I hate infant sleep positioners. They are not safe or helpful. If you have one or know a family/friend who uses one for their infant, throw it out. Trash compact it. Stomp on it. Cut it up in bits. This is one rare thing you should feel good about putting in landfill.
When I was first started in practice, I didn’t even know sleep positioners existed; I was shocked at how many parents told me they were using them. We are led to believe (by manufacturers) that positioners confer safety by keeping babies on their back. Since 1994, the Back to Sleep campaign has helped parents become vigilant (yes!) about putting babies to sleep on their backs. But after my sons were born, and while roaming the super-store aisles for bottles, crib sheets, overpriced silicon, and breast pads (oh the glory), I realized why parents get so confused.
In the infant sleep section, I found plenty of products designed for babies I would never recommend. Never. Sleep positioners, head positioners, comforter-like blankets for the crib, bumpers and stuffed animals. Many products went against what I was taught in my pediatric training and what I’ve learned thereafter. Like so many things in life and medicine, less is more. When asked about setting up a safe infant crib I say, “Boring, bare, basic.”
In 2005, the AAP (American Academy of Pediatrics) issued an updated guideline on the prevention of SIDS. Though the message has been effective, sleep positioners have persisted to sell. Two weeks ago, prompted by 12 deaths (over 13 yrs) due to sleep positioners, the AAP reiterated their position citing the dangers from sleep positioners after the CPSC and FDA (photos seen here) sent out a warning. Even though these positioners go clearly against safety data and medical advice, companies have kept them on the market.
Why?
Fear. Plenty of products designed for infant sleep target those parents who fear sudden infant death syndrome (SIDS). Which, to be honest, is most of us. Products like sleep positioners claim to keep babies on their backs yet go entirely against what we know in protecting infants from unexplained death or SIDS.
The bad news: SIDS, although extremely rare, is the number one killer of infants beyond the neonatal period.
The good news: Over the past decade and a half, the rate of SIDS has been cut in half since pediatricians and providers have advised placing babies on their backs to sleep. In half. Getting rid of a positioner is one change that could prevent an avoidable death. A positioner is made of soft bedding material. Boring, sparsely decorated cribs with firm mattresses, are the preferred, perfect sleeping environment for babies.
Boring, bare, basic is best.
When you leave the hospital, you need very few material goods: breastmilk (or formula), a bare crib or bassinet (with a firm mattress), diapers & wipes, a few outfits, and thin receiving blankets. And the non-material one: love. But that comes naturally.
The causes of SIDS are poorly understood. I don’t necessarily like talking about SIDS on a parenting blog where I am committed to minimizing fear. The below information is not to scare you, rather inform you of ways to minimize the risk. Research continues on preventing SIDS. Theories of what causes SIDS surround concerns for suffocation from soft bedding, re-breathing of the air when babies sleep on their tummies, and overheating. Goals for families to reduce the likelihood of an event demand constructing a safe sleeping environment.
Preventing SIDS:
- Position: Always put your baby to sleep on their back. Remember since the 1990’s death from SIDS has been cut in half since we’ve advised back sleeping. There is no questioning this. Always put a baby to sleep on their back. If your baby rolls over, after you’ve placed them on their back, there is no need to continue re-positioning them.
- People: Tell Grandmas, babysitters, nannies, & the nice-friend-that-helps-you-out to always put your baby to sleep on their back. Babies who are used to sleeping on their back, who are then placed on their tummy by a different caregiver, are at far increased risk of SIDS.
- Bedding: avoid soft bedding, sleep positioners, head positioners, bumpers, stuffed animals, thick blankets, or pillows of any kind in the first year. Talk to your pediatrician if you have any concerns or want to clarify. Boring, bare, basic.
- Lifestyle: Babies who have parents who smoke are at increased risk for SIDS; avoid cigarette smoke and help loved ones quit. Your baby is the perfect reason.
- Pacifier: Pacifiers have been shown to decrease the likelihood of SIDS (the why behind this recommendation is debatable). Offer a pacifier for your baby after 1 month of age when feeding is well established. If the pacifier falls out during the night, there is NO data to support your need to put it back in a baby’s mouth. (Just try to get some sleep while baby is sleeping!)
- Cool: Don’t jack up the thermostat because there is a baby at home. Ideal temperatures for sleeping infants is about 65-68 degrees. New data suggests that using a fan to circulate air (not directly on the baby) may improve the condition as well. Keep the room cool. In the summer use a circulating fan to keep the room comfortable.
- Where: The AAP recommends babies sleep in their own crib or bassinet in their parent’s room until 6 months of age. This makes overnight feeding easier, too (quick commute).
- Inform: Know the facts so you don’t make false assumptions and increase your worry. Share what you know.
- SIDS is rare, but more common in infants who have a family member who died of SIDS or have parents who smoke. If you are concerned about your family’s history, talk with your pediatrician.
- SIDS is most common between 2-4 months of life with 90% of cases occurring in babies under 6 months of age.
- SIDS is possible up until a baby turns 1 year of age. Follow precautions and back to sleep positioning until your infant turns 1 year of age. Following these precautions decreases risk.
- SIDS risk can be decreased by following recommendations and clearing out the crib of soft clutter. Remember SIDS cases have cut in half since we started recommending following these guidelines.
desiree says
i had gotten a sleep positioner as a gift when i was pregnant with my oldest daughter, and could never bring myself to use it. glad that instinct was right!
i’m not sure i believe that the back to sleep campaign has been so successful though. here’s a link to an article in pediatrics that discusses whether a change in classification from SIDS to other causes might explain 90% of that drop: https://pediatrics.aappublications.org/cgi/reprint/115/5/1247
however, i also wonder if a decrease in SIDS deaths was offset by an increase in suffocation deaths as a result of co-sleeping, which seems to be much more common today.
anyway, i like your blog! i just found it!
HereWeGoAJen says
We have a totally naked crib and still use the Halo Sleep Sacks instead of blankets. (Those are hard to find in the giant sizes, by the way.) I started letting her sleep with tiny baby dolls, but not until she was eighteen months old. My nerves couldn’t take it until then.
Alice says
Thanks for posting this. Its been many years since I had my children, and in those days we thought tummy sleeping was the best way to prevent SIDS, since we thought it was related to reflux and perhaps choking. For many years, BACK-TO-SLEEP was difficult to achieve, especially in the hospital, where many of our nurses felt that putting a baby to sleep on their backs would allow them to choke to death in their sleep.
As a pediatrician who provides in-patient care, I still sometimes have difficulty in the hospital, when I am caring for infants whose parents insist on the fact that “they can’t sleep on their back” It is understandable, since, as you point out, many of these folks have received advice from a well-meaning relative or friend. However, I advise them to do exactly as you have recommended, and put the baby to sleep on their backs. If they are old enough to roll over on their own, and they do that during the night, to leave them in their position of comfort.
The critical issue is to put them to sleep on their back from the moment they are born. They learn fast, and will learn to sleep on their backs without a problem. It is also critical that parents ask their health care provider, and not rely upon those well-meaning, but often misdirected friends, family and (perhaps not-so-well-meaning) advertisers of infant products.
Erin H. says
Thank you for this post about sleep positioners. I can’t believe they are still sold in stores. I feel the same about bumpers, especially because they’re all over advertisements for beautiful baby rooms. I wish the stores would put a warning saying these items are not recommended by the AAP.
Colleen says
What is the issue with bumpers and SIDS? I was always told that the bumpers were bad for when the child was older and could stand up on them and fall out of the crib. But what is the danger with having them on when they are younger? Thanks!
Wendy Sue Swanson, MD says
Colleen, the issue with bumpers is that they fall in the category of soft bedding material. Theoretically, they are soft, fluffy material that could lead to suffocation or put a baby in a position where they couldn’t move their face away from the material and have difficulty breathing. And yes, later you’re right, they can be used as a launch/step to exit the crib! The big issue for most new parents is that it’s hard not to want to use one. Bumpers are beautiful in a crib and define “baby,” but still aren’t recommended….
Jean M. says
We are having a terrible time keeping our 4&1/2 month old baby asleep on her back. She recently learned to roll from her back to her tummy and now does it several times a night, waking herself up in the process. I have tried letting her cry it out and stay put on her tummy, after all, the studies on SIDS established an increased risk with how the baby was put to sleep, not how they end up sleeping through the night. However, once she is on her tummy she just gets more and more upset and can’t seem to fall back to sleep until we roll her over. A sleep positioner that keeps her on her back all night is sounding mighty tempting … any suggestions to restore sleep to our weary family?
Wendy Sue Swanson, MD says
I imagine you’re exhausted! This will get better. This will get better. Let’s see…
I think you’re likely doing the right thing–giving your baby a chance to learn how to soothe herself while on her tummy (when she rolls to it) and then helping her when she is past the point of no return. We all know that spot…One of these times I bet she will roll over to her tummy and either stay asleep or get herself back to sleep and you’ll find her that way in the AM. The other thing may be that her sleep cycle is simply changing and she is awakening more often because of that, and not just the rolling.
I can’t recommend the sleep positioner. I think it would be a band-aid for your problem (not a solver) and simply would put her at risk. Just not worth the temporary improvement that you may see. Take turns, get someone to help you find a bit of respite during the day to sleep, too
My big advice (which doesn’t sound all that useful, I’m sure) is be consistent. Do the same thing each and every time so she knows what to expect and so that she can learn from herself, too.
Hang in there, Jean!
Viki says
IMO, if we’re going to talk about SIDS, parents want to get out of safe terrain of the AAP policy statement. 3000 infants per year didn’t die from sleep positions. IIRC, 12 died in the last decade. I was at a baby shower on Saturday and the mommy-to-be was quite anxious about SIDS. She hadn’t purchased a mattress for her baby’s crib yet because the latest theory on SIDS says that when mold meets the flame-retardant chemicals, noxious, baby-killing fumes are created. Each fact we learn about SIDS is reassuring because it’s one more precaution you can take. Unfortunately a large number of SIDS deaths are still unexplained and the last good suggestion anyone had was in 1992.
kelly says
I am with you mama Doc-
And I also agree that it can be a really confusing road to navigate for all of us trying to keep our wee ones safe and healthy. But back to sleep is something that we can clearly do. I have many parents ask about sleep positioners to prevent laying on a flat spot of their head(positional plagiocephaly). Even in these babies for whom we are paying particular attention to their head shape and positions that may affect their head shape, we recommend back to sleep without and special sleep tools or positioners. There are many ways to intervene and improve the rounding out of the head in a child with plagiocephaly- starting with tummy time and time off the back of the head whenever he or she is awake! As always- thanks for your wisdom, sharing your experiences, and making us all think!
Wendy Sue Swanson, MD says
Viki,
Thanks for your comment. I didn’t say that all SIDS deaths were due to sleep positioners. I meant to discuss and outline SIDS safety information to bring context to why I hate sleep positioners. As stated in the blog, the new warning came out because of 12 deaths over the last 13 years.
I believe there have been helpful statements since the AAP asserted the need for back sleeping in 1992 and the Back to Sleep campaign started in 1994. For example, the updated 2005 AAP policy covers information about the possible benefit from pacifier use and warns against side sleeping as it was previously felt to be a safe position.
I agree that the more we learn about SIDS, the more we can make changes to prevent unexplained death. The more we know, I hope the less we will need to worry, too.
Viki says
I know you didn’t make that claim. I’m just saying that while new fact is valuable, they seem to account for a teeny % of deaths. Meanwhile, many of the concern parents have seems to go unstudied or ignored by American institutions. Many parents I know are reading blogs and studies from New Zealand about mold, off-gassing, and mattress wrapping.
Red Tricycle says
couldn’t agree more. we just got back from the ABC Kids Show in LV, which offered a slew of new products for babies & kids, including several types sleep positioners, as well a “helmet” for toddlers to wear in case they fall down(!). My colleague, who doesn’t have kids, looked at the mile-wide sea of products and said, “do you really need all this stuff when you have a kid?” I said, “nope, they prey on the fears of first time parents.”
Unknown says
So we have a boring crib. You said no like comforts we don’t use thoses but we do use the little blankets that are the soft feeling ones and we lay the blankets on top and tuck them into the sides of the crib. He can roll over yet but seems to look like he might be trying too. I worry about him getting cold. Should I just be trying to still swaddle him?
Wendy Sue Swanson, MD says
I don’t recommend swaddling your baby after 4 months of age. Most babies start to roll around that time and you don’t want to restrict their movement or have them roll one way and not be able to reposition themselves due to contraints of the swaddle. Also, at 4 months of age, babies have figured out that their hand is their hand! It’s a good time for babies to learn how to self-soothe and get themselves back to sleep. Using their hands is one great way…
Jean M. says
A quick note of thanks! Your advice helped get us through a difficult patch of sleeplessness without turning to a potentially dangerous quick fix. Im so glad I came across your blog somewhere amidst the advertisements when I googled “sleep positioners”. The rolling in the night continues but our daughter is now able to soothe herself back to sleep on her tummy, a skill she probably would not have learned if we had bought a sleep positioner. Thank you!
Unknown says
Thank you for writing back. When he starts to roll over will the blankets restrict him? Or about him figuring out that his hands are his hands will he pull the blanket that are tucked into the sides of the cribs and not be able to pull them back down? There not just loosy laid on him they are tightly tucked in the sides but at times when he wakes up if he is kicking a lot he can kick them all the way off..
Liz Ditz says
I didn’t know about sleep sacks until my British daughter-in-law came for a visit. What a great idea! They are sort of a long closed vest that you zip the baby into. Target now carries one brand (Halo)
What a great idea!
Dave says
Our 3 month old stuggles with spitting up an oz. or os of milk up to an hour after she has been fed. This often wakes her, wets her outfit which will become cold if left unattended. After reading some blogs we have lowered one end of her crib mattress to see if gravity would help with digestion. This seemed to have some impact and it was suggested that creating a seat out of a Boppy would further help her sleep which seems to have further helped. All this being said it goes against the advice above which worries me. Thoughts?
Alison says
Okay, so our crib is very bare! We used the bumper for a border on the wall. I found a breathable bumper at Babies and it looks cute and is very breathable! My problem is I worry with the colder weather coming now. His monitor reads 68-69 degrees at night. I dress him in cotton pj’s and then a zippered blanket sleeper. He feels warm under that but his face and hands are cold. I’ve tried adding another layer under the sleeper but it was obviously too uncomfortable for him. Is he dressed enough? Should I add a sleep sack on top of all that?
Thank you! Worried, first-time mom! 🙂
Claire says
So how do you feel about co-sleeping? It is very popular in many countries with very low infant mortality rates. Japan is one I can name off of the top of my head. Co-sleeping sees to be gaining in popularity & I have seen it supported as safe & possibly safer than other methods.
Jennifer says
We have been putting our baby (6 weeks old) on her tummy to sleep for about a month. She has reflux and on her back she just cries and cries for hours. We have also tried putting a pillow under the end of her mattress to elevate it to help with the reflux, but she just slides down and wakes up again and she cries and cries some more. Help?
Wendy Sue Swanson, MD, MBE says
Talk to your pediatrician about having a wedge made for the baby. This will elevate your baby’s head in a safe way that won’t have your baby sleeping on her belly but also support her discomfort that may be from regurgitation and/or reflux.
More info here on
SIDS science and prevention: https://www.wendysueswanson.com/understanding-risks-for-sids/
Crying at 6 weeks of age: https://www.wendysueswanson.com/infant-crying-colic-and-the-period-of-purple-crying/
Nicole Stoica says
What do we do about the bald spot created on the back of her head? She sleeps fine on her back but thrashes her head side to side making the spot worse. She hates tummy time but I try a few times a day and after a minute or so she gets upset. I tried putting her on her side but she rolls on her back. What do I do for my balding darling?
Wendy Sue Swanson, MD, MBE says
You wait! After 6 months of age those silly-little bald spots tend to fade into history. The hair will grow!! We used to joke abt our 4 month-old…balding pattern and a mullet. But it gets better 🙂
Amanda says
For the first 4 months we always laid our daughter onto her back to sleep which resulted in a major flattened head in the back.our pediatrician recommended we lay her on her right side due to the shape or lack there of of her head.I’ve been using a positioner to help keep her on her side since she’d roll right back onto her back if not.any suggestions?
Wendy Sue Swanson, MD, MBE says
Sleep positioners aren’t recommended for infants. A bare, basic crib is the safest.
Here’s info from our craniofacial experts on why plagiocephaly (flat head) happens and ways to prevent and help babies.
https://www.seattlechildrens.org/medical-conditions/chromosomal-genetic-conditions/positional-plagiocephaly/
Also here’s information from The American Academy of Pediatrics (AAP) https://www.healthychildren.org/English/news/Pages/Preventing-and-Treating-Flat-Head-Syndrome-in-Babies-.aspx
Here’s the AAP policy statement:
https://pediatrics.aappublications.org/content/128/6/1236
In general, night time sleep should always be on the back in a bare crib. During the day, work on having baby off the back the head, working on not always feeing baby on the same side (while cradling them) working on prioritizing tummy time, play time and time in training seats, and getting out of car seat immediately when home from the car trip (ie don’t let baby sleep in car seat on the same side of their head).
Amanda says
Thank you.she’s 6 months old now and her head has regained its shape nicely.Are we past the point where this is likely to happen again once she’s sleeping on her back verses her side?
Wendy Sue Swanson, MD, MBE says
Head growth slows down after 6 months of age so less likely to change head shape. Here’s head circumference growth curve: https://www.google.com/imgres?imgurl=&imgrefurl=http%3A%2F%2Fwww.chartsgraphsdiagrams.com%2FHealthCharts%2Fhead-circum-birth-36-girls.html&h=0&w=0&tbnid=oWIBsSFKApaCDM&zoom=1&tbnh=264&tbnw=191&docid=U3W0QMmeyXTm3M&tbm=isch&ei=StBjU5iYLrOqsQTJtYHYBA&ved=0CAIQsCUoAA
Good habits still necessary (!!) to keep great head shape but it’s unusual to see significant flattening begin after 6 months.
Tianazelia says
My almost 3 month old has a flat spot surrounded by bulging bellow and above the flat spot he sleeps in a playpen due to lack of funds and space for a real crib. We asked the physicians assistant what to do at our 2 mt well baby visit and she suggested a sleep positioner.. I too am iffy but wonder if I have other options.. Any suggestions?
Wendy Sue Swanson, MD, MBE says
I don’t recommend sleep positioners, even for flattening of the head or what’s called, plagiocephaly. Tummy time is great at this age for playtime to help your baby get off the back of their head.
Here’s my post about sleep positioners
https://www.wendysueswanson.com/why-i-hate-sleep-positioners/
Katrina says
How do you feel about loveys? Is three a safe age to introduce one, and what are the criteria that makes a lovey “safe”? Thanks!
Wendy Sue Swanson, MD, MBE says
Great question. Theoretically they are considered soft bedding. So with strict interpretation of the guidelines and the data I would say they aren’t recommended until 1 year of age. Talk with you pediatrician about thoughts on lovies after 4 to 6 months, when SIDS risk decreases dramatically and babies have improved head control, etc.
vanessa s says
Have you seen this https://www.swanling.com/safe-sleep/slumber-sleeper.html
I’m thinking this might help my 4.5 month old from rolling over to his belly during night time. When he was a newborn till about 4 months, I swaddled him and he slept so good (10pm – 6am). But now that his rolling over, I took him out of the swaddle and started using this Zipadee-Zip (https://www.sleepingbaby.com/collections/zipadee-zip) since I cant swaddle him anymore! Please give me some input regarding the swanling slumber sleeper…thank you!
One Tired Engineer Mama
Zandra says
My son is 1 month old and has acid reflux and I was told that he can’t sleep on his back. I purchased a wedge to go under the mattress and he slides down. Do you have any recommendations?
Wendy Sue Swanson, MD, MBE says
You can talk with your child’s doctor about having a wedge made for your baby that goes in the crib for reflux. Here in Seattle these are typically made in consultation with occupational therapists. I’d suggest you schedule a visit and talk w the pediatrician about options!
Dale says
I purchased a baby box, because one we don’t have a lot of room, and two because I’ve researched that Finland has essentially no cases of sids since 1935 when they introduced them. The one that I purchased came with a firm mattress, with a tightly fitted sheet, and sleep sacks. Back to Sleep instructions, and everything that you could want to start off. (Diapers, onsies, burp cloths, washcloths, bath wash and a bunch of other things). I’ve also found that a few hospitals in the US have adopted them to give to be with parents!! I find them to be wonderful. Would it be something that you would recommend? My baby’s doctors were impressed when I told them about it. Thank you for your time. 🙂
Kimberly says
She didn’t mention once the reason behind why sleep positioners aren’t safe. Just kept repeating that they are against what she had been taught and never explained in detail what she had been taught that directly links sleep positioners with being unsafe …waste of time.
Stacey Ulacia says
Sleep positioners are not safe because they can cause suffocation. The FDA, CPSC and AAP all recommend against using them.
https://www.fda.gov/ForConsumers/ConsumerUpdates/ucm227575.htm
https://www.aappublications.org/news/2017/10/17/HealthAlerts101717
Marie Reimann says
Hi, I was wondering what you thought of the Safe T Sleep they make in New Zealand.