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Ask the Pediatrician: How Do I Help My Baby With a Stuffy Nose Sleep Safely?

Welcome to the weary club of adults caring for little ones with respiratory illnesses. Nasal congestion from colds, flu, respiratory syncytial virus (RSV), or COVID can make it harder for babies to breathe. This may keep them awake at night (and upset family routines, too).

Rachel Y. Moon, M.D., FAAP

Pediatrician and SIDS Researcher, University of Virginia; Chair of the Task Force on SIDS, American Academy of Pediatrics (AAP)

At this point, you’re probably desperate for a solution. But, first, it’s important to review the basics of safe sleep for infants.

Every year in the U.S., some 3,400 babies die while sleeping. Many lose their lives to Sudden Infant Death Syndrome (SIDS), which has no clear cause. Others manage to twist or turn themselves into a position that narrows their airways. Some babies suffocate when pillows or blankets block their mouths or noses.

Based on what research shows are the safest sleep practices, American Academy of Pediatrics (AAP) recommends that babies always sleep flat on their backs on an even, firm surface. Their sleep space also should be free of pillows, props, pads, blankets, stuffed animals or other soft materials. (If you’d like more pointers on infant sleep, here’s a helpful article.)

But shouldn’t congested babies sleep elevated so they can breathe easier?

No. It may seem harmless to prop up your baby on towels or pillows or incline their mattress, but it is NOT safe.

Think of your baby’s airway as a straw. Your baby breathes easiest when the “straw” (meaning the airway) is straight. When your baby’s head is propped up or on an incline, it’s easy for their neck to bend forward or fall to the side. That can cause a bend in the airway that makes it harder for the baby to breathe—even if you’re using a device that seems made for the job.

In fact, the Consumer Product Safety Commission (CPSC) has banned the sale and manufacture of inclined sleepers (any product in which the baby’s head is more than 10 degrees above a flat surface). This was after a series of infant deaths showed how dangerous they can be.

Can I let my baby sleep in a swing or car seat?

I know how tempting it can be to place a fussy baby in a soothing device like a swing, especially if YOU haven’t slept well in days. But keep in mind that your little one is already struggling to breathe. When babies fall asleep in swings, rockers or bouncy chairs, they can’t keep their head upright and their airway straight. So, don’t let your little one sleep in them.

Car seats and baby carriers are made to hold your baby’s head upright or at a slight angle, but they don’t provide enough support for safe sleep. If your little one drifts off in the car, resist the urge to carry them inside in their car seat and let them continue napping. Always move them to a dedicated sleep space as soon as you can.

Is my child’s crib the only safe spot for them to sleep?

It’s perfectly safe for your baby to sleep in a bassinet, bedside sleeper, portable crib or play yard (pack-and-play) or other portable sleeper that meets CPSC guidelines. Just make sure it’s outfitted with a firm, flat mattress with no soft furnishings.

Won’t my baby be cold without blankets, especially when they’re sick?

Many parents worry about this, but it’s fairly simple to keep your sleeping baby comfy. Start by dressing them in warm, breathable layers. Try an undershirt or onesie that’s mostly cotton, topped by a footed sleeper or pajamas with lightweight socks.

You can adjust the room temperature a little if your home tends to be cool. If you do, though, check on your baby now and then. You’ll want to make sure they don’t overheat, which can restrict breathing too.

What tips do you have to relieve my baby’s congestion?

Stuffy noses happen when the blood vessels and tissues inside your baby’s nose fill up with too much fluid. Here are some safe ways to relieve congestion while your baby recovers from a cold, the flu, or any other virus that causes congestion:

  • Saline drops. This method uses plain salt water to ease stuffy noses. Place two drops in each nostril to loosen up the congestion, then use a suction bulb to draw out the saline and mucus. Be sure to squeeze the bulb before placing it in your baby’s nostril so it won’t give off a big puff of air that can move congestion deeper inside. Use plain saline drops without medicine added. (You can even make your own saline drops using sterile, distilled or previously boiled water and salt (see recipe here). Doing this 15 minutes before feeding or naptime can help your child eat and rest better.
  • Gentle suction. You can use something like a bulb syringe to pull fluid and mucus from your baby’s nose. For sticky, stubborn mucus, use a wet cotton swab to gently wipe around the nose.
  • Cool mist. Try using a vaporizer or humidifier to fill your baby’s sleep space with a cool mist that helps clear their nasal passages. Place it close enough that the mist reaches your baby while they’re sleeping, but out of your child’s reach. Change the water every day and follow the manufacturer’s directions to keep mold and bacteria away.
  • You can also try giving your baby a “steam treatment.” Take them into a preheated bathroom. Let the hot water run in the shower for a few minutes, then take your baby into the bathroom and cuddle them while they breathe in the moisture-rich air. This may work especially well before bedtime.
  • Staying hydrated. Make sure your baby stays well hydrated. This can help thin the mucus that makes it harder for them to breathe freely.

    A stuffy nose can cause babies to feed more slowly or not feel like eating. Try to suction your baby’s nose before nursing or bottle-feeding them. If it is difficult for your baby to feed at the breast because of the congestion, expressing breastmilk into a cup or bottle may be an option. In addition, if your baby is at least 6 months old, you can offer them a little bit of water (4-8 oz/day, 0.5-1 cup/day) in an open, sippy or strawed cup.

If my baby is struggling to breathe, what should I do?

Always call 911 if your baby:

  • Is struggling for each breath
  • Can barely make sounds or cry
  • Has bluish lips or face
  • Appears to have something caught in their throat

Call your baby’s doctor if:

  • Their breathing is much faster than normal
  • Their lips or face turn bluish when they cough
  • Nonstop coughing is keeping them from sleeping, eating or playing

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