At what age can a healthy newborn start sleeping on their stomach (prone position)?

When Can a Newborn Lay on Their Stomach?

Newborns can lay on their stomach only when they are awake and under direct supervision, starting as early as possible after birth, but they must never sleep on their stomach until they are at least 1 year old. 1

Sleep Position: Back Only Until 1 Year

• All infants must be placed on their back (supine position) for every sleep period by every caregiver until they reach 1 year of age. 1
• This recommendation applies from birth, including for preterm infants once they are medically stable. 1
• The prone (stomach) sleep position increases SIDS risk dramatically, with odds ratios ranging from 2.3 to 13.1. 1
• Side sleeping is equally dangerous and not recommended, as infants can easily roll from side to stomach (OR: 8.7 for infants placed on side and found on stomach). 1

Supervised Awake Tummy Time: Start Immediately

• Prone positioning is not only acceptable but actively encouraged when the infant is awake and directly supervised. 1, 2
• The American Academy of Pediatrics recommends daily supervised tummy time beginning as early as possible after birth. 2
• This supervised awake tummy time promotes motor development, strengthens upper body muscles, and prevents positional plagiocephaly (flat head syndrome). 2
• Parents must understand the critical distinction: tummy time is for awake, supervised periods only—never for sleep. 2

When Infants Can Roll Independently

• Once an infant can roll both from supine to prone AND from prone to supine independently (typically 4-6 months), they may remain in whatever position they assume during sleep. 1
• However, you should still initially place the infant on their back for every sleep period until 1 year of age, even after they can roll. 1
• Do not attempt to reposition a sleeping infant who has rolled themselves, as this can be disruptive and discourage supine positioning altogether. 1

Common Concerns and Misconceptions

Choking and aspiration fears: The supine position does NOT increase choking or aspiration risk, even in infants with gastroesophageal reflux. 1

• Multiple studies across different countries have found no increased aspiration incidence since the change to supine sleeping recommendations. 1
• Research specifically examining gastric aspiration deaths found zero cases in infants found on their backs or sides, while all three cases occurred in prone position. 3
• Infants have protective airway anatomy and gag reflexes that function effectively in the supine position. 1

Sleep quality concerns: Parents often report that infants don't sleep as well on their backs, but this is actually a safety feature. 1

• Infants in prone position arouse less easily from sleep, which reduces their protective responses to breathing problems. 1
• Frequent waking is normal and physiologically protective—not a sign of poor sleep. 1

Special Circumstances

The only exceptions to supine sleeping are extremely rare upper airway disorders where airway-protective mechanisms are severely impaired (such as type 3 or 4 laryngeal clefts without antireflux surgery), where the risk of death from GERD may outweigh SIDS risk. 1

• Standard gastroesophageal reflux is NOT an indication for prone sleeping. 1
• Infants receiving nasogastric or orogastric feeds have no increased aspiration risk in supine position. 1
• Elevating the head of the crib is ineffective for reflux and dangerous, as infants can slide down into positions that compromise breathing. 1