Will your baby choke from back-sleeping?

In my last articles, I reviewed ways to lower the chance of SIDS, including back-sleeping and breastfeeding. Like many parents, you may have concerns about back-sleeping, such as choking, poor sleeping — and maybe even flat heads!

You may worry that if your baby spits up while on her back she will choke. This is a natural concern. However, your baby has natural ways to prevent spit-up from going down the windpipe (also called the airway). This special protection even exists when she is on her back.

Sometimes, your baby may cough or gag if she spits-up. Her face may even turn red. Those reactions are her body’s normal and natural responses. It does not mean something is “going down the wrong pipe.” Since doctors have been recommending that babies sleep on their backs, research has shown there has been no increase in babies having true choking events. Do not elevate the head of a baby’s crib, even if your baby spits-up frequently (also known as reflux). If the head of the crib is elevated, she may slide to the foot of the crib and no longer be in a safe sleep position.

You may have heard from friends or family that if your baby sleeps on her back, she will not sleep as soundly. You may have even noticed that while your baby is on her back, she may wake up or stir at times. This does not mean your baby is uncomfortable or a “bad sleeper.” It is actually important that babies can awake easily from sleep and probably helps protect against SIDS.

When a baby is on her belly, she is less likely to wake up, even if she is getting into trouble with her breathing. So actually, the same reasons that make belly sleepers seem to rest more soundly may be the same reasons why belly sleepers are more likely to die from SIDS.

When a baby sleeps on her belly, she does not get a good supply of nice, fresh air with a good supply of oxygen. If a baby is on her belly, the old, stale air she just breathed out is more likely to be the same air she will breathe in. The brain needs a good supply of oxygen at all times, and rebreathing old air does not provide good amounts of oxygen. If the brain doesn’t get enough oxygen, it could cause your baby to be extra sleepy. She may appear to be getting “better rest” on her belly. But in reality, what seems like a more sound sleep can actually be a dangerous situation.

Some parents have heard that the back of a baby’s head may get flat from sleeping on the back. This is actually true. But a flat head is usually avoidable and not serious when it occurs. Remember to turn your baby’s head to the side when you put her to sleep. Sometimes turn her head to the left, and other times, turn it to the right. You can also turn her around in the crib, so her head is at the foot of the crib sometimes. This can help if she usually looks in the same direction of the room. If her head does become a bit flat in the back, it usually is not serious. Having awake, supervised “tummy time” will also help prevent the back of her head from getting flat.

“Tummy time” means giving your baby some time on her belly, while she is awake and you are watching her. In addition to helping avoid the baby’s head becoming flat, tummy time helps in other important ways.

Tummy time helps your baby develop the muscles in her chest and shoulders. It also gives your baby a chance to see and explore the world around her. At first, your newborn may not like being on her belly and will only tolerate tummy time for a few seconds without crying. That’s OK. Over time, she will become more used to being on her belly when awake and will probably even start to like it. Make sure to give her some tummy time every day, and always supervise her during these special times.

These sleep tips are intended for babies up to one year. As your baby gets older and is able to roll from her back to her belly, you do not have to wake her to reposition her if you find she has rolled to her belly. This is a natural part of her development and will probably occur around six months.

As your baby’s strength and coordination is increasing, her brain is also developing. These things help lower the chance of SIDS as she gets older. However, SIDS can still occur, so keep following safe sleep advice until her first birthday. That means place her on her back to go to sleep until age 1, but don’t wake her to reposition her if she rolls onto her belly.

If you have questions, be sure to talk to your baby’s doctor. Babies depend on their parents to keep them safe and healthy, and following these tips can help you do just that. May you and your baby both sleep well!

Author Laura Lawler, M.D., FAAP, is chief of Pediatric Hospitalists at Christiana Care.