Is it safer for babies to sleep on their back, side or tummy

A little one spends a big part of the day asleep. Until the first bigger movements arrive around 4 to 6 months, they will stay in the position you put them down in. Once they can wriggle and roll, they will choose the posture that feels most comfortable. At that point it matters less how you lay them down because they can change position any time.

Opinions on sleep positions differ, but current professional guidance from the WHO and the American Academy of Pediatrics says back sleeping is safer for babies. Every baby has different needs. It helps to adapt to these because their comfort and restful sleep come first. It is also useful to understand the pros and cons of each position. Here is a simple overview.

Back sleeping 

A baby sleeping on their back can breathe freely because the chest and tummy are not compressed and the airways are clear. Their face is away from the mattress, which adds to safety.
Because this posture gives the most freedom of movement, a baby may startle and rouse when their limbs move unintentionally. On their back they also see the most visual input from the world which helps development, but can sometimes make nodding off harder. Even so, back sleeping is the most common because it is comfortable, safe and lets a parent see their baby’s face. Not sleeping too deeply can be a downside in one sense, but it can help reduce the risk of long breathing pauses.

Tummy sleeping 

Many parents like tummy sleeping because babies often sleep more soundly in this pose. The gentle pressure on the tummy relaxes them, which can be especially helpful in a colicky spell. If a baby brings up milk, it can flow out of the mouth more easily. If your baby spits up often, place an absorbent cloth under the head. Parents also like tummy sleeping because the back muscles work more and babies start lifting their head in this position.

We must add that most cases of SIDS happen in the tummy position and the exact reasons are still unknown. In the first weeks babies have limited movement. If they do not get enough oxygen they cannot always turn their head and are helpless. Babies also sleep more deeply and can overheat more easily on their tummy. If certain other factors are present as well underdeveloped breathing control, sleep wake regulation problems, tone issues, low oxygen at birth, prematurity and breathing pauses of around 20 seconds can occur which raises the risk of SIDS.

Side sleeping 

With safe support preferably a purpose made side sleeping cushion this position is not only comfortable but also keeps breathing clear and lets milk dribble out if there is a spit up. It adds variety to sleep postures, so many parents like to alternate right and left.
Too much time on the back can flatten the back of the head. Alternating side sleeping can help correct this cosmetic issue

The natural foetal curl 

From around 30 weeks in the womb, as space gets tighter, babies curl up in a foetal position until birth. This is so natural for them that after birth they often like to sleep with knees drawn up. The familiar posture calms them and they can sleep deeply. There are baby cushions that help a little one safely take up this position.

The most common worries 

• With back sleeping the top worry is usually choking if milk comes back up. This is uncommon and the risk can be reduced with good winding after feeds.
• Side sleeping is often avoided for fear of rolling over. A well designed support cushion can help keep a stable posture.
• Tummy sleeping raises concerns about pauses in breathing. Using a baby breathing monitor in this position is advised and can reassure parents.

Watch your baby’s reactions 

The best guide is careful observation in the first weeks in all positions.
How do they most like to sleep. When is their sleep the deepest. When do they wake refreshed.
Make sure the other conditions are calming too quiet room, comfortable temperature, breathable comfy clothing.

It is worth alternating positions so things are not one sided for the body which also benefits the spine, movement and head shape. Try positions again from time to time that they did not like before. As time passes they may accept them. When they reach 4 to 6 months they will choose their own sleep positions anyway.

Safety notes 

All sleep positions have pros and cons. The downsides are most often about safety. Learn the risks, weigh them up and take the right precautions.

Extra care with tummy sleeping 

If your baby is not in a higher risk group for SIDS low oxygen at birth, prematurity and prefers tummy sleep, you can lower risks by following these points:

• Use a firm mattress

• No dummy in the mouth during sleep

• Keep toys, loose textiles and pillows out of the cot

• Use a breathing monitor for every sleep

• Learn infant CPR

• Do not overdress your baby

• Alternate side sleeping

• Never leave your baby unsupervised

Keep blankets away from the face 

A newborn cannot move a blanket away, but soon enough an increasingly wriggly baby can pull one over themselves by accident. This can startle them and you will see arms and legs flailing. To avoid trouble, secure the bottom edge of a light blanket to the cot with a few simple clips made for this purpose until rolling begins. A firmer weave blanket is less likely to mould tightly to the face if pulled up, so it is safer than a very floppy one.

Avoid overheating 

If the room is too warm, the blanket too thick or the clothing not breathable, a baby can overheat. Keep an eye on the room temperature and air the space if needed. Choose breathable babywear and avoid overdressing.

If you want a solution that prevents overheating and also stops a blanket being pulled over the face, look at LiaaBébé bamboo sleeping bags. Their breathable, thermo regulating fabric helps avoid overheating and the neckline that follows the neck adds safety.

If you want tummy time but prefer not to use it for sleep 

You can still give your baby the movement benefits of tummy time in the daytime while they are awake, which also motivates them with sights and sounds to lift the head, then prop on the forearms.

There are only a few common positions families use. By watching your baby’s needs and weighing up pros and cons, you will find a comfortable solution. And remember what is rejected today may be liked in a few weeks.

Sources:

The Lullaby Trust – Sleeping position

NHS – Helping your baby to sleep