Is Side Sleeping Safe for My Baby? What You Need to Know

Even though you always place your baby on their back to sleep, you may have noticed they don’t seem comfortable. Some babies flail about a bit until they’ve managed to work themselves onto their side. Some babies won’t go down at all unless it’s in the side-sleeping position. With all the warnings about SIDS and sleep safety, you may be feeling a lot of anxiety around bedtime if you’re little one won’t stay on their back.

When it comes to infants, the American Academy of Pediatrics, the National Institute of Child Health and Human Development (NICHD), and other partners have recommended parents put babies to sleep on their backs to reduce the risk of Sudden Infant Death Syndrome (SIDS) since 1994. Eventually, as your baby becomes older and stronger, they’ll begin to move more during sleep and many of their risk factors will go away. Until then, there are a number of ways to keep your infant safe. Let’s examine the logic behind putting a baby to sleep on their back and when is it safe for a baby to sleep on their side.

SIDS: The Biggest Danger

SIDS is the leading cause of death between 1 month and 1 year of age. The chance of SIDS is greatest for babies between 2 and 4 months of age, but it can occur at any point during the first 12 months of life.

Research has demonstrated that placing babies in the prone position (tummy down) to sleep and exposure to maternal smoking are major risk factors for SIDS. Infants born preterm are at four times the risk compared with infants born at term. Bed-sharing with infants is another risk factor for SIDS with infants being at greatest risk when younger than 3 months or if the parents smoke, use illicit drugs, or consume alcohol. Sleeping on a sofa or couch with an infant is also extremely dangerous.

The safest place for infants to sleep is in the parental bedroom in their own crib and in close proximity to parents to allow for feeding and comfort. Your baby’s sleep surface should be firm, such as a safety-approved crib mattress, covered by a fitted sheet. Never place your baby to sleep on pillows, quilts, sheepskins, and other soft surfaces. Keep soft objects, toys, crib bumpers, and loose bedding out of your baby’s sleep area.

Secondly, you should always place your baby on their back to sleep — for naps and at night. The back sleep position is the safest, and every sleep time counts. Swaddling is okay (even recommended) until your infant is able to roll over. After that point, they’ll need to have their arms free to minimize their risk of suffocation if they do roll onto their stomach. At this stage, babies placed on their side to sleep are far more likely to accidentally roll onto their tummy than babies placed on their backs, making side-sleeping a major no-no for newborns. 

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Is It Safe For Babies to Sleep on Their Side to Prevent Choking?

Some parents put babies to sleep on their side out of fear that they may choke on vomit or spit up while back-sleeping. This is not true, according to the National Institute of Health. In fact, back-sleeping reduces the chances of choking as it allows babies to better clear their airways by coughing or swallowing.

Will Side-Sleeping Help Prevent a Flat Head?

You may have been cautioned by other parents to let your baby sleep on their side to keep them from developing a flat spot on the back of their heads (plagiocephaly). Babies do have soft, flexible skulls and weak neck muscles (to make delivery easier on mom). Lying in any position – sides or back – for too long can cause a bit of flattening. This is normal and generally isn’t cause for concern as it tends to resolve on its own. 

You can help prevent flat spots from developing by continuing to lay your baby on their back to sleep, but alternating which end of the crib is the “head” and which is the “foot.” This way when your baby turns their head to look at something outside the crib, they’re alternating which direction they have to turn their head. In addition, be sure to give your little one supervised “tummy time” each day as well to help them build strength in their arms, upper body, and neck.

When Is It Safe for Babies to Sleep On Their Side?

For infants younger than 4 months, side-sleeping is never safe since it’s easier for them to inadvertently roll onto their tummies. Most newborns aren’t strong enough at this age to switch positions or raise their heads. If your infant falls asleep on their side while you’re there, carefully move them onto their back as soon as you're able to without disturbing them.

If your baby rolls onto their side after you place them onto their back, there’s no need to panic. According to the American Academy of Pediatrics, it’s okay to let your baby sleep on their side if they’re able to easily roll over by themselves. By 4 months, many babies will have grown stronger and developed more advanced motor skills. They’ll be strong enough to lift their head and roll over on their own when placed on their stomach. If your baby is at the point where they’re able to end up in the side-sleeping position on their own, it’s safer.

That said, you should continue to place your baby on their back for all sleep times – night or naps. Tummy sleeping is never considered safe or recommended during the first 12 months. Intentionally putting your child down in a side-sleeping position makes it easy for them to accidentally end up on their stomach.

How to Prevent Side Sleeping Before It’s Safe

To keep your little one sleeping soundly before it’s safe for them to sleep on their side, try these tips.

• Swaddle your infant snuggly until they can roll over. Keep it just loose enough that they can wiggle their hips.
• Use a sleep sack if your baby doesn’t care for swaddling. You can even get a sleeveless version for babies who are already able to roll. A sleep sack may help your little one stay asleep longer without rolling onto their side.
• Always place your baby on a firm surface. Don’t put your baby to sleep on a soft mattress that allows them to sink or even create an indentation, as this makes it easier for them to roll onto their side.
• Use a video monitor to give yourself a visual heads-up that your little one has shifted and needs a gentle nudge onto their back.

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The Consumer Product Safety Commission recommends avoiding the use of baby positioners during sleep. These padded or foam risers claim to help keep your baby’s head and body in one position, but there have been cases where baby positioners caused suffocation while sleeping.

The Bottom Line

Is side-sleeping safe for babies? The short answer is no, at least while they’re newborns. Sleeping on their backs is safest for infants and greatly reduces the risk of SIDS. Side sleeping is typically safer once your little one is older than 4 to 6 months and is able to roll over on their own after being put down on their back. For the first year, it’s always safest to put your baby down in the back sleeping position. If you notice your infant seems to have a preference for side sleeping, talk to your pediatrician. 

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