Babies should sleep on their back, on a flat and solid surface, with no extra bedding or toys. Once they can roll over independently, they may sleep on their stomachs.

The number one question we have as new parents is universal yet complicated: How in the world do we get this tiny new creature to sleep?

There’s no shortage of advice from well-meaning grandmas, strangers in the grocery store, and friends. “Oh, just flip baby to their belly,” they say. “You slept on your belly back in the day, and you survived.”

Yes, you did survive. But many other babies did not. The struggle to figure out one precise cause for sudden infant death syndrome (SIDS) stumps parents and medical professionals alike. But one thing we know is that we can lower SIDS risk by creating safe sleep conditions.

In 2016, the American Academy of Pediatrics (AAP) released a clear policy statement on safe sleep recommendations to reduce the risk of SIDS. These include placing baby:

  • on a flat and firm surface
  • on their back
  • in a crib or bassinet without any additional pillows, bedding, blankets, or toys
  • in a shared room (not a shared bed)

These recommendations apply to all sleep times, including both naps and overnight. The AAP recommends using a crib or other separate surface free from bumper pads as well, which used to be seen as a safety item — but isn’t anymore.

The million dollar question: What counts as a baby, anyway?

The short answer is 1 year. After a year, SIDS risk drops dramatically in children without health concerns. At this point, for example, your little one can have a light blanket in their crib.

The longer answer is that you should continue putting your baby to bed on their back for as long as they’re in a crib. That doesn’t mean they have to stay that way. If they move themselves into a stomach-sleeping position — even before a year of age — that’s fine. More on that in a minute.

It kind of goes against logic to follow the guidelines — putting the bed in a not-so-cozy environment, away from mom’s snuggly arms, without any comfort objects.

However, the research is pretty clear about the concrete connection between these recommendations and a reduced risk of SIDS, which peaks between 2 and 4 months of age.

The AAP first communicated sleep recommendations in 1992, and the “Back to Sleep” campaign began in 1994, now known as the “Safe to Sleep” movement.

Since the early 1990s, deaths from SIDS decreased from 130.3 deaths per 100,000 live births in 1990 to 35.2 deaths per 100,000 live births in 2018.

Why exactly is belly sleeping a problem, if some babies seem to love it so much? It increases the risk of SIDS, but researchers aren’t entirely sure why.

Some studies suggest upper airway problems like obstruction, which can happen when a baby breathes their own exhaled breath back in. This causes carbon dioxide to build and oxygen to drop.

Breathing in your own exhaled breath can also make it harder for body heat to escape, which causes overheating. (Overheating is a known risk factor of SIDS, though sweating is not.)

The irony is a belly-sleeping baby enters longer periods of deeper sleep, and may be less reactive to noise, which is exactly what every parent dreams of.

However the exact goal parents are reaching for is also what makes it dangerous. Belly sleepers also have sudden decreases in blood pressure and heart rate control.

Basically, it’s kind of safe that a baby comes into lighter sleep frequently and doesn’t seem to go into that uninterrupted sleep cycle we want for them (and for their tired parents).

Myths, busted

One lingering myth is that if you put a baby on their back, they’ll aspirate their own vomit and not be able to breathe. This has been disproven — and there may even be some additional health benefits to back sleeping, such as lowered risks for ear infections, stuffy noses, and fever.

Parents also worry about muscular development and flat spots on the head, but daily tummy time helps combat both concerns.

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Like we mentioned, the guidelines recommend you continue to put your baby to sleep on their back until age 1, even though around 6 months old — or even earlier — they’ll be able to roll over both ways naturally. Once this happens, it’s generally OK to let your little one sleep in this position.

This typically lines up with an age in which the peak of SIDS has passed, although there continues to be some risk until age 1.

To be safe, your baby should be rolling over consistently in both directions, tummy to back and back to tummy, before you start leaving them in their preferred sleeping position.

If they aren’t consistently and intentionally rolling yet but somehow end up on their tummy while sleeping, then yes, hard as it is — you need to gently put them back on their back. Hopefully they won’t stir too much.

Harvey Karp, pediatrician and author of “Happiest Baby on the Block,” has become a vocal advocate for safe sleep, while educating parents on helpful tips to actually accomplish a (semi) restful night.

Swaddling — encouraged by Karp and others — mimics the tight quarters in the womb, and may also help prevent babies from startling themselves awake during their sleep.

A note on safe swaddling

Swaddling has become popular (again) lately, but there are some concerns — such has overheating and hip problems — if done incorrectly. In addition to always placing a swaddled baby on their back in a safe sleep environment free of blankets, pillows, and toys, follow these guidelines:

  • Stop swaddling once baby can roll over or use a sleep sack that allows the arms to be free.
  • Know the signs of overheating (quick breathing, flushed skin, sweat) and avoiding swaddling in warmer weather.
  • Check that you can fit three fingers between your baby’s chest and the swaddle.
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In addition, Karp recommends using loud, rumbling sounds to imitate the womb with a sound machine for naps and sleep.

He has found the side and stomach position to be soothing to babies, and will hold them in those positions while swaying, swinging, and shushing them (but not for actual sleep).

Karp’s methods show how the stomach position, along with his other tricks, activate a calming mechanisms in babies that are up to 3 months old, explaining why some babies would just love to sleep on their stomachs. But once your baby is in a calm, sleepy state, put them to bed on their back.

Talk with your healthcare provider

We don’t really know how many parents put their babies to sleep on their tummies, because it seems to be a secret that people are hesitant to discuss with each other. But online forums suggest it may be a lot.

You’re tired — and that’s a big deal that shouldn’t be ignored — but unfortunately, how baby seems to sleep best isn’t best if it means tummy sleeping before they can roll over (both ways) on their own.

Your doctor is there to help. Talk with them about your frustrations — they can provide tips and tools so that you and baby can both sleep better and with peace of mind.

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In theory, if you’re awake and alert, allowing your little one to nap on your chest isn’t inherently harmful, as long as there is no risk of you falling asleep or being too distracted in any way to ensure a safe situation.

But let’s be honest — as parents of newborns, we’re always prone to nodding off. And baby can roll off of you in an unexpected second.

Other ways parents can help to ensure safety during sleep are:

  • use a pacifier
  • breastfeed if possible
  • ensure baby isn’t overheated
  • keep baby in your room (but not in your bed) for the first year of life

Safety note

Sleep positioners and wedges are not recommended while feeding or sleeping. These padded risers are intended to keep your baby’s head and body in one position, but are not recommended by the Food and Drug Administration due to the risk of SIDS.

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Stomach sleeping is fine if your little one gets themselves into that position after being put to sleep on their back in a safe environment — and after proving to you that they can consistently roll both ways.

Before baby hits this milestone, though, the research is clear: They should sleep on their back.

This can be hard at 2 a.m. when all you want for you and your baby is a little shut-eye. But in the end, the benefits outweigh the risks. And before you know it, the newborn phase will pass, and they’ll be able to choose a sleeping position that contributes to more restful nights for both of you.