Changing Colors: The Blog of Spectrum Pediatrics

May 8, 2017

Safe Sleeping Positions

By: Colleen Donley, PT, DPT

In October 2016, the American Academy of Pediatrics released new sleep guidelines for children up to 1 year of age. Our SLP, Tracy, summarized those suggested guidelines here.

As a physical therapist, I often work with families on safe and appropriate positioning for play and sleep. Frequently, I run into positions that may be unsafe, or safe but position baby improperly. Unsafe positions often put the baby at an increased risk of harm or Sudden Infant Death Syndrome (SIDS). Other positions may be considered safe as they adhere to AAP guidelines but baby’s head or body may be placed in a position that puts them at risk for other developmental issues. Here are some of the most commonly used undesired sleep positions:

  • Tummy: We always want to remember back to sleep and tummy to play. Tummy time is appropriate for playtime and a wonderful activity for baby to develop strength and motor skills. It is always recommended that you put baby to sleep by placing them on their back. Once baby learns how to roll, they may roll in their sleep from back to tummy and tummy to back. Many experts feel that once your baby has learned to roll, it is safe for them to sleep on their tummies but they still recommend starting sleep on their backs.
  • Bumpers in the crib: Bumpers serve as the purpose to protect the baby from getting their little hands or feet stuck in between the crib rails and cushioning the head should baby roll into the crib side in their sleep. AAP recommends babies should be placed to sleep on a firm crib mattress with no soft bedding or stuffed animals. Bumpers pose a serious risk of suffocation should baby roll into them or get pinned against them in their sleep.
  • Car seat: Riding in the car can be very soothing for baby and often a trick parents use to help get a fussy baby to sleep. Sleeping in a car seat poses a similar risk to sleeping on the tummy. If the baby’s head flops down, it could get pinned against the side of the car seat and put the baby at risk for suffocation. Additionally, prolonged positioning in the car seat creates uneven pressure on baby’s head, especially if this is where they sleep and their head falls to one side. Uneven pressure and the head dropping down to one side can lead to plagiocephaly (flat head syndrome) or torticollis (tight neck muscles on one side).
  • Rock ‘n Play: The Rock ‘n Play is widely popular in the world of baby gear must-haves. The Rock ‘n Play places the baby in a semi-reclined position, which goes against the firm, flat surface recommended as a safe way to reduce the risk of SIDS. Additionally, it allows gravity to help pull baby in their most preferred position, exacerbating slight preferences to one side. This can cause or exacerbate torticollis. The soft surface of the Rock ‘n Play makes it harder for the baby to move their head out of a certain position, which allows pressure to remain in a focused spot for longer periods of time. This is often why physical therapists see plagiocephaly associated with prolonged positioning in these soft sleepers.

Remember, it is always best to ask your pediatrician questions or share concerns about sleep positions. Your pediatrician will work with you to educate you on safe sleeping and determine what is best for your baby and family.


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