Safe Sleep Q&A

Whether you’re a new parent, caregiver or child care provider, you may have a lot of questions about how to keep infants safe, happy and healthy at all times. Being mindful of their sleeping habits can further complicate these duties of caring for infants, which is why Georgia’s Safe to Sleep campaign offers this helpful Q&A to provide insights to common questions about infant sleeping practices.

Q: What if my baby spits up? Will they choke while on their back?    

A: This is a very good question and one of much concern for new parents. It would seem to make sense that a child will choke on his or her back; however, our bodies are designed in such a manner that the windpipe is protected while a child is lying on their back. Therefore, a child has less risk of choking when laying on his or her back.

baby diagram

Trachea – tube that moves air in and out of lungs, also known as the “windpipe.”
Esophagus – tube that carries food, liquids and saliva from your mouth to the stomach.

Q: Do babies who sleep on their backs get flat spots on their heads?

A: Babies can get flat spots on their heads (called plagiocephaly), but they don’t have to get flat heads.  Plagiocephaly is most common in babies who are less than 5 months old. That's because the bones in babies' skulls are soft and movable when they are born. By 4 to 6 months your baby will be laying fully on their back less often and will be able to be propped up. This will remove the pressure from the back of their skull.

Here are some steps to help avoid issues with flat spots:

  • Limit the time your baby is left in a car seat (for instance, do not leave infants in a car seat while napping)
  • Switch which end of the crib your baby sleeps each night to change what they view. This will encourage them to turn their heads in different directions when in the crib.
  • Carry your baby on alternate shoulders or hips, and make sure your baby's head isn't always in the same feeding position.
  • Around 3 months of age, encourage supervised tummy time to help strengthen their back and stomach muscles.

Q: I was placed on my stomach when I was young. Why is it so important for me to put my child on their back to sleep?

A: This is a very common question, especially because the popular advice used many years ago was to place babies on their stomachs to sleep. It’s important to know that this advice for stomach sleeping was not rooted in science.

Current recommendations for back sleeping (also called the supine position) is supported by research and we know it is a safer sleeping position for babies. We also know that SIDS deaths have dropped by 50 percent since we started placing babies on their backs for sleep. That’s a lot of babies that are surviving.

Also, these sleeping recommendations have been expanded to give our babies safe sleep environments, which include things like not smoking around infants and avoid putting infants in rooms where they may get too hot.

By closely following these evidence-based actions, we are eliminating sleep-related deaths for all babies and their families.

Q: My baby doesn’t seem comfortable on his back and seems to wake more often. Should I be concerned about their comfort?

A: Babies do tend to rouse (wake up) more often when on their backs; however, the fact that babies rouse more often is actually believed to be a protective factor against SIDS. This means that instead of “forgetting” to breathe because they are so soundly asleep, a baby on their back will rouse more often and ensure that their underdeveloped respiratory system keeps working correctly. 

Q: Why would I want to put my baby all alone in a crib by themselves? That seems more dangerous to me.

A: Just because it is recommended that your baby is alone in her crib, doesn’t mean she needs to be left all alone and by themselves!

To clarify, babies should be alone in their crib without other children and items like blankets, toys and crib bumpers. However, they should still be close to you no matter where their crib is placed. We call this “room-sharing” without “bed sharing.”

Room-sharing is shown to be protective of your baby, especially when they are very young.  As your child gets older, you can decide when the right time is to move him or her into their own room. Until then, keep them close, but keep them safe in their own space too.

Q: My doctor, a nurse and my mother all gave me different information about my infant’s sleep practices. Who should I listen to about sleep safety?

A: Gather as much information as you can and follow your instincts. Even advocates for bed-sharing acknowledge that there are clearly defined steps you should take to reduce your child’s risk of sleep-related death.

These steps align with the advice posted here and are positive healthy ways to improve your child’s well-being. Certain medical conditions may require you to follow different advice than what is provided in this Q&A. Always take into account special circumstances when deciding what is best for you and your family.

Q: Why is smoking bad for my baby and their sleep?

A: Tobacco smoke is damaging to everyone’s lungs, especially for the undeveloped lungs of infants who are new to the world. Tobacco usage by mothers, while pregnant and after birth, has been linked to an increased risk for SIDS. Additionally, you want to avoid all drugs and alcohol when you are nursing your baby or in charge of caring for them.

Q: I’m worried about my baby being cold and getting sick. Why do they suggest no extra blankets in their crib?

A: Most babies only need about one layer more than what you, the adult, are wearing. Very young babies are still learning how to regulate their body temperatures and overheating them is dangerous. Therefore, adding an additional layer is sufficient for keeping them warm without being too hot. 

For example, if you are at home wearing a short sleeve t-shirt and jeans, your baby will be fine in a long-sleeved sleeper. No extra blankets and quilts needed. Some people even dress their babies in a “sleep sack.” Additionally, extra blankets and quilts pose a very serious risk for suffocation. Keeping extra items such as this out of the crib eliminates the risk for sleep-related death due to suffocation.

For questions or training needs, contact:

Terri Miller, MPH, CHES
Safe Infant Sleep Program Manager
[email protected]

Page last updated 12/16/2022