Baby Sleeping Face Down?

BABY ROLLING AND SLEEPING FACE DOWN?  The founders of SafeSleep lost a loved one to SIDS/positional asphyxiation when baby rolled over in the middle of the night; consequently, we are pushing to have breathe-through/air permeable mattresses as the standard for “safe sleep.”   We believe breathe-through crib mattresses that contain no fiber fill provides the solution to bridge the safety gap that is not addressed in the back to sleep campaign—the infant eventually rolls to their belly.

We know too well the scared feeling that comes about when you find your baby asleep on their belly face down in the mattress.  The recommendations and guidelines from the American Academy of Pediatrics (AAP) and other sources for infant safety do not address this situation.  Parents are either inappropriately reassured that once the infant can roll on their own or raise their head, they are no longer at risk of suffocation or told that they should move the infant back into the supine (back) position which is unrealistic with multiple moves possible per night.

Researchers out of New Zealand have shown that over one quarter of the infants who died of SIDS in the prone (tummy) position in their study were last placed non-prone (back).1 These researchers suggested that an infant’s competence in escaping from potentially lethal situations during prone sleep may be impaired by inexperience in prone sleeping.  Their findings were later supported by Dr Moon and colleagues in their review of infant sleep related deaths in child care settings.2  Unfortunately this infant inexperience in prone sleep is now a common unintended consequence of the successful back to sleep campaign.

“Parents and caregivers are frequently concerned about the appropriate strategy for infants who have learned to roll over, which generally occurs at 4 to 6 months of age. As infants mature, it is more likely that they will roll. In 1 study, 6% and 12% of 16- to 23-week-old infants placed on their backs or sides, respectively, were found in the prone (face down) position; among infants aged 24 weeks or older, 14% of those placed on their backs and 18% of those placed on their sides were found in the prone position.  Repositioning the sleeping infant to the supine (back) position can be disruptive and might discourage the use of supine position altogether.  Data to make specific recommendations as to when it is safe for infants to sleep in the prone position are lacking, according to a study published in  The Journal of the American Medical Association .  3  

“The first few times babies who usually sleep on their backs or sides shift to the prone (lying face down) position, they have a 19-fold increased risk of sudden death,” says senior author Bradley T. Thach, M.D., a Washington University pediatrician at St. Louis Children’s Hospital. “We wondered if these babies, finding themselves face down, fail to turn their heads to breathe easier.  If so, is that because their reflexes haven’t developed far enough or because they just don’t wake up?”  The findings also indicate that good head-lifting ability while lying prone may not be sufficient to protect a baby from SIDS. “Many parents think that if a baby can lift its head, he or she is okay to sleep prone, but that is a false assurance,” Thach says. 4

The AAP currently recommends a firm crib mattress with a tight fitting sheet.  However, the firm mattress with tight fitting sheet has been shown to have risks when it was studied for carbon dioxide (CO2) dispersal.  From an AAP article published in 2000 105;774. 5 This finding suggests that even firm mattresses could pose a rebreathing threat when vulnerable infants sleep prone. This finding may be of relevance to recent studies showing that unaccustomed prone sleepers, ie, infants who typically sleep supine but are inadvertently placed or roll prone have an increased risk of SIDS 38,39.   These studies have shown that from 43% to 71% of SIDS victims, unaccustomed to prone sleep, were discovered in the face-straight-down position.” 4

Learn more about breathe-through crib mattresses that significantly reduce the risk of your baby rebreathing carbon dioxide.  http://www/


  1. Mitchell EA, Thach B, Thompson J, Williams S. Changing infants’ sleep position increases risk of sudden infant death syndrome. Arch Pediatr Adolesc Med. 1999;153:1136–1141
  2. Rachel Y. Moon, Kantilal M. Patel and Sarah J. McDermott Shaefer. Sudden Infant Death Syndrome in Child Care Settings. Pediatrics 2000;106;295
  3. Willinger M, Hoffman HJ, Wu KT, et al. Factors associated with the transition to nonprone sleep positions of infants in the United States: the National Infant Sleep Position Study. JAMA. 1998
  4. Paluszynska DA, Harris KA, Thach BT. Influence of sleep position experience on ability of prone sleeping infants to escape from asphyxiating microenvironments by changing head position. Pediatrics, Dec. 1, 2004.
  5. Patrick L. Carolan, William B. Wheeler, James D. Ross and RCP*; and James S.Kemp, Potential to Prevent Carbon Dioxide Rebreathing of Commercial Products Marketed to Reduce Sudden Infant Death Syndrome Risk, Pediatrics 2000 105;774


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