The Importance Of Infant Sleep Position: Why Infants Cannot Sleep On Their Stomach

The topic of infant sleep position has been a subject of extensive research and discussion in the field of paediatric medicine and child development for decades. One of the most fundamental guidelines parents are given is that infants should not sleep on their stomachs. This recommendation, often referred to as “back to sleep,” has been a key element in reducing the risk of sudden infant death syndrome (SIDS) and promoting safe sleep practices for newborns and infants. In this article, we will explore the reasons why infants cannot sleep on their stomach and delve into the scientific and medical rationale behind this crucial guideline.

Understanding the Physiology of Infant Sleep

To comprehend why infants cannot sleep on their stomachs, it is essential to first understand the unique physiology of newborns and their sleep patterns. Unlike adults or older children, infants have distinct anatomical and physiological characteristics that make sleeping on their stomachs potentially dangerous.

1. Airway Development

One of the primary reasons infants should not sleep on their stomachs is related to their underdeveloped airways. Newborns have smaller and less stable neck muscles compared to older individuals. When an infant is placed on their stomach, there is an increased risk that their head will turn to the side or be buried in the bedding, potentially compromising their airway. This positioning can lead to difficulty breathing, suffocation, or even SIDS.

2. Risk of Rebreathing Exhaled Carbon Dioxide

Infants are obligate nose breathers, meaning that they primarily breathe through their noses, especially when asleep. When an infant is placed on their stomach, they may inadvertently press their face into the bedding, pillow, or mattress, increasing the risk of rebreathing exhaled carbon dioxide. This trapped carbon dioxide can lead to hypoxia (low oxygen levels), which is detrimental to an infant’s health and can potentially result in serious consequences.

Sudden Infant Death Syndrome (SIDS)

The relationship between stomach sleeping and Sudden Infant Death Syndrome (SIDS) has been extensively studied. SIDS is a tragic phenomenon characterised by the sudden, unexplained death of an otherwise healthy infant, usually occurring during sleep. Research has shown a strong association between stomach sleeping and an increased risk of SIDS. Several factors contribute to this connection:

  1. Reduced Arousal Response: Infants who sleep on their stomachs have a diminished ability to rouse themselves from sleep. This decreased arousal response can make it difficult for them to wake up if they encounter difficulties, such as impaired breathing or airway obstruction.
  2. Increased Heat Retention: Stomach sleeping can lead to increased heat retention around the infant’s face and body, potentially making them more prone to overheating, which is another SIDS risk factor.
  3. Reduced Ventilation: When an infant sleeps on their stomach, there is less ventilation around their face and head. This restricted airflow can contribute to higher levels of carbon dioxide, which can be harmful.
  4. Pressure on the Face: Stomach sleeping may cause an infant’s face to press against the mattress or bedding, leading to the rebreathing of carbon dioxide and a potential reduction in oxygen levels.

Back to Sleep Campaign

To address the concerning rise in SIDS cases, the American Academy of Pediatrics (AAP) and other health organisations launched the “Back to Sleep” campaign in the early 1990s. This campaign aimed to educate parents and caregivers about the importance of placing infants on their backs for sleep. The initiative has since evolved into the “Safe to Sleep” campaign, which encompasses a broader range of guidelines for creating a safe sleep environment for infants.

Safe Sleep Practices for Infants

To reduce the risk of SIDS and ensure that infants sleep safely, several guidelines should be followed:

  1. Back to Sleep: Always place infants on their backs to sleep, for both naps and nighttime sleep.
  2. Firm Sleep Surface: Provide a firm mattress covered by a fitted sheet in a safety-approved crib or bassinet.
  3. Remove Loose Bedding: Avoid using soft bedding, such as pillows, quilts, blankets, and stuffed animals, in the sleep area.
  4. Avoid Overheating: Dress infants in light and breathable sleep clothing, ensuring they do not become too hot during sleep.
  5. Avoid Smoking: Keep the infant’s sleep environment smoke-free, as exposure to secondhand smoke increases the risk of SIDS.
  6. Supervised Tummy Time: While awake and under supervision, allow infants to engage in tummy time to help develop their neck and upper body strength.

The Impact of Safe Sleep Practices

Adhering to safe sleep practices not only reduces the risk of SIDS but also has broader implications for infant health and development. Here are some additional aspects of how these practices can positively influence an infant’s well-being:

  1. Healthy Brain Development: When infants sleep on their backs, it allows for unrestricted oxygen flow to the brain, promoting healthy neural development. The uninterrupted oxygen supply supports the growth of the brain’s crucial structures during this critical stage of life.
  2. Prevention of Flat Head Syndrome: Sleeping on their backs can help prevent positional plagiocephaly, also known as flat head syndrome. This condition occurs when an infant’s head develops a flat spot due to prolonged pressure on one side. Regular tummy time can also aid in preventing this issue.
  3. Reduced Ear Infections: Some studies suggest that placing infants on their backs for sleep may lead to a lower incidence of ear infections. This may be because fluid drainage from the ears is more efficient in this position.
  4. Lower Risk of Respiratory Issues: Sleeping on the back reduces the likelihood of airway obstruction, which can be critical for infants with respiratory conditions or premature babies with underdeveloped airways.
  5. Safer Co-sleeping Practices: For parents who choose to co-sleep with their infants, following safe sleep guidelines becomes even more critical. Placing the baby on their back and ensuring a safe sleep environment, including a firm mattress and the absence of pillows and heavy bedding, helps mitigate the risks associated with co-sleeping.

Educating Caregivers and the Community

In addition to parents, it is essential to educate caregivers, healthcare providers, and the community at large about the importance of safe sleep practices. Hospitals and healthcare professionals play a vital role in disseminating this information to new parents, both during prenatal care and after delivery. These educational efforts contribute significantly to reducing the number of SIDS cases.

Moreover, raising awareness about safe sleep practices within the community can help ensure that everyone involved in caring for infants is well-informed. Family members, babysitters, and childcare providers should also be aware of the guidelines and encouraged to follow them consistently.

Ongoing Research and Improvements

While the “Back to Sleep” and “Safe to Sleep” campaigns have made substantial progress in reducing SIDS rates, ongoing research continues to refine our understanding of infant sleep safety. New technologies, such as wearable monitors, have been developed to provide additional peace of mind for parents and caregivers. These devices can alert them to any potential issues, such as irregular breathing or unusual movements during sleep.

Researchers are also working to identify additional factors that may contribute to SIDS, including genetic predispositions and environmental influences. This ongoing research is essential for continuously improving safe sleep guidelines and developing new strategies for protecting infants during sleep.


In conclusion, the recommendation that infants cannot sleep on their stomachs is grounded in a deep understanding of infant physiology and safety. Placing infants on their backs to sleep, following safe sleep practices, and educating caregivers about these guidelines are crucial steps in reducing the risk of Sudden Infant Death Syndrome (SIDS) and promoting overall infant health and development.

By creating a safe sleep environment, parents and caregivers contribute to the well-being of the youngest members of our society. The progress made in SIDS prevention over the years underscores the importance of evidence-based practices and ongoing research to ensure that every child has a safe and healthy start in life. Ultimately, the commitment to safe sleep practices reflects our collective dedication to protecting and nurturing our infants, the most precious members of our families and communities.

Leave a Reply

Your email address will not be published. Required fields are marked *