Ashwin Lewis
Inclined sleepers for babies have been linked to hundreds of infant deaths, and are now banned in the US. The safest option for newborns is to sleep on their back on a flat, firm, and waterproof mattress. Sleeping a baby on their side or stomach increases the risk of sudden infant death syndrome (SIDS). While inclined sleepers were marketed as helping with reflux, they do not help with this and risk the infant sliding into an unsafe sleeping position.
| Characteristics | Values |
|---|---|
| Safety | Sleeping on an incline can cause the baby's body to slide down and their head to slump forward, causing positional asphyxia. |
| Recommendations | The Lullaby Trust recommends that babies always sleep on their back, on a flat surface. |
| Regulations | The U.S. has banned inclined sleepers for infants. |
| Alternatives | If your baby has reflux, hold them upright for 20-30 minutes after feeding, or ask a friend or family member for help. |
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What You'll Learn
Inclined sleepers have been linked to infant deaths
Inclined sleepers have been linked to hundreds of infant deaths. The Consumer Product Safety Commission has banned inclined sleepers for infants pursuant to the Safe Sleep for Babies Act of 2021. The ban applies to inclined sleepers for infants, regardless of their date of manufacture or sale.
The American Academy of Pediatrics (AAP) has offered information about deadly products like inclined sleepers, warning that they should be avoided. The AAP and Consumer Reports have supported the continued implementation and enforcement of the ISP Rule, which offers clarity on the importance of banning all inclined infant sleep products.
The ISP Rule states that if a product is not intended for another purpose (such as travel or eating) and can be used for routine sleep, it should not have an incline greater than 10 degrees. This is because sleeping on an incline can cause an infant's body to slide down and their head to slump forward, causing positional asphyxia. Positional asphyxia occurs when a baby's body position gets in the way of their breathing.
Studies have shown that sleeping on an incline increases abdominal muscle activity, which can exacerbate fatigue and contribute to suffocation if an infant cannot self-correct to the supine position. A total of 451 incidents related to infant inclined sleep products were reported to the United States Consumer Product Safety Commission from 2005 to 2019, and many of these cases were fatal.
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They can cause positional asphyxia
Inclined sleepers for babies have been linked to hundreds of infant deaths. The Consumer Product Safety Commission has banned inclined sleepers for infants pursuant to the Safe Sleep for Babies Act of 2021. The ban applies to inclined sleepers for infants, regardless of the date of manufacture.
Inclined sleepers can cause positional asphyxia. This is when a baby's body position gets in the way of their breathing. A baby's body can slide down on an inclined sleep surface, and their head can slump forward, blocking their airway and causing suffocation. Sleep surfaces that elevate both the baby's head and feet, like a hammock, also increase the risk of positional asphyxia. Sitting with the head down and the chin on or near the chest can block the baby's airway and cause suffocation.
Babies should always be placed on their back to sleep, on a flat, firm, and waterproof mattress. This is one of the best things caregivers can do to ensure the baby is sleeping as safely as possible. Sleeping a baby on their front or side increases the risk of sudden infant death syndrome (SIDS). The risk of SIDS is particularly high for babies who are usually placed on their back to sleep but are sometimes placed on their front or side.
Inclined sleep products also result in higher muscle activity of the trunk core muscles (abdominals) and trunk movement, which can exacerbate fatigue and contribute to suffocation if the infant cannot self-correct to the supine position.
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They increase the risk of suffocation
Inclined sleepers for babies have been linked to hundreds of infant deaths. The Consumer Product Safety Commission has banned inclined sleepers for infants pursuant to the Safe Sleep for Babies Act of 2021. The ban applies to inclined sleepers for infants, regardless of the date of manufacture.
The American Academy of Pediatrics (AAP) has warned against the use of inclined sleepers, stating that they do not help with reflux and are unlikely to improve cold symptoms. Instead, they increase the risk of suffocation. When a baby sleeps on an incline, their body can slide down, causing their head to slump forward. This can block the baby's airway and lead to positional asphyxia, which occurs when the baby's body position gets in the way of their breathing.
Studies have shown that inclined sleep surfaces result in significantly higher muscle activity, particularly in the abdominal muscles. This can contribute to faster fatigue and increase the risk of suffocation if the infant cannot self-correct to the supine position. The prone position, where the baby lies on their stomach, already requires higher musculoskeletal effort to maintain a safe posture and prevent suffocation. The increased muscle activity on an inclined surface further exacerbates this risk.
Additionally, soft surfaces and items in the crib, such as quilts, blankets, and pillows, are not safe for babies to sleep on. They increase the risk of SIDS, suffocation, strangulation, and entrapment. It is recommended that babies sleep on a hard, flat surface, such as a safety-approved crib or bassinet, in the same room as their caregiver. This allows for easy monitoring and reduces the risk of suffocation and other sleep-related hazards.
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They don't help with reflux
Inclined sleepers for infants have been banned under the Safe Sleep for Babies Act of 2021. This is because placing babies on an incline does not help with reflux. The American Academy of Pediatrics (AAP) recommends that infants be placed supine for sleep on a flat, firm, and waterproof mattress to prevent sudden infant death syndrome (SIDS).
While it is common for infants with gastroesophageal reflux disease (GERD) to be placed in an inclined position to reduce symptoms, there is little evidence to support this practice. A study with 24 infants claimed that an inclined position does not reduce GERD symptoms. Another study with 79 participants found that a 30-degree incline in the prone position reduced GER, but no benefit was observed in the supine position. However, a third study not cited in either guideline showed that reflux episodes were reduced in infants placed at an incline.
Despite the mixed results of these studies, it is important to prioritize the safety of infants. The AAP recommends placing infants on their backs to sleep, as this position lowers the risk of SIDS. Sleeping a baby on their side or stomach increases the risk of SIDS. Once an infant can move themselves from their back to their front and back again, they will be able to find their own sleeping position.
If your baby has reflux, there are other strategies you can try to alleviate their symptoms. You can check for food sensitivities by trying different formulas or offering breast milk instead. If your baby is eating solid food, you can experiment with different foods to see if that makes a difference. It is important to consult your doctor if your baby is experiencing severe or chronic reflux, as they may have GERD.
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The safest option is to place your baby on their back to sleep
The safest option for your baby is to place them on their back to sleep on a flat, firm, and waterproof mattress. Sleeping a baby on their front or side increases the risk of sudden infant death syndrome (SIDS). There is a lot of evidence from around the world that shows that placing your baby on their back at the beginning of every sleep or nap, day or night, lowers the risk of SIDS.
It is important to keep your baby's sleep surface flat. Don't incline, tilt, or prop the mattress, cot, or your baby. This will not help with reflux and is unlikely to improve cold symptoms. Sleep surfaces with one end higher than the other are not safe for babies to sleep on because the baby's body can slide down and their head can slump forward, causing positional asphyxia. Similarly, sleep surfaces that elevate both the baby's head and feet, like a hammock, also increase the risk of positional asphyxia. Sitting with the head down and the chin on or near the chest could block the baby's airway and cause suffocation.
Once your baby can move themselves from their back to their front and back again by themselves, they will be able to find their own sleeping position. The first few times they roll onto their tummy, you might like to gently turn them back, but you don't need to get up all night to check on them. While they're awake, give them some time to play on their tummy as this helps their development, but keep an eye on them while they do.
For the first six months, babies should always be in the same room as you for sleep, day and night. This makes it easier to feed, comfort, and monitor the baby. Room sharing without bed sharing is the safest option.
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Frequently asked questions
No, newborn babies should not sleep on an incline. The safest way to put your baby to sleep is on their back, on a flat, firm, and waterproof mattress. Sleeping a baby on their side or stomach increases the risk of sudden infant death syndrome (SIDS).
Inclined sleepers have been linked to hundreds of infant deaths. Sleeping surfaces with one end higher than the other are not safe for babies because their body can slide down and their head can slump forward, causing positional asphyxia.
It is recommended that babies sleep in the same room as their parents for the first six months. The baby should be placed in a safety-approved crib next to the adult bed. Bed sharing can be very risky, and room sharing without bed sharing is the safest option.
