Can you help me understand the data/safety around stomach sleeping once a baby can roll over? We always put our four-month-old to sleep on her back, but she often rolls to her stomach and sleeps there, and she can’t yet roll front-to-back. Our pediatrician says to keep rolling her back over when we see it until she’s 1 year? Most things I’ve read say you can leave them there if they can roll both ways on their own, but I’m stumped about this middle stage — I want her to be safe, but I also can’t watch the crib all night. How can I best understand/balance the data, recommendations, and feasibility here?
—Christina
To answer this question, we should ground it in the data we have and the data we do not.
- We know that putting babies to sleep on their back, as a policy, lowers the risk of sudden infant death syndrome. This can be inferred from many things, including what has happened to SIDS rates after this advice was put in place. Notably, the advice here is about how you place your baby to sleep, not about rolling them.
- 2. We know that 75% of SIDS deaths occur between months one and four, and 90% by six months. We also know that there are factors that raise the risk of SIDS, like complications at birth. For healthy infants over four months, the risk of SIDS is extremely small.
From these facts alone, you could infer that your child is at very low risk if you put them to sleep on their back, even if they roll over.
Sleep advice, though, targets safety above virtually anything else. From fact #1, the inference is that more time on the back must be better, which is where people get the message that you should roll your child back if they roll over. The American Academy of Pediatrics has softened its stance on this and suggests that once the baby can roll both ways, you can leave them. It is only logic that suggests this, by the way; there’s nothing in the data.
You’re in an intermediate bucket, as you say: your baby can only roll one way. So you get the advice to “turn them over if you see it,” which feels in some way like an intermediate option.
This advice is, in my view, not internally coherent. Either it’s very important for the baby to be on their back or it is not. There is no logical case that being on their back is important only when the parent happens to look on the monitor.
The fact is that the risks here are extremely low (see above) and the cost of seriously monitoring for back sleeping is very high (one parent would need to be awake at all times, watching the monitor). We should appropriately weigh these tradeoffs when giving guidance.
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I was in the same position with my son at 4 months, I had seen him accidentally flip from stomach to back once or twice but I didn’t know if he could purposefully since he loved tummy time and never wanted to flip to his back. Our pediatrician recommended trying to teach him to flip to his back during tummy time, which only kind of worked, but he was lunge crawling soon after so it was a short time that I was trying to flip him back at night and never really seemed worth it!
My 4.5-month-old is in the same boat – only rolling back to front. I couldn’t possibly flip her over every time, plus she is sleeping better for naps and at night on her stomach.
Imagine my surprise at reading this after spending the night flipping over my 5 month old who’s in the same in-between rolling stage. Thank you and hoping for more restful nights ahead!