How come I'm not supposed to let my baby sleep on her stomach?
They made me watch a whole video about why I'm not supposed to shake my baby. This sleeping thing seems to be just superstition. - Gabe
There's a big increase in risk of SIDS for an infant sleeping on stomach compared to back. - Rochelle
I think that is a pretty misleading figure in my opinion. All the statistics I have seen show that the risk on the back is 1 about in 1000, versus about 2-3 in 1000 on the stomach. So the risk is less than 1% either way, which is very small. It is about the same as the risk for getting type 1 diabetes (which is 1 in 300). - Robert Felty
I also saw a recent study that found that having a fan going in the bedroom while the baby is sleeping may reduce SIDS by up to 70%. Also, note that you can state the same fact in two very different ways: (1) Sleeping on the stomach *doubles* the risk of dying of SIDS (2) Sleeping on the stomach increases the risk of SIDS by 0.1% - Robert Felty
Because the stupids have taken over. Better not take pictures of Hazel naked either. You'll be arrested for pedophilia. :P - April Buchheit
Sorry, Rochelle, but that looks like correlation, not causation. All I see is some anecdotal evidence. - Gabe
The SIDS council changes it's mind every few years, sometimes completely reversing advise it puts out. The problem is that SIDS isn't exactly a 'disease', it's just the lable put on all unexplained infant deaths. So as we discover new causes, they stop being 'SIDS' - Glenn Slaven
I suspect that it's more than correlation. Babies seem more comfortable sleeping on their stomachs. By keeping them on their back, I think they don't get quite as comfortable, which is helpful for that unfortunate percentage that's prone to getting so comfortable that they stop breathing. - Paul Buchheit
We always do it anyway. All 4 of our kids have been just fine. - Jesse Stay
Yeah, Gabe. If you *really* love your baby, you wouldn't let her die. :P - April Buchheit
I don't know how true it is, but I do know that if SIDS were to happen to your child or a child close to you, you'd try almost anything to prevent it from happening again. My boyfriend's sister lost her second child to SIDS. She has all kinds of monitoring equipment now for her 3rd child. Perhaps it's becoming a blanket label something like autism or ADHD, I don't know. - Kamilah Reed (K. Gill)
I don't subscribe to all believed causes of SIDS, I disagree with some of the theories. It helps that my mom is a doctor and I can ask for her opinion about the causes. She says that some of the highest risk for SIDS comes from secondhand cigarette smoke. That sounds totally plausible. I agree with what Victor says below me. I don't want to comment after him since only one comment is visible when the thread collapses. - Kamilah Reed (K. Gill)
The number of SIDS deaths dropped significantly when the AAP introduced the "back to sleep" campaign. We don't know the mechanism, and clearly there are plenty of babies who don't die sleeping on their stomach, but why take the chance? - Victor Ganata
Yes, Kamilah, I wouldn't want it to happen to me. However, since nobody knows why it occurs (by definition), there's no real good way to prevent it. Unfortunately, every other recommendation seems to be the opposite of what they used to have (20 years ago you wouldn't be allowed to sleep on your back), so there's no way to know if the current recommendation helps or hurts. - Gabe
Gabe, you do know that Victor is another doctor, right? He didn't just pull what he just said out of thin air. That doesn't mean he's infallible, but you might want to look closely at what he's saying. What harm does it do to try it? So it was the opposite 20 years ago. Years ago people were told that smoking was good for you or something like that. Things change to the opposite all the time. That's no reason to reject something simple like this. - Kamilah Reed (K. Gill)
Victor: There is no evidence that the number of babies who died in their sleep went down, only that the number who died of SIDS went down. I don't care what ICD-9 code the doctor uses, I just want my baby to not die. The fact that my baby goes from having a 99.9999% chance of living through the night to only 99.9996% is easily outweighed by the benefits of sleeping on her stomach (improved social skills and muscular development). - Gabe
Where do you get the stats for the improvements from stomach sleeping? I've never heard of any of that. I also don't get the distinction you're making between babies dying in their sleep and dying from SIDS. From what Victor said, people put their babies on their backs more and the number of SIDS deaths went down (sleeping or not sleeping? though I've never heard of it outside of sleep, though I guess it's possible). - Kamilah Reed (K. Gill)
Not possible, but babies fall asleep without warning. So babies on their stomachs should be watched. Since SIDS is number one cause of death for babies in the US after congenital abnormalities and premature delivery, we (parents) had no doubts we were going to take reasonable precautions against it. Our daughter gets plenty of tummy time during play. She seems pretty sociable independent of orientation, or isotropically sociable. If you think that the risk for the top avoidable cause of death is negligible, well that's a risk tolerance thing that depends on values and personality and I can't comment on it. But as far as a rational cost benefit analysis, it doesn't seem even close to me. - Antonio Piccolboni
Kamilah: go to and search for "Gross Motor Milestone Delays" - Gabe
From that article "Supine positioning for sleep is clearly evidence-based and has saved the lives of many children." And about Gross Motor Milestone Delays "Prone positioning for play, even in small amounts, may relate to faster achievement of developmental milestones." So it could be, as noted in the article, that some people are so scared by SIDS that they never give any tummy time to their kids, or that kids never get used to be on their tummies that they protest and fuss if given tummy time. The conclusions of the paper are that supine sleeping and a mix of positions for play are the recommendation. - Antonio Piccolboni
Yeah, it includes this highlighted line "Supine positioning for sleep is clearly evidence-based and has saved the lives of many children." I think the main message (I didn't have time to read every word since it is late and way past my bedtime) must be that you want to make sure that the baby has some time spent on their stomach, i.e. prone, but that doesn't necessarily mean that it has to be while they're sleeping. - Kamilah Reed (K. Gill)
Unfortunately, the author of that paper is prone to exaggeration, because the "evidence" is garbage. She took one outlier study and said that the evidence is clear, when in fact it is not. The graph Rochelle originally linked to showed the incidence of SIDS was already on a downward trend before the recommendation for supine sleeping was made, which is evidence that it would have steadily decreased anyway. Additionally, the trend showed a significant decrease from .62 in 2000 to .49 in 2003 while the infant mortality rate was unchanged during that time period, which is evidence that doctors are just diagnosing things differently. - Gabe
We let our children sleep how ever they like, turned out the first liked sleeping on the back, the second on her side and the third on his stomach. - Amit Morson
US infant mortality rates: - Gabe
You just seem determined to ignore everything we're saying, and your kid's very likely survival will be "proof" to yourself that you were right. If this author is "prone to exaggeration", why are you so sure she's not also exaggerating her other findings, or that you must focus on this one finding at the expense of all others? We can all say "through the millennia, a higher percentage of humans survived than did not survive, therefore we can do just about whatever comes naturally and the kids will probably survive". I know that's not exactly what you're saying, but that seems sort of like what your reasoning must be for rejecting back-sleeping. Anyway, what's the point. I won't win, I have no idea what you'll actually do. Go live your life. - Kamilah Reed (K. Gill)
Good point, Kamilah. It seems unlikely that humans have managed to figure out that pork can make you sick, snakes are scary, and that incest is bad, but throughout all of human history nobody discovered that letting your baby sleep on its stomach is so deadly. If such a sleeping position is really twice as likely to cause death, you'd expect there to be some instinct or reflex to tell us that it's wrong, some religious proscription, some culture where it's taboo, or at least some old wive's tale. All we have is advice that's less than 20 years old. - Gabe
There are roughly 4 million live births in the U.S. every year. From those stats, that means that there were about 4,800 SIDS deaths in 1992, when 13% of babies were placed on their back to sleep. In 2003, when almost 73% of babies slept supine, there were only about 1,960 SIDS deaths. Of course, we don't know the mechanism, but not much has changed between 1992 and 2003 besides the new recommendation. - Victor Ganata
And for most of history, infant mortality has been *way* higher than it has been now. Babies were far more likely to die from something else--like diarrhea, sepsis, or a vaccine-preventable disease. SIDS has obviously only been recognized in the modern era, so it makes sense that we've never developed ancient cultural proscriptions against prone sleeping. I mean, if it was 1935, and you had syphilis, would you really refuse to get penicillin because it was a recommendation that was less than 20 years old? - Victor Ganata
I think what my husband is trying to say is that total infant mortality rates over the years remain similar - the statistics have simply been rearranged because we have more medical knowledge of what causes infant mortality. SIDS is a designation used when no other reason can be attributed to the death. So while the number of SIDS deaths are lower, the number of other (and new) diagnoses rise. Does this mean we now have an epidemic of other types of infant mortality? No, the causes have always been there - we have just recently figured it out. - Maggie
The most frustrating thing is how many times (nurses, doctors, lactation consultants, etc.) we've been told not to let our baby be on her stomach. It seems almost alarmist. It feels like we will be regarded as bad parents if she spends any time on her stomach. - Maggie
When I was discussing this with my mom recently, she told me the recommendation was for babies to only sleep on their stomach when I was born. The fear then was of the baby choking on its spit up. Did we discover that this isn't a legitimate fear? It's a tough call, and I feel that every parent should do some reading on the subject. It seems like the current "cause" of SIDS is CO2 pooling around the baby which could easily be avoided by having a fan in the room. - Maggie
I think Gabe is just skeptical, as am I. As for what else has changed between 1992 and 2003 - the rate of smoking. I couldn't find stats going back to 1992, but I did find some that show a decline from 2001 to 2008 As far as the benefits of sleeping on the stomach, the main one would be that the baby sleeps better. If your baby sleeps fine on its back, then its a no brainer, but if the child doesn't sleep well on its back, it could be miserable for both the child and the parents. - Robert Felty
Sorry, Victor, but 2 data points do not equate to evidence. As I said before, the rate of SIDS was already on its way down before 1992, and the infant mortality rate itself didn't change between 2000 and 2006. Fewer babies aren't dying, the deaths are just not being attributed to SIDS. - Gabe
+Victor for his point using syphilis and penicillin as an example. I was just about to say I give up if that didn't get the point across to you, and literally as I was typing your rebuttal popped up. So, I will (try to) resign. (I have a bad argumentative streak, so it's hard for me to ignore the stuff that pops up in my feed, and no, I don't want to hide it.) - Kamilah Reed (K. Gill)
Here's a more likely explanation of SIDS: "A 100% successful crib death prevention campaign has been going on in New Zealand for the past 11 years. Midwives and other healthcare professionals throughout New Zealand have been actively advising parents to wrap mattresses. During this time, there has not been a single SIDS death reported among the over 100,000 New Zealand babies who have slept on mattresses wrapped in a specially formulated polyethylene cover. The number of crib deaths in New Zealand that have occurred since mattress-wrapping began in 1994 is about 810. The number of crib deaths that have occurred in New Zealand on a properly wrapped mattress is zero." - Gabe
Interesting Gabe. I also wanted to point out that the percentage of babies sleeping on their backs is from self-report data. I get asked every time I take Spencer to the doctor, and I lie about it, because I don't need a lecture. I have looked at the risks, and made my own decision based on that information. Once again, I think this is largely an issue between "safety" and risk management. Nothing is safe. We just need to know the risks, and make informed decisions. Doctors don't give you the statistics. They just say "back is best". What they really mean is "back might be marginally better". - Robert Felty
Victor (and Kamilah): If I had syphilis in 1935, the treatment would have included malaria and arsenic. Penicillin wasn't mass-produced until WWII. Prior to arsenic, it was mercury! - Gabe
Gabe, they found out in many studies that SIDS was more common among babies that slept on their tummies. The main reason is to keep them from suffocating in their own vomit/spit-up. Also, until a baby is 1 year of age, there is not supposed to be anything in the crib like blankets, stuffed animals, etc. The baby can get entangled in the blankets. Soooo, get some warm onezies and follow the professionals advice...please! - Disa Albanese
My point was merely that just because advice is new doesn't automatically mean it's invalid. Obviously, there's a lot of work to be done to figure out SIDS. And, in all honesty, once a baby is older than 4 months and can roll over, there's little you can do to make sure they stay on their back. Like I said, lots of babies don't die from sleeping on their stomachs. The point is, we don't know who will die from it, and the intervention is so trivial, and the data shows it saves about 2k lives a year. - Victor Ganata
Anyway, I can't remember the last time anyone took my advice to change their diet and exercise either. Death seems to be a really poor deterrent. So whatever. Do what you want to do. - Victor Ganata
This has nothing to do with babies, since you know, I don't have any but... I can't sleep on my stomach, because I can't breathe if I do that. When Steve was in the hospital, he would shift to sleeping on his stomach, because it was the only comfortable position. Well, when he did that, his vitals drastically changed to a scary degree and I was always on the edge of my seat getting ready to run and get a nurse or a doctor. It makes a BIG difference - Becca
Rebecca, yeah, there are definitely some physiologic differences between sleeping supine and sleeping prone. Interestingly, though, babies with severe reflux do a lot better sleeping on their stomachs. And while the jury is still out on whether it actually makes a difference, putting someone in a prone position is still used as a treatment for acute respiratory distress syndrome. - Victor Ganata
I made my boy sleep on his back until he was able to roll over and push up on his arms on his own. After that there's not much you could do about it anyway. - Jason Williams
Thing is, you've got to have an alternative hypothesis to explain the decline in death rates. Yes, maybe the refinement of the diagnosis of SIDS is responsible, but, as Maggie points out, there haven't been any concomitant increases in any other diagnoses of infant death. So the rates have truly come down. Not much changed between 1992 and 2003 besides the introduction of the back to sleep campaign. Sure, it's not causality, but without an alternative explanation, I'm not going to counsel people otherwise. - Victor Ganata
Victor: I'm not looking for advice (I've already gotten plenty of that), I'm looking for evidence to back up the advice. I agree that there is some correlation between supine sleeping and a decrease in SIDS, but there is also some correlation between global warming and an increase in piracy. If there were actual inverse correlation between supine sleeping and SIDS, I would expect to see SIDS deaths to have skyrocketed when providers started admonishing parents to put babies in prone position. And you're wrong about what Maggie said; her point is that SIDS diagnoses have decreased recently, but not the total number of deaths. - Gabe
Gabe, yeah, like I said, there isn't much known about the actual etiology. One of the leading theories is that babies who die from SIDS have an abnormally high threshold for CO2, so they don't wake and instead suffocate when face down. So I'm sure there's a genetic component to it. But infant mortality in general in the U.S. did decrease from 1992-2003 (although it's been flat for the past few years.) It's not like some other cause of death has suddenly skyrocketed in this time frame. I agree, the data is nowhere near conclusive, and if parents put their babies to sleep on their stomachs, I'm sure almost all of them do fine, but my point is, absent a compelling argument to do otherwise, I personally am not going to start counseling people to do anything other than put their baby to sleep on their backs. - Victor Ganata
O.k. - come clean time. I religiously kept my two eldest on their backs for sleeping. One of them had delayed upper body strength due to insufficient tummy time. The other developed plagiocephaly - flattened back of head. My third wouldn't sleep until one day when she flipped onto her stomach and actually slept longer than an hour. After that, I let her sleep on her stomach whenever she wanted. She slept the best of all of them and has the best upper body strength and fine motor control of the three. - Martha
Yikes, those calculations I made are off by a factor of 10, I've edited them accordingly. - Victor Ganata
It would be interesting to see if prone sleep positioning is really necessary to prevent motor delay, or if sufficient tummy time would be enough. Anyone want to fund a study? :) - Victor Ganata
Victor; Direct and sole relationship? Not likely. Some relationship. certainly. Sorry, I don't have a study. - Martha