Are there adverse effects if an infant sleeps on his/her back all the time?
Back sleepers are less likely to sleep 14 hours a night at 6 months of age than tummy sleepers.
Positional head molding is more common in back sleepers. This can be avoided if your baby spends time on his/her tummy while awake.
Back sleepers attain early motor milestones at a later age than tummy sleepers, including those that involve use of the upper body muscles (rolling, creeping, crawling, pulling to a standing position). Placing baby on his/her tummy while awake may help back-sleepers develop upper-body muscle strength earlier.
Isn't an infant more likely to choke or aspirate when s/he sleeps on his/her back?
Multiple studies in countries that have had more experience with back sleeping than the US has had, have not shown any increase in the rate of choking or aspiration in the back position.
Is it all right to let baby sleep on his/her belly for naps when parents are awake?
NO. Infants do die of SIDS during daytime naps. The only time baby should be on his/her tummy is while baby is awake.
Doesn't an infant sleep better on his/her tummy?
There is good evidence that babies sleep longer and more deeply when on their tummies. This may be precisely what makes tummy sleeping dangerous: Infants may not arouse in response to hypoxia or hypercarbia. Your baby will get used to sleeping on his/her back, and will then prefer that position.
My baby is 2 months old and still awakens every two hours. Can I put him/her to sleep on her belly so that I can get a good night's rest?
Babies who are not used to sleeping on their tummies are at extremely high risk of SIDS when placed on their tummy - as much as 19 times the risk compared to back sleepers. It is thought that this is because these infants have not developed their upper-body muscle strength as well, and are unable to lift or move their head as easily while prone.
Unaccustomed prone sleeping may be partly responsible for the high-risk period at 2-4 months of age. It may also help explain why so many SIDS deaths occur in child care.
What do I tell a babysitter that insists babies sleep better on their tummies?
Do not let the babysitter place the baby on his/her tummy for naps or nighttime. See answer to above question. It is very important to talk to babysitters - whether relative, child care provider, etc - the importance of back sleeping.
A full 20% of SIDS deaths occur in child care!
It seems easier to breast feed if baby sleeps in parent's bed. Is co-sleeping okay?
Co-sleeping may promote breast feeding, minimize tummy infant sleeping, and increase parent and infant arousal, but it may also result in overheating and excessive exposure to passive smoke. Baby may also be sleeping on a soft mattress with pillows and quilts and may be at risk of entrapment between the bed and wall or headboard.
The American Academy of Pediatrics states that co-sleeping does not protect against SIDS and may increase the risk of accidental suffocation. However, many pediatricians and parents strongly advocate co-sleeping. If parents choose to share their bed with their baby, they should follow these guidelines:
Place your baby on his/her back to sleep.
Be aware of the risk of entrapment - adult beds are not designed to meet child safety standards.
Be aware of suffocation risks. Avoid soft sleep surfaces, quilts, and pillows, for example.
Refrain from smoking or using substances that may impair arousal (drugs, alcohol).
What about mattresses that are advertised as guarding against SIDS? And wedges that manufacturers claim keep babies on their sides?
Several manufacturers have marketed ventilated mattresses and wedges designed to keep babies supine or in the side position. There is no evidence that these products prevent SIDS; wedges have not even been studied.
Do pacifiers protect against SIDS?
Several studies have reported a 2- to 3-fold decrease in the incidence of SIDS among babies who use a pacifier. However, pacifiers are also associated with shortened duration of breast feeding, an increase in the risk of repeated ear infections, and an increase in the risk of dental malocclusion.
Back sleeping seems too extreme . . Isn't side sleeping a good compromise?
If you prefer side sleeping, keep in mind what has been borne out by research: A baby who sleeps on his/her side is at twice the risk of SIDS as a baby who sleeps on his/her back. The side position is an unstable one; a baby can roll into the prone position.
My baby does not seem to sleep very long when flat on his back. Can I let him sleep in his car seat in his crib?
Babies who frequently spit up, or have hiccups, or who have a cough or nasal congestion, or who have colic, often sleep better on their backs when their sleeping surface is at a mild slant - of about 30 degrees.
The best way to do this is to slant the crib mattress by adjusting the crib "notches" so that the head side is one notch higher than the foot side. If the crib does not have notches, or your baby sleeps in a bassinet, then slant the entire crib or bassinet, by placing bricks under the legs of the head side. Wedging only the mattress with a pillow or prop could create enough space for entrapment to occur. A car seat in a crib could also be a cause for entrapment and suffocation, especially in babies 4-6 months or older.
A note of caution for babies under 2 months of age: premature newborns (born 3 or more weeks early) and even some full term babies, do not breathe as well with their head elevated, especially in a car seat. Car seats tend to give more than a 30 degree slant and they encourage the baby to sleep "curled up" rather than flat. A newborn's neck is often too crimped when s/he sleeps in an infant seat or swing, etc.
