Back to Sleep, Baby

The Back to Sleep Programme encourages new parents to place their baby in a safe position to sleep at night. New mothers are offered a wide range of help and support to get babies sleeping happily on their back, rather than their front or side. But what exactly are the benefits of putting babies to sleep on their backs, and how much time should babies spend on their backs when they’re awake?


Since the introduction of the Back to Sleep Programme in 1992, infant cot death has reduced by an incredible 50%. A study conducted in 2012 found that there were two main types of risk factor:

  1. a vulnerable infant (a baby that is premature, or who is exposed to tobacco from parents who smoke)
  2. risks from the sleeping environment (sharing a bed with parents or another baby, or babies who sleep on their front or with their face covered).

This study also found that changing sleeping position from front to back halved the risk of cot death.


Whilst a drop in cot death is, of course, very worthwhile, the Back to Sleep Campaign has had some interesting and unintended consequences on infant health. Since 1992, health care professionals have seen an increase in “plagiocephaly”, or “positional head deformity” (PHD). This is an asymmetry of the baby’s head, usually flattening at the back of the head and bulging out at the front. Why does this happen?

When babies are born, their skull bones are soft and the joints between them are loose. This helps them pass through the birth canal during labour smoothly. After the baby is born, the skull bones take a little while to harden and remain relatively soft for about 5 months. This means if a baby spends a long time in one position, the skull will mould and change shape to match. Babies who sleep on their back, and then spend a lot of time during the day lying on their back or sitting in a car seat, can end up with flattened areas on the back of their skull, causing the front to bulge outwards.

It has also been noticed that babies who spend a lot of time on their back often have a delay in learning how to lift the head, push themselves up on their arms, rolling over and crawling, which are important skills to learn in the development of the nervous system.

Tips for preventing PHD:

1) Tummy time! This reduces time spent on the back, but also encourages baby to learn new motor skills and develop the nervous system. Begin with 15 minutes per day and increase by 1 minute per week.

If your baby does not initially like being on their front, try the following tips to get them used to it:

  • Place blanket roll under the chest so baby can see beyond the floor and then decrease the thickness over time as the infant’s skills progress.
  • A parent can lie on the floor on their back, then place the baby on their chest to allow some interaction.
  • Put interesting objects (e.g., toys, pictures, or even goldfish in a bowl) where baby can see them. Remember that the most interesting object to any baby is mum or dad’s face.


2) Throw in some variety by changing sides in some of the following activities

  • Feeding from different sides, or in a different position
  • Change the position of the crib to encourage the infant to look in the opposite direction.
  • Reverse the head-to-toe position of the baby in the crib or change toy, mobile, and crib positions, weekly.


3) Limit the time spent on the back in car seat, infant swing and infant carriers. You might want to try baby wearing instead, in a soft stretchy sling.


4) See a chiropractor to ascertain if there’s any underlying cause, such as tension in the neck, jaw or upper back

Tension in the neck, jaw or upper back can be very common in babies because of the mechanics of labour and delivery, and can be especially pronounced in very quick deliveries or deliveries that required intervention (forceps, ventouse, C-section). But even before the birth babies sometimes adopt unusual positions in the uterous (sometimes known as IUC, inter-uterine constraint). This is more common in mothers with low amniotic fluid (oligohydramnios) or in multiple pregnancies (twins, triplets,etc). Paediatric Chiropractors are highly skilled and detecting and treating these conditions.


  • Babies should be placed on their backs to sleep, to reduce the risk of cot death
  • During the day, babies should have regular supervised tummy time to reduce the risk of PHD and help the back and shoulder muscles develop so babies learn to sit and roll
  • Vary the position of the cot in the room so your baby is encouraged to look to both sides
  • Visit a chiropractor to correct any underlying neck problems which may be causing the PHD

You can find a Paediatric Chiropractor by searching the Royal College of Chiropractors Paediatric Faculty. Members of this faculty have achieved special recognition for their expertise in treating babies and young children.

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