November 23, 2017 tummy-sleeping-high-needs-baby

Tummy Sleeping And The High Needs Baby

Updated June 22nd, 2020

Tummy sleeping is one of the great taboos of parenting. When we published our review of the Babocush, a tummy-down soothing cushion, we got a LOT of nasty emails. Being called “baby killers” was a rough moment, but it did get us thinking about how tummy-sleeping is an emotional issue.

The truth is, all of us in our little group have put our babies to sleep on their tummy at some point. And there is a quiet revolution going on among sleep-deprived parents… some of us just know that our babies do better when they sleep on their tummy.

Disclaimer: We’re parents too. What we’re NOT trying to do:

  • Downplay SIDS or the risk factors that end in the most horrifying situation imaginable for a parent.
  • Cherrypick bits of research that suit a slanted agenda. Anything referenced here is just to illustrate a point (and there is no agenda)

What we ARE trying to do

  • Talk more openly about something that is already happening in many homes
  • Challenge some of the commonly accepted truths around SIDS. 

What is SIDS, really?

Sudden Infant Death Syndrome (SIDS) is a catch-all acronym for “We have no idea what happened.”

SIDS isn’t choking or suffocation, SIDS isn’t a seizure, it’s not an accident or a disease. It may not even be the same cause of death from one baby to another. We have no international definition of SIDS, and varying medical skills & equipment around the world means that a cause of death may be determined in one place but attributed to SIDS in another.

It’s a complete mystery. Kind of. While we don’t really know what causes SIDS we know a whole bunch of risk factors that kick-started the Back To Sleep campaign in the 1990s. The main ones were:

  • Tobacco smoke: smoking while pregnant and/or smoking in a room with baby
  • Poverty
  • Being a boy. Boys are 50% more represented in SIDS deaths than girls
  • Soft objects in the sleeping area. Not strictly because of the suffocation risk but because of the way soft stuff traps carbon dioxide
  • Sleeping position (often facedown in soft bedding)
  • Heavy drinking while pregnant

The interesting thing to note here is that SIDS had already dropped by 25% before the Back To Sleep campaign began. Most research attributes this to families being more aware of creating a healthy pregnancy and living environment for their babies.

In defense of tummy sleeping

tummy sleeping baby

Why would we put our precious babies on their tummy when the Back To Sleep campaign drummed the dangers of tummy sleeping into our collective wisdom?

Ok, here goes….

The whole point of putting a baby to sleep on their back is to stop them from sleeping deeply.


Let’s stop and think about that for a moment. Back sleeping is specifically designed to prevent deep sleep.

It’s all about something called Sleep Efficiency. That sounds like a really good thing, right? Who the hell couldn’t use a little more Sleep Efficiency? Well, for some babies it’s a big problem; they simply don’t wake up enough to get the oxygen they need.

Hold up! That doesn’t mean these poor babies suffocate. If death was caused by suffocation we would know what it is, and it wouldn’t be called SIDS.

There’s a series of mechanisms behind this, mostly involving an overload of carbon dioxide (we think), but the end result is the same – babies never waking up enough to move their heads into a position where they can breathe more easily.

Sleep efficiency means deeper sleep. If a baby sleeps too deeply they may never wake up

[Tummy sleeping showed a] significant increase in sleep duration (+ 6%) and in non-rapid eye movement sleep (+25%) and a significant decrease in number of arousals (–40%) and in their duration (–43%).


But one of the things that high needs babies have in common is they are are notoriously difficult sleepers. In fact, they basically have zero sleep efficiency.

Does any of this sound like your high needs kiddo?

  1. Difficulty getting to sleep
  2. Light sleeping, easily woken
  3. Too-short naps. Difficulty getting over the sleep cycle ‘hump’ to dive back into deeper sleep.
  4. Difficult to resettle when woken even though they’re obviously tired
  5. Overtired the whole day, and cranky about it
Photo Credit Amanda Tipton

Our little demons are simply unable to get into the deep sleep they so desperately need, and that we need them to have!

So the very thing that puts normal babies at risk of SIDS could save a high needs baby from all kinds of problems.

The dangers of back sleeping and sleep deprivation

Yep, just when you thought you were doing everything right, it turns out there’s something else to worry about. Sigh.

Sleep deprivation is dangerous for baby AND for mom


Otherwise healthy infants who were deliberately deprived of sleep showed a worrying increase in apnea and “obstructive respiratory events” (these babies couldn’t breathe). For those of us who KNOW that our tummy-sleeping babies are better-rested, this is a pretty significant piece of information.  Reference

Sleep deprivation is strongly linked to post-natal depression. We also call this The Science Of The Freaking Obvious. Reference

Back-sleepers are behind in milestones

Warm coloured photo of baby smiling during tummy time

Let’s be clear here – you’re not dooming your kid to a life of remedial classes if they sleep on their back. By 18 months old all kids are hitting the same milestones at the same time.

But SIDS only exists up to 12 months. If a baby dies mysteriously after 12 months they call it something else, so if we’re talking about preventing SIDS that 18 month catch-up age means jack-shit. We need our babies to be strong and skilled long before 18 months rolls around

We’re constantly told about the importance of tummy time, and yet so many of us know how much our kids hate it.

Naturally, tummy sleepers are getting waaay more tummy time than back sleepers.

Tummy sleepers are faster to:

  1. Lift their head
  2. Turn their head
  3. Push up on their arms
  4. Crawl
  5. Pull up to stand


Tummy sleeping babies spend their entire sleeping time (all 14 minutes of it haha) doing the stuff that Tummy Time is for.

Tummy sleeping babies know safe sleeping habits

A baby who sleeps on their tummy will learn life-saving head movements that back-sleeping babies don’t yet know.

The most dangerous time in a baby’s life is when they are back-sleeper learning how to roll. Even if they’re not swaddled they will do all the wrong things with their head.

Instead of rolling their head to the side like a tummy-sleeping baby does, they kind of bob their head up and down and smush their nose into the mattress. They never learn the tricks they need to survive


Tummy sleepers retain their body heat


It’s no accident that preemies in the NICU sleep on their tummies. Those nurses know that they sleep better that way and they stay warm.

Back-sleepers get colder and stay colder when sleeping.


Plagiocephaly and related conditions

Photo credit GeekAran

There is a rise in “flat-head syndrome.” Researchers are perfectly up-front about the most likely reason for this: the Back To Sleep campaign. Although these things are easily treatable, it adds an extra layer of complexity to the lives of families already struggling with high-needs babies.

The number of referrals for treatment of torticollis and related conditions rose by 600% in the two years following the Back To Sleep guidlines


Babies are still dying on their back


The number of SIDS deaths has stayed pretty constant over the last few years. And almost half of today’s SIDS deaths are babies on their backs. To be exact, 47 percent.

This is a pretty strong indicator that back-sleeping alone is not a guaranteed way to keep our babies risk-free for SIDS.

But it’s even more sinister than that. We know that SIDS probably occurs in a perfect storm of risk factors.

What if, for some babies, being on their back IS a risk factor? 

We really hope we’re wrong.  But that’s the painful thing about SIDS, we just don’t know.

We do know that some studies link back-sleeping to apnea and apnea to SIDS. We do know that the peak time for SIDS is 4 months old, right around the time a back-sleeping baby is learning to roll without knowing all those life-saving tricks we talked about earlier. We do know that when all risk factors are removed, babies are still dying.

For 20 years back-sleeping has been touted as the primary cause of a reduction in SIDS. But it’s not really that simple.

Which leads us to the simple question: were our grandmothers right about tummy-sleeping all along? For some of us the answer is a quiet yes.

Further Reading

  • This post owes a lot to a now defunct blog post written in 2011. It’s no longer online but you can see a snapshot version at the Wayback Machine.  Excellent reading for an examination of how the numbers are presented all wrong.
  • A harrowing post on Life After SIDS, written by a mama reassessing the Back To Sleep guidelines after losing her baby Toby.
  • An academic challenge of the assumptions and claims made by the Back To Sleep campaign


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