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What is the safest sleep solution for my baby with reflux?

Anthony Porto, MD, MPH, FAAP


What is the safest sleep solution for my baby with reflux?

By: Anthony Porto, MD, MPH, FAAP

Naturally, you want to do whatever you can to keep your baby safe. And if your baby is one of the many who have reflux―also called gastroesophageal reflux (GER)―there are a fair share of myths and misconceptions out there when it comes to sleeping positions.

Here are three sleep safety tips from the American Academy of Pediatrics (AAP) for babies with reflux:

Note: Many of the factors that contribute to GER in infancy are part of typical growth and development―including a short esophagus in newborns that will grow as the baby does, along with a muscle at the bottom that is also relatively short and not as strong as it will be later in life. GER typically starts at 2-3 weeks of age and peaks at 4-5 months in full term infants. GER typically gets much better after 6 months once a baby learns to sit up; the esophagus gets longer and the lower esophageal sphincter functions properly.

1. Back to sleep―even with reflux!

Though parents are often concerned that their baby may vomit and choke while sleeping on their back, it is a total myth! Babies automatically cough up or swallow fluid that they spit up or vomit because of the gag reflex, that naturally prevents choking from happening. There is no evidence that healthy babies placed on their backs are more likely to have serious or fatal choking episodes than those placed on their stomachs. But there is strong evidence that babies placed on their stomachs are at higher risk for sudden infant death syndrome (SIDS).

Take the spitting over the SIDS!

Back sleeping is the best way to reduce the risk of SIDS and is the recommended position until babies can roll over fully on their own―even for babies with reflux.

2. Transfer a sleeping baby to a firm, flat safe sleep surface when not traveling.

If baby falls asleep while riding in his car seat―which often happens―the AAP recommends transferring him out of the seat when you reach your destination and placing him on his back in a crib, bassinette or play yard with a firm, flat mattress, free from soft bedding, including pillows or blankets, toys and bumpers.

Car seats and other sitting devices, like swings or reclined bouncy seats, are not safe sleeping environments; neither are sleep positioners or nests―a mat with raised supports or pillows surrounding it, frequently resembling a raft. These products are unregulated and there are no safety standards that apply to them. The AAP does not recommend sleep positioners or nests, as their safety has not been well researched. In addition, there is evidence that a semi-inclined position can make a baby's reflux worse.

Placing your baby in a semi-inclined position does not make reflux better.

In 2019, the U.S. Consumer Product Safety Commission (CPSC) and Fisher-Price issued a recall of 4.7 million Rock 'n Play infant sleepers following reports of over 30 infant deaths. Death was associated with infants turning over while sleeping in these inclined sleepers leading to an increased risk of suffocation and strangulation.

The AAP does not recommend letting infants sleep in inclined products like the Rock 'n Play that require restraining a baby. AAP policy calls for infants to sleep on their back, on a separate, flat and firm sleep surface without any bumpers, bedding or stuffed toys. 

3. Gadgets are not recommended.

There are many gadgets that are marketed for treating reflux. Wedges and sleep positioners are not needed and although these are sometimes marketed to reduce the risk of SIDS, research is lacking.

Avoid devices designed to maintain head elevation in the crib.

Elevating the head of a baby's crib is not effective in reducing GER. It's also not safe as it increases the risk of the baby rolling to the foot of the bed or into a position that may cause serious of deadly breathing problems.

This recommendation is supported by the AAP, the North American Society of Pediatric Gastroenterology, Hepatology and Nutrition, and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition.

So with sleep positioners and gadgets out, what's a parent of a baby with reflux to do?

Reflux will end for most babies. As difficult as it can be, wait it out. Most babies outgrow the symptoms. We know that by 4 months of age, the great majority of babies are spitting up. By 6 months, that dramatically drops off because they're sitting up on their own.

If you have any concerns about your baby with reflux, it is always best to talk with your pediatrician and come up with a plan together for best sleep practices. 

Additional Information:

Anthony Porto, MD, MPH, FAAP

​Anthony Porto, MD, MPH, FAAP is a board certified pediatrician and board certified pediatric gastroenterologist. He is an Associate Professor of Pediatrics and Associate Clinical Chief of Pediatric Gastroenterology at Yale University and Director, Pediatric Gastroenterology at Greenwich Hospital in Greenwich, CT. He is also the medical director of the Yale Pediatric Celiac Program. Within the American Academy of Pediatrics, Dr. Porto sits on the PREP Gastroenterology Advisory Board and is a member of the Section on Gastroenterology, Hepatology and Nutrition. He is also a member of the North American Society of Pediatric Gastroenterology, Hepatology and Nutrition's Public Education Committee, a pediatric expert on nutrition for The Bump's Real Answers, and is the co-author of The Pediatrician's Guide to Feeding Babies and Toddlers. Follow him on Instagram @Pediatriciansguide.​

Last Updated
American Academy of Pediatrics (Copyright © 2019)
The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.
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