My Baby Will Not Sleep On It's Back

Date: 17 Sep 1998

My 1month old son refuses to go to sleep on his back or side. He just started this about 2wks ago. When he is put down to sleep on his back or side he just screams. Nothing we do seems to work. He has been sleeping in his infant car-seat for almost 2 weeks now. It is the only way we can get him to sleep. When we lay him on his tummy, he goes right to sleep and is very relaxed and peaceful. I am very aware of the risk of SIDS, but don't know what to do. I have read that in certain situations, doctors recommend that babies sleep on their tummies. Is this a situation in that it would be okay to allow my son to sleep on his tummy. I should also tell you we have had to change his formula to a soy based one because of excessive fussiness and gas. Please help me with advice on this matter, I am very concerned about what to do.

Date: 18 Sep 1998

I would suggest that you contact your pediatrician, there may be an important reason why your son finds the back position so uncomfortable, by the way, side position is not a recommended position to reduce the risk of SIDS.

Henry Krous, MD
San Diego
hkrous@health.ucsd.edu

January 24, 2003

My 6-month old has been using a sleep positioner, but can now roll over it. He keeps rolling to his stomach, sometimes crying, but sometimes falling asleep. We have lost sleep hoping he doesn't roll to his stomach and going to check on him many times. WHEN IS IT SAFE for babies to sleep on their stomachs??? I have read research that states that babies who have previously slept on their back and switch to their stomach are at a higher rate for SIDS, but it doesn't say anything about age??? I don't know what to do.

You raise an important question, but unfortunately not one we have a definitive answer for. Data from Australia and a few other countries suggests that the effect of not sleeping on the stomach is most important during the peak age range for SIDS --- 2-4 months of age. After that age, countries that have changed infant sleeping position from prone to supine do not see as much of a reduction in SIDS as they do in the 2-4 month age. Therefore, we assume it is less important, but we can not be sure. In general, we recommend trying to have babies sleep on their backs during the first year of life. However, we know that most babies will be able to roll over, and are often found on their stomachs by many months before a year of age. You can only do the best you can. Babies should be put down to sleep on the back. We do not recommend tying babies down or restraining their motion in any way, as this may be worse than the sleeping position the baby would adopt.

Thanks,
---Tom Keens, MD
tkeens@chla.usc.edu

January 27, 2003

While I defer to Tom Keens, Ron Ariagno, and other clinicians, I would offer the following:

First, SIDS is rare after age 6 months, less than 10% occur during the second 6 months of life, and the overall incidence is now down to .5 per 1000 live births, so the statistical odds are overwhelmingly in favor of survival!

Secondly, it is impossible to keep a baby on its back when it is rolling over easily. Muscle development and strength have greatly improved since birth, therefore it is far easier for a baby to "rescue" itself when in a dangerous situation compared to the peak risk period of SIDS.

Thirdly, stop worrying, and get a good nights sleep!

Henry Krous, MD
San Diego
hkrous@health.ucsd.edu