Tommy's PregnancyHub

Positioning your premature baby

Supporting your baby’s position is essential for their growth and development. Your healthcare team can show you how to position your baby correctly.

Supporting your baby’s position is essential for their growth and development, it can help make them feel secure, help with their breathing, strengthen their muscles and reduce the risk of sudden infant death syndrome (SIDS), which is also known as cot death.  

In the last weeks of pregnancy, babies are curled up tightly in the womb with little space to move around. Pushing against the walls of the womb helps to strengthen their muscles. This helps with their growth and development after they’re born.  

But when a baby is born prematurely, they miss out on this time in the womb. As a result, their muscles aren’t strong enough to lift their arms and legs against gravity. Their shoulders and hips flatten against the bed, with their arms forming a ‘W’ shape and their legs in a ‘frog’ shape.  

Premature babies can find it stressful and tiring to try moving against gravity. They need help to lie in a position that’s comfortable, develops their muscles and helps them feel more secure. 

The healthcare team will show you how to change your baby’s position to help strengthen their muscles.

A good position for your premature baby 

Babies require regular position changes. The healthcare team will place your baby on their front, side or back. The amount of time spent in each position will depend on your baby’s individual needs and what they prefer. 

Putting your baby on their front at home can increase the risk of sudden infant death syndrome. Only put your baby on their front while they are being monitored in the baby unit. 

If babies lie in one position for too long, they can develop flat patches on their head. They may also get used to turning their head in the same direction, which can make it uncomfortable for them to face the other way. Changing your baby’s position regularly will help prevent this. 

The healthcare team will use supports or rolled-up bedding to make a ‘nest’ that keeps your baby in a position where they feel secure. They may also place a weighted cover over your baby. Supports and covers give your baby something to push against, which helps to strengthen their muscles and helps them move their arms and legs more easily. 

Some baby units tilt the incubator or cot slightly so your baby is lying flat but with their head higher than their feet. This may help with breathing, blood flow and digestion. A baby should always be lying completely flat, regardless of the angle of the cot.

When your baby’s muscles are stronger and they’re able to control their movements better, the healthcare team will gradually reduce the amount of support they have around their body. 

Taking your premature baby home

If you are travelling by car, your baby will need to travel in a car seat. Premature babies are more at risk of breathing problems when they are in car seats so the healthcare team in some units may do a ‘car seat challenge’. This is where your baby sits in their car seat on the baby unit, while the healthcare team check for any breathing problems or changes in your baby’s heart rate. If there are any problems, they may change your baby’s position in the seat or suggest a ‘car bed’, which allows your baby to lie flat. 

Find out more about taking your premature baby home.

Caring for your premature baby at home

Before you take your baby home, they will spend time getting used to sleeping on their back with no supports. This is safest for your baby when they’re at home because it lowers the risk of sudden infant death syndrome (SIDS).  

The healthcare team will give you information about caring for your baby at home. Unless you have been told otherwise, you should: 

  • avoid placing supports, nests or bumpers in your baby’s cot
  • avoid putting any comforters or toys in your baby’s cot
  • avoid putting any soft layers, such as sheepskin, between your baby and the mattress
  • keep the mattress level – don’t raise the head of the mattress or bed
  • lie your baby on their back
  • place your baby’s feet at the bottom of the cot – feet to foot – so they can’t wriggle down under the covers.

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

Lying on their front is fine in the baby unit

In hospital, babies are being constantly monitored so it's safe for them to lie on their front. This position can help babies with breathing problems.  

The healthcare team will gradually get your baby used to lying on their back before they go home. 

Putting your baby on their back at home

Once you take your baby home, you should lie them on their back, because sleeping on their front is linked with cot death, also known as sudden infant death syndrome or SIDS. 

Baby on the move? Put your baby on their front or side

When your baby is starting to move around and is awake for longer periods of time, they can spend some time on their front or side. This ‘tummy time’ helps prepare them for crawling, sitting and standing. Only place them in these positions when they’re awake and never leave them alone.  

The healthcare team in the baby unit can give you more information about the best position for your baby. 

EFCNI, Silva E et al. (2018) European Standards of Care for Newborn Health: Positioning support and comfort. European Foundation for the Care of Newborn Infants. https://newborn-health-standards.org/positioning-support/
  
Thames Valley Neonatal ODN Quality Care Group (2018) Positioning and Handling on the Neonatal Unit. https://southodns.nhs.uk/wp-content/uploads/2018/10/Positioning-and-Handling-on-the-Neonatal-Unit-V3-July-2017.-Final-version.pdf

NHS. Reduce the risk of sudden infant death syndrome (SIDS) https://www.nhs.uk/conditions/baby/caring-for-a-newborn/reduce-the-risk-of-sudden-infant-death-syndrome/ (Page last reviewed: 17 September 2018 Next review due: 17 September 2021)

Smith VC (2013) Neonatal intensive care unit discharge preparation, family readiness and infant outcomes: connecting the dots. Journal of Perinatology 2013; 33: 415–421.

Rivas‐Fernandez M et al. (2016) Infant position in neonates receiving mechanical ventilation. Cochrane Database of Systematic Reviews 2016, Issue 11. Art. No.: CD003668. DOI: 10.1002/14651858.CD003668.pub4. 

NHS. Sudden infant death syndrome (SIDS). https://www.nhs.uk/conditions/sudden-infant-death-syndrome-sids/ (Page last reviewed: 20 July 2018. Next review due: 20 July 2021.)