Written by Jill Zwarensteyn, Editor
Since 19941 parents have been told that “back-to-sleep” is the best way to keep infants safe during the night. The American Academy of Pediatrics as well as the National Institute of Child Health and Human Development have promoted this message over the years, citing that sleeping on their stomach increases an infant’s risk of sudden infant death syndrome (SIDS).1
However, some babies simply don’t seem to want to sleep anywhere but on their stomach. How dangerous could this really be? Is “back-to-sleep” still recommended by the American Academy of Pediatrics in 2024? And, if so, when can babies sleep on their stomach? In this article, we’ll explore the research behind these guidelines and answer your other questions about keeping your baby safe while sleeping.
When Can Babies Sleep on Their Stomach?
Your baby shouldn’t sleep on their stomach during the first 12 months2. During the first year, stomach sleeping has been associated with an increased risk of sudden infant death syndrome (SIDS), suffocation, low oxygen/increased carbon dioxide from poor airflow, and/or overheating.2
For this reason, you should always lay your baby down to sleep on their back.2
There will come a point during the first year when your baby can easily roll from their back, to their side, to their stomach, and then return onto their back. Usually, this is around four to six months old.2
At this point, the American Academy of Pediatrics recommends that you still put your baby to sleep on their back.2 However, if they roll over onto their stomach on their own, it’s typically safe as long as they can easily roll onto their side or back.
Why Shouldn’t Newborns and Babies Sleep Face Down?
Sleeping face down was encouraged for many years3 until doctors noticed an increase in unexplained infant deaths. In 1994, the “Back-to-Sleep” campaign was launched, and the cases of SIDS were cut in half by 2010.1 Now, back sleeping is one of the top safety recommendations new parents are given.
The risk of SIDS is highest during the first year of life but particularly during the first six months.2 From the time you bring your newborn home, it’s advised that you always place them on their back for naps and at bedtime.2 Research has also discovered other benefits to this position4, including fewer fevers, stuffy noses, and ear infections.
What If Your Baby Rolls Onto Their Stomach While Sleeping?
You should always put your baby to sleep on their back, but it’s okay to let the child sleep in any position they choose after you do so. Typically once babies can roll over onto their stomach, they are at an age that they can roll onto their side or back.4
If your baby can only roll one way, though, you should reposition them.2 Again, most babies can change positions at about four to six months old.4 Therefore, we advise that you look to see if they roll on their own or need your help.
How Long Should I Put an Infant on Their Back?
The current guidelines recommend that babies be placed “back-to-sleep” for the first year.2 So for every naptime and bedtime during the first year, you should place your child on their back when they go to sleep.2
Once they have gotten to the point, though, when they can roll themselves from their back, to their side, to their stomach, and then onto their back, you don’t need to worry about repositioning them onto their back while they’re sleeping.4
Be sure to practice this during tummy time when your baby is awake. This is supervised time spent on their stomach during the day can help them strengthen their neck and back muscles, prevent flat spots on the head, and can be an important developmental step toward crawling and eventually, walking.4
Related: Best Crib Mattress
Other Safety Precautions for Sleeping Babies
The sleep safety guidelines for infants by the American Academy of Pediatrics were updated in 2022 and include2:
- Babies should sleep on a firm and flat sleeping surface, such as a crib, bassinet, portable crib, or play yard.
- Parents should not put any soft materials or objects, including blankets, bedding, bumper pads, pillows, or toys, in the baby’s crib with them.
- Babies should sleep in the same room as their parents. Additionally, the infant should be near the bed but not in the same bed for at least the first six months.
- The AAP recommends breastfeeding and the use of a pacifier for reducing the risk of SIDS. However, you should delay introducing a pacifier until breastfeeding is firmly established.
- Avoid overheating a sleeping baby, though a light sleep sack may be used for warmth.
- Discontinue swaddling your infant once they start rolling.
- Avoid any smoking or nicotine use during pregnancy and after birth.
- Avoid alcohol, marijuana, opioids, or other illicit drug use during pregnancy and after birth
Does the Risk of SIDS Decrease Over Time?
The risk of SIDS is highest in the first six months and gradually decreases after this point.2 By the baby’s first birthday, the risk is substantially lower. That being said, experts recommend continuing to put your baby on their back throughout the entire first year.
Being able to roll over both ways is usually the first sign that a baby is on their way to safely sleeping on their stomach.
It’s also important that they are able to easily lift their own head. If their neck and back muscles aren’t developed enough to lift their head, then they can’t lift their head5 to breathe when lying on their stomach. Even babies that can lift their heads during tummy time may not be able to safely do so during sleep.
More research is needed to fully understand how SIDS risk decreases over the first year, but for now, we know that following the AAP guidelines (including “back-to-sleep”) is best.
What If a Baby Prefers to Sleep On Their Stomach?
Many babies prefer sleeping on their stomach. Sleeping in a position that’s similar to “child’s pose” can be comforting for infants. Unfortunately, though,, this position isn’t safe for babies who haven’t yet developed the ability to hold their heads up and easily move between positions on their own.
The best solution for these younger babies is to teach them to feel comfortable and safe while lying on their back. You can gently train them that it’s time to sleep using safe practices like swaddling, white noise, rocking, sucking, and implementing a pre-bed routine. If your baby has become accustomed to sleeping face down and you’re trying to implement a change, you may see a temporary regression in sleep. Just be patient, and know that your infant will soon adjust.
If babies roll onto their stomach during sleep, you can gently roll them onto their back.2 Once they’re consistently rolling in both directions, continue to place them on their back, but if they roll onto their stomach during sleep, you can let them stay in that position without having to worry about rolling them over.4
After their first birthday, you can feel free to let your baby fall asleep in any way that they choose.
When Should I Call the Doctor?
When you’re exhausted, it may be tempting to bring your infant to bed with you or fall asleep holding them on the sofa or in a chair. Unfortunately, all of these scenarios greatly increase the risk of SIDS.2 If nobody in your household is sleeping, it may be time to ask for help.
Lactation consultants, infant sleep specialists, and doctors are all available to help. They should be able to offer some tools and advice to get everyone the rest they need.
There are a few exceptions6 when doctors may recommend placing babies on their stomach for sleep. Generally, these are because of health conditions that make sleeping on the back more dangerous for the infant than sleeping on their stomach.6 In these situations, doctors should also provide some guidelines on how to go about this in the safest way.
Frequently Asked Questions
Is side sleeping okay for a baby?
The AAP does not recommend side sleeping for babies under one year old.2 Babies who are sleeping on their side can easily flip onto their stomach, facing the same increased risk of SIDS.2 So, until they turn one, all babies should be placed on their back for sleep.
What if a baby has acid reflux and GERD?
Before the 1990s, people were encouraged to place their babies on their stomach for sleeping in order to “prevent the child from choking when they spit up.”3 However, research throughout the 90s disproved this, and by 1994, the AAP recommended back sleeping as the safest sleep position, regardless of reflux or GERD.3 In fact, babies naturally cough up or swallow fluids and tend to do so more safely7 when sleeping on their back.
Will my baby develop a flat spot?
Flat spots on the head can happen when infants lay in the same position for too long.4 While these are harmless and typically resolve on their own, there are ways to prevent them8. Try limiting time in car seats and swings, encourage plenty of supervised tummy time during the day, and change the direction you lay your baby in when you place them in their crib from week to week.8
Is tummy time safe?
Yes, supervised tummy time is both safe and encouraged.8 Giving your baby plenty of tummy time while awake is one of the best ways to promote healthy growth and development.8 Some babies may fuss at first, so start with a few minutes at a time spread throughout the day and gradually increase.
Conclusion
New parents are often bombarded with advice from well-meaning family and friends., but when it comes to your baby’s safety, it’s best to trust the experts. The AAP recommends putting babies “back-to-sleep” until their first birthday.
Once your infant starts rolling and can safely move between positions and lift up their head, stomach sleeping should be safe. However, you should still lay them down on their back to sleep until they turn one.
We know that following this advice can be a challenge when you’re desperate for some rest at 3:00 a.m., but in the end, your baby’s safety is worth it.
Jill Zwarensteyn
Editor
About Author
Jill Zwarensteyn is the Editor for Sleep Advisor and a Certified Sleep Science Coach. She is enthusiastic about providing helpful and engaging information on all things sleep and wellness.
Combination Sleeper
References:
- “Campaign History”. Eunice Kennedy Shriver National Institute of Child Health and Human Development. Webpage accessed August 26, 2024.
- Moon MD, Rachel Y., Carlin MD, Rebecca F., Hand MD, Ivan. “Sleep-Related Infant Deaths: Updated 2022 Recommendations for Reducing Infant Deaths in the Sleep Environment”. American Academy of Pediatrics. 2022.
- Robinson, Marcene. “Unsafe newborn sleep influenced by grandmas and family traditions”. University of Buffalo. 2015.
- “Frequently Asked Questions (FAQs) About SIDS and Safe Infant Sleep”. Alameda County Public Health Department. Webpage accessed August 26, 2024.
- “SIDS (Sudden Infant Death Syndrome)”. Cleveland Clinic. Last modified May 22, 2024.
- Klaas MD, Kelsey M., Cook MD, Walter J. “How to put your baby to sleep safely”. Mayo Clinic. 2022.
- “Will Baby Choke if they vomit while sleeping on their back?”. Red Nose Australia. Last modified April 17, 2022.
- “Tummy Time for a Healthy Baby”. Eunice Kennedy Shriver National Institute of Child Health and Human Development. Webpage accessed August 16, 2024.