Sleeping Position – Why the Back is Best

The American Academy of Paediatrics recommends that healthy infants be placed on their backs to sleep, as this is the safest sleeping position for babies. Sleeping on the back reduces the risk of Sudden Infant Death Syndrome (SIDS), which is responsible for more infant deaths in the United States than any other cause during the first year of life. Although SIDS is not fully understood, research suggests that infants who sleep on their stomachs may receive less oxygen or expel less carbon dioxide because they can “rebreathe” air trapped in a small pocket of bedding around the nose.

This recommendation applies throughout the first year of life, but it is especially important during the first six months, when the risk of SIDS is highest.

Avoid placing babies on soft or porous surfaces such as pillows, quilts or comforters, sheepskins, or beanbags, as these can obstruct the airway if the baby sinks into them. A firm mattress covered with a fitted sheet is the safest option. Keep all soft toys and stuffed animals out of the cot throughout infancy. Cot bumpers can also interfere with breathing and should be avoided.

Use appropriate sleep clothing, such as a one-piece sleeper or babygrow, without additional loose coverings. If extra warmth is needed, a wearable blanket, such as a sleep sack, is a safe alternative.

Despite common beliefs, there is no evidence that choking is more common in infants who sleep on their backs compared with other positions, nor is there evidence that back sleeping is harmful to healthy babies. Since the American Academy of Paediatrics began recommending this sleep position in 1992, the annual rate of SIDS has declined by more than 50%.