Which baby pillows are useful and safe? An overview

Many parents are unsure whether their baby needs a pillow. There are special pillows for flat head syndrome (plagiocephaly), positioning and nursing pillows, wedge pillows for reflux, or standard flat pillows. However, as a general rule: a baby's bed should be as bare as possible. Experts have emphasized for years that babies should sleep on a firm, flat surface without any soft objects during the first months. Therefore, pillows, thick blankets, or crib bumpers have no place in a sleeping environment. Below, we introduce the various types of pillows and their purposes – with a focus on the risks and recommendations from pediatricians, midwives, and health experts.

Overview of Baby Pillow Types

• Head-shaping pillows (Plagiocephaly pillows): These pillows usually have a hollow for the back of the head and are intended to reduce pressure on the skull when the baby is lying on their back. They are often marketed as "baby pillows for flat head." In practice, however, parents are advised to focus on changing positions and targeted exercises (such as tummy time and alternating lying positions) rather than relying on a pillow. Scientifically, the effectiveness of these special pillows is not proven. Studies show no significant benefit; the heads of babies with flat spots usually correct themselves over time. Rather, experts emphasize that the baby should continue to sleep on a firm surface and that pillows can actually be dangerous in this context (see below). A common recommendation is to use such a pillow only after consulting a pediatrician or physical therapist and to observe the baby closely while using it.
• Positioning and nursing pillows: Positioning pillows (also called side-lying or neck pillows) are often U-shaped cushions intended to support the baby, for example in a side-lying position or while breastfeeding. They can help support the head or keep the baby gently "held." Important: These pillows are only useful for short periods when the baby is awake and supervised – they are not suitable for sleeping in a crib. There is a risk of suffocation, especially if the baby rolls over unintentionally. Medical specialists emphasize that babies should always sleep on their backs if possible and that unsupervised side or tummy sleeping should be avoided. A positioning pillow should at most be used to support the chosen position during changing or nursing.
• Wedge and anti-reflux pillows: These types of pillows are usually wedge-shaped or slightly inclined and raise the baby's upper body. They are often recommended for babies with infant reflux (spitting up) to prevent stomach acid from flowing back. Such pillows are also offered for respiratory issues (e.g., a cold). From a medical perspective, however, great caution is advised: The American Academy of Pediatrics (AAP) expressly advises letting babies with reflux sleep flat on a level, firm surface and avoiding products that elevate the head. In Germany, too, experts recommend treating reflux with other methods (upright feeding position while breastfeeding/bottle-feeding, potentially medication) instead of elevating the baby with pillows at night. Tilting by more than approximately 10° is also considered unsafe. If a baby lies on a wedge pillow, there is a risk of sliding; the baby can roll off the pillow and end up in a tummy-down position. Conclusion: Wedge/anti-reflux pillows should only be used under medical guidance and never in a regular crib.
• Classic baby pillow (small flat pillow): Soft, flat baby pillows are popular among parents – often with cute designs. However, child sleep experts advise avoiding pillows entirely during the first year of life. Only at an age when the child can move safely on their own (from approx. 12–24 months) can a very flat, firm pillow be used. Even then, it should be as low as possible so that the child does not sink into it. Until then, the rule is: the baby's head is best placed directly on the mattress or inside a sleeping bag without any padding – this protects the neck and back.

Medical Recommendations

Pediatricians, midwives, and health institutions recommend a simplified sleep environment. The Stiftung Kindergesundheit (German Foundation for Child Health) advises: "In the first twelve months of life, your baby needs no pillow at all and it should be avoided for safety reasons." A flat pillow (only high enough so that the head does not sink in) may follow later if necessary. The DGKJ (German Society for Pediatrics and Adolescent Medicine) also warns against having objects in the crib that could cover the mouth and nose – this includes large pillows, crib bumpers, or soft mattresses. The AAP safety guidelines state: "Babies under one year are safest when they sleep on their backs on a firm, flat surface, without pillows, blankets, bumpers, or other soft bedding." In all cases, the rule is: use a sleeping bag instead of a blanket (no loose linens), back sleeping, and room temperature of approx. 16–18 °C. Reflux and back problems: According to the AAP, even babies at risk for reflux should not be positioned with their heads elevated. Midwives and pediatricians finally emphasize that a pillow can only be used once the child is mobile and can protect themselves (approx. 1–2 years). These professional groups summarize: Your baby should sleep without a pillow throughout the entire first year of life.

Safety Aspects

The main dangers are suffocation and overheating. In the first few months, babies often cannot reliably turn their heads, making a soft pillow a dangerous barrier. If the face sinks into the pillow, the baby cannot keep their airways clear. Studies clearly link soft-padded sleeping environments (pillows, blankets, bumpers) to a higher risk of SIDS (Sudden Infant Death Syndrome). Heat accumulation also plays a role: a warm pillow can lead to overheating, another known risk factor. Therefore, experts advise: Babies should sleep as flat as possible, without any padding. Correct positioning is also important: even outside the bed, positioning aids such as pillows for breastfeeding or bassinets may only be used under observation. Small parts (zippers, ribbons) on a pillow can be swallowed and are also strictly prohibited.

• Only use pillows under supervision during sleep (e.g., while changing or nursing, never unsupervised).
• Never leave extra padding in the bed overnight: Back sleeping without a pillow and blanket is safest.
• The mattress should be firm (the baby must not sink in) and lie flat.

Age and User Recommendations

• 0–12 months: Absolutely no pillow; use a sleeping bag instead of a blanket. Even anti-reflux or orthopedic pillows are generally prohibited during this period.
• From ~12 months: A very flat child's pillow (approx. 2–4 cm high) can be used once the child is mobile. Even then, it is better to avoid a pillow if possible: it is best to wait until about 18–24 months, when the child can sit up and turn over on their own.
• Wedge/Anti-reflux pillows: Use only in exceptional cases and after medical consultation (e.g., for severe reflux during the day, never in a crib). The AAP recommends that babies with reflux should instead sleep flat on their backs.

Tips for Safe Use

• Under supervision: Use special pillows only when the baby is awake and at least partially supervised (e.g., while playing on the floor or nursing). Never leave them in the bed unsupervised while sleeping.
• Flat shape: If a pillow is necessary at all (from approx. 1 year), it should be very flat. Experts recommend a height of only a few centimeters – just enough to keep the neck slightly supported. A pillow that is too soft (such as a down pillow) is unsuitable; the head should not sink in deeply.
• Materials: Look for breathable, allergy-friendly fabrics and materials tested for harmful substances (e.g., Oeko-Tex®). A removable, washable cover is sensible.
• No extras: Pillows for babies must not have small parts such as ribbons or buttons (choking hazard). Mirrors or toys on positioning cushions are also prohibited.
• Seek expert advice if unsure: If you are concerned about specific head deformities or reflux, seek advice from a pediatrician, midwife, or pediatric physical therapist. Often, consistently alternating the head side or supervised tummy time is more effective than any pillow.

Comparison Table: Baby Pillow Types

(*) *Use only with caution and guidance; newborns in particular should generally lie without a sleeping pillow. **This pillow shape (wedge) is used only in exceptional cases, such as during the day under medical guidance.***With a flat, well-ventilated pillow, if there is a need for neck support. Sources: Guidelines from AAP, DGKJ, Stiftung Kindergesundheit; professional literature and safety recommendations.

Conclusion / Checklist

• Keep the sleeping area minimal: In a baby's bed, "less is more." Only back sleeping on a firm mattress; it is better to use a sleeping bag than a blanket.
• No pillow under 1 year: All experts agree: until 12–24 months, the baby should sleep without a pillow. After that, only very flat and as needed.
• Supervision is mandatory: Positioning pillows (side-lying/positioning or nursing pillows) can only be used when the baby is awake and supervised. They should never be in the bed for sleeping.
• Choose safely: If a pillow is used, it should be flat, firmly padded, and well-ventilated. Look for materials free from harmful substances and a wipeable or washable cover.
• Helmet/Head repositioning as needed: For pronounced plagiocephaly, positioning therapy and physical therapy usually follow; only in a few cases is helmet therapy necessary. The pediatrician will decide this.

Ask experts if in doubt: If you have concerns (e.g., flat back of the head, severe reflux), seek medical advice. For healthy baby sleep, the rule is: "Keep it simple" – avoid pillows and soft bedding to protect your baby from risks.