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When Can Infants Sleep on Their Tummy?

Have you ever wondered if your little one might sleep better on their tummy? It’s a common belief that babies might sleep more soundly on their stomachs as it’s a position believed to reduce the occurrence of startle reflexes, which could lead to fewer awakenings. This can be an appealing idea for sleep-deprived parents. However, it’s important to understand that while this position may encourage deeper sleep for some infants, it significantly increases the risk of Sudden Infant Death Syndrome (SIDS).

This is why AAP (American Academy of Pediatrics) recommends that you always place your baby to sleep on their back on a firm flat surface for the first year of life. This ensures safe sleep for your little one. But what happens when your baby starts to roll to their side or tummy? How do you keep them safe then?

This blog will cover the basics of safe tummy sleeping, the signs your little one is ready to sleep on their tummy, and how you can ensure the safest sleep environment.

Why is it So Important to Place a Baby Down on their Back for Sleep?

Before the 1994 “Back to Sleep” campaign, it was common for pediatricians and healthcare providers to recommend that infants be placed on their stomachs for sleep. This practice was based on beliefs that it could reduce the risk of choking, lessen the startle reflex during sleep, and provide a more comfortable sleeping position for babies. However, extensive research eventually linked stomach sleeping to an increased risk of Sudden Infant Death Syndrome (SIDS), leading to the shift in recommendations and the initiation of the “Back to Sleep” campaign. This campaign emphasized the importance of placing babies on their backs to sleep, significantly reducing the incidence of SIDS.

What About Flat Spots?

If you’re worried about your baby’s head becoming flat due to back sleeping there are some things you can do to help prevent this condidtion.

  • • Adjust your baby’s sleep position when you lay them down on their back so their head is facing the opposite direction each day.
  • • Do tummy time several times each day
  • • Avoid having your baby spend too much time in swings or car seats
  • • Hold your baby upright for periods of time

My Baby Startles When Placed On Their Back

Swaddling can help with the startle reflex, but by around 2 months you want to start to transition away from swaddling so your little one can get used to having their arms free and accessible. It’s important to make this transition before your baby starts to roll so you have time to make the change gradually. If you wait until your baby is already rolling you have to stop swaddling immediately as it’s not safe for your baby to roll to their side or tummy while swaddled. (See this blog for more information about swaddling and how to transition away from using it.)

As with anything related to your little one’s safety, it’s important to consult with your baby’s pediatrician if you have any questions or concerns. Though it may be tempting to put your baby on their tummy for sleep for naps or for nighttime sleep especially if you think you will be close by and can keep an eye on your baby, it really is best to always put your child down on their back for sleep for both naps and bedtime. Once they can roll to their tummy on their own they can sleep that way, but consistently putting them down to start out on their back is best.

What Do I Do If My Baby Rolls to Their Tummy During Sleep?

While it’s firmly established that babies should always be placed on their backs for sleep, it’s less clear what to do if your little one rolls to their side or tummy during sleep. This knowledge gap leaves many parents fearful of letting their little one roll in the sleep space, or they stay up all night repositioning their infant who has learned to roll to their tummy back onto their back (an effort that leaves everyone frustrated and exhausted).

There are countless sleep positioning products on the market designed to keep your baby safely on their back for sleep, and a product like that might be appealing if you’re in the camp of parents repositioning your baby all night long. However, it’s important to note that the AAP recommends that infants sleep on firm flat surfaces free of any loose bedding, pillows, wedges, or other such items that could become suffocation or entrapment hazards. This includes sleep positioning products.

When infants start to become more mobile, usually between 4 and 6 months old, they may roll onto their stomachs during sleep. In such cases, there is no need to reposition the infant as long as they are put to sleep on their back initially and the sleep environment is free of loose or soft objects.

How Do I Get My Baby Ready for Tummy Sleeping?

In short—supervised daytime practice! Tummy time during waking hours is important for helping your little one develop their motor skills. It also helps prevent plagiocephaly (flat spots on the back of baby’s head) and promotes strength for future milestones like rolling, crawling, and walking.

All babies go through a progression of developmental movements beyond reflexive movements such as the rooting reflex, the startle (or Moro) reflex, and the stepping reflex to name a few. One of the first developmental movements is rolling along with clasping hands to the midline of the body and reaching deliberately for something seen or heard. These usually begin to occur between 3-5 months for most babies but some are known to roll earlier or later than this. Given that rolling is a developmental movement it is a drive that compels a baby to practice that movement. Once they figure out how to roll you can’t stop them from doing it. Nor would you want to.

When a baby rolls to their tummy they are strengthening upper back and neck muscles which are important in helping them gain control of their heavy head. It also ensures that they can lift their head off the mattress or blanket on the floor. You want to be sure your child can do this so that if they need to adjust their position either while playing or sleeping they can do so.

Most babies will begin to roll to their side and then to their tummy and tend to have a preference for one side over the other, to begin with. Some babies will figure out how to roll from their back to their tummy first while others can roll from tummy to back first. Either way, you’ll want to ensure your baby can roll in both directions so they know how to adjust their position.

Spending time playing on a blanket on the floor and time awake in the crib will give your baby a chance to get used to moving their body so that they can figure out how to roll to their side and then their tummy. The sooner you do this the better, even if it’s just a short amount of time. It’s through repetition that they will develop the strength and muscle memory for rolling.

When Can I Let My Baby Sleep on Their Tummy?

Once your baby has figured out the mechanics of rolling they will likely want to roll quite a lot! If you put your baby down in the crib on their back with nothing in it except your baby and your baby is not swaddled or wearing a padded or weighted sleep suit, and they roll to their tummy, you can let them sleep that way.

If they don’t yet know how to roll back to their back then they may become upset being on their tummy. Give your baby a few minutes to get used to laying on their tummy and then go in and calmly talk to them while patting or brushing their back to reassure them that they are ok. Then slowly roll them back to their back again. You want to roll them back to their back rather than lift them from their tummy so they can feel how to roll from tummy to back.

It may take a few days/nights of rolling and becoming upset before your baby gets the hang of it, but once they get comfortable putting their head down while on their tummy most babies will settle into sleep. Keep in mind that some babies start out putting their faces straight down on the mattress rather than turning their heads to the side. This is why it’s important to have a firm mattress with a well-fitted sheet. Eventually, your baby will lay with their head to the side.

This article was written by Batelle – team of sleep experts, lactation consultants, therapists, doulas, and early education specialists.

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