Baby Won’t Sleep on Back? When to Worry

Baby Won’t Sleep on Back?

In 1994 the Back to Sleep Campaign officially launched as a collaboration between the American Academy of Pediatrics and the National Institute of Child Health and Development. Two years earlier the American Academy of Pediatrics had issued a warning saying babies should be placed on their backs to sleep. The incidence of Sudden Infant Death Syndrome (SIDS) prior to this was about 1 in every 500 babies. After the back to sleep campaign launched, the incidence of SIDS was reduced by half. In fact, the back to sleep recommendations are considered one of the seven greatest triumphs in federally backed pediatric research.

So, you’re aware of the safety implications of back sleeping, but what if your baby won’t sleep on their back yet? Will you ever sleep again? What’s a parent to do? There’s a lot of advice out there about baby sleep to sift through. To keep it simple, below are 5 tips for when baby won’t sleep on their back.

Tips for When Baby Won’t Sleep on Their Back

1. Talk to your Pediatrician

Although relatively rare, there are anatomical reasons that a baby may fuss and won’t sleep on their back. If you are having serious struggles, always check with your pediatrician. He or she can examine your baby and determine if there is a physical cause for their back sleep refusal. If this is the case, your pediatrician can advise you on how to move forward to ensure your baby is getting safe and quality sleep. Note that reflux is not a reason for a baby to sleep on their stomach. It is safe for babies, even babies with reflux, to sleep on their backs. Your baby’s esophagus is situated in such a way that if they spit-up on their back, it will drain into their esophagus and not their lungs.

2.Use a Swaddle Blanket

Let’s start with the basics and look at why your baby doesn’t want to sleep on their back yet. Your newborn baby has just left the comfort of the womb where they are curled up and cozy. Being placed on their back can feel very unsafe to a newborn baby. This is largely because of the startle reflex that newborns have. The startle reflex is a basic survival instinct. Placing a baby on their back when they’re used to being cuddled up can feel like they are being abandoned, even though this is far from the truth. Survival instincts kick in. They may stiffen up and flail their arms. Adrenaline rushes their system. This is obviously not an ideal state for good, restful sleep. Your baby won’t sleep on their back because they feel vulnerable and unsafe.

Benefits of Swaddling

One way to overcome this natural, survival instinct is by swaddling. Putting baby in a tight swaddle keeps their arms from flailing and provides a sense of comfort and safety. You can use anything from a specially designed swaddle sack to a large muslin blanket to achieve a nice, cozy swaddle. You may need to try a few different ones until you find a swaddle style that you and your baby prefer.

Keep in mind, when your baby is able to roll over, you will need to transition them out of a swaddle since this can pose a potential safety hazard. At this point, if your baby is having trouble sleeping on their back without the swaddle blanket, you can look into various sleep suits that achieve a similar effect, while also preventing baby from rolling over. One final word of caution with a swaddle: make sure your baby’s sleeping environment is at an appropriate temperature while in the swaddle. Overheating is also linked to SIDS.

3. Let Baby Fall into a Deep Sleep Before Laying Them Down

Another trick for the baby that won’t sleep on their back is to slowly transition them into back sleep. You can do this by allowing baby to fall asleep in your arms, a place where they will feel comfortable and secure. Wait until they are in a deep sleep and then gently place them in their crib or bassinet on their back. As your baby becomes more used to sleeping on their back, you can eventually start to put baby down to sleep when they are drowsy, but not yet fully asleep. Stay consistent. Baby will eventually become used to back sleeping.

4. Prop Baby Up

Propping baby up in their crib or bassinet may be more comfortable for the baby who doesn’t want to sleep on their back. Keep in mind that the use of infant sleep positioners are discouraged by the American Academy of Pediatrics. Sadly, there have been multiple instances of babies who have suffocated from these. Remember that the guideline is to have baby on their back to sleep without blankets or padding around them. You can, however, use a blanket or sleep positioner underneath the mattress where it won’t harm baby. Just be careful you don’t have the mattress at too great an angle where baby can slide around.

5. Use a Pacifier

Another useful tool for the baby who won’t sleep on their back is to use a pacifier. It is actually easier for a baby to suck on a pacifier while on their back than on their tummy. When babies are on their tummies, pacifiers tend to fall out more easily. Additionally, multiple studies have shown that pacifiers can help reduce the risk of SIDS. Scientists don’t fully understand why this is, but the correlation is significant. Although some parents may worry about pacifiers causing problems with tooth development or breastfeeding, these concerns can be easily avoided. Wait a few weeks after baby is born to introduce the pacifier and simply discontinue it before baby becomes a toddler. The recommendation for back sleeping is only for ages newborn to one year old.

Getting a new baby to sleep is one of the most important things for any parent to do. Sleep for a new baby is connected with a variety of positive outcomes, including growth, mood, cognitive development and more.

However, how a child sleeps is almost important as the amount that a child sleeps, and on this front, researchers are virtually unanimous: It is vitally important to keep your baby sleeping on their back.

In this article, we’ll take a look at:

  • Why it’s so important to have a baby sleep on their back
  • How to keep a sleeping baby on his back
  • What if my child rolls over?
  • How to monitor your baby’s sleep

Why it’s so important to have a baby sleep on their back

Simply put, a baby sleeping on their back is a safer baby, and a baby less likely to die prematurely. A child sleeping on their back is more likely to have normal “arousal” symptoms, which will allow a baby to wake up and resume normal breathing patterns during standard episodes of sleep apnea. Additionally, babies who sleep on their back have less fevers and less nasal congestion. Parents need not worry about a child who sleeps on their back choking: A baby’s airway remains clear when they are sleeping on their backs, and their gag reflex works to help ensure that.

Most importantly, a baby sleeping on their back will protect their health. A baby sleeping on their back is far less likely to die of SIDS.

What is SIDS?

SIDS stands for “Sudden Infant Death Syndrome,” and it is every parents worst nightmare. While much about the disease is not yet understood, research have pinpointed a few risk factors which can enhance your child’s risk of dying due to SIDS. One of those risk factors is sleeping on their stomach. This is one of the many reasons why it is so important to keep your baby sleeping on their back.

The risk of a baby dying of SIDS is greatest for the first six months of a baby’s life, but continues until the baby is a year old. As such, let’s be as clear about this as possible: Keeping your baby sleeping on their back will keep them alive.

How to keep a sleeping baby on his back

It’s very important that you keep a baby sleeping on their back, and there are a variety of ways to do so. These include:

  • Swaddle your baby in order to increase their sense of comfort and security.
  • Use a firm mattress which will prevent your baby from sinking too much. Never allow your baby to sleep on any other surface.
  • Make sure that the temperature is comfortable and that the child is dressed appropriately for the room.
  • Give your baby a pacifier to sleep, but don’t force the child to suckle it if they don’t want it. Additional research shows that giving a baby a pacifier may reduce SIDS deaths.

Never, under any circumstances, should you allow your baby to sleep in the same bed as an adult. Doing so only risks the baby’s life in the event that the adult rolls over in their sleep.

Keep the crib clear

For newborn babies, a crib should be kept as clear as possible. This means no positioners, stuffed animals, pillows, blankets or anything that could potentially pose a suffocation risk. Do not, under any circumstances, place anything in a crib which could obstruct a baby’s breathing. Remember, babies do not have the strength or coordination to remove obstructions if something gets in their face. As such, anything you put in the crib could suffocate a baby, or increase its risk of SIDS.

The goal of a crib is not for decoration. It’s to keep a child sleeping on their back.

What if my child rolls over?

Children typically learn how to roll over between four to six months, just when their risk of dying of SIDS is starting to peak. But, there’s good news here: Babies who roll over have a decreased likelihood for SIDS. You should continue to put your child to sleep on their back, but if the child rolls over, that’s fine. You do not need to adjust a child who has rolled over onto their side.

Why children who roll over have reduced risk of dying of SIDS?

Again, SIDS is an area where more research is needed, and one which doctors still do not fully understand. However, from the research done, doctors believe that babies who die of SIDS often suffer from sleep apnea. Babies who are old enough to roll over have a better physical sense of when they need to move, and the ability to do so. As such, babies who can roll over on their own have a significantly reduced risk of dying as a result of SIDS.

However: Researchers still recommend that, when you put your baby to sleep, you place your baby sleeping on their back. While SIDS decreases as a child gets older, risk does not completely disappear until the child is one year old. At that time, SIDS risk does disappear, and it is safe to allow a child to sleep on their stomach. Until then, put your child to bed sleeping on their back.

How to monitor your baby’s sleep

The American SIDS institute recommends that a child sleep in their parents room until the age of six months – and ideally, up to a year – in order to ensure that a child is sleeping and breathing well. This is the best way to keep your baby close, learn their sleeping and breathing patterns, and be alerted if there is ever some sort of problem which requires your immediate attention. Thankfully, there is no shortage of travel cribs available which can be used to ensure that your children get a good night’s sleep, no matter where they go.

That being said, be warned: Wherever you travel, make sure that the same rules which apply to your baby’s crib (keep the crib clear, make sure its surface is firm, etc) apply to the travel crib as well. Even in the travel crib, a put your child to bed so the baby is sleeping on their back.

Baby monitors can help, but you can’t rely on them

There are no shortage of baby monitors available to monitor a baby sleeping on their back. Some monitors are audio only and some add visual and motion detection, which can then be tracked on a separate device or a phone. Some monitors sell themselves as being able to track a child’s heart rate or breathing patterns, and say they are able to alert parents to a potential problem. However, some experts recommend against these monitors, as they say that they cause needless worry, many false alarms and overstate the danger of losing a child to SIDS. There are situations in which these monitors are needed, no doubt, but these are usually confined to medically fragile children who have breathing problems or need oxygen. Additionally, there is no evidence which directly links these monitors to a reduction in SIDS deaths.

Remember, there are many things you can do to reduce your child’s SIDS risk. Top among them? Put them to bed so your baby is sleeping on their back.


Making sure your baby sleeps on their back is vital for their health, can ease their comfort and keeps them alive. Thankfully, there are things you can do which can encourage your child to sleep on their back. As a parent or caregiver, that responsibility is on you.

If all else fails, consult your pediatrician to make sure that your child doesn’t have any physical issues which may prevent them from sleeping comfortably on their back. Difficult though it may be – particularly for fussy babies or babies who have acid reflux – it is important for a baby’s health that you work to keep the baby sleeping on their back.

While it may require some extra effort, helping your baby learn to sleep on their back has so many benefits. Recent research has shown that back sleepers benefit from the following:

  • Reduced the risk of SIDS (sudden infant death syndrome) by up to 60%
  • Fewer fevers than babies that sleep on their stomachs.
  • Less problems with nasal congestion than babies that sleep on their stomachs.
  • No more likely to spit-up or choke on their spit-up than babies who sleep on their stomachs.


With all of these benefits, getting a baby to sleep on their back is certainly worth the effort. Incidences of SIDS peak around 2-4 months old so this age is especially critical. The risk reduces after 6 months old, but the recommendation is to place babies on their backs for sleep until the age of one.

Note that when your baby starts rolling on their own, you do not have to get up multiple times in the middle of the night to continually reposition them. Once they can roll on their own, they usually have the development necessary to move their heads, so they can breathe. In the meantime, like anything new, it may take a baby who won’t sleep on their back a little while to get used to back sleeping, but eventually they will adjust and become comfortable and safe little back sleepers!