1. Back to Sleep
BACK TO SLEEP FAST FACTS
- Before 1992, 8,000 to 10,000 babies died every year due to sleep-related causes.
- Infant Sleep-related deaths declined by 50% once parents began placing their babies on their back to sleep instead of on their tummy.
- Back sleeping reduces the risk of death due to suffocation and Sudden Infant Death Syndrome (SIDS).
- Babies are less likely to choke when sleeping on their back than on their tummy.
Continue reading below to learn more…
STEP 1
Place baby on their back
to sleep for every sleep.
BACK TO SLEEP FAST FACTS
- Before 1992, 8,000 to 10,000 babies died every year due to sleep-related causes.
- Infant Sleep-related deaths declined by 50% once parents began placing their babies on their back to sleep instead of on their tummy.
- Back sleeping reduces the risk of death due to suffocation and Sudden Infant Death Syndrome (SIDS).
- Babies are less likely to choke when sleeping on their back than on their tummy.
Continue reading below to learn more…
Why Back to Sleep?
Before 1992, caregivers were told to put babies on their tummies to sleep. This was because people believed it was safer, thinking it reduced choking and helped babies sleep longer and deeper.
In 1992, the American Academy of Pediatrics (AAP) reviewed studies and evidence from other countries, like Australia, where switching to back sleeping led to fewer infant deaths. The AAP initially recommended back or side sleeping, and the U.S. saw a similar drop in SIDS rates.
By 1994, the AAP updated their guidance to recommend only back sleeping, as babies placed on their sides could easily roll onto their stomachs, increasing the risk of SIDS.
The “Back to Sleep” campaign launched that year and reduced SIDS rates in the U.S. by over 50%, saving thousands of lives by promoting the back-sleeping position.
What makes tummy sleeping dangerous?
Suffocation
Back sleeping reduces the risk of suffocation. When babies sleep on their backs, their airways remain open and unobstructed. When babies sleep on their tummies, they are more likely to suffocate as their nose and mouth can become pressed against the mattress and/or bedding.
Rebreathing
The side or stomach sleep position can increase the risk of a baby rebreathing their own exhaled air, which leads to low oxygen levels and death.
Rebreathing explains that when a baby lies face-down or near face-down, exhaled air (carbon dioxide) can get trapped near their nose or mouth. As the baby continues to breathe, they may take in more carbon dioxide instead of fresh oxygen. If the baby doesn’t wake up or adjust their position, this can be life-threatening.
The risk is even greater if the baby is on a soft surface or in a smoke-filled environment.
Watch the video from Professor David Greenblatt for a clear explanation of rebreathing.
Choking (Aspiration)
Many caregivers worry that babies might choke while sleeping on their backs. In the past, doctors thought stomach sleeping was safer because they believed it reduced the risk of choking if a baby spit up or vomited. However, research and science have proven this idea wrong.
When babies sleep on their backs, the esophagus (the tube for swallowing) is below the trachea (the airway). If a baby spits up, the liquid comes out of their mouth, and gravity pulls any leftover liquid back into the esophagus. This means it is swallowed and goes where it belongs.
When babies sleep on their stomachs, the trachea is below the esophagus. In this position, spit-up can flow into the trachea and get stuck in the lungs. This is called aspiration, and it is very dangerous.
In addition, healthy, full-term babies have natural reflexes to protect their airways. They automatically turn their heads, cough, or swallow to keep fluids away from their airway.
We now know that because of our anatomy, babies are more likely to choke or aspirate when sleeping on their stomachs than on their backs.
Watch the video to better understand how our anatomy works.
Arousability
Arousability refers to a baby’s likelihood or ability to wake up one their own. A baby can be considered more or less arousable when in sleeping in certain positions.
Less Arousable = More difficult to wake up
More Arousable = Easier to wake up
When babies sleep on their backs, the baby is more arousable. This means that baby can wake up more easily if something is wrong, such as if they are having difficulty breathing, or their oxygen levels drop. The ability to wake up is a natural defense mechanism and allows the baby to adjust their position, cry for help, or restore normal breathing.
When babies sleep on their stomachs, they are more difficult to wake up because the stomach position make them less arousable. This deeper sleep can prevent them from responding to environmental dangers, such as rebreathing their exhaled carbon dioxide or move their head to respond their airway being obstructed.
Temperature Regulation
Overheating is a risk factor for Sudden Infant Death Syndrome. Overheating can increase a baby’s arousal threshold and makes it harder for them to wake up if they are having difficulty breathing. When a baby sleeps on their stomach, heat will become trapped between the baby’s stomach and the mattress or bedding. Back sleeping allows the heat to escape more easily from the chest and abdomen, which helps to keep the baby’s body temperature regulated.
Dressing your baby appropriately for sleep is another way to help with temperature regulation. Read more about dressing your baby for sleep here.
Unaccustomed Tummy Sleeping
Unaccustomed Tummy position is when a baby who is usually placed on their back to sleep is placed on their stomach for sleep. Unaccustomed Tummy Sleeping significantly increases the risk of death – up to 18 times greater risk! – due to Sudden Infant Death Syndrome (SIDS).
This is because babies who are placed on their stomachs are at a higher risk of rebreathing, their arousal threshold will be higher, and babies who are not used to sleeping on their stomach may not have developed the muscle strength or head-turn habits to protect their airway while lying on their stomachs, so they are more likely to suffocate.
To avoid unaccustomed Tummy Sleeping, always place your baby on their back to sleep and make sure you spread the safe sleep message with all caregivers, including grandparents, babysitters, and daycare providers, to ensure consistency. Learn more about spreading the safe sleep message here.
What should I do if my baby is rolling over?
As your baby grows stronger and gains muscle control, they will begin to roll over. Once babies can roll over independently, they do not need to be repositioned onto their back during sleep. However, caregivers should always place babies on their back at the start of every sleep time.
When a baby is able to roll, it is fine for them to sleep on their stomach if they roll into that position on their own. At this stage, babies have developed the strength and reflexes needed to lift and turn their heads to keep their airway clear, reducing the risk of suffocation and rebreathing.
By this point, babies also have more mature reflexes, such as coughing, swallowing, and waking up if their breathing is disrupted, providing an added layer of protection.
Even after a baby starts rolling, it is crucial to maintain a safe sleep environment and ensure they are dressed safely for sleep. Always ensure the crib or sleep space is free of soft bedding, loose blankets, pillows, and stuffed animals. Learn more about creating a safe sleep environment here.
Remember: Always Place your baby on their back to sleep, but if they begin to roll, they do not need to be repositioned as long as they are in a safe sleeping environment.