Back to Sleep: The Best Bedtime Position for Baby
The what, why, and how of infant sleeping positions
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.”
For those still looking for a more definitive answer to why Baby should sleep on his back in order to prevent SIDS, there are a few likely explanations but no decisively certain one. We do know for sure that the statistical link between back sleeping and lower SIDS rates exists. Most of the explanations pertain to infant breathing. For example, when sleeping on her front, Baby is more likely to create a little pocket around her nose and mouth that traps the exhaled carbon dioxide, which is then re-breathed, reducing oxygen in her system to lethal lows. Similarly, heavy blankets or plush toys could cause this same CO2 poisoning, especially when Baby has her face against the fluffy stuff. Another explanation is that back sleeping helps keep airways more open.
Overheating may be a contributing factor. So skip the blankets and put Baby in an adorable sleep sac outfit or gown with a drawstring bottom and hand covers if you live in colder climes. Keep the room comfortable for a lightly clothed adult. Smoking in the household or by the mother before birth is also linked to sudden infant death syndrome. So for this and a thousand other reasons, quit smoking as soon as you think of conceiving.
One key point is that babies should sleep on their backs every time they sleep, whether for the night or just while napping, and all caregivers who take care of the child should know this. The rate of SIDS among back sleepers who were then put on their stomach to sleep is a scary 18 percent higher than the usual rate.
What Is SIDS?
According to the NICHHD, sudden infant death syndrome is technically defined as “the sudden death of an infant under one year of age, which remains unexplained after a thorough case investigation, including performance of a complete autopsy, examination of the death scene, and review of the clinical history.”
SIDS is a new parent’s worst fear. An apparently healthy baby with no obvious previous or present illness goes to sleep and never wakes up. As the NICHHD definition states, examination of the infant’s medical history, home, and even an autopsy do not reveal a cause of death in true SIDS cases.
Infants at increased risk for SIDS are those older than one month but younger than six months, those born prematurely, males, and twins or triplets. African-American babies are at higher risk than babies of European descent, and American Indian or Alaskan Native babies are considerably more so—up to two or three times the national average.
While breathing issues are the start of a SIDS death, recent research suggests that its deadliness comes in combination with a wiring problem in the baby’s brain. Certain infants may have a delay in maturation or poor development of a network of brain cells normally responsible for waking or alerting the child when a life-threatening situation (like lack of oxygen) is present. The brain areas involved develop in midgestation.
In 1990, there were 5,417 reported SIDS deaths in the US, according to the National Vital Statistics Reports, National Center for Health Statistics, and in 2004 there were 2,246 such deaths reported, which attests to the efforts to prevent it. (The infant mortality rate from all causes declined in that period as well, it should be noted, and preliminary results for 2006—the most recent figures available—show a further decline.)
The Back to Sleep recommendation is for healthy infants only. Those with upper airway anomalies, gastroesophageal reflux, or other problems may or may not benefit from sleeping on their backs. Parents should discuss these special situations with their child’s doctor.
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