When Can Babies Sleep On Their Stomach (Q&A)

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When can babies sleep on their stomach

We’ve all heard that it’s safest for our babies to sleep on their backs.  Yet some babies seem to sleep best on their stomach.  We might attempt a stomach or side-sleeping position every now and then, feeling guilty and grateful in turn for some sound sleep.  This begs the question, how important is it really that babies avoid sleeping on their stomach?  And when can babies sleep on their stomach?

Stomach Sleeping and SIDS

Sudden Infant Death Syndrome (SIDS) is the unexplained death of an infant younger than 1 year of age.  It’s most common between 1 and 4 months of age.  In 1991, studies began to show a significant link between SIDS and stomach sleeping.  Large-scale studies about infant sleep practices began to emerge and the trend became more clear.  Babies who slept on their stomach were at a greater risk of SIDS.

Back in 1994, the National Institute of Health (NIH) started a campaign, Back to Sleep, to teach people how to reduce the risk of SIDS.  Hospitals were trained in safe sleeping habits, and public service announcements blasted the news to parents. As more and more babies were put to sleep on their backs, SIDS cases clearly decreased.

Back Sleeping and SIDS Rate

When can babies sleep on their stomach - SIDS and NPR

Source: CDC’s National Center for Health Statistics; National Infant Sleep Position Study Credit for Graphic: NPR (https://www.npr.org/2011/07/15/137859024/rethinking-sids-many-deaths-no-longer-a-mystery)

What About Stomach Sleeping Makes It Risky?

When can babies sleep on their stomach-risks of stomach sleeping

You’ve noticed that your baby sleeps more soundly on his stomach.  And this is probably true!  However, it’s possible that the sound sleep contributes to SIDS.  Compared with infants who sleep on their backs, infants who sleep on their stomachs:

  • Are less responsive to noise
  • Move less
  • Are harder to wake up
  • Have longer periods of deep sleep

The exact reason why stomach sleeping might lead to SIDS isn’t clear.  But studies suggest the following can occur when babies sleep on their stomachs:

  • More likely that baby re-breathes his own exhaled breath,  leading to carbon dioxide buildup and lower oxygen levels
  • Upper airway obstruction
  • More likely to overheat

Stomach Sleeping & Choking

When Can Babies Sleep On Their Stomach - risks of stomach sleeping

Image Credit: Safe to Sleep®

One fear that parents have a hard time shaking is, “What if my baby spits up while sleeping on his back?  Won’t he choke?”

Studies have found that back sleeping does not actually increase the risk of choking.  In fact, babies may actually be better able to clear fluids while on their backs.

In a back sleeping position, the trachea lies on top of the esophagus.  Any spit-up would have to work against gravity to enter baby’s lungs through the trachea.  In a stomach sleeping position, the spit-up would pool at the opening of the trachea, making it easier for baby to choke.

When Can Babies Sleep On Their Stomach?

Ok, ok, I get it!  It’s safest for babies to sleep on their back.  But when can babies sleep on their stomach?!!!

I think the following recommendation from the NIH is helpful:

Most babies start rolling over on their own around 4 to 6 months of age. If your baby rolls over on his or her own during sleep, you do not need to turn the baby back over onto his or her back. The important thing is that your baby start every sleep time on his or her back to reduce the risk of SIDS.

Here’s how I read this:

  1.  Start your baby to sleep on their back
  2. If your baby is old enough (at least 4-6 months old) to roll from front to back on their own, it’s safe for them to remain in the sleep position they choose

Other Safe Stomach Sleeping Habits:

Assuming your baby is now old enough and turning well enough to sleep on his stomach, here are a few more safety tidbits to remember:

  • Use a firm sleep surface
  • Do not put anything else in the crib with baby (ie. toys, pillows, blankets, bumpers)
  • Avoid overheating baby
  • Keep your baby away from cigarette smoke
When can babies sleep on their stomach - safe sleeping infographic

Graphic from Safe Sleep®

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References:
National Institute of Child and Human Development Safe To Sleep® Campaign.  Retrieved from https://www1.nichd.nih.gov/sts/Pages/default.aspx