Does Laying A Baby On Its Back Prevent SIDS?
Posted July 23, 2008 by Mister Knowitall

Sandy T. in Portland asks: Everyone tells me that I have to lay my new baby on its back to prevent Sudden Infant Death Syndrome, but when I used to babysit as a teenager, everyone said to lay babies on their stomachs. When did this change, why, and is it on the level or one of those medical fads?

If it’s a fad, it’s a long-lived one, because the medical establishment has been recommending it officially for 16 years. Whether it’s as big a deal as they make it out to be is another story.

The one thing to know is that SIDS is not an actual disease. SIDS is a category into which doctors place any infant that died because it stopped breathing in its sleep and no one knows why. There could be a dozen different causes of SIDS. When the real cause can’t be identified, it’s chalked up to SIDS.

A baby’s sleeping position is just one of the risk factors in SIDS that education programs have tried to communicate to new parents. Additional risk factors that raise the possibility of SIDS include:

• Mothers who use alcohol, tobacco, or drugs while pregnant
• Smoking around the infant
• Letting the infant get too warm
• Letting the infant sleep with you (co-sleeping)
• Mothers who don’t get good pre-natal care
• Low birth weight

Since the NIH (National Institutes of Health) began “Back to Sleep” in 1994, the SIDS rate has dropped by half. And if you listen to the proponents of putting babies to sleep on their backs, they’ll try to claim that it’s entirely responsible and that none of the improvement can be attributed to programs trying to eliminate the other risk factors (like getting pregnant women to stop smoking).

And remember how SIDS technically means “we’re not sure why the baby died in its sleep”? With improvements in diagnostic tools and medical knowledge over that 12-year period, it’s highly likely that some of those babies were still just as dead, but now the doctors knew why and they didn’t end up in the SIDS statistics.

On the other side of the issue are doctors at respected research institutions who claim that keeping babies cooler and on their backs is actually doing more harm than good. Various skeletal problems with a baby’s skull, neck, and shoulders have been associated with back sleeping and developmental delay has been associated with some of them. As well, keeping the baby cooler and on its back makes it harder for the baby to get truly deep sleep (i.e. not “sleeping like a baby”). This affects brain development and a 1998 study in England showed that 6-month-old babies that slept on their backs had lower test scores for motor skills and social development in comparison with babies that slept on their stomachs, though these differences mostly disappeared at 18 months.

In the long run, the decrease in SIDS rates means that for every 2,000 mothers, 1 will lose their baby to SIDS no matter whether it’s on its back or stomach, 1 might save her baby by putting it on its back (or by quitting smoking before she tries to conceive, or by having a healthy pregnancy), and for the other 1,998 women SIDS will never touch their baby, whether it’s on its stomach or on its back.

To put the statistic in context…

• 1 in 2,000 babies die of SIDS in the first year of their lives.
• 1 in 7,500 Americans die in traffic accidents each year.
• 1 in 684 Americans die from smoking-related causes every year.
• In 2002, 73.8% more babies died from birth defects in the first month of life than died from SIDS in the first year.

We won’t recommend that you put your baby on its stomach. That’s a personal choice. But now you have some facts to make an educated decision about the risks.