The Down Side of Back to Sleep

IMG_1195I can’t imagine anything worse than losing a baby to SIDS. I rank it as my top fear and consequently get very little sleep. My sleeplessness is compounded by the decision I made to allow my baby to sleep on his stomach. If you’ve read any article about SIDS then you know allowing stomach sleeping is about the worst thing you can do for your child. So how do I justify my decision?

First of all my baby simply will not sleep well on his back. Maybe some infants do. Maybe some can be easily trained but after a month of trying it just wasn’t happening for us. So I started reading a little more about why back sleeping is so forcefully recommended. I was surprised by what I found.

Even though SIDS is the leading cause of death in otherwise healthy infants (meaning it beats out accidents and homicide) the death rate is still pretty low – 1.2 in a thousand before the Back-to-Sleep campaign started in 1994 and in 2006 it was .55 in a thousand.  However, if you look at the graph here you’ll see the rate was already declining before the Back to Sleep campaign.

I have some problems with the Back to Sleep campaign mainly because I’m not convinced the studies showed conclusively that back sleeping is that much of a threat. If you get past the PR messaging which is very emphatic, making it sound like tummy sleeping will make your child die in an instant, and start reading through some of the studies, you get the feeling that someone was looking for this specific conclusion and, as anyone in the PR business can tell you, if you want a specific result you can always figure out a way to get a poll or study to give it to you.

The fact that the SIDS death rate declined during the Back to Sleep campaign could also be due to the overall increased awareness of SIDS brought about by the campaign. Also, as we come to understand SIDS a little more, deaths that once would have been designated as SIDS are now designated as something else lowering the statistic further.

My point is, the majority of parents now force an unnatural sleeping position on their infants on the recommendation that it may prevent a death that is unlikely to occur anyway. However, even Back to Sleep proponents acknowledge that back sleepers have more frequent occurrences of sleep apnea and don’t reach the same slow, restorative sleep state reached by stomach sleepers. You can probably see this in your own child. Sleeping on his back, my infant twitched constantly even while swaddled and woke frequently. He never seemed to be in a restful sleep state. That all changed when I began placing him on his stomach.

So is that how we prevent SIDS? Never allow your child to fall into a deep sleep for fear they won’t wake up? You have to wonder, what are we doing to our infants by preventing them from quality sleep? Future sleep disorders? ADHD? Autism, even? I’m purely speculating, but I know I’m a mess if I don’t sleep well for too long and those first six months in a child’s life are so crucial to neurological development.

Some babies sleep great on their backs but for those parents that are struggling with this issue I think it’s important to understand that stomach sleeping doesn’t result in an automatic death sentence.

I hope more research goes into this. I worry we may regret the stringent recommendation of Back to Sleep, but until a different recommendation comes along my tummy-sleeping baby may sleep well, but I won’t.


Does the supine sleeping position have any adverse effects on the child?

The Flip Side of ‘Back to Sleep’ Campaign”



  1. Great Post! Check out my blog Tummy Sleep Central where I question the safety of the SIDS Back to Sleep Campaign and also question the statistics.

    “…you get the feeling that someone was looking for this specific conclusion and, as anyone in the PR business can tell you, if you want a specific result you can always figure out a way to get a poll or study to give it to you.”
    Been there, done that. I get the same feeling when I research the Back to Sleep Campaign.

    Dr. John Kattwinkel who is the main PR person for it here in the U.S. had an infant daughter die at 3 days of age in the 1960′s. It’s very tragic but he’s probably not unbiased.

    Dr. Peter Fleming who is the main PR person for it in the UK goes around the world collecting awards for being a great humanitarian saving “hundreds of thousands” of infant lives. Kind of hard to admit you may not be right after collecting all those awards and accolades.

    Here is some background on the Autism / Back Sleep connection:

    1.Graph 1: Autism Rate of 8 Year Olds Born
    Between 1992 and 2001


    Graph 2: Back Sleep Rate of Infants Born
    Between 1992 and 2001

    Graph 4: Graph of Autism Rates (A) and
    Infant Back Sleep Rates (B)
    and Vaccination Rates (V):
    A=Autism Rate
    B=Back Sleep Rate
    V=Vaccination Rate


    Graph 5: Scatterplot of Autism Rates and
    Back Sleep Rates. The Y axis is Autism
    Rate and X axis is be Back Sleep Rate.

    ****0.0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

    About this Scatterplot:
    Pearson Correlation Coefficient=0.97 (MS Excel)
    94% of the Increase in Autism can be “explained”
    by the increase in infant back sleep if my
    hypothesis is correct.

    Also see these Findings in Peer Reviewed
    Medical Journals (all of which support the Back to Sleep
    Campaign so they consider these findings “minor”…Do you?):
    Infants who sleep on their backs (supine) compared to infants who sleep on their stomachs (prone)
    are impacted in the following ways:
    - Social skills delays at 6 months (Dewey, Fleming, et al, 1998)
    - Motor skills delays at 6 months (Dewey, Fleming, et al, 1998)
    - Increased rates of gastroesophageal reflux (GER) (Corvaglia, 2007)
    - Below norm AIMS scores (Majnemer, Barr, 2005)
    - Milestone delays (Davis, Moon, et al., 1998)
    - Increased duration of sleep apnea episodes during REM sleep at both 2.5 months and 5 months (Skadberg, Markestad, 1997)
    - 6% decrease in sleep duration (Kahn, Grosswasser, et al.,1993)

    Here are some quotes from various professionasl:
    “There are indications of a rapidly growing population of infants who show developmental abnormalities as a result of prolonged exposure to the supine position.”
    Dr. Ralph Pelligra regarding the impact of the Back to Sleep Campaign

    “Since the implementation of the “Back to Sleep” campaign, therapists are seeing increasing numbers of kindergarten-aged children who are unable to hold a pencil.”
    Susan Syron, Pediatric Physical Therapist

    “In its fundamental purpose it has been largely successful. The incidence of SIDS has been reduced dramatically. However, as many orthotists can attest, this important gain has not been without its lesser comorbidities. The one we tend to think of has been the rapid increase in the incidence of positional plagiocephaly and positional brachycephaly. However, there have been whispers and rumors of other effects.”
    Phil Stevens, MEd, CPO regarding side effects of the Back to Sleep Campaign.

    Also, there are questions about whether the Back to Sleep campaign
    actually even works and the safety of it’s methods:
    “A lot of us are concerned that the rate (of SIDS) isn’t decreasing significantly,
    but that a lot of it is just code shifting,’
    Dr. John Kattwinkel – U.S. SIDS Task Force
    Scripps Howard News Service Interview

    “…physiologic studies demonstrate that infants who sleep
    supine have decreased sleep duration, decreased non-
    REM sleep, and increased arousals; this effect peaks at
    2 to 3 months of age and is not evident at 5 to 6 months
    of age, thus coinciding with the peak incidence for
    SIDS at 2 to 4 months of age. The SIDS risk-reduction
    strategy of supine sleep will result in a lower arousal
    threshold and a reduction in quiet sleep.”

    U.S. SIDS Task Force (chaired by Dr. John Kattwinkel)
    Journal of Pediatrics

    “The potential implications of a SIDS risk-reduction strategy
    that is based on a combination of maintaining a low
    arousal threshold and reducing quiet (equivalent to
    slow-wave sleep) in infants must be considered. Because
    SWS is considered the most restorative form
    of sleep and is believed to have a significant role in
    neurocognitive processes and learning, as well as in
    growth, what might be the neurodevelopmental consequences
    of chronically reducing deep sleep in the first
    critical 12 months of life?”

    Dr. Raphael Pelayo, Stanford University

    You can also download my book for free on LULU. It’s called “How the SIDS Back to Sleep Campaign Caused the Autism Epidemic”:

    Unfortunately, I am not great at editing and was under a lot of time constraints when I wrote it so at some point I plan on revising and republishing it.

    All the Best!!!!

    Tom McCabe

  2. BTW, since you mentioned that your child had such trouble sleeping on their back you may want to consider keeping an eye out for obstructive sleep apnea. But, simply putting him on his stomach will probably cure that. Just something to keep an eye out for though. It tends to run in families so if anyone in your family is a heavy snorer that’s even more reason to be aware of it.

    In infants obstructive sleep apnea (OSA) is typically treated with a CPAP (continuous positive airway pressure) mask. In toddlers/children OSA is typically treated by CPAP or removing the tonsils and adenoids. In adults OSA is typically treated by CPAP, removal of tonsils/adenoids, or UPPP (removal of tonsils/adenoids + additional surgical intervention).

  3. Thanks very much, Tom, for filling in my research. This information is hard to ignore. I’ll be checking out your book.

  4. Thanks for posting my comments. Below is a link from a doctor in New York who also writes a lot about my hypothesis. Having worked with doctors doing marketing analysis in the pharmaceutical industry I’m always wary of them as they tend to water down many ideas and tend not to be willing to outright oppose the AAP. Whereas I am basically a statistical risk consultant so opposing the AAP wouldn’t impact my career. Anyway, here’s his initial blog on the Back to Sleep campaign and he’s written many, many more since. Like I said I’m wary of medical professionals commenting on it because I’m afraid they might water down the negative impact of the Back to Sleep campaign. Nonetheless, here’s his blog just in case your curious:

    Thanks for posting my comments and again all the best!

    Tom McCabe

  5. Hi Tom,

    As a school psychologist and a recent mother, I have started to believe their is definitely a correlation but whether it is a causation would be such an interesting research project in regards to the Back to Sleep campaign.

    Really hope someone investigates this further.


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