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Positional Asphyxia in Infants

Positional asphyxia in infants can happen very quickly and cause death. In a review of 30 cases where infants died from positional asphyxia, the following were identified as some of the causes:

  • positional asphyxia/wedging from slipping between a mattress and bed/crib sides or wall
  • moving into a position where the face was covered and the upper airway occluded (over half of the cases)
  • suffocation from plastic bed covers

In this article about positional asphyxia in infants, we are going to share methods to help keep your infant safe. After reading this article, you will be able to identify unsafe sleeping environments that could potentially harm your baby.

What is Positional Asphyxia in Infants?

Positional asphyxia, also called Postural asphyxia, simply means that something is blocking the airway due to the way the body is positioned. This can happen to an infant when they are placed in a position that blocks their nose and mouth.

It can also happen if an infant is sitting up, but their head is slumped forward. This position may allow air into the mouth or nose, but the windpipe is pinched shut due to the angle of the tilted head.

Lastly, it can be due to a position that restricts the ability of the chest to expand and contract for proper breathing.

Why is positional asphyxia in infants a concern?

Asphyxia leads to low oxygen levels in the brain. This can lead to both behavioral and cognitive problems immediately or delayed.

You can go without food for several days. You can even go without water for a few days. But you cannot live without oxygen for more than a few minutes.

About 3,700 infants die in sleep-related incidents each year. Accidental suffocation and strangulation are among the causes.

Who is at risk for positional asphyxia?

Young infants and newborn babies are at risk for positional asphyxia. This is because they lack the motor skill to move out of a dangerous situation.

Premature and babies born with low birth weights are the highest risk. Their nervous systems and motor functions are the most compromised.

But you should know:

Toddlers have also died from positional asphyxia in car seats, swings, and other furniture not designed for sleeping.

Bad Positioning Techniques

There are specific positioning techniques that should not be used when placing a baby in the crib for sleeping.


The Prone position

In medical terms, a prone position indicates a person is lying flat on their stomach. Infants do not have much muscle control until they become more developed.

Placing them facedown on a flat surface could easily block their nose and mouth. This could easily predicate positional asphyxia. Even putting them prone with their head turned to one side is not a good idea.

And remember:

There is no guarantee that the baby won’t turn their head to be facedown during sleep.

Plus, once hypoxia (low oxygen) starts to happen, there is already the beginning of cognitive impairment and coordination.

The Side position

Another common unsafe practice is to place an infant on their side. If the baby somehow rolled onto their tummy, there is a chance of positional asphyxia.


Some parents will place a positioning wedge up against the infant. The wedge is meant to keep them from rolling onto their tummy.

But the wedges themselves, have caused positional asphyxia.

Best practice: never place anything else in the crib with your infant.

This includes blankets, pacifiers, or toys…as mentioned in our article about The ABCs of Safe Sleep.

Any of those items mentioned can become a hazard.

Sitting in a car seat

Infant car seats are designed for transportation, not sleeping. They are designed to keep infants safe during an automobile accident.


But many families do not know how to install or use the car seats properly. A study from 2015 shared that 69% of parents with newborns had restraining straps that were too loose.

When the car seat straps are too loose, infants can lean forward, leading to accidental positional asphyxia. Sleeping in car seats have led to death.

Never leave a baby unattended while in a car seat. When it is time to nap, use an appropriate infant crib.

The Supine position

Laying them on their back, or supine is the recommended sleep position for infants. This places their anatomy in such a way that choking and positional asphyxia is minimized.

Here is a great video explaining why the supine position is the best for infants:

Additional crib items


When it comes to sleep time or nap time, always remove everything from the crib, including blankets.

But I keep my baby covered with her favorite blanky to keep her warm…

The baby’s clothes should be enough to keep warm without a blanket. If not, consider changing your room temperature. Also remeber it is better for a baby to be a little chilly as opposed to being too warm.

What if a little one falls asleep with a pacifier, and it falls out when they are sleeping?

You should remove it from the crib. Some parents are tempted to put the pacifier back into the infant’s mouth. We do not recommend that practice.

Once your infant is already asleep, there is no need to reintroduce the pacifier. Doing so can lead to a dependency on the pacifier to go to sleep. It also creates a risk of asphyxiation once it is out.

Crib pads (bumper pads) don’t count, right? They keep my baby safe.

Unfortunately, there are cases of bumper pads leading to positional asphyxia and death. There are 27 accidental deaths from asphyxiation due to bumper pads listed in this study.

Sometimes the cause of death is from the bumper ties that hold the pad in place. They have caused strangulation in some cases.

Sharing your bed

When your child falls asleep next to you in bed, it is understandable that you don’t want to move them. It may also be tempting to catch a few winks yourself after a long day.

But you need to put your little one in their own sleeping place to keep them safe.

Here’s why:

There are many cases of positional asphyxia in infants because the parent allowed the infant to stay in bed with them. At some point, someone moved, and the infant could no longer breathe.

As recent as 2018, WebMD is warning that this tragedy is on the rise. In fact, it doubled from 1993 to 2010. Co-sleeping with infants creates an unsafe sleeping environment and should be avoided at all costs.


Other dangers that can lead to positional asphyxia in infants

So far, we have discussed some of the more common causes of positional asphyxia in infants.

But that’s not all.

Here are other dangers that you need to be aware of as a parent.

  • Faulty crib or bassinet construction may result in defects through which infants may fall and become suspended, or in spaces which entrap the head.
  • Projections on the inside of cribs may snag clothing causing hanging, as may nearby curtain cords and restraining harnesses.
  • The mouth and nose may be covered by plastic sheeting or by the mattress of partially filled waterbeds.
  • Rocking cradles with excessive angles of tilt may also place infants’ heads into positions where breathing is compromised.
  • Finally, external pressure by adults in shared sleeping situations may result in fatal chest compression or an airway occlusion.

Let’s talk about preventing positional asphyxia!

An ounce of prevention is worth a pound of cure. Have you ever heard that one? It’s true. In the case of our little ones, it is better to be safe than sorry.

Ready for safety tips?

Alone, Back, Crib

The best method we’ve seen is outlined in our article Alone, Back, Crib. The catchy phrase is a reminder to let the infant sleep ALONE on their BACK and in their own CRIB.

An extended version of the ABC method is the ABCs method. And the additional “s” stands for “smoking.” It is very important to keep infants away from secondhand smoke.

Know the sleeping environment

Use your bassinet appropriately if that is where your baby sleeps. There are particular manufacturer’s suggestions and recall tips in this article. Understanding the size requirements and limitations is essential.

Take care of yourself too

Being a parent is tough. But you have to find ways to rest and relax. Things can get very complicated quickly when the caretaker is too tired to pay attention.

Have a list of friends and family who you can call for help.


There are enough dangers out there in the big, wide world for our helpless little angels. Positional asphyxia in infants doesn’t have to be one of them. Remove their occurrence by following the advice given in this article.

Share this with your friends and family too.

Parents and caretakers can never be too prepared!

Remove everything from the crib when they are put down for sleep or nap time. Resist the urge to sneak some sleep when they fall asleep next to you on the bed. Always place them on their backs so nothing can block their airway.

You can do this! Someone is counting on you…