How to get an infant to sleep on his back?
March 8, 2012 3:34 PM   Subscribe

First-time parents looking for resources to get 4-month infant to sleep on his back. We've already consulted our pediatrician and family, and searched online... would appreciate any more help!

Our son is 4 months old. He's healthy, happy, and active. However, we've been unsuccessful getting him to sleep on his back and he only remains asleep when he's on his stomach. Since birth he's had excellent neck control and is able to turn his head from side to side. After a few weeks he was strong enough to lift his head, and he's gotten stronger. He's about 18 lbs (8 kg) now, and 26" (66 cm) in length. We're not aware of any medical conditions or allergies, and we ourselves are non-smokers and have no ongoing medical conditions. His crib and mattress are under no current recall.

Given the above, we're semi-comfortable with allowing him to sleep on his stomach. He sleeps well through the night, waking up once or twice to feed. On a good night he'll sleep for 6 hours. However, we're consistently admonished by medical professionals about it (see below) and it's gotten us overly paranoid that we're "doing it wrong."

So when it's time for sleep we try and place him on his back, but he will fuss and cry continuously, and while his voice gets hoarse, he doesn't appear to tire. We've tried allowing him to cry for as much as half an hour, and we fully believe he would keep going longer. Needless to say we don't want him to suffer any trauma, so we pick him up and comfort him, rock him to sleep and place him on his front.

Some of the things we've tried:
  • We rock him until he's asleep in our arms, then place him on his back in the crib. As soon as he's down his eyes open and he begins fussing and crying.
  • We have the room dark, with a ceiling fan and mobile overhead. We use a white noise app that plays a variety of sounds from running water and ocean waves to static and music. He appears to ignore all of them while he's on his back and crying.
  • We've tried swaddling him tight, but he's apparently strong enough to twist and wriggle until he loosens the blankets. We're loathe to use thicker blankets because we live in a very warm tropical area. The only thing we haven't done is tie the blankets closed, mostly because he doesn't appear to appreciate being restricted like that and will twist and wriggle and cry in frustration.
  • We consulted our parents, who said that both myself and my spouse were placed on our stomachs, so since we're alive it can't be that bad. Granted, those were different times.
  • My spouse's therapist (for PPD) said that if the boy can only sleep prone, let him sleep prone. However, I understand this recommendation was made more to address my spouse's physical and mental well-being.
  • We've consulted our pediatrician. He just kept saying that infants must sleep on their backs, we should just buy some earplugs and warn the neighbors, and we wouldn't want our kid to die, would we? His tone sounded very judgmental and it made us uncomfortable. Also, he did not offer any other help nor any resources to try and get our infant to sleep on his back, beyond saying we should just do it and let him cry (we're going to find a new pediatrician).
What we're looking for:

We are aware of the correlation between supine sleeping (lying on the back) and a decreased risk of SIDS. We know this is a very serious issue and we want to make the best decision possible. We're open to hearing and discussing possible options, but unfortunately we no longer feel our current pediatrician is the right person for that. We are in the process of looking for a new pediatrician, but for the time being, is there any advice or other resources we can look up for more info? For what it's worth, we are in the US.

We've tried searching around for other tips on getting an infant to sleep on his back, but haven't found anything not already mentioned above. We did see some older AskMe questions and recommendations for activity monitors; we will definitely invest in one, but we'd also like to alleviate more concerns and really get our infant to sleep in any position, front or back. If anything for the sake of our own well-being!

Additionally, we've tried searching for possible exceptions to the "back to sleep" rule. We're wondering if our infant's "strengths" and his environment put him at less risk for SIDS or suffocation, but we haven't found anything. I'm not expecting any medical professional to state that sleeping on the stomach is okay, but I'm hoping there might be something out there that says our son has a better advantage than most. Does anyone know of research that support exceptions to the "back to sleep" rule?

We feel blessed to have such a healthy child, and every day he's a bounty of joy. This "prone vs supine" sleeping issue is the only thing that's dampening our spirits!

Thank you, all!
posted by anonymous to Health & Fitness (35 answers total) 4 users marked this as a favorite
Plenty of medical professionals will tell you that once a baby can turn his head, he's ok to sleep on his stomach. Just keep blankets/stuffed toys away from his face, and honestly, let him do what works for him. I'm a parent myself and don't mean to sound glib, but you sound like you are worrying way too much about something that is obviously working for you!
posted by tetralix at 3:39 PM on March 8, 2012 [6 favorites]

My wife is a doctor and (admittedly irrationally) obsessed about SIDS.

Other factor in SIDS that minimize an already incredible rare event:

Airflow. Keep a fan going.
Do not smoke in the house.
Do not co-sleep.
Do not drink and co-sleep (obviously not SIDs, but these accidental suffocations are tallied with SIDs).

18lbs at 4 months?! What a hoss! My boy was 19lbs at a year and we constantly worried about his eating habits, but you know, it all works out.

You are doing a great job. Don't let this bog you down. Your child will be great.
posted by LeanGreen at 3:46 PM on March 8, 2012 [1 favorite]

We rock him until he's asleep in our arms, then place him on his back in the crib. As soon as he's down his eyes open and he begins fussing and crying.

This may sound like a small trivial thing, and may not be an issue at all since you said you live in a warm climate, but my 6mo will do the same thing and we've tracked it down to the temperature change from ambient air to cool bed. When I put her down I hold my hand under her head/neck between her and the bed. With my other hand I can tuck in her blanket. By the time I get her blanket tucked in the bed is warm were my hand was and then I can slide my hand out without her waking up.

Also I don't see mention of a pacifier - have you used one with him? Our oldest would not use one at all, but the new one loves them, especially the wubbanubs. They're great because she can usually find it in the middle of the night and put it back into her mouth and go right back to sleep.
posted by Big_B at 3:47 PM on March 8, 2012

Add to that SIDs list:

No not have bumpers. Ever.
posted by LeanGreen at 3:47 PM on March 8, 2012 [1 favorite]

The SIDS risk goes way down by 4 months. Plus, by 5 months or so, babies are frequently rolling over onto their bellies by themselves, and pediatricians say it's fine to let them stay that way if they're asleep. I think you should be able to comfortably relax and let the babe sleep!
posted by wyzewoman at 3:48 PM on March 8, 2012 [4 favorites]

The way it's done is to never put them on their stomach until they discover it on their own, lol. It's believed that if they can roll their way onto their stomach, they can roll themselves off again if their breathing requires them to do so.

Statistically, I read long ago that most SIDS cases are male, between 2-4 months old, in February, often on a couch or chair in a warm room. 90% of cases are before 6 months. I was really terrified of SIDS, and researched it constantly. You seem to have sailed through the age/time of year with the worst luck. If I were you, I would probably make sure the room was cool, cross my fingers, and let it go.
posted by MeiraV at 3:50 PM on March 8, 2012

We swaddled* ours until he was 4 months (and weighed less than yours - he's now 6 months and 18 lbs) but my point is that at our 4 month visit our ped said he was holding up his head well enough and had good enough neck control that he was able to sleep on his stomach, so we stopped swaddling him and let him sleep on his stomach. Life became soo, soo much better.

He was waking up about 2x/night for a feeding/diaper change, it is down to one now.

He does like to sleep with his binky, and we do have the AAP approved breathable bumper, as he was sticking his limbs out of the slats. Also, blankets? Try a sleep sack instead.

*once he was able to Hudini out of blanket swaddles we moved on to velcro ones, which were awesome.
posted by cestmoi15 at 3:56 PM on March 8, 2012

I should also note that many many babies have trouble of sleep at four months, regardless of what position you put them in: it's the 4-month wakeful, and it's tons of fun! But it does eventually end.
posted by wyzewoman at 4:00 PM on March 8, 2012 [1 favorite]

Hmmm, last comment: I can't find the plot I saw regarding the drop off in SIDS rates by age. There is one in this paper which shows a much slower drop off than I remembered, but even so by 5 months the frequency is down nearly half from the max. I seem to recall that the distribution has shifted since the introduction of the Back To Sleep campaign, but I can't remember in which direction! So, please take my statistics with a grain of salt.
posted by wyzewoman at 4:06 PM on March 8, 2012

Our doctor told us that once he started rolling over his own, it wasn't worth stressing over anymore. If you want to try swaddling again, velcro swaddle blankets like the swaddleme are amazing, and the knit ones are lightweight enough to not be a bother in warm weather. (The swaddleme blankets were the only way we we got our son to sleep for at least six or seven months. I kinda wish they made them for 2-year-olds, but oh well...)
posted by logic vs love at 4:15 PM on March 8, 2012

IANAP(ediatrician). I have several friends with babies with reflux issues who have had their doctors recommend sleeping on their stomach. In those cases the docs thought the benefits outweighed the risks, and these were for babies much smaller/weaker/less developed than yours. One suggestion I have heard to help reduce the risk of SIDS while stomach sleeping is to elevate the head of the crib 30 degrees. Again--I am not a doctor--but if you google "head of crib 30 degrees while stomach sleeping" or something similar, a bunch of links should appear, including NIH studies. Sounds like you definitely need a new, more helpful pediatrician as well. Good luck!
posted by Bella Sebastian at 4:16 PM on March 8, 2012

My son slept on his stomach from the start with the blessing of our pediatrician and our pediatric gastro doc due to his reflux. Both docs just emphasized the basic precautions - firm mattress, no extra bedding, no bumpers and suggested using a sleep sack. IANAD, but I'd say if you're following those basics and have a fan on, then just don't stress about it. He'll be rolling over in a few weeks anyway and then there's really nothing you can do about how he sleeps.
posted by PorcineWithMe at 4:20 PM on March 8, 2012

Our daughter was like this. Will he sleep on his side? if he will, what we did is put her on her side with her back up against the side of her bassinet/crib, and a rolled up blanket in front her her to kind of keep her on her side. I can't remember how long we did this until we just let her sleep on her stomach - certainly once she could roll herself over we never rolled her back.

@logic vs. love - they don't make the swaddle mes, but they do make the sleep-sacks that big, and I have friends who use that because their kids roll around in the night and won't stay covered!
posted by dpx.mfx at 4:32 PM on March 8, 2012 [1 favorite]

logic vs love: " If you want to try swaddling again, velcro swaddle blankets like the swaddleme are amazing, and the knit ones are lightweight enough to not be a bother in warm weather. "

Just in case you did try a velcro swaddle blanket already and he got out of it, I'd recommend the Miracle Blanket. Our baby found being on his back infuriating, and the nights before the Miracle Blanket were terrible. 15 minutes in a Swaddleme and he'd be wearing it like a necklace. He wore the Miracle Blanket until 6 months and he never even loosened it a bit. It was also nice and cool.
posted by that's how you get ants at 4:37 PM on March 8, 2012 [1 favorite]

Honestly, it sounds like you should just let the baby sleep on his stomach. You're taking all the other precautions to reduce the risk of SIDS. The risk of SIDS is quite small to begin with, especially once you're past 4 months. I think this is just a case where you need to do what's best for your family and ignore your pediatrician (who sounds like a bad fit anyway).
posted by barney_sap at 4:46 PM on March 8, 2012

I would also chime in to say the risk of SIDS is way down by four months. If you're still concerned about it, I don't know what they're called, but you can buy these things that are like two cylinders joined by material. You put the baby inbetween the cylinders and it discourages rolling, but at four months I wouldn't worry about it.
posted by smoke at 4:57 PM on March 8, 2012

We went through a similar situation at 4 months. Our daughter was fine once she managed to get to sleep, but it would take up to two hours a night of rocking, crying and comforting before that would happen. We swaddled, played ocean sounds, something that was supposed to sound like the inside of the womb, lighted mobile, no mobile, and absolutely nothing worked until we flipped her over on her belly one day, patted her three of four times on the tush, and she snuggled in and went straight to sleep. Just like my mother had been telling me all along.

My husband stayed up to keep watch over our daughter that night, and the next day we bought one of these. To be honest we never discussed it with our doctor because I knew what she would say. I also knew that there was an older, mellower doctor in the same practice whose advice was usually "do what you need to do". We did some research, looked at the statistics and risk factors, and decided that our risk was probably much lower than the national average. Our daughter happily slept on her stomach until she started flopping all over the crib. On a related issue, my husband insists that we bring the alarm system with us anytime we travel and will be sleeping away from home, and our daughter turned two in January. So if anyone knows how to wean a husband off a baby alarm, let me know.
posted by defreckled at 5:28 PM on March 8, 2012

Have you tried propping up one side of his bed? I think our baby got pretty fussy around this age. She was in a bedside co-sleeper and we put some books under the feet to raise the head of the bed and that seemed to help her sleep a little better. Maybe she was having a little reflux or congestion?

Around 5 months, she was able to roll over on her own and once she started really getting out of her swaddle, we phased it out. And soon after she was sleeping in her preferred position, on her belly, legs tucked up, butt in the air. Seems very common.
posted by amanda at 5:31 PM on March 8, 2012

If you really don't want to have him on his tummy, you could try his side - there's a side sleeper wedge contraption that we used with my daughter when she had reflux. You can adjust the thickness between the pillows for how big your baby is.
posted by Addlepated at 5:32 PM on March 8, 2012

Another vote for side sleeping.
I had success with getting our bubs to sleep by patting them to sleep while they were snuggled on their side, and then once they were firmly asleep I would gently sneak them over so they were more on their back than their side. Not so they were fully on their back, but just enough so that they were not going to roll accidentally onto their stomach and not be able to roll back.
I also encouraged lots of tummy time to get their core strength up so that they could roll over and sleep however they wanted.
posted by bingoes at 5:51 PM on March 8, 2012

I'm not a doctor, but we went through this with our second kid. Letting the baby sleep, even on his tummy, is better for everyone than letting him cry and stressing everyone out. Don't lose any sleep over it (literally). You've done everything you can to minimize the risk.

If it makes you feel better you can get an AngelCare monitor.
posted by Simon Barclay at 5:51 PM on March 8, 2012 [1 favorite]

With kid #1 we stressed about it and tried to make him sleep on his back, with kid #2 we just let him do what he wanted, kept an eye on him, and we were all much happier. But the reason I'm commenting is really about all the swaddling suggestions. While I'm clearly a little lax about some of the anti-SIDS recommendations, I don't think it's safe to swaddle a big, active, strong baby for sleeping. He could bust out of the swaddle and get tangled up in the blanket, or flip himself over and not be able to get back to a position where he can breathe easily.
posted by chickenmagazine at 6:12 PM on March 8, 2012 [5 favorites]

I've found this link to be very helpful in addressing my concerns regarding sleep position. Best when read in full.
posted by mooselini at 6:12 PM on March 8, 2012 [1 favorite]

Another anti-SIDS precaution is to have the baby sleep in the same room as the parents, although on a different surface. If its practical to move his crib into your bedroom that might make you feel better.
posted by bq at 7:01 PM on March 8, 2012

IMHO, you should just let him sleep on his stomach. Keep away normal hazards like pillows, bumpers, blankets, etc.
posted by gnutron at 9:07 PM on March 8, 2012

All three of my children were stomach sleepers. Their ages now, 14, 8, and 5.

Your baby has good parents, lives in a healthy environment, and is a healthy baby.

Lie to your doctor. Enjoy your baby.
posted by myselfasme at 7:02 AM on March 9, 2012

Just to throw some caution to some of what's been written above, my daughter died of SIDS at eight months old, and we've met several other parents over the years whose children have died of SIDS as late as a year old, so while the risk does go down it does not go away. Our daughter always slept on her back (we never had trouble with it, I'll get to this in a sec), we are non-smokers, and she had none of the other risk factors, environmental or otherwise. So, it happens, it can happen even in the best of situations, and the best, best, best way to prevent it is to have your child sleep on his back.

With our daughter, who was big like your boy sounds to be, she loved to be swaddled. It sounds like you've struggled with this, and we have too... with our twin boys.

For our experience with them I can echo the recommendations of the Miracle Blanket from above, it really did help with them settling in well, none of the other swaddling devices/blankets/etc. really did. We kept them in a crib next to our bed, and we slightly angled the mattress to help deal with reflux. We found that the transition from our arms to the crib was much shorter when the crib was next to our bed, and that my wife (or I) could keep a hand on them while they settled (or if they fussed).

I do agree with several of the folks above that it's probably time to look for a new pediatrician. I have nothing nice to say about SIDS monitors (and have posted elsewhere here at length about all of the not nice things...).

Good luck!
posted by togdon at 7:47 AM on March 9, 2012

Side-sleep wedges and rolls have been recalled for SIDS risk, so be aware of that.

The above statements about his body control being an important advantage versus SIDS are worth attending to - no, stomach sleeping is not ideal, but if you try everything else and have to let him do it, he has a better chance of moving his head for air.

Don't put rolled up anything in the crib. The warnings about crib bumpers are right on. You can get mesh bumpers that prevent wedging and slat-entrapment. Wedging him against the side of the crib could be more dangerous than letting him sleep on his stomach.

Do try elevation, the fastening swaddlers, and equalising the temperature of the bedding before putting him down.

Crying it out is actually more likely to affect his sense of well-being than not at that age (even Ferber doesn't support it until post-6mos), so I'm very glad you're looking for new pediatric doc.
posted by batmonkey at 11:26 AM on March 9, 2012

If you end up keeping him on his stomach but want to monitor him, you could get one of these:
posted by mingshan at 11:37 AM on March 9, 2012

Togdon, I am so, so sorry to hear about your daughter.

I think part of the reason I'm so quick to spout the statistics is that it's less scary if I can think I'm over the risk with my own five-month old, but it's clear I shouldn't let that desire to not worry lead me to unsafe practices. (Although my son rolls to his belly on his own now, so how he sleeps is out of my control.)
posted by wyzewoman at 8:09 PM on March 9, 2012

Trust me, I was right there with everyone else on the statistics. I remember sitting in the semi-mandated hospital birthing classes where they actually said "Babies don't die of SIDS after six months."

Then the reality struck and all of a sudden you get to see behind the curtain and realize that that's just when a lot of the SIDS deaths stop, but certainly not all of them. There's no doubt that most of them happen between one and six months (weirdly there are almost none before a month), but all of the people who I've met whose children have died of SIDS have had children who were older than six months, and several of them have had children die either right before or after their first birthday.

Since the inception of the Back to Sleep campaign in 1994 the rate of SIDS deaths has dropped by about 50%, and while I'm not certain (and don't have the time to check) I'm guessing that almost all of that decline is in the one to six month range. So, is it safe to let your baby sleep on their stomach around six months? Maybe. Did we fight our twins tooth and nail to keep them on their backs until they were at least a year old? Yup, and it was a huge pain to do so (so, I completely sympathize with Anonymous, and wish them the best of luck).

One great(?) thing to keep in mind with SIDS is that while it's something that I think every parent freaks out about it's actually pretty rare, roughly 2500 deaths a year in the US (compared to roughly 4M births). My wife and I used to joke that we took one for the team when our friends would freak out. There are enough Mefites around that I'm guessing I'm not the only one whose child died of SIDS, but I'd be willing to bet there aren't more than two of us (and while I'm making that bet I'd double down that if there's another Mefite out there who child died of SIDS it was pre-1994).
posted by togdon at 12:34 PM on March 10, 2012

This paper shows, in Figure 1, the incidence of SIDS by age, both before and after the Back To Sleep campaign. As togdon hypothesized, most of the decline in rates seems to be in the early months, which could imply that back sleeping is less of a risk factor for older infants. But I suppose it's also possible that the campaign has simply had a smaller effect on the sleep positioning of older babies, or that these data are more noisy.
posted by wyzewoman at 4:26 PM on March 11, 2012

Er, make that "which could imply that stomach sleeping is less of a risk for older infants."
posted by wyzewoman at 4:29 PM on March 11, 2012

Oh, shoot. This is why one needs to read plots very carefully: turns out the figure I just mentioned is a plot of the percentage of SIDS deaths by age, not the absolute SIDS risk by age. Thus what it actually says is that since the Back To Sleep campaign, SIDS deaths have decreased at every age, just somewhat more for the younger infants. So the implication is the exact opposite of what I said before: putting the baby on their back does seem to reduce the risk even for older babies. However, the risk reduction is a little smaller and the absolute risk at these older ages is much, much smaller.
posted by wyzewoman at 9:21 PM on March 11, 2012

Mod note: From the OP:
It's been 10 months, and before comments are disabled I wanted to update this thread.

The boy is now 14 months, still healthy (barring typical colds and viruses), happy, and active. He sleeps in any position in his crib, and at times I'll find him completely turned around 180 degrees.

Reading everyone's responses lessened our worries immensely, and we were very interested in reading wyzewoman's linked article.

We also found a new pediatrician, one who was able to address our concerns with empathy and willing to work with us. He did tell us about the risks, but unlike the previous doctor, he also told us how we could minimize those risks, and how statistically the risks drops as the child grows older. In fact, he would likely fit very well here with the way he helps answer questions.

Thank you, everyone! I really appreciate your assistance, and am very grateful for this community!
posted by restless_nomad (staff) at 11:27 AM on January 3, 2013 [1 favorite]

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