It's important for all babies to be placed on their backs to sleep.
Since the early 1990s, this global advice has significantly reduced SIDS deaths around the world.
But what do you do if your baby is one of many who won't settle on their backs?
Parents worry that their baby's sleep preference for their tummy or side puts them at higher risk of SIDS, yet lack of sleep is stressing the whole family.
Here are 6 tips to help your baby sleep comfortably, peacefully and importantly for you, baby and your family, have more sleep:
#1: Transition To Bed To Avoid The Startle Reflex / Fear
Having been cradled tightly in the fetal position, many babies find being laid on their back on a firm surface alarming, even though we know it is safest for them.
This can be, in part, due to a natural response known as the moro – or startle – reflex. This instinctive reaction goes right back to pre-historic times. When a newborn baby was lying on their back, it was at its most vulnerable, as the mother would never separate from her baby that way.
So as far as your baby is concerned, she has been abandoned. All hope is lost, and the tiger is going to get her! Her response to any sudden, backward movement is a fearful anticipation — her arms will fling out, her body will go tense and adrenaline will flood her system. Not exactly a relaxed state, ready to sleep.
You can help your baby with this transition by giving her lots of time snuggled against your chest in these early days. Daytime sleeps may be easiest in your arms or a baby carrier, rather than trying to lay him down on his own.
Gradually introduce time on his back while sleeping in your arms, and after breastfeeding lying on your bed beside you. If you are likely to fall asleep during or after these feeds, make sure you are following safe bed-sharing guidelines; otherwise have another adult around to take the baby if you doze off.
Learning to sleep on his back will be easier with you by his side. Find out more about the fourth trimester and how you can help your baby adjust here.
Never go to sleep while wearing your child in a baby carrier. While babywearing is a safe and comfortable place for your baby to sleep, it becomes a risk if you lie down for a sleep on your bed, or take a nap on a sofa or arm chair. Always remove the carrier and practice safe bed sharing guidelines.
#2: Let Him Fall Into Deep Sleep Before Putting Him Down
When your baby falls asleep during a feed, don't hurry to transfer him to his cot.
That early sleep is light REM sleep and is easily disturbed. Enjoy a cuddle with your baby for around 20 minutes, until he transitions into the deeper, quiet sleep cycle. Now you can lay him down on his back with less risk of him waking.
If you swaddle your baby to sleep, prepare beforehand by laying out his wrap on his bed, so you can gently wrap him while he sleeps, then leave him in position.
#3: Sleep Your Baby On Your Chest
Observe any other primate with a baby and you'll quickly work out where nature intended our babies to sleep! Little fingers and toes gripping tightly to the hair of their mother's chest. Baby gorillas, chimpanzees and orangutan sleep on their mother’s chest.
You can also use this natural position. A baby sleeping on his parent's chest, with his head higher than his bottom (i.e. with the parent on an angle) creates a secure environment for sleep. The breathing and movement of the caregiver's body stimulates the baby's breathing, even when they are both asleep.
Sleeping chest to chest has no known risks, but does have documented benefits. Indeed, it is thought the risk from tummy sleeping alone may be because babies sleep too deeply. Perhaps nature intended the adult to stimulate the sleeping baby and prevent this deep sleep.
Find out more about co-sleeping, breastfeeding and sudden infant death syndrome here.
#4: Take Baby Steps
If your baby will fall asleep on his tummy or side, then let him do so under your supervision.
Once you think he is deeply asleep, ease him over onto his back. As he gets used to this, you may be able to move him once he becomes drowsy, rather than waiting for deep sleep. You might need to go in stages: first move from tummy to side sleep, then from side to back.
#5: When It Matters Most
The recommendation is that you place your baby on his back to sleep for the first 12 months. However, in the second half of the year, most babies become mobile and will move around in their cot, while both awake and asleep! You cannot stay with him all night re-positioning him and nor should you. Make sure his sleep space meets all other recommendations, regarding bedding, toys etc., and accept that there truly are some things that you cannot control.
Keep in mind that the peak risk for SIDS is around 2-4 months of age, and 95% of cases occur before 6 months. There is nothing you can do that will guarantee your baby won't be affected, nor do all babies not following the recommendations die.
Do the best you can, without becoming obsessed. To put it into perspective, 99.9% of babies do not die from SIDS.
#6: Don't Be Tempted To Wedge Your Baby Into Position
In 2010, the U.S. Food and Drug Administration (FDA) and Consumer Product Safety Commission (CPSC) issued a warning to parents to stop using sleep positioners. They cited reports of 12 babies who died when they suffocated in a sleep positioner or between a sleep positioner and the side of a crib or bassinet.
There have also been reports of babies who were placed on their back or side in a sleep positioner, but were later found in a potentially hazardous position in or next to the positioner.
The incidents involved two types of positioners: flat mats with side bolsters and inclined (wedge) mats with side bolsters.
Always place your baby directly on his sleep surface without additional props designed to keep him in place.
The incidence of SIDS has dropped from one in 500 to one in 1000 since the ‘Back to Sleep” campaign began. However, the other guidelines are just as important. Find out more about reducing the risk of SIDS.