When her twins were born in 2008, Amy Cress of Silver Spring dutifully put her babies on their backs to sleep. But at about 6 months of age, her son Nathan rolled onto his stomach during the night. Cress was so relieved that her son was asleep, she left him like that. He preferred sleeping on his stomach from then on.
“We used bumpers, too, which is really not allowed,” she says. “We felt like rebels.”
It has been 20 years since the American Academy of Pediatrics (AAP) first recommended that parents place their babies on their backs to sleep for the first year of life to prevent sudden infant death syndrome, or SIDS. The rate of SIDS in the United States has plummeted more than 50 percent since the government launched its “Back to Sleep” campaign in 1994. In 2006, 2,327 infants died from SIDS in the United States.
Still, about 25 percent of U.S. babies sleep on their stomachs or sides, according to a national infant sleep position study. (In 1992, before the “Back to Sleep” campaign, that proportion was roughly 85 percent, according to the study.)
Like Cress, many parents find that infants sleep better and longer on their stomachs. New babies startle easily while on their backs and can wake themselves up frequently. Swaddling them can help prevent this, but wrapping a crying baby like a burrito isn’t always easy for a sleep-deprived parent in the middle of the night.
For some parents, there’s also a credibility issue. Despite the correlation between back sleep and the drop in SIDS deaths, scientists still don’t know the precise cause of SIDS. In fact, SIDS is by definition a death without a known cause, or, as the Centers for Disease Control and Prevention defines the syndrome, “deaths in infants less than 1 year of age that occur suddenly and unexpectedly,” and whose causes “are not immediately obvious prior to investigation.” Moreover, changing recommendations — between 1992 and 2000, the AAP said that side-sleeping was a safe alternative to back sleeping — make some people skeptical of the experts.
Other parents worry that babies will get flat heads from sleeping on their backs or will be delayed in reaching such milestones as rolling over.
Marian Willinger, who runs the SIDS research program at the National Institute of Child Health and Human Development in Bethesda, concedes that back-sleeping babies might have such delays; they might also learn to crawl later than stomach-sleepers. But by 18 months of age, there is no difference between the two groups, she says. Back-sleeping babies might also develop flat spots on the back of the head, but parents can help prevent it by repositioning the baby’s head during sleep and by having the baby spend time on his or her stomach during the day, she says.