Safest Sleep Position for Babies with Reflux

I get a lot of questions about babies and reflux, especially as it relates to sleep—how to get them to sleep well if they seem fussy, irritable, or have like heartburn-like symptoms. One of the most common questions parents ask me is how to elevate the head of the crib so that baby doesn’t have as much acid reflux and I want to set the record straight:

You should never elevate the head of the crib.


In adults, a common heartburn remedy is to sit with pillows elevating the head to keep the stomach acid from coming back up the esophagus, but that doesn’t work in babies and puts them in a VERY unsafe sleeping position. According to the most recent position paper from the NASPAGHAN (The North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition) your baby should always sleep flat on his or her back, regardless of whether they have reflux, colic, fussiness or not.

If you look at the anatomy of a baby, sleeping flat on the back protects them best when they have any sort of regurgitation. Gravity brings the milk up, then gravity brings it back down, and it goes back into the esophagus. When babies are sleeping on their tummy, regurgitation can go into their trachea and lungs, which can cause fatal aspiration. The safest way for a baby to sleep, and the safest way for a baby to regurgitate, is ALWAYS flat on his or her back.

I recommend that parents who like for their baby to sleep in an elevated crib to stop. Of course, always talk with your own pediatrician, but the general consensus is that the risks of babies sleeping in this position far outweigh the benefits. Colic, fussiness, and pitting up are all normal things that babies do and they often don’t require any evaluation or management. In fact, new research on the use of acid-suppressing medicines shows that acid-suppressing medicines can increase the likelihood of food allergies. I know there are babies out there that are inconsolably fussy all the time because they have acid irritating their esophagus, but for the most part, even fussy, spitty babies do not need acid suppression that doesn’t even decrease the frequency or volume of their spit-up. (But again, you ALWAYS want to discuss anything like this with your own pediatrician.)

In regards to car seats, they are the absolute worst for reflux. You may think that the angle will help them regurgitate and spit up less and have less acid reflux, but the studies from the NASPAGHAN show that this angle is even worse for reflux symptoms and spitting.

So, one more time, babies should sleep flat on their backs.

Babies should sleep FLAT on their BACKS.

BABIES SHOULD SLEEP FLAT ON THEIR BACKS regardless of what other things they have going on with reflux, colic, or any condition needing acid-suppressing medicine. It is, by far, the safe position for baby to sleep. Elevating baby’s head or positioning baby to sleep on his or her stomach does not help and is not safe.

Safe sleep is critically important and a much bigger deal than having a colicky baby for a few weeks or months. My emphasis with my patients is always on safe sleep practices. Even if that means we have a little bit more spitting up or that baby is a little bit fussier from time to time. Safe sleep (alone in a boring crib, flat on their backs) trumps all of that by a large margin.

If you have any questions, feel free to comment them below. Share this blog with somebody that needs to hear the message. Keep up the good work.


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