Neonatal Intensive Care Unit (NICU): Sleep positioning of a premature or unwell baby in hospital vs safe sleeping at home.

Claire’s son Jack was born prematurely in 2019 – after six long weeks in the NICU, he finally came home. During Jack’s stay in NICU, Claire* was surprised that Jack* was often put to sleep on his tummy by the NICU nurses.

Our National Education and Health Promotion Manager Loren explains why babies sometimes sleep on their tummies in the NICU – and why it’s so important to place babies on their back to sleep at home.


Jack was born prematurely in May 2019. He spent several weeks in the NICU due to breathing difficulties. When visiting Jack in the NICU, Claire says she was alarmed to see that Jack was laid on his tummy to sleep.

“When I arrived one morning, I found Jack sleeping peacefully, facedown, in nothing but a nappy and a little hat. He was surrounded by blankets that were cocooning him in what looked like a nest.”

“And I thought to myself, why are they doing all of these things that aren’t safe sleep practices?”

“The NICU team was terrific – they explained that they were trying to work out what was wrong with Jack. They explained that during the process of diagnosis, NICU babies are often slept prone or on their sides (if stable enough) and are nursed this way to support respiratory function and prevent muscle problems particularly in the hips and neck. They went on to explain that sleeping in different positions when sick and small also encourages midline orientation development, enhances comfort and reduces stress.

“They reassured me that these practices were appropriate in the NICU environment because there was 24/7 monitoring of babies– once Jack was well enough to go home, we would need to follow the safe sleeping recommendations.

“The good thing was, the nurses were able to guide us through how to sleep Jack safely on his back which made it very easy once we were home.

“He is now a cheeky, active, very verbal four-year old, who you would never know had been so unwell as to need 24-hour care in the NICU.”

Red Nose Chief Midwife Loren sheds light on the care of premature babies, placing a strong emphasis on practices grounded in research within Neonatal Intensive Care Units (NICUs).

“A doctor may request a specific rest/sleep positions they deem beneficial based on a child’s individual needs. Such as the positive impacts of nesting, whether on the tummy (prone) or back (supine) for premature infants, which include improved oxygen saturation, enhanced weight gain, reduced stress response, and the promotion of a deeper sleep for energy conservation, muscle relaxation, and growth hormone release.” However, Loren emphases that these practices must only occur when supervised and monitored by trained professionals.

“Being small and unwell, they are more sensitive to the effects of their new life outside of the uterus, and they are subject to the effects of gravity and immobilisation when placed flat on a firm surface for prolonged periods.

“NICU babies sleep on their tummy or their sides with full supervision and are nursed this way to support respiratory function, encourage physiological flexion and purposeful movements of the limbs.”

“These practices are not recommended or encouraged once the baby transitions, into an open cot, from hospital to the home environment. This transition signifies a shift in care, once babies are well enough to leave the hospital, it is imperative parents follow Red Nose’s 6 safe sleep recommendations. These include: always place the baby on their back to sleep, keep their face and head uncovered, use a safe cot with a firm flat mattress that is not tilted, use safe bedding, and make sure there are no additional items in the cot.”

“Together, this will help baby have a safer sleep and help reduce the risk of sudden infant death.”

Red Nose Six Safe Sleep Recommendations

  1. Always place baby on their back to sleep
  2. Keep baby’s face and head uncovered
  3. Keep baby smoke free, before and after birth
  4. Safe sleeping environment, night and day
  5. Sleep baby in a safe cot in parents’ or caregiver’s room for the first 6-12 months
  6. Breastfeed baby

For more safe sleeping tips and advice, visit the Red Nose Safe Sleep Advice Hub, or speak with baby’s health care team.

* Names have been changed to protect the family’s privacy.

Last modified: 13/11/23