Goto Sleep despite Someparental Resistance, More Babies Snooze on Their Backs

Article excerpt

Byline: Rachel Saslow Special to The Washington Post By Rachel Saslow Special to The Washington Post

By the time new parents take their babies home from the hospital, they have been thoroughly drilled on the litany of infant-sleep no-nos: No stomach-sleeping. No loose blankets. No pillows. No soft mattresses. No crib bumpers. The list goes on.

Whether parents choose to follow these rules is another matter.

When her twins were born in 2008, Amy Cress of Silver Spring, Md., dutifully put her babies on their backs to sleep. But at about 6 months of age, her son Nathan rolled onto his stomach during the night. Cress was so relieved that her son was asleep, she left him like that. He preferred sleeping on his stomach from then on.

"We used bumpers, too, which is really not allowed," she says. "We felt like rebels."

It has been 20 years since the American Academy of Pediatrics first recommended that parents place their babies on their backs to sleep for the first year of life to prevent sudden infant death syndrome, or SIDS. The rate of SIDS in the United States has plummeted more than 50 percent since the government launched its "Back to Sleep" campaign in 1994. In 2006, 2,327 infants died from SIDS in the United States.

Still, about 25 percent of U.S. babies sleep on their stomachs or sides, according to a national infant sleep position study. (In 1992, before the "Back to Sleep" campaign, that proportion was roughly 85 percent, according to the study.)

Like Cress, many parents find that infants sleep better and longer on their stomachs. New babies startle easily while on their backs and can wake themselves up frequently. Swaddling them can help prevent this, but wrapping a crying baby like a burrito isn't always easy for a sleep-deprived parent in the middle of the night.

For some parents, there's also a credibility issue. Despite the correlation between back sleep and the drop in SIDS deaths, scientists still don't know the precise cause of SIDS. In fact, SIDS is by definition a death without a known cause, or, as the Centers for Disease Control and Prevention defines the syndrome, "deaths in infants less than 1 year of age that occur suddenly and unexpectedly," and whose causes "are not immediately obvious prior to investigation." Moreover, changing recommendations -- between 1992 and 2000, the AAP said that side-sleeping was a safe alternative to back sleeping -- make some people skeptical of the experts.

Other parents worry that babies will get flat heads from sleeping on their backs or will be delayed in reaching such milestones as rolling over.

Marian Willinger, who runs the SIDS research program at the National Institute of Child Health and Human Development in Bethesda, Md., concedes that back-sleeping babies might have such delays; they might also learn to crawl later than stomach-sleepers. But by 18 months of age, there is no difference between the two groups, she says. Back-sleeping babies might also develop flat spots on the back of the head, but parents can help prevent it by repositioning the baby's head during sleep and by having the baby spend time on his or her stomach during the day, she says.

Meanwhile, research on the cause of SIDS continues. Some studies have pointed to risk factors such as prematurity or exposure to secondhand smoke. Willinger and her fellow researchers are looking at defects in neurotransmitter pathways in the brain as a possible cause. SIDS victims seem to have had pathway deficits in brain regions that control automatic functions such as breathing, heartbeat, blood pressure, body temperature and arousal from sleep.

"Part of the problem is that you find a baby dead with no history of disease, so we're starting at the end," she says.

Other sleep-related deaths are more easily understood, such as accidental suffocation or entrapment due to pillows, quilts, crib bumpers or sharing a bed with a parent. …