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Advice for Patients
December 7, 2009

Infant Sleep Position: Back to Sleep

Arch Pediatr Adolesc Med. 2009;163(12):1168. doi:10.1001/archpediatrics.2009.230

Sleep position is an important safety issue for infants younger than 1 year. This is because sudden infant death syndrome (SIDS) is associated with infants sleeping on their tummies. Sudden infant death syndrome is the leading cause of death for infants younger than 1 year. It most commonly occurs in babies between the ages of 2 and 4 months. Despite more than 15 years of the “back to sleep” educational campaign, some parents still are not provided with appropriate education about the safest sleep position for babies.

Can't i put my baby to sleep on his or her tummy once in a while?

About 1 in 5 deaths from SIDS happen when an infant is being cared for by someone other than a parent. Many of these deaths occur when babies who are used to sleeping on their backs are then placed to sleep on their tummies by another caregiver. This is called unaccustomed tummy sleeping. This is dangerous because babies who are used to sleeping on their backs and are put to sleep on their tummies are almost 20 times more likely to die of SIDS.

While it is not safe to place babies on their tummies to sleep, health care providers recommend that babies spend some time while awake on their tummies. This “tummy time” should be when babies are awake and supervised. Tummy time helps babies to develop strong neck and shoulder muscles.

What if my baby likes to sleep on his or her side?

Babies who sleep on their sides are more likely to accidentally roll onto their tummies. Sleeping on their backs is the safest position for babies.

What else can i do to provide a safe sleep environment for my child?


  • Your child's crib should have a firm mattress and a well-fitting sheet. Do not place babies to sleep on any other type of bed (adult bed, chair, couch, or pillow).

  • It is not safe for babies to have toys, pillows, or fluffy blankets in their crib. If your child were to roll into those types of materials, he or she may have trouble breathing.


  • Breastfeed your baby through his or her first year of life.

  • Only put your child to sleep in a room that is smoke-free. Exposure to cigarette smoking is associated with increased risk of SIDS.

What should i do when someone else is looking after my baby?

Before leaving your baby with another caretaker, be sure to discuss safe sleep positions with that person. You can use this article during that discussion if needed to emphasize that sleeping on their backs is the safest sleep position for babies. Before leaving your baby with anyone, be sure the caretaker agrees that the safe sleep practices discussed in this article will be followed each time your baby goes to sleep.

For more information

National Sleep Foundation http://www.sleepfoundation.org/article/sleep-topics/sudden-infant-death-syndrome-and-sleep

Inform yourself

To find this and other Advice for Patients articles, go to the Advice for Patients link on the Archives of Pediatrics & Adolescent Medicine Web site at http://www.archpediatrics.com.

Source: American Academy of Pediatrics, http://www.healthychildcare.org/pdf/SIDSparentsafesleep.pdf

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The Advice for Patients feature is a public service of Archives of Pediatrics & Adolescent Medicine. The information and recommendations appearing on this page are appropriate in most instances, but they are not a substitute for medical diagnosis. For specific information concerning your child's medical condition, Archives of Pediatrics & Adolescent Medicine suggests that you consult your child's physician. This page may be photocopied noncommercially by physicians and other health care professionals to share with patients. To purchase bulk reprints, call 312/464-0776.

This article was corrected online for typographical errors on 12/7/2009.