Before one year old is an important period for a baby to lay the foundation for long-term health, development and happiness, it is also the most prone to the accidental death period in life. Sudden neonatal death and other accidental asphyxia deaths during sleep have always been one of the leading causes of death for children under five, especially newborns. The security issue is required to be highly emphasized. How should we ensure the safety of a baby's sleep and make the baby sleep better?
best position for babies to sleep
An epidemiological survey that began in the 1980s found that sleeping on the stomach is the main risk factor for sudden neonatal death syndrome.

In 1987, the Netherlands started a newborn sleep campaign, suggesting that parents let their newborn babies sleep on their backs instead of lying on their stomachs. Subsequently, the exercise of recommending babies to sleep on their backs was launched in the United Kingdom, New Zealand, and Australia in 1991. Then, the United States and Switzerland starting from 1992, and Canada starting from 1993 onwards, also recommended that babies sleep on their backs.

In 1992, the American Academy of Pediatrics first recommended lying on the back or on the side, and then revised this recommendation in 1996, thinking that lying on the back is the safest and best position for babies to sleep.

Sleeping on your stomach is not safe
best position for babies to sleep
Sleeping on the stomach is a very unsafe sleeping position for newborns and should be avoided.

Sleeping on your stomach will make it easier for your baby to inhale the exhaled exhaust gas, which can easily lead to hypercapnia and hypoxia.

Prone sleeping also increases the risk of overheating, because such a sleeping position reduces heat dissipation and increases body temperature.

Some recent studies have also found that sleeping on the stomach will change the regulation and control of the baby's cardiovascular system during sleep, especially at 2-3 months. And sleeping on your stomach may also reduce the baby's brain oxygen supply.

Sleeping on the stomach also increases the risk of sudden neonatal death by 2.3-13.1 times that of sleeping on the back.

Sleeping on your side may be more insecure than sleeping on your stomach.
best position for babies to sleep
Some recent studies have suggested that the risk of sudden neonatal death when sleeping on your side and lying on your stomach is about the same (compared to supine, the probability of sudden neonatal death is 2 times and 2.6 times, respectively), and some population studies have reported that the danger of sleeping on the side is greater.

Furthermore, the risk of sudden neonatal death is especially high in babies who sleep on their sides and are pressing on their stomachs, which is 8.7 times that of sleeping on their backs. Side sleeping is a natural and extremely unstable posture. The baby may roll, and the possibility of turning from side sleeping to tummy sleeping is significantly higher than changing from side sleeping to back sleeping.

And those babies who are not used to sleeping on their stomachs and are deliberately put to sleep on their stomachs have a much higher risk of sudden neonatal death than those who have been sleeping on their stomachs. Therefore, the best way for a baby to sleep is supine, and it is very important for every adult who takes care of the baby to lie on the bed in a supine position every time he sleeps.

Will my baby be uncomfortable or sleep well when sleeping on his back?

Some parents think that the baby sleeping on the tummy or side will be more comfortable, and lying on the back will cause poor sleep.

In fact, it is normal for babies to wake up frequently at night and should not be regarded as poor sleep. Physiological studies have found that babies who are lying on their backs are less likely to wake up. Besides, when the baby has various discomforts including nightmares during sleep, waking up from sleep is a very important physiological protective response. Too deep asleep and too long sleep may not be a physiological advantage.

Does lying on your back make it easier for your baby to be choked by food?

best position for babies to sleep

Some parents worry that lying on their back will cause the baby to choke or reflux food into the airway. This is because parents misunderstood the cause of coughing or vomiting, which is a normal, protective gag reflex to choke or inhale the airway. Numerous multi-center studies conducted in various countries have found that lying on the back does not increase the risk of choking or inhaling food into the airways.

Exceptional circumstances

When a baby is diagnosed with gastroesophageal reflux, special attention should be paid to the inhalation of foreign bodies into the airway. In cases where an infant is diagnosed with gastroesophageal reflux, the American Academy of Pediatrics supports the recommendations of the North American Society of Neonatal Gastroenterology and Nutrition: The infant should still be placed on the back.

However, these institutions also pointed out exceptions: some babies have severe gastroesophageal reflux, and their risk of death due to gastroesophageal reflux is higher than the risk of sudden neonatal death, but this is extremely rare. Mainly those babies whose upper respiratory tract dysfunction and airway protection mechanism are not sound, including nasal anatomical abnormalities, such as 3rd or 4th-degree cleft larynx, have not yet undergone anti-reflux surgery.

best position for babies to sleep
Newborns should sleep on their backs within the first few hours of born

When the baby is asleep, he must be placed on the cot in a supine position.

Many medical staff will put the baby on the side after the baby is born, and this has always been a headache. The reason for this operation is that many nurses believe that newborns need to clear the amniotic fluid in the airway, and it may be more difficult to inhale amniotic fluid when lying on their side. But there is no evidence that lying on the side may make it easier to clear the amniotic fluid. To make matters worse, some parents may not think it is very important to let the baby lie on their back when they see the medical staff placing the baby in this way (sideways or on the tummy). In this way, parents and family members may follow the way of medical staff and let the baby sleep on the side or on the stomach at home.

The American Academy of Pediatrics recommends that as long as the baby is placed in the cradle (without being held in his hands), he should immediately be put down in a supine position.

Premature babies should be placed on their backs as soon as possible

Premature babies have a greater risk of sudden neonatal death, so when the clinical state of premature babies is stable, they should be placed on their back as soon as possible.

The American Academy of Pediatrics recommends that premature babies should sleep on their backs in hospitals, so that these babies can develop the habit of sleeping on their backs before they are discharged from the hospital. But even in the United States, after many years of such advice, only about 50% of medical staff will place premature babies on their backs. The study on the sleep of premature babies before discharge found that those premature babies who sleep on their stomachs will have longer sleep cycles (as mentioned earlier, for newborns, too long sleep cycles are not a good thing), less wake up, more central apnea.

The American Academy of Pediatrics’ fetus and preterm infants task force believes that doctors and nurses responsible for organizing preterm infants discharged from the intensive care unit, as well as other relevant professionals, should memorize the recommendations for reducing the risk of sudden neonatal death: Once the premature baby is medically stable, it should be placed on the back immediately, and before the premature baby is discharged from the hospital, give parents a good example of implementing the supine recommendation.
best position for babies to sleep
When does the danger of sleep begin to decrease

Ninety percent of sudden neonatal death syndromes occurred six months ago, and most of them occurred between 1-4 months.

At present, there is not enough data to suggest when babies can not sleep on their backs, but many authoritative organizations recommend that babies continue to sleep on their backs before one year of age. However, parents may find that after 4 or 6 months, many babies will already turn over during sleep. Although they are lying on their backs when they are on the bed, they will lie on their sides or sleeping on their stomachs in the middle of the night or at dawn. If babies turn over on their own during sleep, they can be kept in this sleeping position, and there is no need to turn them over deliberately.

The benefits of having babies lying on their stomachs when awake

In the case of adult care, letting the baby lie on his stomach when awake can promote the development of athletic ability and greatly reduce the occurrence of plagiocephaly.

Plagiocephaly due to posture, or plagiocephaly without bony connection may be related to sleeping on your back. Especially in these cases, it is more likely to cause plagiocephaly: the position of the baby's head does not move when sleeping; the baby is not placed on his stomach when he is awake and under the supervision of an adult; the baby is not held with his head up when not sleeping. In healthy babies, the incidence of plagiocephaly drops from 20% (at about 8 months) to 3% (at 24 months).

Although there is no specific data to suggest how long to lie on the tummy, it is recommended to give your baby a time to lie on the tummy every day under the care of an adult.

You should give your baby time to play on his stomach as soon as possible (from the first day of birth), which can promote the development of athletic ability, help the muscle development of the upper body, reduce postural plagiocephaly, and may also help relieve the baby’s colic pain.

Smoking, sleeping with an adult, overheating

It's also a killer in babies' sleep

Whether during pregnancy or after the baby is born, exposure to smoking will increase the chance of accidental death during sleep. Therefore, mothers cannot smoke during pregnancy and after the baby is born. There should not be smoking around the pregnant mother or baby.

From the beginning of preparing to welcome the baby into this world, the family should formulate strict regulations to avoid exposure to second-hand smoke as much as possible for pregnant mothers and babies. When sleeping in the same bed with a smoker, the risk of the sudden death of a newborn is particularly high.

Many mothers think that sleeping in the same bed is convenient for breastfeeding, convenient for taking care of the baby, and sleeping in their arms is the safest for the baby. But in fact, many tragedies happen every year because of this. It is not necessarily that the mother is pressing on the baby, and it is not necessarily that the baby's nasal cavity is completely blocked. In many cases, the cause is unknown.

When you are extremely tired due to frequent feedings at night, and fall asleep, it may be just a few tens of seconds, and accidents may happen. Sometimes tragedies can happen when the mother falls asleep while breastfeeding on the sofa or elsewhere. Security issues must be highly emphasized. For safety, please place your baby on a safe crib or cradle that is within your reach, where you can see and hear each other. Not only you can conveniently pick him up to breastfeed, can also see and hear his needs, and respond quickly. Although a little convenience is lost, the result is a safer sleeping environment.

Packing too tightly or covering too much can cause the baby to overheat, which is also a risk factor during sleep.

Many parents are worried that their baby will catch a cold, especially in winter, so they wear a lot of clothes. This is not only unnecessary but also increases the risk of sleep. In general, the baby should be covered according to the temperature of the environment, and the number of layers of the baby's clothing should not exceed the layer that the adult is comfortable wearing. If the baby sweats at night, or the temperature of the baby’s chest and hands is very high, it means that he wears too much cover (it’s not because of kidney deficiency and night sweats! It is too much cover).

In particular, be careful not to wrap your head too tightly, and do not cover your baby's face or head with anything.