If a child who normally sleeps on his or her back is placed face-down to sleep the risk of sids

You should always place your baby on their back to sleep and not on their front or side.

Sleeping your baby on their back (known as the supine position) for every sleep day and night is one of the most protective actions you can take to ensure your baby is sleeping as safely as possible.

There is substantial evidence from around the world to show that sleeping your baby on their back at the beginning of every sleep or nap (day and night) significantly reduces the risk of sudden infant death syndrome (SIDS).

Important things to remember

• You should always place your baby on their back to sleep and not on their front or side (unless your doctor has advised you of a medical reason to do so)
• Sleeping a baby on their front or side greatly increases the chance of SIDS
• It is important that you always put your baby on their back as part of their regular sleep routine – the chance of SIDS is particularly high for babies who are sometimes placed on their front or side
• Keep your baby’s sleep surface flat. Do not incline, tilt or prop the mattress, cot or baby. Doing so will not help with reflux and is unlikely to improve cold symptoms.”

If your baby rolls onto their tummy

Once your baby can move themselves from their back to their front and back again by themselves, they will be able to find their own sleeping position.

The first few times they roll onto their tummy, you might like to gently turn them back, but do not feel you have to get up all night to check. Give them some time to play on their tummy while they are awake to help their development, but make sure you supervise them while they are on their front.

The importance of routine in reducing the risk of SIDS

The best way to make sure your baby sleeps on their back is to do this from day one, and keep putting them to sleep on their backs for every day and night time sleep.

It is also important that you keep the same routine for your baby, as babies who are normally slept on their backs but sometimes slept on their fronts are at a great risk of sudden death.

The safest sleep position for your baby: FAQs

My baby was born prematurely and slept on her front in hospital, is it okay to sleep her on her front at home as well?

Some babies who were born very prematurely and spent some time in a neonatal unit may have been slept on their fronts for medical reasons. Remember that babies in neonatal units are under constant supervision. By the time your baby comes home they should be sleeping on their back.

Babies may find it hard to adjust from a sleeping position they have been used to, so persevere and do speak to your paediatrician if you are concerned. Front-sleeping should only be continued for on-going medical reasons on the advice of your paediatrician.

Is a baby sleeping on their back more likely to choke on their own vomit?

Some parents worry that by sleeping their baby on the back they will be at a greater risk of choking on their own vomit. However, no research has found this to be the case, and we now know that babies are far safer sleeping on their backs.

My mum says I was slept on my front and that was the advice then, why has it changed?

Many parents will have been slept on their tummies as babies, as that was the advice before 1991. However, research has since shown that the chance of SIDS is much higher when a baby is placed on their front to sleep.

We know that in the early 1990s, there were thousands of babies worldwide dying suddenly and unexpectedly every year. The reason the number of deaths is much lower now is due to the new advice being followed by parents, such as lying babies on their backs to sleep.

My baby loves sleeping on his front, how do we change to his back without him waking up?

We sometimes get calls from parents who say their baby prefers sleeping on their front. If a baby is given a choice, they may well prefer this position, but unfortunately it is not a safe one!

This is why we encourage all parents to follow back-sleeping from day one. Getting your baby to stick to sleeping on their back once if they have tried sleeping on their front might be difficult, but is made easier if your baby is always put down to sleep whilst awake rather than allowing your baby to fall asleep in your arms. Keep going, they will eventually get used to it.

Is sleeping a baby on their front better for babies with reflux?

All babies should be slept on their backs unless there is medical advice saying something different. If your baby has reflux, or any other on-going health condition, speak to your doctor about the best care for them.

You should not sleep your baby on their front unless you have been advised to do so by a medical professional.

Do not incline, tilt or prop the mattress, cot or baby. Doing so will not help with reflux.

Will a sleep positioner help keep my baby on their back to sleep and therefore lower the risk of SIDS?

There is no need to use any type of equipment or rolled up blankets to keep your baby in one position unless you have been advised by a health professional for a specific medical condition.

It is much safer for your baby to be in their cot with just the sheets or blankets, and no extras which could be pulled over their face or cause an accident. As babies grow stronger they learn to move and roll and this is fine. For more information, please read our clear cot advice.

Sudden infant death syndrome (SIDS) is the sudden, unexplained death of an infant under 1 year old. The exact cause is unknown, but researchers hypothesize that the rapidly maturing respiratory and cardiovascular control of infants—especially in the first months of life—may be why SIDS peaks between 2 and 4 months of age.

Despite years of research, SIDS is still a devastating challenge for both families and the medical world. SIDS is part of a phenomenon known as sudden unexplained infant death syndrome (SUIDS), according to Steven A. Shapiro, D.O., chair of the Pediatrics Department at Abington-Jefferson Health.

The good news is that the incidence of SIDS has dropped tremendously since the launch of the Safe to Sleep (formerly Back to Sleep) campaign in 1994. Yet the Centers for Disease Control and Prevention (CDC) reports about 3,400 sudden and unexpected infant deaths occur each year in the U.S.

The unpredictable nature of SIDS justifiably scares many new parents who desperately want to keep their baby safe, but you can take some actions to help reduce your baby's risk. Here are the top SIDS prevention strategies and facts that parents need to know.

In terms of age, "the peak danger is between 2 and 4 months old," says Marian Willinger, Ph.D., special assistant for SIDS at the National Institute of Child Health and Human Development in Bethesda, Maryland. However, you should continue to take steps to safeguard your child from SIDS until they turn 1.

The causes of SIDS aren't really understood. "Most babies who die of SIDS appear perfectly normal," says Rachel Moon, M.D., a pediatrician at Children's National Medical Center in Washington, D.C., and chair of the American Academy of Pediatrics's SIDS Task Force.

But experts believe that babies with SIDS have an immature arousal center in the brain. Put simply, they can't wake themselves up when they're having trouble breathing. Infants who sleep on their stomachs are particularly vulnerable to SIDS—possibly because this position increases the likelihood that they will re-inhale oxygen-depleted air.

"We do know that there are demographic and environmental risks," Dr. Moon adds, noting that African American and Native American babies die of SIDS at a rate two to three times the national average, and three out of five SIDS deaths are males. Other groups at increased risk include premature babies, low-birthweight babies, and infants who are exposed to cigarette smoke.

Unfortunately, not all cases of SIDS can be prevented, and research like a May 2022 study published in The Lancet suggests there may be a biological component involved in SIDS. However, there are steps you can take to help reduce the risk of SIDS in your baby.

Back-sleeping reduces the risk of SIDS by increasing a baby's access to fresh air and making them less likely to get overheated (another factor linked to SIDS). But some parents still practice stomach-sleeping: 18% of Parents readers say they usually put their infants to sleep on their stomachs, and another 13% do so some of the time.

"Some exhausted new parents may do it out of desperation because infants tend to sleep better and more deeply on their stomachs," says Jodi Mindell, Ph.D., author of Sleeping Through the Night: How Infants, Toddlers, and Their Parents Can Get a Good Night's Sleep.

But the truth is, stomach sleeping really is correlated with higher risks of SIDS: Infants who normally sleep on their back are actually 18 times more likely to die of SIDS when placed down on their tummy for a snooze. "Infants seem to have difficulty adjusting to the change," says Dr. Moon.

Despite the dangers of stomach sleeping, though, you shouldn't worry if your little one begins to flip over on their own. "Once a baby can roll over by themselves, their brain is mature enough to alert them to breathing dangers," says Dr. Moon. "And by the time they are 6 months old, their improved motor skills will help them to rescue themselves, so the SIDS risk is greatly reduced."

Keep in mind, however, that awake tummy time is still an important part of your baby's development. Your baby should still have several supervised "tummy time" sessions every day. This helps your baby's development, and it also prevents flat spots on their head from sleeping on their back. "Babies need tummy time when parents are awake, alert, and observing carefully," advises Dr. Shapiro. "Tummy time is not sleep time—it's development time."

Studies show that putting a baby down on their side rather than on their back increases the risk of SIDS. "It's easier for an infant to roll onto their tummy from their side than from their back," says Dr. Moon. "And they may not yet have the skills to roll back in the other direction."

Blankets, pillows, comforters, and stuffed toys can increase the risk of SIDS by hindering your child's breathing; even soft or improperly fitting mattresses can be dangerous. So, wait until your baby's first birthday to put a pillow and blanket in the crib.

If you're worried that your little one may get chilly, swaddle them in a receiving blanket or use a sleep sack. According to a 2017 study, swaddling helps fussy infants sleep better on their back and may protect them from SIDS by causing them to startle more easily. But always practice proper swaddling techniques, and don't swaddle too tight. "Your baby needs to be able to move around and have the ability to kick and squirm," says Dr. Shapiro.

While things like breastfeeding pillows or "lounge" pillows can be helpful during your baby's awake time, they increase the SIDS risk and should never be used for sleeping. Additionally, you should never let your baby sleep in anything other than an approved crib or bassinet with a flat sleeping surface. Car seats, baby swings, baby seats, and things like the recalled "Rock 'n Play" should never be used for sleep either.

"A nursery that's too warm substantially increases an infant's SIDS risk," says Warren Guntheroth, M.D., professor of pediatrics at the University of Washington, in Seattle. So, make sure you don't overheat your baby with swaddling or a high room temperature.

The link between higher temperatures and SIDS might be because the warm baby falls into such a deep sleep that it is difficult for them to awaken if they are in trouble. Set the thermostat at 68 degrees, don't put the crib near a radiator, and dress your child in light layers that you can remove easily if they get hot.

Despite numerous studies that confirm the heightened SIDS risk caused by co-sleeping, many parents continue to do it. According to a Parents poll, 52% of readers do it all or some of the time, citing the added convenience for nighttime feedings and the security of having their infants next to them.

While co-sleeping in bed, your infant could be suffocated by a pillow or a loose blanket. Their air supply may be cut off if you or your partner inadvertently roll over onto them. And they could be strangled if their head gets trapped between the headboard and mattress. The same dangers occur with co-sleeping on a couch or an armchair.

It's important to be aware of the risks of co-sleeping and SIDS. If you decide to co-sleep, don't put your baby right in the bed. And think twice about a co-sleeping crib that clamps onto the frame of your bed, since "parents could still suffocate their baby with an arm or leg," warns Dr. Shapiro. The best bet might be room-sharing by moving your baby's crib into your room, which is what the AAP recommends in its safe sleeping guidelines that were updated in 2022.

To reduce the risk of SIDS, your little one should be able to move around and squirm while sleeping. "A baby that can't move very well can get into dangerous positions that become compromising," says Dr. Shapiro. He advises parents to avoid super-narrow bassinets and other small beds. "Position your baby with their hands out above their heads so they are freely movable, and don't wrap hips tight if swaddling," he says.

Pacifiers can actually reduce the risk of SIDS. "We don't know why yet," Dr. Moon says, "but it may be that sucking on a pacifier brings a baby's tongue forward, which opens the airway a little bit more." Or it could be that babies who use pacifiers don't fall into as deep a sleep as babies who don't.

The AAP now recommends that you consider giving your child a pacifier at night and for naps during their first year. Note: If you're breastfeeding, you may want to hold off on introducing a pacifier until your infant is 1 month old and nursing well.

Babies who are breastfed are more easily roused from sleep than formula-fed babies, which may be a reason breastfed babies are less likely to die from SIDS. Parents who breastfeed are also less likely to smoke, and a baby's exposure to smoke—both in the womb and secondhand—increases the risk for SIDS, says Dr. Shapiro.

However, all those late-night nursing sessions may also pose a risk too, so be proactive in making sure you lay your baby down in their crib. (And don't be afraid to enlist your partner if you need help!)

"If you are feeding your baby and think that there's even the slightest possibility that you may fall asleep, feed your baby on your bed, rather than a sofa or cushioned chair," said Lori Feldman-Winter, M.D., FAAP, a member of the American Academy of Pediatrics (AAP) Task Force on SIDS. "If you do fall asleep, as soon as you wake up be sure to move the baby to their own bed," she said.

It's always a good idea to confirm your child care provider's guidelines and practices for SIDS prevention. One out of five SIDS deaths occurs when a baby is in daycare or being watched by someone other than a parent, according to research published in the journal Pediatrics. There are no national safe sleep guidelines daycares must follow and it's up to states to set their own rules, so it's always best to check your daycare's policies for yourself.

That's not to scare you out of daycare, but rather to reinforce the importance of reviewing SIDS precautions with everyone who watches your child, whether it's a daycare worker, a babysitter, a relative, or a friend. They must know how to keep your infant safe while they sleep, so you can rest easy too.

Unless your baby has a diagnosed cardiac or respiratory illness, using an electronic breathing monitor doesn't help prevent SIDS, says the AAP—and it may actually give parents a misguided sense of security. Devices marketed to reduce carbon dioxide rebreathing, such as crib mattresses with built-in fans, are also not proven to be effective. And avoid wedge-shaped sleep positioners that claim to keep your baby on her back: An infant can slide off and suffocate against it.

In order to prevent SIDS, do the following things:

• Always put your baby to sleep on their back—never on their stomach or side.
• Have your baby sleep in a crib in your room; never share your bed with your baby.
• Make sure your baby's crib mattress is firm.
• Don't put anything in the crib except a tight-fitting sheet; avoid crib bumpers, blankets, pillows, and soft toys.
• Use a pacifier at sleep time.
• Try swaddling your child.
• Don't smoke or use illicit drugs while pregnant, and don't allow anyone to smoke around your infant.
• Don't overdress your child or put their crib near a heat source.

SIDS can occur anytime during a baby's first year of life (it's extremely rare after 1 year of age). Although the causes of SIDS are still largely unknown, doctors do know that the risk of SIDS appears to peak between 2 and 4 months of age and decreases after 6 months.