Humans come in various shapes and sizes, with all kinds of opinions and preferences. If there is one thing that we can all agree on, however, it is that we could all use more sleep. But it is not just about how long you sleep, it is also about how well you sleep. There are a ton of factors that influence the quality of your sleep, like your mattress, your bedsheets, your pillow.

For the best results, a lot of thought and research should go into your bedding purchases. Should you get a firm or a soft pillow, a high or a low loft pillow? These and many more decisions will change the way you sleep, for better or worse. Surely the same applies to your newborn baby too, right? Well, not quite.

While most of us could not imagine sleeping without a pillow, there are many cultures around the world where it is not customary to use pillows. As long as you are sleeping in a supine position (i.e. on your back), a pillow is not necessary. The same goes for your little ones.

When can a baby have a pillow
Image by kbt1016 from Pixabay

The dangers of an early pillow

More than just being unnecessary, however, sleeping with pillows can be detrimental to the health of your baby. Using pillows as well as soft and fluffy bedding increases the likelihood of accidental suffocation or sudden infant death syndrome (SIDS), both subcategories of sudden unexpected infant death (SUID).

Suffocation and SIDS are among the five most common causes of infant mortality in the United States of America, following birth defects and pre-term births, and the fact that parents are not well-informed about when can a baby have a pillow might play a role in these statistics.

The majority of deaths caused by suffocation happen to babies in unsafe sleeping environments. This includes being smothered in bedding and toys. In fact, more than two-thirds of suffocations involve soft bedding, e.g. a blanket or a pillow. Additionally, if your child accidentally rolls onto their front, their face can sink into the mattress and potentially suffocate them.

In order to avoid this, it is important for the baby to sleep on a firm mattress. Under no circumstances should the baby sleep on a soft couch, chair, or the like. In addition to this, all pillows, plush toys, and other suffocation hazards should be removed. This includes crib bumpers and sleep positioners, too. While some manufacturers claim that their sleep positioners prevent SIDS, there is no scientific evidence to support those claims.

Sudden infant death syndrome (SIDS) is a term used to denote any unexplained deaths of infants younger than one year of age. Although suffocation and SIDS are not the same thing, oftentimes it is impossible to tell if a baby’s death was caused by obstruction of respiratory pathways or by other factors.

Essentially, any infant death that we cannot ascertain the cause of is filed under SIDS. As we do not know for sure what causes these sudden deaths, it is impossible for us to completely remove all factors that could result in a SUID. However, there are things we can do to greatly lower the risk of something like this happening to our children.

How should the baby sleep

The first thing recommended by experts (including the American Academy of Pediatrics, the National Institute of Health, and pretty much everyone else) is to put your baby to bed in the supine position (i.e. lying on their back). Even if it is just a nap, you need to make sure that your baby is lying on their back.

Data from the Centers for Disease Control and Prevention (Sudden Unexpected Infant Death Case Registry) tells us that most cases of accidental infant suffocation involved the baby sleeping on their stomach or side. These sleeping positions have also been correlated with a higher incidence of SIDS.

As a quick side note, if your little one sleeps in the same position every night, they might end up developing plagiocephaly – flat head syndrome.  In the United States of America, this happens to more than one in ten infants. Seeing as your baby will be sleeping on their back every night, you should alternate the position of their head every night (i.e. facing left or right).

When can a baby have a pillow
Image by Stephanie Pratt from Pixabay

In addition to this, you should give your baby plenty of tummy time each day, i.e. giving your baby time on their stomach while they are awake (and of course in your presence, or in the presence of other adults) in order to counteract the possible effects of repeated supine sleeping.

Not much research has been conducted on the actual amount of tummy time a child should have each day, but you should be able to figure that one out on your own by paying close attention to your child’s muscular development. You should also spend a fair bit of time carrying the baby in your arms or in a baby carrier to help prevent flat head syndrome. The jury is still out on swaddling, however, as the research on its effects is not conclusive.

With that out of the way, let us return to the main topic. Soft bedding, pillows, blankets, plush toys; all of these things do correlate with SIDS incidence. Newborns have very limited ability to control their heads and necks, so they might not be able to move their heads to breathe if pillows or similar suffocation hazards cover their mouths.

When your baby is sleeping, the only thing that should be on your baby’s mattress is – your baby. If you are afraid your baby might miss their toys, you could perhaps place them in view but outside of the crib, where they can pose no threat to your baby’s health. You should also avoid having your baby sleep in the same bed as you during their first year of age, as this has also been connected to an increased likelihood of SIDS.

So the question is: when can a baby have a pillow?

Now, as for the question posed in the headline, the answer is not a particularly complicated one. The American Academy of Pediatrics urges parents not to give their child a pillow until at least age 2. Although SIDS only affects children under one year of age, suffocation is still a possibility for toddlers.

When your toddler gets to be about 35 inches tall or when the height of the crib rails is less than three-quarters of your toddler’s height, it is probably time to switch to a toddler bed or regular bed, to avoid a tumble.

As your child might transition to a toddler bed as early as 18 months of age, you can give your child a toddler pillow as soon as that transition is made. It is, however, safer to wait until your child is two years old, or better yet – three years old. While it should be safe for your two-year-old to sleep with a pillow, it would not hurt to put it off for one more year.

When the time comes for your little one to finally get a pillow, you would still do well to err on the side of caution. Experts recommend giving your child a small and firm pillow. The younger your child is, the firmer the pillow should be.

The pillow should be smaller than an adult pillow so that it fits the size of your toddler’s head and neck properly. If your child has allergies, consider buying a hypoallergenic toddler pillow (we’d recommend this one) and an organic crib mattress (check our article on how to choose an organic crib mattress). Also watch out for pillows filled with grains, pellets, or similarly small particles that could potentially act as choking hazards.

Upon reaching 18 months of age, your toddler can also have a blanket in bed. Big stuffed toys and ones with ribbons or strings should probably still be kept away from your little one’s bed, as they could still suffocate or strangulate your child.

Don’t rush the pillow

Do not be surprised if your little one does not start using the pillow right away, even if you have made the transition to a bed. What is uncomfortable for you is not necessarily uncomfortable for your child, and you could end up seeing your toddler’s pillow on the floor. This is completely normal, as every child’s development is different. So do not worry, your little one will take to sleeping with a pillow when they feel like it.

Hopefully, this article will have given you some sense of how to approach your little one’s sleeping arrangements and by now you know when can a baby have a pillow. If you would like to educate yourself further, there are plenty of resources on the Internet. The website of the National Institute of Health’s Safe to Sleep campaign has an enormous amount of resources for all current and future parents and babysitters. The American Academy of Pediatrics is another great source, with comprehensive information on this topic and many others.

This almost goes without saying, but remember that you should always consult with a pediatrician or your general practitioner before making decisions like these. Sudden infant death syndrome is very real and should not be taken lightly.

While following these general guidelines will greatly reduce the risk of SIDS, these only apply to sleeping conditions. There are many more factors to take into account, both general ones that apply to all children, as well as ones that may be specific to your child.