Can newborns sleep on their side? What the NHS and AAP say, and our six-week turn-back log

Eleven days in, I put our daughter down after a 3am feed and she rolled, in the lazy way newborns do, onto her left side and went still. She looked more settled than she ever did flat on her back. So can newborns sleep on their side? The three sources a parent in Dubai is most likely to meet all give the same answer, and it is no. The NHS says to "always place your baby on their back to sleep in the feet-to-foot position". The Lullaby Trust says "Sleeping a baby on their front or side greatly increases the risk of SIDS." The American Academy of Pediatrics, through its parent site, says "The side position is just as dangerous as the stomach position". Back, for every sleep, day and night, until the baby can roll both ways on their own.

Why is side sleeping treated as risky as front sleeping?

The side looks like a halfway position. It is not treated as one, and the reason is mechanical. The AAP page puts it in one sentence: the side "is just as dangerous as the stomach position, partly because your baby can roll more easily onto their stomach when they are placed on their side." A newborn laid on their side is one small movement from being face down, and a newborn cannot reliably move back.

The Lullaby Trust adds a point I had not heard before our daughter was born. "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." Nobody plans to be a side-sleeping household. They plan to do it properly, and then at 3am the baby looks so settled that way.

The dangerous version is not the family that always does it wrong. It is the family that usually does it right and makes an exception.

The NHS phrases the whole rule with one position and one direction: back, feet at the bottom of the cot so the baby cannot wriggle down under anything. The same page says to keep the cot "clear of anything that could cover their face and head", and lists pillows, duvets, cot bumpers, loose blankets and soft toys. It does not name the rolled towels and wedges sold to hold a baby on their side, but a rolled towel is a loose thing in a cot, and we kept them out on that reading.

Won't a baby choke on their back if they bring up milk?

This was the worry behind our 3am side-rolling. Our daughter brought up a little milk after most feeds, and the instinct that a baby on their back might inhale it is strong. The AAP page answers it directly: "Babies will not choke when they're on their backs, because their airway anatomy and gag reflex will keep that from happening." It is the same site that says babies on their backs "are much less likely to die suddenly and unexpectedly than babies who sleep on their stomachs or sides."

I am not a doctor and this is not medical advice. A baby who is unwell, or whose reflux a paediatrician is treating, is a conversation for that paediatrician, not for a blog.

What did we actually do when she kept turning onto her side?

The rule is one line. Living it is a log. From week two to week eight I kept a tally on the fridge, next to the feed log from the day-night post, of how many times a night one of us turned her from her side back onto her back. One baby, rounded, no claim beyond our flat.

Two things stand out. The first is week two: half of the side-sleeping was us. After a side-lying feed in bed, the easiest motion is to lower a baby in the same position she fed in. Making "upright, then onto her back" a deliberate two-step removed a chunk of the problem before she changed at all.

The second is the lamp. She turned her head and then her body toward the one dim light in the room, and the cot sat with the lamp to her left. Moving the cot so the light was beyond her feet took the side-turning from most nights to rare. I cannot prove that caused it; she was also five weeks older by then.

The NHS wording for the turning itself is exactly what we did: "move your baby onto their back if they roll (until they can roll onto their front and back again by themselves)". The Lullaby Trust is kinder about the 3am part than I was with myself: "The first few times they roll onto their tummy, you might like to gently turn them back, but don't feel you have to get up all night to check on them."

When can a baby sleep on their side?

When the baby decides, not the parent. The Lullaby Trust: "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 AAP says the same with the practical bit added: the baby still goes down on their back, "but if they're comfortable rolling both ways (back to tummy, tummy to back), then you don't need to keep turning your baby to their back again." Its page notes that its recommendations apply to babies up to one year unless it says otherwise.

So the position a parent chooses stays the same for the whole first year. What changes is how much the baby can override it.

The rest of the NHS checklist carried on unchanged: a separate cot or Moses basket "in the same room as you for every sleep for at least the first 6 months", and a room "between 16C to 20C", which in a Dubai summer means the air conditioning is doing the work and a room thermometer earns its few dirhams.

Three years on, the same child sleeps on her front, her side, diagonally and once with her feet on the wall. That is her business now. The last thing before the light goes down is a slow book, currently The Tide Goes Out, read at the pace its pages set, and she lies however she likes while she listens. For the first weeks there was only one position, and the job was the small, dull one of putting her back into it.

Sources

• Reduce the risk of sudden infant death syndrome (SIDS) · NHS
• The best sleeping position for babies · The Lullaby Trust
• How to Keep Your Sleeping Baby Safe: AAP Policy Explained · HealthyChildren.org, American Academy of Pediatrics (Rachel Y. Moon, MD, FAAP)