When Should Children Start Using a Pillow? Expert Advice on Timing and Height

When should a baby start using a pillow?

Hello, doctor.
I have a few questions about when to start using a pillow.
I found information online stating that some say to start at three months, while others say one year or even two years.
What is the recommended height for the pillow in centimeters? Thank you!

Yi Ding, 20~29 year old female. Ask Date: 2014/07/09

Dr. Xiao Kaiwen reply Pediatrics

The American Academy of Pediatrics recommends that cribs should not contain any soft objects, including pillows, stuffed toys, comforters, blankets, wool products, or soft bedding, to prevent the risk of infant suffocation.
Therefore, it is not necessary for infants under one year old to use pillows.
Parents can also refer to the educational guidance section in the back of the pediatric health manual for recommendations on infant sleep positions and sleep environments.

Reply Date: 2014/07/09

More Info

When it comes to the appropriate age for children to start using a pillow, the consensus among pediatric experts is that infants under one year old should not use a pillow at all. The American Academy of Pediatrics (AAP) strongly advises against placing any soft objects, including pillows, in a crib for infants due to the risk of suffocation and Sudden Infant Death Syndrome (SIDS). Therefore, it is generally recommended that babies sleep on a flat, firm surface without any additional cushioning.

For infants, particularly those under the age of one, the primary concern is safety. Babies are still developing their motor skills and may not have the ability to reposition themselves if they accidentally roll onto a soft surface. This is why a pillow is not only unnecessary but potentially dangerous for infants. The AAP suggests that the sleep environment should be free of any soft bedding, including pillows, blankets, and stuffed animals, to minimize the risk of suffocation.

As children grow and reach the age of one, they may begin to transition to using a pillow, but this should be done cautiously. At this stage, a very thin pillow may be introduced if the child seems to need it for comfort. However, it is important to note that many toddlers do not require a pillow at all, as their neck and spine are still developing. If a pillow is used, it should be low-profile and firm to provide adequate support without elevating the child's head too much.

The height of the pillow is also an important consideration. For toddlers, a pillow height of about 2 to 3 inches is generally sufficient. The goal is to maintain a neutral spine position while sleeping. A pillow that is too high can lead to neck strain and misalignment of the spine, which can cause discomfort and potentially lead to long-term issues as the child grows.

In summary, the best practice is to avoid using a pillow for infants under one year old. For toddlers, a thin, firm pillow can be introduced if needed, with a height of about 2 to 3 inches. Parents should always prioritize safety and comfort when making decisions about their child's sleep environment. If there are any concerns about sleep habits or comfort, consulting with a pediatrician is advisable to ensure that the child's needs are being met appropriately.

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