Supine Sleep Position Significantly Reduces SIDS Risk
Yes, supine (back) sleep positioning dramatically decreases the risk of SIDS and should be used for every sleep period until 1 year of age. 1, 2
The Evidence for Supine Positioning
The American Academy of Pediatrics has consistently recommended supine positioning since 1992, and the results have been striking:
- SIDS mortality decreased by more than 40% following implementation of the "Back to Sleep" campaign, coinciding with prone sleeping rates dropping from >70% to approximately 20% 3
- Supine positioning confers the lowest risk compared to all other sleep positions 4
- Side sleeping is NOT safe and should not be used as an alternative, as it is inherently unstable and increases the risk of the infant rolling to the prone position 1, 2
Why Supine Positioning Works
The prone position creates multiple physiologic hazards:
- Increases rebreathing of expired gases, leading to hypercapnia and hypoxia 1
- Decreases heat loss and increases body temperature, raising overheating risk 1
- Reduces arousal from sleep, which is a critical protective mechanism against stressors during sleep 1
Implementation Guidelines
For all infants:
- Place wholly on the back for every sleep by every caregiver until 1 year of age 1, 2
- Continue supine positioning even after the infant can roll independently (4-6 months), though the infant may be allowed to remain in whatever position they assume once they can roll both ways 1
For preterm infants:
- The association between prone positioning and SIDS is equal to or stronger than in term infants 1
- Place supine as soon as medically stable, ideally by 32 weeks postmenstrual age before discharge 1, 2
Addressing Common Concerns
Choking and aspiration fears are unfounded:
- The supine position does NOT increase choking or aspiration risk, even in infants with gastroesophageal reflux 1, 2
- Infants have protective airway mechanisms that prevent aspiration when supine 1, 2
- Elevating the head of the crib is ineffective for reflux and may cause the infant to slide into a compromised position 1
Rare exceptions:
- Only infants with specific upper airway disorders (such as type 3 or 4 laryngeal clefts without antireflux surgery) where the risk of death from gastroesophageal reflux complications exceeds SIDS risk should be considered for alternative positioning 1, 2
Critical Pitfall to Avoid
Healthcare professionals modeling incorrect positioning: When hospital staff place infants on their sides or prone (often believing newborns need to clear amniotic fluid), parents observe this and incorrectly assume supine positioning is unimportant 1. There is no evidence that side positioning clears fluid more effectively 1. Infants should be placed supine as soon as they are ready to be placed in a bassinet 1.