You carefully put your baby down at bedtime, keeping in mind that “back is best.” However, your little one squirms in their sleep until they’ve managed to roll onto their side. Or maybe your baby refuses to fall asleep at all unless you put them on their side to begin with.
That bundle of joy has turned you into a bundle of worry — and all the warnings about safe sleeping positions and SIDS aren’t helping.
Take a deep breath and look away from the baby monitor for a minute or two. You’re doing a great job even if your baby isn’t a natural-born or serene back sleeper.
It’s true: Back sleeping is best when it comes to babies. Side sleeping can also be safe as your baby grows and gets stronger. You’ll find your baby gets more and more active during sleep as they near their first birthday — which, thankfully, is also when a lot of these sleep-position worries go away. In the meantime, there are several ways to help keep your little sleeping beauty safe.
Here’s a look first at some of the reasoning behind back sleeping for babies — and when it’s safe to allow your little one to side sleep. Spoiler alert: The risks we talk about below do pass, and both you and baby will be sleeping easier before you know it.
Let’s get this beast out of the way from the get-go: Putting babies to sleep on their back is definitely safer than sleeping on the tummy. Stomach sleeping increases the risk of sudden infant death syndrome (SIDS) and suffocation, and it’s an easy roll from side to stomach — gravity means very little effort on baby’s part.
Tummy sleeping isn’t the only factor. The risk of SIDS also rises if:
- mom smokes during pregnancy or baby is around secondhand smoke after birth
- baby is born premature (
fourtimes the risk)
- baby is sleeping in the same bed as the parent(s)
- baby is sleeping in a car seat or on a sofa or couch
- parents drink alcohol or misuse drugs
- baby is bottle-fed instead of breastfed
- there are blankets or toys inside the crib or bassinet
Not all of these are within your control — and for the ones that aren’t, you should never feel guilty or let someone shame you for it. Most babies born prematurely do quite well, and a fed baby — breast or bottle — is a healthy baby.
But that good news is that some of these factors are within your control. First off, the safest place for your newborn to sleep is in your bedroom with you, but in a separate bassinet or crib.
Second, place baby on their back to sleep. Early swaddling is fine — preferable, even, since it mimics the safety and security of the womb — until your little one can roll over. Then, they need to have their arms free to lower suffocation risk should they roll over onto their tummy.
It’s the risk of tummy sleeping that also makes placing your baby on their side to sleep a big no-no at this stage: It’s easier to accidentally roll from side to tummy, even for babies that aren’t yet rolling over intentionally, than it is to roll from back to tummy.
The risk for SIDS is highest in the first 3 months, but it can happen at any time up until the age of 1 year.
You may worry that your baby might choke if they spit up milk or vomit while sleeping on their back. But according to the National Institutes of Health (NIH) — a very reliable source with many years of research behind it — it’s a myth that side sleeping can prevent choking while sleeping.
In fact, NIH says that studies show back sleeping has a lower risk of choking. Babies are better able to clear their airways while sleeping on their backs. They have automatic reflexes that make them cough up or swallow any spit-up that happens, even while sleeping.
Think about how easily your baby burps up spit-up. They’re naturally gifted to be able to do this in their sleep, too!
You may have heard that letting your baby sleep on their back or in only one position can cause a flat or an oddly shaped head, medically known as plagiocephaly.
It’s true that babies are born with softer skulls. (Thank goodness — can you imagine a hard-as-nails head going through the birth canal?) They also have weak neck muscles in the early months of life. This means that sleeping in one position — back or a particular side — for too long may cause some flattening.
This is totally normal and usually goes away by itself. There are also several ways to prevent flat spots from happening in the first place.
Lay your baby on their back for nap time or sleeping. You might notice that they turn their head to look at something interesting rather than just the wall. To see this in action, just place a toy or something bright outside — never inside at this age — the crib or bassinet.
Keep the “view” but change your baby’s head position by alternating positions in the crib, especially if the crib is against a wall:
- Place your baby with their head at the head of the crib.
- The next day, place your baby with their head at the foot of the crib. They’ll likely turn their head the other way to maintain the view into the room.
- Continue alternating in this way.
- Remove any overhead hanging mobile toys so your baby looks to the side and not straight up.
- Check to make sure your baby is lying or sleeping on their back, but has their face turned towards the room.
Give your baby plenty of supervised tummy time during the day. This helps to prevent a flat head and encourages your baby to develop their neck, arm, and upper-body muscles.
So remember, side sleeping isn’t the solution to a flat head, given that a temporary flat head is harmless and more serious risks (like SIDS) exist with side sleeping. Back sleeping with an alternating head position is best.
Torti, what? It may sound unfamiliar, but if you’ve ever woken up with a sprain in your neck from sleeping funny, you already know what torticollis is. Unfortunately, newborns can also get a kind of torticollis (“wry neck”).
It most commonly happens from birth (due to positioning in the womb) but can develop up to 3 months later. When it develops after birth, it can be because your baby sleeps on their side, which is less supportive for the neck and head.
Torticollis in babies can be hard to miss because they don’t yet move their necks very much. But if your sweet little one has this neck condition, you may notice signs like:
- tilting the head in one direction
- preferring to breastfeed on one side only
- moving their eyes to look over their shoulder at you rather than turning their head to follow you
- being unable to turn the head completely
Torticollis can also affect how your baby sleeps. Your baby may prefer sleeping on one side or turning their head to the same side every night to be more comfortable. But this isn’t ideal. Continue to place your baby on their back.
Talk to your baby’s pediatrician if you notice any of the symptoms of torticollis. It can often be treated with neck-strengthening exercises that you do with your baby at home. A physical therapist can also help. You’ll need follow-up appointments with your baby’s doctor.
Harlequin color change happens because blood pools in the smaller blood vessels on the side that the baby is lying on. It goes away as the baby grows.
Avoid letting your baby side sleep to help prevent the color change from happening. The color change is harmless — but remember, there are more serious conditions you’ll be helping to prevent by doing so.
As we’ve mentioned, putting your baby to sleep on their side may make it easier for them to accidently roll over onto their stomachs. This isn’t always safe, especially if your little one is younger than 4 months. At this tender age, babies are often too small to change positions or even lift their heads.
If your baby only falls asleep on their side (under your supervision), gently nudge them onto their back — as soon as you can do so without waking them up!
If your acrobatically gifted baby rolls into a side-sleeping position after you put them down on their back, don’t worry. The American Academy of Pediatrics advises that it’s safe to let your baby sleep on their side if they’re able to comfortably roll over on their own.
After the age of about 4 months, your baby will be stronger and have better motor skills. This means that they can lift their head to explore — this will be fun for both of you! — and roll themselves over when you put them onto their tummy. At this age, it’s safer to let your baby sleep on their side, but only if they ends up in that position on their own.
Bottom line: It’s still safest to lay baby down on their back for nap time and bedtime. Putting your little one to bed on their stomach isn’t safe at any time in the first year of life — and placing them in a side-sleeping position is unfortunately a quick way to get to the stomach. Tummy time is for when your baby is wide awake and ready to exercise with you.
Your baby already has a mind of their own — and you wouldn’t want it any other way. But you do want to prevent them from sleeping on their side before it is safe enough to do so. Try these tips:
- Use a firm sleep surface. Make sure your baby’s crib, bassinet, or playpen has a firm mattress. This means that your baby shouldn’t leave an imprint on it. Avoid softer mattresses that allow your baby to sink in slightly. This makes it easier to roll to the side.
- Use a video baby monitor. Don’t rely on just any kind of monitor; get a direct visual on your baby once they’re in their own room. Monitors may help give you the heads-up that your baby is on the move to side sleeping.
- Swaddle your baby until they can roll over. Wrapping your baby like a burrito may help them sleep more comfortably on their back. Make sure to swaddle loose enough that they can easily move their hips. And know when to stop — swaddling becomes a risk when your baby can roll.
- Try a sleep sack. If your baby can’t stand being swaddled, try a sleep sack. It’s also a good intermediate step. These look like tiny little sleeping bags that your baby wears to sleep. You can find arms-free versions that are safer for babies that can roll, but the sack itself might help your baby stay asleep longer without moving over onto their side.
A safe crib should only have a firm mattress and a tightly fitted sheet. It might seem natural to use an extra pillow or baby positioners to keep your baby on their back while sleeping. After all, most baby car seats have built-in cushions to keep your baby’s head in place.
But the Consumer Product Safety Commission and the Food and Drug Administration advises that using baby positioners during sleep may not be safe. Baby positioners are padded or foam risers that help keep your baby’s head and body in one position. There have been some cases (12 reports in 13 years) of baby positioners causing suffocation while sleeping.
Similarly, avoid other bulky or moveable things in the crib that might get caught between your sweet one and the crib. These include:
- large teddy bears and stuffed toys
- bumper pads
- extra pillows
- extra or bulky blankets
- too much clothing or layers
Back sleeping is best for babies. This sleep position has been proven to prevent SIDS. Most of the other risks of side sleeping — like wry neck or color change — are easily treated, but your precious little one is worth the world to you. Side sleeping isn’t worth the risk.
Side sleeping is usually safe once your baby is older than 4 to 6 months and rolls over on their own after being placed on their back. And always put your baby to sleep on their back until the age of 1 year.
Tell your baby’s pediatrician if you notice a preference for side sleeping in the first three months. And also make an appointment if you’re worried about a flat head — but rest assured, a temporary flat spot won’t take away from your baby’s cute appearance.