Baby Sleeping Position – What Is Safe?

Babies sleep a lot, and ensuring a safe sleeping environment is crucial for their health and well-being. One of the key factors in promoting safe sleep is the baby’s sleeping position. Ensuring they sleep in a safe position is very important because wrong sleeping positions in infants can sometimes lead to SIDS (sudden infant death syndrome). SIDS in children is caused due to suffocation or strangulation. If you have an infant at home, it is essential that you know everything about the ideal sleeping positions for babies and how certain sleeping positions can cause sudden deaths in newborns.

Which Sleeping Positions Increase the Risk of Sudden Unexpected Death in Infancy (SUDI)?

You may have observed infants sleeping in various positions. Some of these sleeping positions increase the risk of sudden, unexpected death in infancy (SUDI). SUDI is a broad term that encompasses all sudden deaths in infants, including SIDS, which is generally caused by suffocation in a newborn. Sleeping on the chest/stomach is one of the most dangerous positions for infants (8). Let’s look at more newborn sleeping positions that increase the risk of SUDI.

1. Sleep-on-Stomach Position

Risk Involved

The sleep-on-stomach position for babies is highly unsafe for the following reasons:

• This position may put some pressure on the baby’s jaws and block the airways, making it difficult for the baby to breathe.
• Sleeping on the stomach causes the baby to lie with his face very close to the sheet, causing him to breathe the same air. This may result in breathing recycled air, which is low in oxygen.
• Sleeping on the stomach on a very soft mattress may cause suffocation in babies. The risk of rebreathing the exhaled air is higher while lying on a soft mattress because the baby’s face slacks deeper into the soft fabric of the mattress, which might block the baby’s airways from all sides (4).
• Also, because the nose is placed very close to the mattress in this position, the baby breathes in the microbes present in the sheet covering the mattress, which may lead to allergies.

While there are exceptions, such as children with gastroesophageal reflux or certain upper-airway malformations like Pierre Robin Syndrome, who may be advised to sleep in this position, it’s crucial to consult a physician before doing so.

2. Sleep-on-the-Side Position

Sleeping on the side is not a recommended infant sleeping position, as infants tend to roll onto their tummy while asleep eventually, and this increases the risk of SIDS due to one of the reasons mentioned above.

So, which sleeping position is good for your baby? The only option left now is the sleep-on-back position. Let’s take a closer look at it.

Safe Sleeping Position for Infants

The sleep-on-back position is the safest and the best sleeping position for an infant (1). It is the most suggested sleeping position for babies as it keeps the airways open and has minimal risks of suffocation. This position not only ensures the safety of your baby but also promotes sound sleep, which is crucial for their development. The US NICHD (National Institute of Child Health and Human Development) recommends the sleep-on-back position for short naps as well as for sound sleep throughout the night in babies.

However, this sleeping position also has some risks involved. Here are some of them:

Risks Involved in the Sleep-on-Back Position

Children lying in the sleep-on-back position for a long time may suffer from ‘positional plagiocephaly’, a flattened head, or the baby may also suffer from ‘brachycephaly’, a flattened back. But, these temporary conditions normalise as soon as the baby turns one. Having said that, there are some techniques that you can use to avoid these conditions altogether –

• More tummy time when the baby is awake.
• Turning the baby on the sides while he is not asleep.
• Reducing the time spent in carriers or car-seaters.

These techniques allow the baby to lie in different positions instead of lying on the back.

You can follow a few more things to ensure your baby sleeps safely. The tips below will help you manage or correct your baby’s sleep positions.

Tips for Safe Baby Sleep

Here are some tips to reduce the risks of SUDI and ensure that your baby has a sound sleep.

1. Use a Firm Mattress for the Baby’s Bed

Many parents make the mistake of choosing soft mattresses for babies. This must be avoided. Babies must be put to sleep in firm beds. Also, bumper pads, pillows, or soft toys inside the baby’s crib must be avoided, as they may accidentally cover the baby’s head (5).

2. Avoid Quilts and Comforters

Avoid using quilts and comforters on top of the mattress to make the bedding soft. This may cause the baby to sink under the bedding and increase the risk of suffocation. Just place a clean, fitted mattress inside the crib and cover it with a clean bed sheet, and that is enough for your baby to have a comfortable sleep.

3. Tug the Blanket Properly

Blankets should only cover the baby up to the chest. The arms must be kept outside the blanket to ensure that the blanket does not roll up to the head and suffocate the baby (3). Sleeping bags with fitted necks and armholes are easily available and highly recommended. They are safe to use and keep the baby warm, too.

4. Night Clothes Should Be Light Clothes

It’s important to dress the baby in light clothes for a good night’s sleep. Ensure the clothes are not too tight and not too loose (2).

5. Keep the Room Cool at Night

It is also suggested that children should sleep in a cool environment, preferably 20 degrees centigrade (6).

6. Use Pacifiers If Necessary

The American Academy of Paediatrics (AAP) suggests that infants can be given pacifiers before sleep. However, forcing newborns to use pacifiers is not advisable. Wait till they are about four weeks old before you even try it.

7. Avoid Co-Sleeping With the Baby

Sharing beds with parents, siblings, or even their twins is not advisable for infants. Co-sleeping with the baby can increase the chances of SIDS. When sleeping, your arms, breasts or your clothes may accidentally cover your baby’s face and end up suffocating the baby. In India, co-sleeping with the baby is common, and feeding the baby at night is easy. But now you know why it must be avoided!

8. Share the Same Room

The baby’s crib must be installed in the same room as the parents. This makes breastfeeding convenient and makes it easy for the parents to keep a close watch on the baby’s sleeping positions. The AAP (American Academy of Pediatrics) recommends room-sharing rather than bed-sharing as a baby sleep safety guideline (7).

9. Use a Baby Monitor

This is particularly useful for parents who can stay home but cannot always be around the baby. The monitor helps them watch the baby from anywhere in the house.

Parents often have several questions about their baby’s sleeping positions. The FAQs given below will cover most of your questions.

FAQs

1. Can babies sleep on their stomachs?

As discussed earlier, it is not recommended for babies or infants to sleep on their stomachs. But, as babies age 4 to 5 months, they learn to roll from their back to their stomach, which is normal. By this time, the risk of SIDS lowers in children, and hence, it is okay to allow the baby to find his comfortable position. A 5-month-old baby can turn his head to the side and keep the mouth and nose free for breathing. However, it is advisable to keep a watch while the baby is asleep and place the baby on the back while putting him to sleep.

Please note that babies sleeping on their tummy are at a high risk of SIDS only until they are about four months old, but it remains a considerable threat until they are about 12 months of age.

2. Can babies sleep on their side?

The side sleeping position for babies is not particularly alarming. However, recent research shows that babies who sleep on the side eventually turn on their tummy, and this increases the risk of SIDS. Babies tend to learn to roll over by the age of six months. If this is the case, you can let the baby continue to sleep on his side as the rolling over indicates strong internal organs and a low risk of choking. However, if the baby rolls over to the side before six months, ensure you put him in the sleep-on-the-back position.

3. Why do some babies sleep in the fencing reflex position when sleeping on the back?

The fencing reflex is also known as the Tonic Neck reflex. It is one of the many involuntary movements exhibited by infants while sleeping. In this case, when a baby is put to sleep on his back, his head turns to one side with the arms and legs extended to the same side. This prevents the baby from rolling from its back position to the stomach. It must be noted that this self-precautionary movement will disappear anytime between 3 and 6 months of age.

4. What if my baby is finding it difficult to sleep on the back?

Infants often may not be comfortable sleeping on their backs or lack sound sleep. However, parents need to get the babies used to sleeping on their backs to avoid SIDS. Gradually, they will adjust and fall asleep.

Also, babies with congested noses may feel uncomfortable sleeping on their backs. In such cases, place a humidifier in the baby’s room. This will moisten the air and loosen congestion.

5. What if my baby chokes while sleeping on the back?

Healthy babies don’t usually choke while sleeping on the back. It has been established that babies with gastroesophageal reflux disease do not choke when put to sleep on the back. One must only take care not to put babies to sleep with a feeding bottle in their mouths. This can cause choking as well as an ear infection.

6. Which are the best sleeping positions for preterm babies?

Preterm infants are at a very high risk of SIDS. Preterm infants, too, should be put to sleep on the back. But, if the infant is suffering from acute respiratory disease, then he can be put to sleep on the stomach under strict observation. This is only advisable in a highly monitored inpatient setting.

7. Can sleep positioners help my baby to sleep on the back and reduce the risk of SIDS?

The FDA (Food and Drug Administration), a federal agency of the United States Department of Health and Human Services, does not approve sleep positioners for infants. Using a baby sleep positioner to help babies sleep on their backs could be dangerous and must be avoided.

8. How often should I check on my baby while they are sleeping?

It is recommended that you check on your baby periodically while sleeping, especially during the first few months. However, avoid disturbing their sleep unless necessary.

Newborn babies are prone to SIDS and SUDI on account of incorrect sleeping positions. It is, therefore, essential to know about various sleeping positions and the risks they pose to newborn babies. Taking time out to learn this necessary information will go a long way in keeping your newborn safe and healthy.

References/Resources:

1. Baby sleeping positions: your questions answered; NCT; https://www.nct.org.uk/baby-sleeping-positions-your-questions-answered

2. Ball. H, Blair. P; HEALTH PROFESSIONALS’ GUIDE TO: “CARING FOR YOUR BABY AT NIGHT”; UNICEF; https://www.unicef.org.uk/babyfriendly/wp-content/uploads/sites/2/2011/11/Caring-for-your-Baby-at-Night-A-Health-Professionals-Guide.pdf

3. Sudden infant death syndrome (SIDS); Healthdirect; https://www.healthdirect.gov.au/sudden-infant-death-syndrome-sids#prevented

4. Sudden Infant Death Syndrome (SIDS); Nemours KidsHealth; https://kidshealth.org/en/parents/sids.html

5. Sudden Infant Death Syndrome (SIDS); Boston Children’s Hospital; https://www.childrenshospital.org/conditions/sudden-infant-death-syndrome-sids

6. Sudden infant death syndrome (SIDS); NHS; https://www.nhs.uk/conditions/sudden-infant-death-syndrome-sids/

7. Falusi. L. O; Sudden Infant Death Syndrome (SIDS): Common Questions & Concerns; American Academy of Pediatrics; https://www.healthychildren.org/English/ages-stages/baby/sleep/Pages/Sleep-Position-Why-Back-is-Best.aspx?

8. Sudden Unexpected Infant Death and Sudden Infant Death Syndrome; Centers for Disease Control and Prevention; https://www.cdc.gov/sids/about/index.htm

Also Read:

Basic of Baby Sleep
Baby Sleeps with Open Eyes
Bad Sleeping Habits of Baby
Tips to Deal with Baby Sleep Problem

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