Always put your baby down to sleep on their back (with a word about rolling and reflux, too)
Why does knowing about baby sleep safety matter so much?
Suddenly, you are responsible for the well-being of a precious little human, which can feel quite overwhelming at times! Sudden Infant Death Syndrome (SIDS) and Sudden Unexpected Death in Infancy (SUDI) can be hard to talk about, because the thought of any precious little baby dying is distressing. But some things are important to know, so that you can protect your baby against SIDS or SUDI, as much as is possible.
Our babies are at increased risk of SIDS or SUDI throughout the first year of life, with greater risk in the first six months of life, and the highest risk between two and four months of age. It's thought there are three main things that contribute to SIDS or SUDI.
Some babies seem less able to arouse during sleep and recover when these dangers arise, for reasons that relate to genetic or other vulnerabilties, outside our control.
Smoking cigarettes either during pregnancy or after baby has arrived, whether from tobacco or e-cigarettes (vaping), is a big risk factor for SIDS or SUDI. It seems that cigarette smoke exposure (through the mother's bloodstream or by baby directly inhaling it) affects babies' internal regulation pathways, and makes them less likely to arouse and recover if they face the danger of one of the three main things (above) that contribute to SIDS or SUDI.
Once you know about these three things, plus the risk of exposure to cigarette smoke, recommendations about how to sleep your baby as safely as possible make sense.
Always place your baby on her back to sleep
Putting your baby on her back to sleep is the first step towards keeping her as safe as possible. There is no need to use any special wedges or equipment to keep your baby on her back while she sleeps.
When babies sleep on their side or on their tummy, they are at increased risk of SIDS. This is because they are more likely to re-breathe carbon dioxide or to have their airway accidentally block off when they sleep on their sides or tummy.
What to do when your baby can roll onto his tummy
Once your baby is able to roll from his tummy to his back, you can let him find his own sleep position. Babies often roll from their tummy to their back before they roll from back to tummy.
Sometimes, though, a baby might reach an in-between stage of being able to roll on to her tummy, but is unable to roll herself from her tummy onto her back again. You don't need to worry. This too is a normal part of development. Your job is to
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Put her down to sleep on her back
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Put her down in the same room you're in for at least the first 6 months of her life, and ideally for the first year
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Roll her onto her back when you notice she has rolled on to her tummy or side.
But don't feel you have to make special efforts to check on your baby frequently whenever he sleeps because he's rolling but still can't get from his tummy to his back. There's no reason to think that frequent checking makes your baby any safer while he's still learning to roll from front to back. If your baby can roll onto his tummy, he's developed to a stage where he's better able to protect his own airway. Worrying and feeling that you have to check very frequently while your baby sleeps places a lot of strain on you, without evidence of benefit, which is not good for anyone.
Babies develop motor skills at different rates. Your baby doesn't need to do any special exercises to develop muscle control faster. (Remember though that tummy time, which you can offer in different ways, is good for babies.)
Will your baby inhale reflux if she is sleeping on her back?
The fluid that comes up from your baby's stomach with a puke or vomit is known as reflux. It is normal for babies to bring up reflux from their tummies. Sometimes you hear baby's reflux being swallowed back down. Often it comes out of your baby's mouth as a vomit.
Parents often worry that putting their baby down to sleep on their back means baby will choke if she pukes or vomits. However, it's the other way around: your baby has an increased risk of choking and airways blockage if she is on her tummy! This is because the food pipe or oeophagus is towards her back, closer to her spine.
If your baby is lying on her back, gravity helps any reflux fall backwards where it is more likely to be swallowed down, and less likely to irritate the entry into the airways. The larynx and trachea are at the front, closer to your baby's chin. If your baby is lying on her tummy, reflux falls forward with gravity, and is more likely to be inhaled into the airways or irritate the airways and cause baby's larynx to close up, at least for a moment.
Of course, your baby's airway protection reflexes still kick in when your baby refluxes on his back, and you might hear gagging or coughing sometimes. These are signs that your baby's reflexes are working well!
There is no need to raise the head of your baby's cot, or to put a wedge under your baby, to try to stop reflux happening. These don't make any difference to your baby's reflux, but can make it more likely that your baby ends up in an unsafe sleeping position.
Acknowledgements
The image below comes from the Baby Sleep Info Source basisonline.org.uk, and was taken by Beverley Latter.
Recommended resources
The website Baby Sleep Information Source, by the Durham Infancy and Sleep Centre UK, is the world's leading source of information and photographs for parents about safer infant sleep.
You might be interested in a podcast conversation I had with Professor Helen Ball in which we discuss sleeping babies safely here.
How to keep the place where your baby sleeps as safe as possible
When your breastfeeding or breast milk feeding baby comes into bed with you
When your formula-feeding baby comes into bed with you
What about bedsharing when you have a baby whose breathing is more vulnerable?
How to keep your baby at the right temperature in the night
Wrapping or swaddling your baby: how to do it safely and does it help with sleep, anyway?
Why is there so much conflicting advice about bringing your baby into bed?
Selected references
Cole R, Young J, Kearney L, Thompson JM. Infant care practices, caregiver awareness of safe sleep advice and barriers to implementation: a scoping review. International Journal of Environmental Research and Public Health. 2022;19:7712.
Queensland Clinical Guidelines. Safer infant sleeping. Guideline No. MN22.71-V1-R27. Queensland Health. 2022. Available from: http://www.health.qld.gov.au/qcg