How Dangerous Is It For a Baby to Nap on Their Stomach?

Is there detailed data on the risks of stomach sleeping? I know it’s forbidden, but it’s hard to make sense of the rules. My two-month-old was born full-term, is in the 80th percentile for size, and has great neck control. I admitted in my Facebook birth group that I let him nap on his stomach during the day where I can keep an eye on him (never alone, and never while I’m sleeping), and people reacted as if I said I let him cuddle with a loaded firearm. I actually had to leave the group because one person threatened to report me to CPS! Is it really so dangerous in every situation? It feels taboo to even ask. And yet I know my parents, like everyone else in their generation, put my siblings and me face-down in our cribs without a second thought. My baby won’t nap on his back yet, despite my efforts, and I do occasionally want to put him down to sleep!

—Forbidden Nap Lover

Let me say first: I’m sorry for your experience. It’s extremely unfortunate that someone would threaten you, and it strikes me as exactly this kind of behavior that makes people unlikely to actually look for evidence.

The rhetoric around safe sleep, in general, can strike something of a hysterical and overstated tone. We see this in bed sharing — public service announcements in some cases literally pictured a baby sharing a bed with a giant kitchen knife to draw parallels. That’s not the same! Of course, a lot of people do bed-share, and often feel they have to do it in secret (see this article, for example).

In the case of back sleeping: there is good evidence that, in aggregate, the move to put infants to sleep on their back has lowered sudden infant death syndrome (SIDS) rates. The best evidence, I think, comes from looking at mortality from SIDS before and after the “Back to Sleep” campaign in 1991. I talk more about that here. There was a reduction in SIDS risk of an estimated 11 per 10,000, or about 1 in 1,000.

This argues for putting your baby to sleep on their back, all else being equal. (Note: Once they are able to roll over, there isn’t any evidence to suggest you need to go rolling them back.) In your case, though, all else is not equal, since your baby will not nap on his back.

The steps you have taken — only doing this when you can see the baby, not when they are alone — along with the fact that your baby was full-term and doesn’t have other medical issues means the risks are mitigated. If there is an increased risk of SIDS, it would be far less than the 1 in 1,000 above, maybe orders of magnitude smaller. What we can say here is that back sleeping is the safest option and that the added risk in your case is very, very small.

This is not dissimilar to where I land on co-sleeping in Cribsheet — if done as safely as possible, the added risk is there but very small. And, as in that case, it may be outweighed by other factors.