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    Should babies sleep on their back or stomach? Here's the truth

    Updated 26 September 2022 |
    Published 14 August 2019
    Fact Checked
    Reviewed by Dr. Anna Klepchukova, Intensive care medicine specialist, chief medical officer, Flo Health Inc., UK
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    When you have a baby, you want to make sure that you're doing everything you can to keep them safe, healthy, and happy. There's a lot you can do to ensure this. Placing your baby in a safe position when they sleep is very easy, but it can make a big difference to your baby's health.

    Sleeping comes naturally to most adults, so it's easy to underestimate how important it is for your newborn to sleep safely. But creating a safe environment for your baby to sleep in is one of the most crucial things you can do while they're infants.

    Most parents have heard about sudden infant death syndrome (SIDS). SIDS, also known as crib death, occurs when a baby dies unexpectedly and without explanation before their first birthday. Thinking about SIDS can be very stressful for new parents. Fortunately, one of the most effective ways to prevent SIDS is also very simple.

    Putting your baby to sleep on their back carries a much lower risk of SIDS than putting them to sleep on their stomach. In the past, parents were encouraged to put their babies to sleep on their stomach. But as research on SIDS became more common and new discoveries were made, scientists realized that babies who sleep on their stomach have an increased risk of SIDS.

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    The cause of SIDS is still unknown, as is the reason why back sleeping is safer for babies. Experts have theorized that there are several mechanisms that make stomach sleeping unsafe, including:

    • Increased risk of upper airway obstruction
    • The baby might re-breathe the air that they've already exhaled, which could lead to low oxygen levels and carbon dioxide buildup
    • Overheating due to improper body heat dissipation
    • Decreased reactions to noise and other stimuli that should wake them up
    • Abnormally high blood pressure and heart rate while sleeping

    Although putting babies to sleep on their back doesn't make them immune to SIDS, doctors recommend the "back to sleep" approach for all babies under the age of one. 

    Campaigns to encourage parents to make sure that their babies are sleeping on their backs have resulted in lower rates of SIDS in many countries around the world. Front sleeping has also been linked to more frequent fevers, ear infections, and increased nasal congestion in babies. Research has also shown that side sleeping carries as much risk as front sleeping when it comes to SIDS.

    How to get your baby to sleep on their back

    Consistency is the best technique to get your baby to sleep on their back. Swaddling your baby can help them feel more secure, which is one of the things they seek when they roll on to their stomach. Use a swaddling blanket until your baby is old enough to remove it on their own. Once this happens, which could be as early as two months old, you can use a sleeping sack meant for babies, which they won't be able to take off.

    To help your baby sleep on their back, try rocking them in your arms before placing them in their crib. If your baby falls asleep in their car seat, sling, stroller, or any other surface, make sure you place them in their crib as soon as possible. The crib should have a firm mattress and fitted sheet.

    To make sleeping in a crib safer for your baby, avoid using blankets, comforters, or pillows. You should also keep their crib clear of other objects such as bottles, cups, toys, and teethers. Additionally, making sure that your baby isn't exposed to smoke can further decrease the risk of SIDS. Breastfeeding has been found to decrease the risk of SIDS. If you've already stopped breastfeeding, it's even more important to take preventative measures against SIDS.

    Is learning to sleep on their back difficult for babies?

    A lot of babies seem to naturally prefer sleeping on their stomachs. Many experts believe that this is caused by their desire to feel secure and bundled up, which is how they felt inside the womb. However, most babies will get used to sleeping on their back as long as you make it a habit to put them in that position.

    In rare cases, babies can have undiagnosed physical conditions that make it uncomfortable for them to sleep on their back. If your newborn won't sleep on their back and becomes irritable whenever you place them that way, talk to a pediatrician to rule out any anatomical problems.

    What should you do if your baby won't sleep on their back?

    If your baby is old enough to roll over on their own, don't worry if they flip over during their sleep. Once a baby learns how to roll over, which usually happens when they're four to six months old, their risk of SIDS decreases significantly. SIDS is more prevalent in babies who are under six months old. However, parents are still encouraged to put their babies to sleep on their backs until they're one year old, even if they flip over while they sleep.

    If your baby is fussy, they may have more trouble falling asleep in general. Keep this in mind, especially if you're taking medications. Certain medications, such as antibiotics, can cause colic-like symptoms if you're breastfeeding your baby. This will make it more difficult for them to fall asleep.

    Don't use extra pillows or rolled up blankets to keep your baby on their back. Having extra objects in the crib can increase the risk of SIDS. Instead, offer your baby a pacifier while they're on their back. It's usually difficult for babies to keep a pacifier in their mouth when they flip to a different position, so they'll learn to stay on their backs to keep the pacifier in place.

    Medical research agrees that babies should be placed on their backs to sleep. This position can help prevent SIDS, and it's also been linked to fewer ear infections and less nasal congestion in babies. To teach your baby to sleep on their back, make sure you're consistent, always place them in the same position, and keep their crib clear of any objects.

    References

    “Can SIDS Be Prevented?” HealthyChildren.org, www.healthychildren.org/english/ages-stages/baby/sleep/pages/sleep-position-why-back-is-best.aspx. Accessed 26 Sept. 2022.

    Flickr, Follow us on. “Research on Back Sleeping and SIDS.” Https://safetosleep.nichd.nih.gov/, safetosleep.nichd.nih.gov/research/science/backsleeping. Accessed 26 Sept. 2022.

    Gilbert, Ruth, et al. “Infant Sleeping Position and the Sudden Infant Death Syndrome: Systematic Review of Observational Studies and Historical Review of Recommendations from 1940 to 2002.” International Journal of Epidemiology, vol. 34, no. 4, Aug. 2005, pp. 874–87.

    Moon, Rachel Y. How to Keep Your Sleeping Baby Safe: AAP Policy Explained. 2019, www.healthychildren.org/English/ages-stages/baby/sleep/Pages/A-Parents-Guide-to-Safe-Sleep.aspx.

    “Preventing Flat Heads in Babies Who Sleep on Their Backs.” Paediatrics & Child Health, vol. 6, no. 10, Dec. 2001, pp. 790–95.

    History of updates

    Current version (26 September 2022)

    Reviewed by Dr. Anna Klepchukova, Intensive care medicine specialist, chief medical officer, Flo Health Inc., UK

    Published (14 August 2019)

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