Tummy Sleeping: Good or Bad?

In 1994 the National Institute of Child Health and Human Development launched a campaignto have all babies sleep on their backs instead of their tummies in an effort to reduce the incidence of Sudden Infant Death Syndrome (SIDS). Pediatricians became convinced that this was important because of the confluence of a number of factors. First, a paper from China suggested that their low rate of SIDS was directly attributable to the fact that the Chinese tend to lie their babies on their backs. In addition, it was found that African American babies were more likely to be put down on their tummies than white babies and also had a higher rate of SIDS. Whether the SIDS was connected to the sleeping position was not definitively determined, but inferred based on epidemiological data. The connection between SIDS and sleeping position was regarded as confirmed when SIDS rates decreased dramatically after the Back to Sleep campaign. However, simple logic tells us that a lot of other factors could also have changed in the intervening years.

On the other hand, there are physiological factors that have been hypothesized to link sleep position to some features of SIDS. For example, some suggest that SIDS may be a result of a brain stem defect whereby some infants are unable to rouse themselves from a deep sleep even when their noses are buried in their mattresses–a good reason for avoiding soft sleeping surfaces. Since tummy sleepers sleep more deeply than back sleepers, it is logical that tummy sleeping may be a contributing cause for SIDS.

Despite this, many mothers have reverted to placing their infants on their tummies. They report that their babies do not sleep well on their backs. In fact, studies conducted in 1998 showed that infants placed on their backs sleep 8.3% less than those who are placed on their tummies. The back-sleeping children tend to have more acid reflux and colic and thus wake up more frequently. They also get significantly less stage 3 and stage 4 sleep. Does this matter? Yes. It was also found, and has been confirmed in later studies, that back sleepers are significantly delayed in their motor skills and mental development. In an attempt to overcome this problem, mothers are now being told to be sure to give their babies tummy time when awake. Unfortunately, this does not overcome the problem ofinsufficient sleep, which is highly likely to be the cause of the delayed development.

How is the above related to integrity in science? Well, it is evident that the case for tummy as opposed to back sleeping is complex. In fact, the NICHHD recommends that most infants sleep on their backs, but they say that babies with symptomatic gastric reflux or Robin syndrome should sleep on their tummies. The verdict seems to be out on how premature babies suffering with respiratory issues should sleep. Basically, there are no easy answersand no guarantees against SIDS. Back sleeping may help, but it has significant drawbacks.

However, it is always important for the public to be educated so parents can make the best decision for their child. Otherwise, they will do as is reported in the NY Times article– what seems best to them–but they will feel unsure and guilty about their decision. And that benefits no one.