Here at Red Nose, one of our key safe sleeping recommendations has been to sleep your baby on its back from birth. It’s a recommendation that has largely contributed to an 85 per cent reduction in SIDS deaths since the 1990s.
But why should you always place your baby on their back to sleep?
Research has found that sleeping your baby on their back greatly reduces the risk of sudden and unexpected death in infancy (SUDI), which includes SIDS.
This is because healthy babies placed on their back to sleep are less likely to choke on vomit than tummy sleeping infants.
In fact, Red Nose’s Chief Midwife Jane Wiggill explains, sleeping your baby on their back will actually provide them with airway protection.
“When a baby is sleeping on the back, the upper respiratory airways are positioned above the oesophagus, which is the tube that carries food from the mouth to the stomach,” she says.
“Babies protect their airways by swallowing. Regurgitated milk from the oesophagus lies at the lowest level and can be easily swallowed.
“It is actually difficult for the fluid to work against gravity and be pushed up and into the respiratory tract. Hence, the risk of choking is reduced when baby is sleeping on the back.”
Jane says it is a misconception that a baby can choke on vomit while sleeping on their back.
“When a baby sleeps on the tummy, the oesophagus sits above the baby’s upper airways. If a baby regurgitates or vomits milk or fluid, these substances will pool at the opening of the airways and are more likely to be inhaled into the baby’s airway and lungs,” she says.
“Babies also sleep more deeply on their tummy and swallow less frequently. This means they are less likely to arouse if they need to wake up.
And what about side sleeping?
There is, explains Jane, a risk that babies who are put to sleep on their side can easily roll on to their tummies.
“Babies who are usually slept on their back, and then are placed on their tummy or side for the first are also at an increased risk of sudden and unexpected death.
“Always, always place your baby on its back for sleep.”
My baby is beginning to roll. What do I do?
Your baby will usually start to roll around 4-5 months of age, says Jane.
“At this age, and once your baby has been observed to repeatedly roll from back to front and back again on their own for several weeks, they can be left to find their preferred sleep position,” she explains.
“It is very important at this critical time of starting to roll that the sleep environment remains safe, with no extra soft bedding, toys, and bumpers in or around the cot.”
And, says Jane, stop wrapping or swaddling your baby as soon as they show signs of rolling.
“Make sure you leave your baby’s arms free once the startle reflux disappears, and consider using a sleep bag once they are out of wraps.
“Using a sleep bag will delay your baby rolling on to its tummy until your baby is past the peak risk age for sudden and unexpected death,” explains Jane.
“It will also keep your baby’s temperature at a more constant level while sleeping.”
I place my baby on their back, but I find they roll on to their tummy during their sleep. What do I do?
This can be very challenging for families with older babies becoming more mobile in the sleep environment.
Always continue to place baby on their back for sleep, Jane says, but allow older babies to find their own comfortable sleep position.
“If you observe your baby sleeping on their tummy, gently roll them on to their back,” she says.
“And make sure the cot has no additional bedding, toys or bumpers, and that baby is sleeping on a firm and flat surface.”
Can I use positioners to keep my baby on their back and stop them from rolling on to their tummy or side?
Simply put, the answer is no, says Jane.
“Red Nose does not recommend positional products such as anti-roll devices and items that fasten a baby into a sleeping position,” she says.
“There are no Australian Standards for these products, and case studies have shown that these products can be unsafe.
“Therefore, we don’t recommend using products that restrict the movement of a baby, or a baby’s head.”