Overview
Safe sleep practices for newborns aim to reduce the risk of Sudden Infant Death Syndrome (SIDS) and other sleep-related hazards. The consensus from major health organizations, including the American Academy of Pediatrics (AAP), is that the safest sleep position for healthy, full-term newborns is on their back (supine position) for every sleep, until a child can roll over both ways independently.
Key takeaway:
- For healthy newborns, back-sleeping is recommended for every sleep.
- Side-sleeping is not considered safe or recommended as a daily sleep position.
- If a baby rolls onto their side or stomach during sleep, it is generally advised to place the baby on their back for the next sleep period, as long as the baby can roll both ways and is outside of risk factors.
Why back sleep is recommended
- Reducing risk of SIDS: Back-sleeping has consistently been associated with a lower risk of SIDS compared with side- or stomach-sleeping.
- Safe sleep environment: Back sleeping aligns with other safety measures such as a firm, flat sleep surface, a clean sleep area free of loose blankets, pillows, or stuffed animals, and room-sharing without bed-sharing.
What does side-sleeping mean in newborns?
- Side-sleeping occurs when a baby is positioned on their side, often with the body resting on the side and the chest and head angled slightly forward or back.
- For many newborns, maintaining a true side-lying position can be unstable, and the infant may roll to their back or stomach during sleep.
- Because the side position does not consistently protect against airway obstruction in every baby and can be difficult to maintain, it is not recommended as a safe, primary sleep position.
Safety considerations and evidence:
- SIDS risk factors: While the overall risk of SIDS is about 1 in 1,000 to 1 in 2,000 live births in many developed settings, certain practices increase or decrease risk. Back sleeping is consistently associated with a lower risk.
- Reputable guidelines: The AAP’s Safe Sleep Guidelines emphasize the “Back to Sleep” (now called “Back to Sleep/Back to Sleep—supine position”) as the default position for healthy infants.
- Exceptions: Some medical conditions may influence sleep position recommendations. In rare cases, a clinician may advise a specific position for medical reasons (for example, certain airway or neurological conditions). In such cases, follow your pediatrician’s instructions.
Practical sleep position guidance:
- Daily routine: Always place your newborn on their back to sleep for every sleep, including naps and nighttime sleep.
- Transitional moments: If a baby rolls onto their side or stomach on their own, you generally should not force them back into a back position during sleep. Instead, resume back-sleeping for the next sleep period, and ensure the sleep environment is safe.
- When to switch to other positions: As babies grow and develop neck and trunk strength, they will eventually roll both ways on their own. This is considered a normal milestone. The key is to continue safe sleep practices and monitor the baby.
Safe sleep environment essentials:
- Sleep surface: Use a firm, flat sleeping surface, such as a mattress in a safety-approved crib, bassinet, or play yard. A soft mattress, pillow, or other soft objects should be avoided.
- Sleep position verification: Always double-check that the baby is on their back after placing them to sleep.
- Bedding and clothing: Use a fitted sheet, and avoid pillows, blankets, quilts, comforters, bumper pads, or stuffed animals in the sleep area. Dress the baby appropriately for the room temperature to minimize the need for loose coverings.
- Room-sharing: The baby should sleep in the same room as caregivers (but not in the same bed) for the first 6 to 12 months, ideally for the first year, to aid feeding and comfort while maintaining a safe sleep space.
- Temperature and environment: Keep the room at a comfortable temperature to avoid overheating. Overheating has been associated with higher risk of SIDS.
Breastfeeding and sleep position:
Breastfed babies have a reduced risk of SIDS when following safe sleep practices. The rate of SIDS in breastfed babies is not higher; however, ensure safe sleeping conditions are consistently applied regardless of feeding method.
Pacifiers and sleep:
Introduction of a pacifier at nap time and nighttime after breastfeeding is established may reduce the risk of SIDS. If a baby refuses the pacifier, don’t force it. If one falls out during sleep, it does not require replacement.
Important considerations and common questions:
- What if a baby sleeps on their side or stomach? If a baby ends up on their side, the safest approach is to place them back on their back for the next sleep. If they roll over on their own and stay in a position, that is a normal development milestone. Continue safe sleep practices and consult your pediatrician if you have concerns.
- Can I place a baby to sleep on their side for medical reasons? Only under the guidance of a pediatrician. Do not rely on side-sleeping as a standard practice unless advised by a clinician for a specific medical condition.
- Is it safe to sleep with a baby in a parent’s bed? Bed-sharing is associated with a higher risk of SIDS and other sleep-related hazards, especially when factors like parental smoking, alcohol use, or certain medications are present. Safer alternatives include room-sharing with the baby in a separate sleep surface.
Common myths and evidence-based clarifications:
- Myth: Back-sleeping causes plagiocephaly (flat head). While prolonged pressure on one part of the head can contribute to flat spots, repositioning during awake time and supervised tummy time while the baby is awake helps. Use supervised tummy time to strengthen neck muscles and reduce flat spots, while continuing back-sleeping for naps and night sleep.
- Myth: Babies need to sleep on their stomach to be comfortable. The evidence supports back-sleeping as the safest position for most healthy newborns, with tummy time when the baby is awake and supervised.
Tummy time and awake periods:
- Tummy time is essential for motor development and should start soon after birth, with short sessions increasing gradually as tolerated by the baby.
- Begin with a few minutes several times a day while the baby is awake and supervised, gradually increasing to longer periods as the infant grows older and more comfortable.
What to discuss with your pediatrician:
- If your baby was born prematurely or has certain medical conditions, your clinician may tailor sleep position recommendations. Some infants with certain conditions may require adjustments to the standard guidelines.
- If you notice breathing difficulties, persistent wheezing, or signs of possible distress during sleep (grunting, flaring nostrils, head bobbing), seek medical attention promptly.
Resources and references (for further reading):
- American Academy of Pediatrics (AAP) Safe Sleep Guidelines
- National Health Service (NHS) Safe Sleep for Babies
- World Health Organization (WHO) Safe Sleep Practices
- Local pediatric associations and health authorities
Resources and references (for further reading):
- American Academy of Pediatrics (AAP) Safe Sleep Guidelines
- National Health Service (NHS) Safe Sleep for Babies
- World Health Organization (WHO) Safe Sleep Practices
- Local pediatric associations and health authorities
Takeaway:
- The safest sleep position for healthy newborns is on the back for every sleep, including naps and nighttime sleep.
- Side-sleeping is not recommended as a regular practice due to instability and insufficient protection against airway obstruction.
- Maintain a safe sleep environment with a firm surface, no loose bedding or soft objects, and room-sharing without bed-sharing.
- Encourage supervised tummy time when the baby is awake to support development and reduce the risk of flat head syndrome.
- If your baby begins to roll onto their side or stomach on their own, resume back-sleeping for the next sleep period and consult your pediatrician if you have concerns or if your baby has special medical needs.