Back To Sleep changes to Safe To Sleep

Reducing the Risk of SIDS

Room sharing without bedsharing.
Room sharing without bedsharing helps create a safe sleep environment for infants. Photo by NICHD

The incidence of SIDS has fallen greatly since the introduction of the Back to Sleep campaign by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), the Maternal and Child Health Bureau of the Health Resources and Services Administration, the American Academy of Pediatrics (AAP), First Candle/SIDS Alliance, and the Association of SIDS and Infant Mortality Programs.

Back To Sleep

The biggest gains in reducing the rates of SIDS came with the recommendation that all babies be put to sleep on their back - the 'Back to Sleep' campaign that began in 1994. Since then, the rate of SIDS has decreased by just over 50 percent.

Unfortunately, since then, the incidence of SIDS has plateaued. The original Back to Sleep SIDS policy statement from the AAP Task Force on Infant Position and SIDS came out in 1992 and was simply named "Positioning and SIDS." It stated that 'the Academy recommends that healthy infants, when being put down for sleep, be positioned on their side or back.'

The next report on SIDS came out in 2000 and it made recommendations about other risk factors, including soft sleep surfaces and loose bedding, overheating, and maternal smoking. The 2000 SIDS report also stated that back sleeping was preferred over side sleeping.

The 2005 SIDS report from the AAP, 'The Changing Concept of Sudden Infant Death Syndrome: Diagnostic Coding Shifts, Controversies Regarding the Sleeping Environment, and New Variables to Consider in Reducing Risk,' ended the side vs. back issue.

The new recommendation became that infants should be put to sleep wholly on their back.

The Latest SIDS Recommendations

With their latest, 2011 SIDS recommendations, the AAP is focusing on safe sleep environments, in addition to talking about Back to Sleep recommendations.

They now also talk about the protective role of breastfeeding and the importance of vaccinations and prenatal care.

Like the advice from the AAP, the FDA offers the following guidelines to reduce a baby's risk of SIDS:

  • Alone in their own bed.
  • Back to sleep - every sleep.
  • Crib.

An even easier way to remember the ABCs of reducing the risk of SIDS is to think - Alone on the Back in a bare Crib.

The FDA also warns that they have "never cleared or approved a baby product to prevent or reduce the risk of SIDS." That includes baby monitors, infant positioners, mattresses, or pillows, etc., none of which have been proven to prevent or reduce the risk of SIDS.

Safe To Sleep

In 2012, a new Safe to Sleep campaign was introduced to help emphasize a "continued focus on safe sleep environments and back sleeping as ways to reduce the risk of SIDS and other sleep-related causes of infant death." It replaces the original Back to Sleep campaign.

In addition to continuing to educate parents about the important of always putting infants to sleep on their back, the Safe to Sleep messages help teach parents to:

  • share their room, not their bed, as "room sharing without bedsharing may reduce the risk of SIDS by as much as 50% and helps prevent accidental suffocation."
  • create a safe sleep environment by keeping pillows, crib bumpers, and blankets, etc., out of your baby's crib
  • not let their baby get overheated
  • put their baby to sleep on a firm sleep surface

The campaign also helps dispel many myths about SIDS, including that "If parents sleep with their babies in the same bed, they will hear any problems and be able to prevent them from happening." This popular myth that leads to cosleeping is not true and is in fact very dangerous.


American Academy of Pediatrics Technical Report: SIDS and Other Sleep-Related Infant Deaths: Expansion of Recommendations for a Safe Infant Sleeping Environment. Pediatrics 2011; 128:5 e1341-e1367.

American Academy of Pediatrics Policy Statement: SIDS and Other Sleep-Related Infant Deaths: Expansion of Recommendations for a Safe Infant Sleeping Environment. Pediatrics 2011; 128:5 1030-1039.

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