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Ask Dr. Sears: Encouraging Back Sleeping

Q. My 3-month-old son refuses to sleep on his back or in his crib. In fact, he seems to prefer being in an upright position (such as in a carrier or swing) when he's sleeping. It was fine when he was a newborn, but now he's getting too big. How can I get him used to sleeping in his crib and on his back?

A.
You are wise to try putting your baby to sleep on his back. Back-to-Sleep campaigns throughout the world have lowered the risk of Sudden Infant Death Syndrome (SIDS) by about 50 percent. There are several reasons why back-sleeping lowers the SIDS risk: Back-sleepers arouse from sleep more easily and sleep less deeply than tummy-sleepers; back-sleeping babies are less likely to become overheated; and finally, babies who sleep face-down may press their heads into a soft surface, which obstructs breathing.

Bear in mind, however, that SIDS is a rare occurrence. Currently SIDS affects about 1 in 2000 babies, meaning that there's a 99.9 percent chance that your baby will be just fine, regardless of his sleep position. Also, many SIDS researchers believe that babies naturally assume the sleep position that allows them to sleep and breathe most comfortably. For example, babies with certain medical conditions, such as gastroesophageal reflux, sleep more comfortably on their tummies. The regurgitation of stomach acids while lying flat on the back causes painful irritation of the esophagus. Sleeping on the tummy, and even in a semi-upright position, allows gravity to help keep the stomach acids down. The fact that your baby prefers being upright indicates that he may have gastroesophageal reflux. I suggest you consult your baby's health care provider for further evaluation. In addition, try these strategies to help your baby sleep safely as well as comfortably:

Elevate the head of his crib. Using books or special blocks (available from infant product stores), elevate the head of baby's crib about 30 degrees. Place baby to sleep on his back in the crib. This allows him to sleep in a semi-upright position.

Try a reflux wedge. If your baby's pediatrician also suspects your baby has GER, try a reflux wedge (available from infant product stores)  -- a foam wedge that you place on top of baby's mattress in his crib. Put baby to sleep on top of the wedgeI for a semi-upright position.

Extend his arm. To lessen the chances of a side-sleeping baby rolling onto his tummy, place him to sleep on his left side.(Side-sleeping allows gravity to empty stomach contents faster, and reflux seems to be reduced on the left side.) Then stretch his left arm forward. The arm acts as a stabilizer to keep baby from rolling over.

Flip him over onto his back after he falls asleep. First, put him to sleep on his back. After he flips over onto his tummy, wait until he is in a deep sleep and then gently turn him over onto his back. If your baby continually flips over onto his tummy after you put him down to sleep on his back, this may be the right sleeping position for him.

Try a co-sleeper. Many babies experience separation anxiety when sleeping too far away from their parents. This may be why your baby dislikes sleeping in his crib. A co-sleeper allows baby to sleep closer to you, but you both still have your own sleeping space. I recommend the Arm's Reach Co-Sleeper, found at most baby gear stores.

Try a hammock. Some babies, especially babies with GER or those who like to fall asleep while being carried or rocked, sleep better in an Amby Baby Motion Hammock. This cradle-size hammock hangs from sturdy springs and moves a bit when baby stirs. It helps minimize gastroesophageal reflux because baby sleeps in a slightly upright angle, and you can still put him to sleep on his back. This is the device we recommend in our pediatric practice for babies with severe gastroesophageal reflux.

It's important that both you and your child get a good night's sleep for health and well-being. Keep experimenting with the above sleep strategies until you find the one that best helps your baby sleep in safety and comfort.

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