Back to Sleep: The Best Bedtime Position for Baby

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Rule number one in infant care: Put Baby to sleep on his back! Here's why and what to watch for when you try it.

People often lament jokingly that babies don't come with instruction manuals. And first-time parents sometimes feel truly surprised at being sent home from the birthplace with a one-, two-, or three-day-old and no experience whatsoever: "They're letting us take him home by ourselves? Are they nuts?"

One instruction you will definitely be given at any hospital or birth center, however, is to place your infant on her back to sleep. They'll even send you home with little doorknob signs saying "Back to Sleep" to remind you.

Now, you may sometimes wish your baby would get back to sleep, or you may be tempted to scratch out Sleep and change the sign to "Back to Wail and Cry." But stick with it; back sleeping for newborns is more than a baby-care fad; research shows it's safest.

Why Should Baby Sleep on His Back?

In 1974, Congress passed the Sudden Infant Death Syndrome Act in an effort to discover what was causing the devastating and seemingly inexplicable deaths of otherwise healthy infants while they slept. More than two infants for every thousand born were dying this way every year. Thanks to research by the National Institute of Child Health and Human Development (NICHHD) and others, a correlation was soon seen between sleeping on the stomach and increased rates of sudden infant death syndrome (also called SIDS, or "crib death" in the past).

By 1991, the research was convincing enough that the American Academy of Pediatrics (AAP) was recommending back sleeping. And in 1994 the NICHHD and the AAP pushed a full-on national public health education campaign called Back to Sleep. Since that time there has been a remarkable 50 percent decrease in the incidence of SIDS, according to the AAP. "Other countries with similar campaigns have had similar success," notes pediatrician Karen Sadler, MD, yet the AAP and NICHHD report it is still the leading cause of death after the immediate postnatal period. "Ninety percent of infants who die of SIDS are under six months of age; most are between three and five months old," Sadler adds. "Neither do we know why this is the most vulnerable age."