Choose the only safe sleeping position: On The Back

Latest update: March 2, 2019

Author: Heidi Holvoet, PhD
Medical fact-check: Dr Leah Alexander, M.D., F.A.A.P.

On the back is the baby sleeping position that best protects your little one from SIDS (Sudden Infant Death Syndrome, also called cot or crib death).

Back to Sleep

Worldwide Back to Sleep campaigns in the late 80s-early 90s made a huge effort to advise parents to put their babies to sleep on their backs. They were very successful; the number of SIDS cases has decreased tremendously since then.[1]

Before that, it was believed that putting babies on their stomach at night was safer as on the back was thought to lead to aspiration problems. No evidence was found for this though.

On the contrary, lying on the stomach is when breathing can more easily be obstructed.

Not all babies have the strength or reflex to lift their head when necessary which can be life-threatening. Also sleeping on the side must be avoided.

On The Back is THE single recommended baby sleeping position.

Some situations require extra caution:

  • When two or more risk factors are combined the odds get worse. A premature or light-weight that does not sleep on her back is at extra risk.
  • When having gotten used to always lying on the back and then being put on the stomach gives an extra high risk of SIDS.

Putting your little one on the side to sleep is not recommended either. She can easily roll onto her stomach. Any wedges or other fixing systems to keep baby in any one position can be dangerous. Baby can get stuck or suffocate.

There is a specific medical condition, Pierre-Robin Syndrome that will require baby to be on her belly when sleeping. Evidently you'll do this only following professional medical advice.

How to keep baby on her back

Until your baby is strong enough to easily roll back and forth from back to tummy, you might want to gently turn your baby back on her back when you notice she's rolled over.

Once your baby rolls back and forth easily, you will still want to put her on the back to sleep whenever first placing her in the crib. Some parents stay near and resolve to keep turning them around. Most experts agree though that this isn't necessary (see external links below).

Following the SIDS prevention guidelines, you will be near your baby (supervise closely or sleep in the same room) to monitor carefully. That is especially advised in the first year, either with baby in her own crib or cosleeping safely. This way you automatically monitor your baby and can roll her over when necessary.

But once your baby is so agile and strong to roll back and forth easily, and you are confident that she will also be able to do it while asleep, the risk from being on her tummy decreases, as this comment by Dr Sears and the answer to the rolling over question on Safe to Sleep state.

A sleeping bag or wearable blanket can help encourage some babies to remain on their backs when sleeping, especially a slightly heavier one like the Slumbersac Sleeping Bag 2.5 tog. It makes it slightly more difficult to roll over. Of course make sure you get the right (safe) size for your baby and always coordinate with the room temperature to avoid getting too hot.

A sleeping bag also keeps your little one covered without the risk of sliding under it with her head.

I advise against the use of a blanket, sheet, quilt, comforter or similar as they are not deemed safe with respect to SIDS risk. I always advise sleeping bags or wearable blankets.

WARNING! Do NOT use a sleep positioner or any type of "holding" wedges. They are not safe.

How to keep baby asleep on her back

Many parents notice that their baby more easily wakes when she sleeps on her back. Her sleep seems light most of the time. Many babies often wave their arms in their sleep and wake themselves up like that.

This easy arousal is actually part of why the back position helps with SIDS risk reduction. They have more ability to wake up when necessary.

It is true that many babies sleep better when on their stomach. The reason is that they often go into a deeper sleep (which is why the SIDS risk increases).

So, as much as we want quiet and long naps and nights, it's safety first ...

As their child grows and becomes stronger (beyond 6 months), parents do report placing their babies on their stomach for better naps and nights.

To be on the safest side, I don't recommend this. Definitely avoid it if your baby has any of the higher risk factors and make sure you are around to check on in on her very regularly. Always consult your doctor when in doubt.

What about tummy time?

Tummy time, or having your baby spend time on her stomach, is the standard method to help develop motor skills.

Research has suggested that certain motor skills develop later since the recommended baby sleeping position became "on the back" ...

The skills do develop, only a bit later. The choice between putting child's life at risk or develop motor skills a bit later is easily made.

That said, it is still a good idea to have baby play on her tummy when she is awake to practice those muscles often! Dr Alexander, M.D. advises to link tummy time with an activity you do frequently, like for example changing the diaper. Start with say 1-2 minutes of tummy time after each diaper change after the 2 week old visit, then allow longer periods as your baby tolerates it.

Combine sleeping on the back with the other guidelines to reduce the risk of cot death.

Resources

[1] International trends in sudden infant death syndrome Hauck RF, Tanabe KO. 2008.  Pediatrics 122(3): 660-666.