advised against face-down sleeping positions wasn’t released until 1992. Since then, the evidence that “back to sleep” is the best solution for babies has only grown stronger, and all major health organizations including the American Academy of Pediatrics fully recommend the supine position.

So what do you say to your mom or grandma? The truth is, anyone who thinks you should put your baby on his or her stomach to sleep is absolutely wrong. The evidence is overwhelming that this increases the risk of SIDS.

Putting your baby to sleep (safely)

How do we apply this knowledge to real-life? It’s simple: put your baby to sleep flat on their back, right from the beginning, and make sure that every person caring for your baby does the same.

While the supine sleeping position is a very important part of safe sleep for an infant, it’s only part of it. Other factors go into creating a safe sleep environment as well, like:

  • Place the baby on a firm sleeping surface (no soft mattresses)
  • Keep soft objects, including crib bumpers, blankets, pillows, and stuffed animals, out of the baby’s sleeping area
  • Do not allow your baby to sleep for a prolonged period of time in a car seat, carrier, stroller, swing, or anything that keeps them from lying flat on their back
  • Be aware of cords in the baby’s sleeping area, including those for window coverings or lighting, which pose a threat of strangulation
  • Do not allow your baby to sleep in your bed; this increases risk of suffocation and SIDS

What about “flat head syndrome?”

Plagiocephaly, or “flat head syndrome,” is a common concern for parents who put their babies to sleep on their backs. The idea is that if you allow a baby to rest their head in the same way for too long, it can cause a flat spot to develop, since a baby’s skull is soft after birth.

The truth is, most cases of plagiocephaly are harmless, and have more of a cosmetic effect than anything else. It’s unlikely to affect brain development. Your doctor will be able to tell you if it’s something to worry about.

The syndrome can also be treated, often with the use of a molded helmet that reshapes the skull.

Of course, there are also things you can do to prevent plagiocephaly. Encourage your baby to turn their head to the side when lying on their back in the crib. You might want to put a brightly-colored or music-making toy outside their crib, for example, to attract their attention. You can switch the direction you lay your baby down each night (put his head at one end of the mattress one night, and the other end the next night, and so on), so that he’ll turn his head the other way to keep looking into the room.

Supervised tummy time during the day is another way to help prevent plagiocephaly.

So when is it safe for babies to sleep on their stomach?

With a newborn, sleep position is fairly easy to control. If you put them on their back, they’re likely to stay there. However, there comes a point where you can’t control your baby’s sleep position anymore. He or she may start rolling over in the night, making it impossible for you to make sure they stay on their back. So when can you stop losing sleep over this problem? And at what age is it safe to put your baby on his or her tummy?

The highest risk of SIDS happens between one and four months of age. During this stage, it is absolutely crucial that your baby sleeps in the supine position, flat on their back. When your baby learns how to roll over, usually around 6 months, she may roll from her back to her belly during the night. When this happens, you should still put your baby to sleep on her back, but you don’t have to worry if she rolls over herself when you’re not around. (Again, make sure to leave any soft objects out of the crib.)

SIDS remains a risk until your baby is about one year old. Until then, you should always put your baby to sleep on his or her back. After that, you probably won’t be able to control your baby’s sleeping position, and it’s okay to allow them to sleep however they want to.

A very important note about newborn sleep positions

One of the things that drastically increases the risk of SIDS is suddenly putting an infant on his tummy when he is accustomed to sleeping on his back. Research has found that this sudden change can dramatically increase risk.

Why is this important? You need to be firm and clear with anybody else who watches your child. Tell your mom, dad, brothers, sisters, daycare workers, and babysitters that you always want your baby going to bed on his or her back every time. Do not compromise and don’t feel guilty—this is well-researched and clearly documented, and will help keep your baby safe.

Is it ok for my baby to sleep on her side?

Like prone (stomach) sleeping, side sleeping is not recommended. Do not let your newborn sleep on her side. It’s very easy for her to roll over to her tummy.


In summary:

1-5 months: Always put your baby on their back to sleep.

5-12 months: Put your baby on their back when you put them down to sleep, but don’t worry if the baby rolls over in the night.

12 months and older: Your baby is going to sleep however he or she wants to!

It’s simple. Never put your baby to sleep face down during the first year. The best newborn sleeping position is the supine position—on the back. Don’t let anybody tell you otherwise!

Do you want to discover all the ways that you can reduce SIDS? Sleep position is just one of the seven most important things to do.

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