Is it safe for newborns to lay on their stomachs?

Newborn Sleep Position Safety

Newborns should only be placed on their stomachs when they are awake and supervised, but should always be placed on their backs for sleep to reduce the risk of Sudden Infant Death Syndrome (SIDS). 1

Safe Sleep Positioning for Newborns

Back to Sleep for Every Sleep

• Infants should be placed in a supine position (wholly on the back) for every sleep by every caregiver until the child reaches 1 year of age 1
• Side sleeping is not safe and is not advised as it is inherently unstable and increases the risk of the infant rolling to the prone position 1
• The supine sleep position has been associated with a more than 40% decrease in SIDS rates since recommendations were implemented 2, 3

When Prone (Stomach) Positioning is Acceptable

• Prone positioning is acceptable if the infant is observed and awake, particularly after feeding 1
• "Tummy time" while awake and supervised helps prevent occipital flattening and promotes motor development 2
• Prone positioning during sleep should only be considered in rare cases of infants with certain upper airway disorders where the risk of death from gastroesophageal reflux disease may outweigh the risk of SIDS 1

Common Misconceptions About Infant Sleep Position

Choking and Aspiration Concerns

• The supine sleep position does not increase the risk of choking and aspiration in infants, even those with gastroesophageal reflux 1
• Infants have airway anatomy and protective mechanisms that prevent aspiration when placed on their backs 1
• Parents often misinterpret normal protective gag reflexes (coughing or gagging) as choking 1

Comfort and Sleep Quality

• Although some parents believe infants sleep better on their stomachs, physiologic studies show that infants are less likely to arouse when sleeping in the prone position 1
• The ability to arouse from sleep is an important protective physiologic response to stressors during sleep 1
• Frequent waking is normal for infants and should not be perceived as poor sleep quality 1

Additional Safe Sleep Recommendations

Sleep Surface

• Infants should be placed on a firm sleep surface (e.g., mattress in a safety-approved crib) covered by a fitted sheet with no other bedding or soft objects 1
• Soft mattresses, including those made from memory foam, could create indentations that increase the chance of rebreathing or suffocation if the infant rolls to the prone position 1
• Elevating the head of the infant's crib is ineffective in reducing gastroesophageal reflux and is not recommended 1

Special Considerations

• Preterm infants should be placed supine as soon as medically stable 1
• Preterm infants are at increased risk of SIDS, and the association between prone sleep position and SIDS among low birth weight infants is equal to or stronger than among term infants 1
• Hospitalized preterm infants should be kept predominantly in the supine position from at least 32 weeks postmenstrual age to acclimate them to this position before discharge 1

High-Risk Groups for Non-Adherence

• Black mothers are more likely to place infants in the prone position (OR: 2.06) 4
• Families living in poverty (OR: 1.81) and homes where the infant's grandmother is present (OR: 1.83) are more likely to use prone positioning 4
• Infants who are observed in the prone sleep position while in the hospital are significantly more likely to be placed prone at home (93%) 4

By following these evidence-based recommendations, parents can significantly reduce their infant's risk of SIDS while still providing opportunities for healthy development during supervised awake time.