Partners in Pediatrics

Back to sleep, tummy to play

Why should babies sleep on their backs?

The American Academy of Pediatrics has recommended the following to help reduce the risk of Sudden Infant Death Syndrome (SIDS) and other sleep related infant deaths, such as suffocation.

  • All healthy babies should sleep on their backs, in a safety approved crib bassinet or play yard on a firm mattress covered by a fitted sheet.
  • Keep the head of the crib flat, unless the doctor gives other instructions because of your child’s medical condition.
  • Keep loose bedding (pillows, blankets, bumpers) and soft toys out of the crib.
  • Consider using a wearable blanket to keep baby warm for sleep rather than a loose blanket
  • Keep baby in the same room-not the same bed. Babies and children younger than 2 years should not sleep in the same bed with anyone else, due to the risk of suffocation.  If you bring baby to bed to breastfeed place him back in his own crib, bassinet or pack and play when you are finished.
  • A pacifier is okay when settling to sleep. When it falls out after your baby is asleep, leave it out.
  • Babies who can roll over should be put to bed on their backs, but allowed to change positions as they like. You don’t need to roll them back.

How does sleeping on the back affect my baby?

As a result of these recommendations, the SIDS rate has dropped almost 50 percent. During this same time, however, plagiocephaly (head flattening) and torticollis (a one-sided tightness in neck muscles) have increased.

Some babies tend to keep their heads in a favorite position while on their backs. This can affect their development. It makes it hard for them to strengthen their neck muscles evenly, and hard to learn to use both sides of their body.

How can I prevent these problems?

Sleeping

Place your baby on the back to sleep, alternating head position so not always lying on the same side of the head. Or alternate positions in the crib (feet toward one end, then the other end) so your baby needs to turn the head to look toward activity in the room.

If your baby always lies on one side of the head, try changing the direction of the crib or move things in the room that your baby likes to look at.

Some products claim to be designed to keep a baby in one position. These products have not been tested for safety and are not recommended.

Equipment

Limit the use of toys such as swings, infant seats, and exercise saucers. Always use a car seat for travel, but take your baby out of it as soon as the trip is over. When awake, babies need to be held, or on the floor exploring and developing motor skills as much as possible.

Tummy time

When baby is awake and you are watching her, your baby should spend plenty of time on the tummy. Tummy time strengthens the back, neck, and arm muscles, which are needed for holding the head upright, rolling, sitting, and crawling. Tummy time is also good for visual and mental stimulation because your baby is encouraged to look around to explore the surroundings.

The sooner you start tummy time, the sooner your baby will get used to it, benefit from it, and come to enjoy it. Babies who have not spent much time on their tummies may need extra encouragement and practice to get used to it. Here are some ideas to help your baby learn to enjoy tummy time. Remember, tummy time should always be supervised – never leave baby alone on her tummy or on these positioning products.

  • It works best if your baby is well rested and happy before trying tummy time.
  • Start with 5 minutes of tummy time every time your baby is awake and slowly work up to 20 minutes.
  • Put your baby’s favorite toys within reach. Play some favorite music.
    • Put a mirror in front of your baby.
  • Your baby will need to first develop the strength and experience to lift the head and play. If playing on the floor is challenging, propping your baby at an angle can make it easier to lift the head. You can use:
    • a small pillow (such as a Boppy® pillow).
    • a towel roll under the arms and chest.
    • a foam wedge.
    • Baby can lie across your legs while you’re sitting, or on your chest while you’re leaning against the couch or lying on your back against a pillow. Your baby will love feeling the warmth of your body and your heartbeat.
      • Get down on the floor in front of your baby and sing or talk face to face.
      • If getting tired, you can roll your baby onto the back to rest for a moment, or carry for a while, and then try tummy time again.

Be patient. Your baby may be challenged a bit at first, but it is important to keep trying. As your child gets stronger, tummy time will be more fun. The benefits are worth it.

What else do I need to know?

Talk with grandparents, child-care providers, and babysitters. Make sure everyone who cares for your baby knows about safe sleep:

  • Every sleep time counts! Put baby on his or her back for sleep in a safety-approved crib.
  • Keep soft items out of the bed:
    • No pillows
    • No blankets
    • No bumper pads
    • No toys
  • Put your baby on the tummy to play during supervised awake time.

Questions?

This sheet is not specific to your baby, but provides general information. For more information about sleep positions or SIDS, please talk to your health care team.

Reviewed 6/2017