Tommy's PregnancyHub

Positioning your premature baby

Positioning your premature baby correctly can make them feel secure, improve their breathing ability, strengthen their muscles and reduce the risk of cot death.

Once your baby is stabilised their positioning helps their short and long term recovery.

Supporting your baby

The way your baby lies in the incubator, cot, or in your arms can have an effect on their development. Premature babies do not have strong muscles. When they lie on a mattress the effect of gravity tends to pull them flat against the surface and it is hard for them to fight this. This means that their arms can end up in a prone 'W' position, and their legs in a 'frog' shape. This has several effects on the health of your baby

Babies on their backs with 'W' arms may find it difficult to:

  • bring their shoulders and hands forward and together
  • get their fingers and hands to their mouth for sucking and hand clasping, or to touch their mouth and head
  • when they are older, they may find it difficult to lie prone on their elbows, crawl, sit and balance.

Babies with 'frog legs' have hips that are not positioned well and they fall out to the side. These babies may:

  • have dislocated hips
  • find it difficult to crawl, stand and walk later on.

Because the baby is weak the head tends to fall to the left or right. This can cause shortening of neck muscles and your baby may want to turn his/her head to the same side. A poorly positioned neck can also affect breathing, swallowing and feeding.

Premature babies' limbs tend to flail around, instead of curling up as in older babies, so they need some help to lie in a position that is comfortable, helps their muscle development and may help them feel more secure.

A good position for your premature baby 

If there are any breathing difficulties requiring support with CPAP or high flow nasal cannulae, then the team are likely to recommend that your baby stays on their tummy for most of the time in the early days after birth because this helps the bottom of the lungs to stay aerated.

As time goes on the team will introduce more positions into your babies routine and start to focus on getting into a good position through 'containment'. This means limiting their movement and giving them something to push against so they can practise flexing their muscles, similar to the position that they would naturally have in the womb at this stage of development. This is often done using rolled-up bedding, but make sure any fabric cannot get close to their face and impede their breathing. This can be done with your baby on his front or back.

Another option is to 'nest' your baby: building a nest of rolled-up blankets around so they are contained. They may need some cushioning under bony parts of their body such as their hips and knees.

The team will put your baby in a variety of positions to help their development whilst caring for them. Sometimes they will be on their front, sometimes on their side, sometimes on their back. The team will use supports for different parts of their body. 

Putting your baby on their front can increase the risk of sudden infant death syndrome when they get home so only put your baby in this position whilst they are being monitored on the unit and not at home.

Changing your premature baby's sleeping position

Premature babies are more prone to positional plagiocephaly (flat head) and dolichocephaly (long narrow head). To avoid this, it's important to change your baby's position regularly, including the position of their head, to help prevent a flat patch developing.

Avoiding cot death and breathing problems: front, back or side?

Lying on their front is fine in the baby unit

In hospital, it's safe for your baby to lie on their front, as they are being constantly monitored - and, in fact, this position can aid breathing problems in babies with respiratory problems. However, you will need to get her gradually used to lying on their back before taking them home.

Putting your baby on their back at home

Once you take your baby home you will be told to lie them on their back, because sleeping on the front is associated with cot death, also known as sudden infant death syndrome.

Baby on the move? Put the baby on their side

To prepare your baby for crawling, sitting and standing, it is important that they spend some time on their tummy and side. However, they should be awake at the time and you should never leave them unattended. Ask the staff on the unit for more information about this.

  1. Jane K. Sweeney and Teresa Gutierrez, ‘Musculoskeletal Implications of Preterm Infant Positioning in the NICU’, The Journal of Perinatal & Neonatal Nursing 16, no. 1 (June 2002): 58–70.
  2. T. Jarus et al., ‘Effects of Prone and Supine Positions on Sleep State and Stress Responses in Preterm Infants’, Infant Behavior & Development 34, no. 2 (April 2011): 257–63, doi:10.1016/j.infbeh.2010.12.014.
  3. Cambridge University Hospitals NHS Foundation Trust, ‘Supporting and Comforting Your Baby’, n.d.,
  4. Macdonald S and Magill-Cuerden J (2012) Mayes’ Midwifery, Fourteenth Edition (Edinburgh: Bailliere Tindall Elsevier, 2012)
Review dates

Last reviewed: 5 October, 2016
Next review: 5 October, 2019