What sleep positions are recommended for newborns?
As per the American Academy of Pediatrics’ safe sleep guidance, newborns should always be placed on their backs to sleep unless there’s a medical reason not to. Known as the “supine” position, this is the safest sleep position because it minimizes the risk of sudden infant death syndrome (SIDS), which is increased when a baby sleeps on their stomach or side.
It’s also important for newborns to sleep on a firm, flat mattress (with no incline or tilt) covered with a fitted sheet. Their bed should be free of any loose items or soft objects like pillows, loose bedding, or soft toys. To further reduce the risk of SIDS, it’s recommended that your baby sleeps in the same room as a parent or caregiver for at least the first six months.
Why should newborns sleep on their backs?
In the 1990s, a campaign called “Back to Sleep” was launched, educating parents on the importance of placing newborn babies on their backs to sleep. This has led to a significant reduction in SIDS cases — in the US, for example, occurrences of SIDS have declined by more than 50% since the campaign’s introduction in 1994.
For a newborn, sleeping on their side or stomach can dramatically increase the risk of SIDS. Stomach sleeping may multiply the risk by almost 13 times, for example, partly as there’s a higher chance of their airway becoming blocked, while they can also rebreathe “expired” air and take in too much carbon dioxide. This is why back sleeping is always the safest option.
Isn’t back sleeping dangerous for babies?
Some parents fear that if their baby vomits or spits up during the night, there’s a greater risk of them choking if they’re sleeping on their back because of, well, gravity. This concern is understandable, but when a baby is on their back, their trachea (windpipe) sits above the esophagus (food pipe), so if they spit up, gravity pulls it down the esophagus and not into the airway.
Conversely, when a baby sleeps on their stomach, the esophagus is above the trachea, meaning regurgitated fluids can flow more easily into the windpipe and increase the risk of choking.
Is it safe for my baby to sleep on their side?
It’s not safe for your baby to sleep on their side until they can roll over on their own, which typically happens somewhere between 4 and 6 months. For newborns and babies who haven’t yet mastered rolling by themselves, side sleeping increases the risk of them turning onto their stomach and not being able to reposition themselves — which poses a much greater risk of SIDS.
When is it safe for a baby to sleep on their stomach?
As with side sleeping, a baby can safely sleep on their stomach once they’ve gained the motor skills to roll over on both sides by themselves. Before this, stomach sleeping can be very dangerous as it’s associated with a higher risk of SIDS. You should always put your baby on their back to sleep.
When your baby is able to roll over independently, there’s not necessarily any need to reposition them if they happen to roll onto their side or stomach while sleeping. That said, when putting them down to sleep it’s best to still place them on their back — on a firm, flat mattress with a fitted sheet and no loose bedding or objects — until at least their first birthday.
What if my baby rolls onto their stomach during the night?
If your baby can roll over unaided — as they’re usually able to from around 4-6 months — it’s not usually a cause for concern if they turn over onto their stomach during the night. Unless they appear uncomfortable or are struggling to breathe, you needn’t panic or feel the need to flip them over onto their back every time.
If your little one isn’t yet capable of rolling by themselves, it’s unlikely they’ll be able to turn onto their stomach if laying on their back. If they do somehow manage it, gently turn them over onto their back, and consider monitoring them periodically to ensure they’re sleeping in a safe and comfortable position.
Of course, if you’re at all concerned about your baby’s sleeping positions, it’s always best to consult your pediatrician.
What if my baby refuses to sleep on their back?
Knowing that back sleeping is by far the safest way for your baby to snooze, it can be concerning if they resist sleeping on their back or become agitated when you try to lay them in this position. Most babies sleep happily on their backs, but if they do put up a fight, here are a few things you can do:
Consider swaddling. For newborns, swaddling recreates the cozy, secure feeling of being in the womb, and can help soothe them to sleep while keeping them in a safe position.
Check for signs of discomfort. Your baby might be resistant to sleeping on their back if they’re uncomfortable due to gas or reflux. In this case, consider feeding them earlier before bedtime and keep them upright for 20-30 minutes after feeding.
Aim for drowsy but awake. Laying your baby down for a doze when they’re sleepy but not yet fully asleep can help them learn to self-settle, which may help them drift off more easily if they’re typically resistant to bedtime.
Be persistent. Until they’re able to roll over, on their back is the only safe way for a baby to sleep. It’s important to lay them on their back to sleep consistently, establishing a clockwork-like bedtime routine to signal when it’s time for bed.
Consult your pediatrician. If your baby consistently refuses to sleep on their back and you can see no underlying reason, it’s best to seek professional advice.
We don’t recommend the use of so-called “anti-roll” devices or “sleep positioners”, as these can increase the risk of suffocation. As mentioned above, aside from a firm mattress and a fitted sheet, nothing should be in your baby’s bed other than your baby.
Of course, you can’t keep your eyes on your baby every second they’re sleeping — you need your rest, too — but remembering the mantra of “back to sleep” and placing them on their back on a firm, flat surface is always safest for your baby.
It’s less of a concern when they develop the ability to roll back and forth themselves, but back sleeping is best for at least their first year. As they grow into a walking, talking little person, they’ll discover their favorite sleeping position all by themselves — maybe you’ll even have a little starfish on your hands!
Reviewed by Rosey Davidson, Sleep Consultant, founder & CEO, in December 2024.