Sleep Positions for Infants (SIDS)

What is the safest sleep position for my baby?
The American Academy of Pediatrics (AAP) recommends that all healthy infants sleep on their back for the first 6 months of life.
Several studies have shown that sleeping on the back reduces the risk of Sudden Infant Death Syndrome (SIDS).
SIDS is the sudden unexpected death of a healthy infant.
Thousands of babies die each year from SIDS.
Typically, a baby dies from SIDS while sleeping.
The recommendation for babies to sleep on their back was issued in 1992 by AAP.
Majority of parents (85%) now follow this advice, and there has been a 40% drop in the rate of SIDS.

Why does sleeping on their stomach increase risk of SIDS?
Laying a baby on his/her stomach puts pressure on the jawbone.
This causes the airway in the back of the mouth to become narrower.
If your baby sleeps on a soft surface, the nose and the mouth may sink in, so the child breathes from a small pocket of stale air.
If your baby sleeps on its stomach, the risk of SIDS is 3 – 9 times greater.
Sleeping on the side is safer than the stomach, but still carries twice the risk of SIDS as the back position does.
If you use a child care center or a babysitter, make sure they are aware of the importance of putting your baby on its back to sleep.

Are there other ways to reduce the risk of SIDS?
You can reduce the risk by using a firm mattress.
Young infants should never be placed in waterbeds, sheepskin, soft pillows, bean-filled pillows or other soft spongy surfaces.
Make sure that none of these surfaces are placed in the crib. Even if you place your child to sleep on its back, it is possible your child will roll over during the night.
Do not let your baby sleep in your bed during the first twelve 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 SIDS is 20 times higher for babies sleeping in an adult bed compared to a crib.
Breastfeeding your baby is recommended.
Protecting your infant from exposure to cigarette, cigar or pipe smoke is also recommended.
Ensure the room temperature is optimally healthy.

When should a baby sleep on its stomach?
Your baby should only sleep on its stomach if recommended and supervised by your child’s healthcare provider.
The AAP recommends putting your baby to sleep on its stomach in the following cases:

Infants with complications of spitting up such as recurrent pneumonia from aspiration, interruption of breathing, which is referred to as apnea, or acid damaged lower esophagus, and choking. While spitting up is common, these complications are quite rare. Many years ago, doctors recommended that babies sleep on their stomachs to decrease the risk of choking. However, choking has been noted to be extremely rare and it has never been proven that the stomach position prevented choking better than any other position.

A baby should sleep on its stomach if it has 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 its stomach must also be placed on a firm sleeping surface.

Are there any disadvantages to sleeping on the back?
There are two minor disadvantages.

While lying on the back 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 three step Borino wrap technique. Start with your baby lying on the blanket and the arms on 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 of the blanket over the tuck.

The other disadvantage is that some babies get a flattening of the back of the head. You can prevent this by changing the position of the baby’s head slightly during sleep. Our Pediatric Neurosurgeon has received several calls from parents about this common cosmetic problem.

Should I lay my baby on his/her back during playtime?
It is good for your baby to spend some time on his/her stomach while awake during the day.
The back position is only recommended for bedtime and naps.
Letting your baby play on his or her stomach helps strengthen the shoulder muscles. Changing positions also will keep your baby’s head from becoming flattened from lying in the same position all of the time.

For more information on this subject, please contact the Sudden Infant Death Syndrome Alliance at 1314 Bedford Avenue, Suite 210, Baltimore, MD, 21208 or call them at 1-800-221-SIDS (7437), or email the organization at SIDSHQ@charm.net.