Safe Sleep Practices for Newborns: Back vs. Tummy Positioning

Newborn infant

Hello, doctor.
I would like to ask, for newborns who cannot yet roll over, is it better for them to sleep on their backs or on their stomachs? Do they need a pillow? Thank you.

Kandi, 30~39 year old female. Ask Date: 2014/02/20

Dr. Xiao Kaiwen reply Pediatrics

Infants should always be placed on their backs to sleep to reduce the risk of Sudden Infant Death Syndrome (SIDS).
Sleeping on the stomach is one of the risk factors for SIDS, which, although less common in newborns under one month, peaks at 2 to 3 months of age.
Side sleeping is also not considered safe.
To promote development and prevent positional plagiocephaly, infants can be placed in a prone position while awake under parental supervision.
The crib should not contain any soft objects, including pillows, stuffed toys, comforters, blankets, or any soft bedding materials.
The crib should be firm and covered with a fitted sheet to prevent airway obstruction.

Reply Date: 2014/02/20

More Info

When it comes to safe sleep practices for newborns, the consensus among pediatricians and health organizations is clear: infants should always be placed on their backs to sleep. This recommendation is based on extensive research demonstrating that back sleeping significantly reduces the risk of Sudden Infant Death Syndrome (SIDS), which is a leading cause of death in infants under one year of age.

Back vs. Tummy Positioning:
1. Back Sleeping: Placing your newborn on their back to sleep is the safest position. This position helps keep the airway open and reduces the risk of suffocation. It is essential to ensure that the sleep surface is firm and flat, free from soft bedding, pillows, toys, or bumper pads that could pose a suffocation hazard.

2. Tummy Sleeping: While tummy time is crucial for your baby's development when they are awake and supervised, it is not recommended for sleep. Tummy sleeping has been associated with an increased risk of SIDS, as it can lead to rebreathing of exhaled air, which may cause a buildup of carbon dioxide and decrease oxygen levels.

Use of Pillows:
Regarding the use of pillows, it is advised that infants should not use pillows while sleeping. Pillows can pose a suffocation risk, as they can elevate the baby's head and create a situation where the infant can roll or slide into a position that obstructs their airway. Instead, a firm mattress with a fitted sheet is all that is needed for a safe sleep environment.

Additional Safe Sleep Practices:
- Room Sharing: It is recommended that infants sleep in the same room as their parents for at least the first six months, but on a separate sleep surface, such as a crib or bassinet. This arrangement can help facilitate breastfeeding and allow parents to monitor their baby more closely.

- Avoiding Overheating: Dress your baby in light sleep clothing and keep the room at a comfortable temperature to prevent overheating, which is another risk factor for SIDS.

- Pacifier Use: Offering a pacifier at nap time and bedtime may also reduce the risk of SIDS, although it should not be forced if the baby does not want it.

- Avoiding Smoke Exposure: Ensure that your baby is in a smoke-free environment, as exposure to smoke increases the risk of SIDS.

In summary, for safe sleep practices, always place your newborn on their back to sleep, avoid using pillows, and create a safe sleep environment free from soft bedding and toys. These practices are essential for reducing the risk of SIDS and ensuring your baby's safety during sleep. If you have any concerns or questions about your baby's sleep habits or health, it's always best to consult with your pediatrician for personalized advice.

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