Baby Sleeping Position – What is Safe?

Wrong sleeping positions in Infants or newborn 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 all about the ideal sleeping positions for babies and how certain sleeping positions can cause sudden deaths in newborn babies.


Which Sleeping Practices 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 due to suffocation in a newborn.


Safe and Unsafe Infant Sleeping Positions

Here are few safe and un-safe infant sleeping positions that all parents and baby care-takers must know about.

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 baby’s jaws and block airways making it difficult for the baby to breathe.
  • Sleeping on the stomach makes the baby lie with his face very close to the sheet, making him breathe the same air. This may result in the breathing in 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. This might block the baby’s airways from all sides.
  • Also, because of the nose placed very close to the mattress in this position, the baby ends up breathing in the microbes present in the sheet covering the mattress, and this may lead to allergies

However, sometimes, in case of certain medical conditions, doctors may advise parents to put the baby to sleep in the stomach position. Usually, children with gastroesophageal reflux or certain upper-airway malformations like Pierre Robin Syndrome are advised to sleep in this position, but recent studies do not support this reasoning. Hence, it is advisable to consult the physician properly before putting the baby to sleep on his/her stomach.

2. Sleep On Back Position

Sleep on back position is the safest and the best sleeping position for the baby. It is the most suggested sleeping position for babies as it keeps the airways open. 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.

Risks Involved

Children lying on the same back position for a long time may suffer from ‘positional plagiocephaly’, a case of flattened head, or the baby may also suffer from ‘brachycephaly’, a case of flattened back. But these are temporary conditions and the shape of both the skull and the back becomes normal as soon as the baby turns one and hardly needs any treatment. Some techniques can help to avoid these conditions altogether.

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

3. Sleep On The Side Position

Sleeping on the side is not a recommended infant sleeping position, as an infant tends to eventually roll-on to their tummy while asleep and this increases the risk of SIDS.

Tips for Safe Baby Sleep

Here are some tips to ensure that your baby has a sound and good night’s 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, use of bumper pads, pillows, or soft-toys inside the baby’s crib must be avoided as it may accidentally cover the baby’s head.

2. Avoid Quilts and Comforters

Usage of materials like quilts and comforters on top of the mattress to make the bedding soft must be avoided. It may make the baby sink under the bedding which can be risky in case of an infant. Just place a clean, fitting 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 babies up to the chest. The arms must be kept outside the blanket to ensure that the blanket does not get rolled up to the head, suffocating the baby. Sleeping bags with fitted neck and armholes are available in the market and are highly recommended. They are safe and keep the baby warm too.

4. Night Clothes Should be Light Clothes

It’s important to dress the baby up in light clothes for a good night’s sleep.

5. Keep the Room Cool at Night

It is also suggested that children should be put to sleep in a cool environment, preferably 20 degrees centigrade.

6. Use Pacifiers If Necessary

The American Academy of Paediatrics (AAP) suggests that infants can be given pacifiers just before sleep-time. However, forcing new-borns to use pacifiers is not advisable. Wait till they are about 4 weeks old before you even try it.

7. Avoid Co-Sleeping With the Baby

Infants sharing beds with parents, siblings or even with his/her twin is not advisable. Co-sleeping with baby can increase the chances of SIDS. When in sleep, your arms or breast or your clothes may accidentally cover your baby’s face and end up suffocating the baby. In India, co-sleeping with the baby is a common norm as it is easy to feed the baby at night. But now you know why it must be avoided!

8. Share the Same Room

It is important that the baby’s crib is installed in the same room as the parents. It makes breastfeeding convenient, and it is easy for the parents to keep a close watch on the baby’s sleeping positions. Room-sharing and not bed-sharing is recommended by the AAP as a baby sleep safety guideline.


1. Can Babies Sleep on Their Stomach?

As discussed earlier, it is not recommended for babies or infants to sleep on their stomachs. But as babies become 4 to 5 months old, they learn to roll from their back to their stomach, which is absolutely normal. By this time, the risk of SIDS lowers in children, and hence it is okay to allow the baby to find his/her own comfortable position. A 5-month-old baby will be able to turn his/her 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/her to sleep.

Please note that babies sleeping on their tummy are at a high risk of SIDS only till they are about 4-month-old but it remains a considerable threat till they are about 12 months of age.

2. Can Babies Sleep on Their Side?

The side sleeping position for babies is not particularly alarming. But 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, and may roll over from the back to a side position. 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 low risk of choking. However, if the baby rolls over to the side before six months of age, ensure you put them back in the back position.

3. Why Does Baby Sleep in Fencing Reflex in the Back Sleep Position?

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/her back, the baby’s head turns to one side with the arms and legs extended to the same side. This prevents the baby from rolling from their back position to stomach. It must be noted that this self-precautionary movement will disappear anytime between 3 to 6 months of age.

4. What If My Baby is Finding It Difficult to Sleep on the Back?

In many cases, infants may not be comfortable sleeping on their backs and may lack sound sleep. But it is important for parents to get the babies used to sleeping on the back to avoid SIDS. Gradually, they will adjust and fall asleep.

Also, babies suffering from a congested nose may not feel comfortable sleeping on their backs. In these cases, place a humidifier in 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 even 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?

Pre-term infants are at a very high risk of SIDS. It is advisable that pre-term infants too should be put to sleep on the back. But in very rare cases, if the infant is suffering from acute respiratory disease, then he/she can be put to sleep on the stomach under very strict observation. In fact, this is only advisable in a highly monitored inpatient setting.

7. Can Sleep Positioners Help My Baby to Sleep on Back and Reduce the Risk of SIDS?

FDA (Food and Drug Administration), a federal agency of United States Department of Health and Human Services, does not approve of sleep positioners to put infants to sleep. Using a baby sleep positioner to help a baby sleep on his/her back is dangerous and must be avoided.

New-born babies can be prone 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 new-born babies. Taking time out to learn this necessary information will go a long way in keeping your new-born safe and healthy.