Back to Sleep: The Best Bedtime Position for Baby
The what, why, and how of infant sleeping positions
Are There Any Downsides to Back-Sleeping?
The number-one problem with back sleeping is the possibility of developing a misshapen head, from lying on the same spot on a still somewhat soft skull all the time.
Back sleeping may cause flat spots on the back of the head, which you may hear called by its fancy name, positional plagiocephaly. This is a cosmetic concern that rarely requires surgical intervention. According to Dr. Sadler, “There are no neurological problems associated with positional plagiocephaly. Development is indeed normal, and in the vast majority of cases the asymmetry resolves as the infant spends more time upright, rolls over in bed on his/her own, and spends less time sleeping. It only becomes a cosmetic issue when the molding is severe, or when the child is approaching the age of two when the growth of the head is 75 percent to 80 percent complete.”
Most health insurance plans won’t cover treatment for cosmetic problems like an asymmetrical head if it is not causing a health problem, so parents should be alert to this possible side effect of back sleeping, and take preventive measures.
Changes in head shape can usually be prevented or treated by alternating the head position (facing left or right) during sleep from week to week or day to day. Changing the baby’s orientation to outside activity such as the door to the room often accomplishes this. Changing the placement of interesting things such as mobiles or mirrors beside the crib can also entice Baby to look the other way. Babies should also spend time on their stomachs when they are awake. In extreme cases where the asymmetry is noticeable and the baby resists measures to change head position, a pressure-distributing helmet can be used during sleep, but this has largely fallen out of favor.
Another problem that can plague parents is a baby who seems to refuse to sleep on his back. The AAP used to suggest side sleeping in such cases, which didn’t seem to reduce the SIDS risk as much as back sleeping but was at least a big improvement over tummy sleeping, but since 2005 the organization has not recommended side sleeping. Dr. Sadler observes that “many, many children have slept on their stomachs and done fine.” “However, any increased risk isn’t worth it when it comes to a child,” she says, “so I’d encourage you to keep Baby on his back—despite the wails—at least until he is well past six months old.”
One remedy for both of these problems is a lot of tummy time. Time spent on her belly, holding her head up, kicking her feet, reaching for objects around her, or playing with textural parts of a play mat give Baby’s head a break from pressure on the skull. They also provide mental stimulation and physical exertion, both of which should help her sleep better when her next naptime rolls around.
What Other Sleep Recommendations Do Experts Give?
The AAP policy recommends back sleeping first and foremost for babies. But its other recommendations for healthy sleep include these:
- A firm sleeping surface is safest (such as a firm mattress covered by a sheet). Fluffy mattress covers or sheepskins should be avoided for sleeping.
- Skip loose bedding and stuffed animals. Make sure any crib bumpers are thin, firm, and securely attached to the crib sides.
- Don’t smoke during pregnancy, and don’t allow smoking in the house where the newborn lives. Likewise avoid other smoky situations (such as a daycare provider’s) for the baby.
- Co-sleep safely. While there are many proponents of co-sleeping in Mom and Dad’s bed, the AAP’s recommendation is to let an infant sleep in the same room but not the same bed. A “sideca” arrangement or bassinet or crib in the mother’s room is what the AAP deems safest, with the baby in the adults’ bed only for nursing and comforting.
- Offer a pacifier at sleep time: It seems correlated with lower SIDS incidence. You might wait a few weeks to start this, so as not to add any confusion to breastfeeding habits. Offer the pacifier before laying the baby down. Don’t try to insert it after Baby is asleep, and if Baby refuses it don’t force it. The pacifier may help make Baby more arousable or hold the mouth in position to keep the airways open. Using it up to one year of age should not interfere with dental structure.
- Avoid overheating the room or overdressing the baby.
- Save your money and don’t buy devices that are promoted as SIDS prevention. None have been tested rigorously enough to stand up to the claim, according to the AAP.
- Likewise, don’t rely on audio, video, or movement monitors to prevent SIDS. There is no evidence that their use reduces the incidence of SIDS.
Watch for and take the measures noted above to prevent a misshapen head on your happy, healthy, back-sleeping baby.
YOU MIGHT BE INTERESTED IN