In 1992, The American Academy of Pediatrics recommended that healthy infants sleep on their back or side during the first six months of life. Several studies in other countries found a 5-times increased risk of crib death, or SIDS, in infants sleeping face-down. In 1996, the Academy recommended the back position only. The side position is an unstable one and has twice the risk of SIDS as the back position. Although this change won't eliminate SIDS, it reduced the total number of cases.
Why does the face-down position cause an increased risk of SIDS? The infant sleeping face-down pushes back the jaw bone, and this narrows the airway in the back of the mouth. Also, if the infant is sleeping on a soft surface, the nose and mouth may sink in, leaving the child breathing from a small pocket of stale air.
What type of surface should a small baby sleep on? Use a firm mattress. Never use a soft surface. Everyone now agrees that young infants should never be placed on waterbeds, sheepskin pads, soft pillows, bean-filled pillows or other soft, spongy surfaces. These surfaces are also potentially dangerous to the child who is placed in the crib on his back, since he may roll to the face-down position during the night.
Are there any side effects from always lying on the back? Yes. Lying on the back throughout the day can cause some flattening of the back of the head and also some decreased strength in the shoulder muscles. Avoid these side effects by keeping your infant tummy-down for some of his playtime and waking hours. Remember: the back position is not necessary if your infant is awake and being observed.
In summary, ten years have passed since the recommendation to have infants sleep on their back. Now over 80% of parents follow this advice. Current research shows a 40% drop in the SIDS rate. Provide your baby with this added margin of safety and if you use a child care center, be sure they are aware of your preference.
If you have other questions about sleep position, consult your healthcare provider.
Disclaimer: This information is not intended to be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.
Author and Senior Reviewer: Barton D. Schmitt, M.D. FAAP
Last Review: 6/1/2008
Last Revised: 9/1/2001
Copyright 1994-2008 Barton Schmitt, M.D. Parent Advice Messages.