Back to Sleep

Putting back-sleeping concerns to rest

Chances are good you were raised as a "belly baby" — spending all of your non-waking hours (as well as many of those when you were awake) lying comfortably on your belly.

Yes, parents in generations before us did the best they knew how and all of you obviously managed to make it to the point where you are trying out parenthood for yourself. But since those days when we were so tenderly laid belly down to rest, new information has come to light about the potential role sleep position plays in sudden infant death syndrome (SIDS) — an occurrence that is admittedly rare but nonetheless terrifying to think about.

Based on an ever-increasing amount of evidence linking belly sleeping to an increased risk of SIDS, the American Academy of Pediatrics (AAP) launched its major Back to Sleep Campaign in 1992. After a full decade of education aimed squarely at getting parents and caregivers to place infants to sleep on their backs instead of their tummies, SIDS prevention efforts have been impressively successful — in how babies are put to sleep and more importantly in significantly decreasing the number of babies who die from SIDS. If you're interested in the actual numbers,: As of 1998, more than 75% of babies were estimated to be put to sleep on their backs, in contrast to 25% in 1992. Over this same period, there was a dramatic decline in the number of SIDS deaths — by some estimates as much as 40%.

Putting Back-Sleeping Concerns to Rest

It's probably a safe bet that this isn't the first time you've been introduced to the benefits of raising a back-sleeping baby. Most new parents today are well informed when it comes to SIDS and why back sleeping is so strongly recommended. However, it's worth acknowledging the fact that you may find yourself with some practical concerns when faced with putting principle into practice. For the most part, the following concerns cause parents to worry unnecessarily.

• Spitting up and vomiting. The most common back-sleeping concern we hear time and time again is the fear that babies will spit up and choke while asleep. Fortunately, several reassuring studies as well as the test of time have demonstrated that babies put to sleep on their backs are not only able to turn their heads and/or protect their airways if and when they spit up, but are no more likely to have breathing or digestive-related problems than their belly-sleeping counterparts of days past.
• Flat heads. It is true that the shape of your newborn's head is not yet set in stone, and that there has been a general increase in the number of babies "walking" around with flat heads since back sleeping came into vogue. The fact of the matter is that it's really not that much of a problem for most back-sleeping babies. In large part, that's because you have a good deal of control over the situation. All you need to do is try to make sure your baby gets laid to rest alternating the way she faces her head (turned to either side or looking straight up) each time she's on her back — while she is asleep and also when she is awake. By offering your newborn plenty of tummy time and time spent in positions other than flat on her back while she is awake, you can also help decrease the likelihood of a flat or misshapen head.
• Taking sides. Perhaps the most tempting and readily available products marketed to those parents who just aren't convinced of the safety of back sleeping (despite all the information we have included above) are infant side sleepers. These wedge-like cushions come in various shapes, sizes, and colors and allow parents to position babies on their sides while preventing them from rolling over as they sleep. It is true that the initial SIDS prevention recommendations included back and side sleeping as reasonable alternatives to belly sleeping, but the "new and improved" back-sleeping campaign does not leave room for interpretation. The recommendation was shifted to and continues to encourage only back sleeping. Perhaps side sleeping was eliminated from the "side or back" recommendation because there was a good possibility that side-sleeping babies would end up on their bellies before night's end (a concern that is admittedly addressed by side-sleeping wedges), but the AAP recommendation still stands: "Devices designed to maintain sleep position…are not recommended since none of these have been sufficiently tested for their safety or effectiveness."
• Delayed milestones. Some of you will undoubtedly hear or read that back sleeping has been associated with delayed motor development. In addressing the question of delayed milestones — or more specifically, a delay in the time when back-sleeping babies first begin to roll over — it all seems to even out in the end. Even if your baby doesn't take to rolling quite as early as her belly-sleeping counterparts of generations past and present, to our knowledge no college application has ever asked applicants how early they mastered the ability to roll over (or, for future reference, sit, crawl, walk, or toilet train). When it comes to strengthening the muscles your baby needs to roll and, at the same time, decreasing your baby's chances of ending up with a flat head, just be aware that both can be easily accomplished by allowing your baby plenty of time on her belly when she's awake.
• Improving the air we breathe? Not too long ago, there was an exposé done on one of the prime-time television shows about infant mattresses that reportedly prevented babies from re-breathing air during sleep. Despite inflated claims that this type of improved air flow around a baby's face effectively decreased the risk of SIDS, the investigative report subsequently uncovered evidence supporting the AAP stand: Re-breathing devices are not proven to be effective. What are they good for? Preying on a parent's greatest fear. When it comes to deciding whether to purchase a SIDS-preventing mattress, we suggest you stick to the basic and proven approach and instead buy a good, firm one that fits snugly in your crib.

 

The Reality of SIDS

Sudden infant death syndrome (SIDS), sometimes called crib death, is the sudden, unexplained death of an otherwise healthy baby. It is certainly not a topic that parents or pediatricians enjoy bringing up with excited new parents, but it is one that is definitely worth being informed about. While SIDS is always a tragedy for the roughly 2,500 babies and families it affects each year in the United States, the odds of it happening to your child are very low and it is well within your power to lower them even further. Although SIDS rarely occurs during the first month of life (the risk is greatest from 1-4 months), there are simple things you can do to protect your newborn right from the start. Back sleeping and breastfeeding have been shown to lower the risk of SIDS. Things that increase the risk of SIDS: belly sleeping, putting a baby to sleep with another child or adult who might roll onto him, exposure to cigarette smoke, prematurity, overheating, and loose or soft bedding.