A plot of SIDS rate from 1988 to 2006

A plot of SIDS rate from 1988 to 2006 (Photo credit: Wikipedia)

Where Is the Best Position for a Baby to Sleep In? 

This past October, moms.today.com reported that grandparents flunked a recent safety quiz about babies.

Intrigued, I tracked down the author of the quiz, pediatrician and Assistant Professor of Pediatrics at the University of Alabama at Birmingham, Dr. Amanda Soong.

Dr. Soong had just presented her findings at the annual meeting of the American Academy of Pediatrics (AAP).

She surveyed 49 grandparents, from three grandparenting support groups, many of them primary caregivers for their grandchildren.

She asked them to fill out a 15-question survey, then, discussed their answers with them.

When I interviewed Dr. Soong, herself the mother of a 13-month-old and a three-year-old, I asked her what prompted her to do this research.


“When I was getting ready for my first baby, I bought a crib and sheets for the mattress.

When my Mom saw it she said it looked boring.

She was thinking about all those pretty pictures of nurseries and crib bumpers that match the curtains and baby blankets.

If it hadn’t been for the fact that both my husband and I are pediatricians, I don’t know how hard it might have been to convince her that safety was more important than pretty.

It got me thinking about what other grandparents believe.

I’ve actually had patients getting pushback from their mothers or mothers-in-law on some of these issues.

Several patients have asked me if I couldn’t just write a note to back them up.

I decided to construct a survey to find out what grandparents know about current AAP safety recommendations.”


Over the next couple of months, I will be taking each question on her survey in turn to discuss what the current AAP recommendations are and why.

Each post will also include a discussion with Dr. Soong about her research and what she found in talking to grandparents.

Question 1: What Is the Best Position for a Baby to Sleep In?

If you said, “On Its Back”, you are right.

And, so were 43.8% of the grandparents Dr. Soong surveyed.

But, that means 56.2% got it wrong, with 33.3% picking “on its stomach”, and 22.9% choosing “on its side.”

Haven’t they been paying attention?

AAP started recommending that babies be put down on their backs in 1992.

As this was long after Baby Boomers were raising our children, we might be forgiven for not knowing what current recommendations are.

The NIH’s National Institute of Child Health & Human Development, along with AAP, started their Back-to-Sleep campaign to raise awareness in 1994.

Many grandparents, when told about this new recommendation, fall back on the familiar argument, “I raised X number of children and they all turned out fine.”

In fact, when my children were born, in 1968 and 1979, parents were told specifically to put babies down on their stomachs so if they spit up in the middle of the night, they wouldn’t choke.

What Changed?

SIDS happened.

When my children were young, an unexplained crib death was usually assumed to be murder by the parents.

They must have simply put a pillow over the baby’s face and suffocated it.

Why else would they stop breathing in the middle of the night for no apparent reason?

Why Did Researchers Start Looking at Sleep Position?

In 1985, a researcher noted that in Hong Kong, where babies are put down on their backs, SIDS is rare.

When researchers looked at what happens when a baby sleeps on its back, they found that it roused more easily.

Now, to most parents this finding would mean that babies sleep better on their stomachs, since they rouse less easily.

And, in fact, babies sleeping on their stomach were found to sleep longer and deeper.

What it meant to researchers, however, was that babies on their stomachs could not breathe as easily or awake from deep sleep if needed.

This meant they could not as easily recover from obstructions to their breathing, like blankets too close to their face or a stuffy nose or an overheated room.

In fact, AAP’s original recommendation was that babies be put down on their backs or sides.

In 1996, further results prompted them to change this to recommend that babies only be put down on their backs.

What About the Spit-Up Issue?

It turns out this just isn’t much of an issue.

Babies can turn their heads to the side if they spit up.

They are not likely to choke on spit-up, as we had been told.

What About When a Baby Learns to Turn Over On Its Side?

At about six months, a baby will learn to turn over.

So, even if you put the baby down on its back, by morning it will be on its stomach anyway.

Should you still put it down on its back?

The answer is yes.

Put the baby down on its back and then let it sleep in whatever position it ends up in.

Do not put bolsters around to keep it on its back.

Do not turn it over, and risk waking it up.

The risk of SIDS drops dramatically after six months.

What Is Tummy Time?

Since babies are not naturally lifting their head when they wake up, as they do if they’re sleeping on their stomachs, AAP recommends two 10-minute sessions a day of “tummy time.”

This is when you put a baby that is awake down on its tummy to build up its neck and chest muscles.

They aren’t used to it and may fuss, but they need that time to build their muscles.

You can talk to them or sing to them to entertain them, but make sure they get a couple sessions of tummy time every day.

Risk Factors for SIDS

At least we know a lot more about the risk factors for SIDS now.

It is not depressed, homicidal parents.

Rather, babies are at higher risk of SIDS under the following conditions:

  • Mothers who smoke during pregnancy
  • Family members who smoke around the baby after it is born
  • Mothers who are under 20 years old
  • Premature babies
  • Babies with a lower than normal birth weight
  • Mothers who don’t get medical care during pregnancy
  • Babies who don’t get medical care after they’re born
  • Mothers who do not breast-feed
  • Babies who don’t sleep on a firm mattress
  • Babies who sleep with pillow, blankets and toys in the crib
  • Babies who are dressed in too many clothes when they sleep.

So, the good news is, we know what the risk factors are and what to do about them.

We know that the Back-to-Sleep campaign has cut the number of SIDS deaths in half.

Going forward, we need to make sure all grandparents catch up with this news.

Tell your Mom. Tell your mother-in-law.

Consider this a note from your doctor.

Click here and listen to our audio Interview with Dr. Soong Q1, discussing the question:

What Is the Best Position for a Baby to Sleep In?

Answer: On its back.

Thanks to my awesome daughter-in-law, Brigid, for bringing this article to my attention.

Would you have answered this question right?

Did you know that second-hand smoke was a risk factor?

Do you know anyone who lost a baby to SIDS?

Get our free report on how things have changed since Boomers raised our children, How to Leap the Generation Gap: 58 Reasons Child-Rearing Is Different Today, below and get more posts like this one on Child Safety and current recommendations:

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To you and the continued safe sleeping of your precious grandbabies.


Carol Covin, Granny-Guru

Author, “Who Gets to Name Grandma? The Wisdom of Mothers and Grandmothers


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