02/19/2026
When it comes to safe sleep practices, one fear we hear from parents is that if they put their baby on their back, they could choke if they spit up. It’s a scary thought, but understanding newborn physiology helps us see that babies are actually safer on their backs.
“When a baby is on their back, the windpipe (trachea) sits above the esophagus (the feeding tube),” explains WashU Medicine neonatologist Bryanne Colvin, MD. “If they spit up, gravity helps that fluid stay in the feeding tube or go back into the stomach, rather than pooling near the airway. On their stomach, that anatomy is reversed. When you combine this anatomical 'safety valve' with a baby's natural gag reflex, their body is remarkably well-equipped to keep their airway clear.”
While their anatomy provides protection, you can help your baby stay comfortable and manage spit-up with these safe habits:
The 20-Minute Rule: Hold your baby upright for 20–30 minutes after a feeding.
Burp Often: Take time to burp during and after feedings to reduce gas.
Stay Flat: Never use wedges or tilt the mattress. Propping a baby up can cause them to slide down, potentially compromising their breathing.
“It is completely natural to want to change your baby’s position when they seem uncomfortable,” says Dr. Colvin. “But you should feel confident that your baby's body is designed to stay safe on its back.”
