The back-sleep ideologues

This story says,

The American Academy of Pediatrics, or AAP, recommends that babies always be placed on their backs to sleep, even for just a nap.

I think this is worst advice ever. I don’t find convincing the evidence that this reduces death of infants. I am convinced instead that it leads to widespread sleep problems among babies at least until age four, it slows their motor development and probably their cognitive development, and leads to many children wearing helmets to reshape their heads.. A friend of mine quoted a pediatric physical therapist as saying, “The back-sleepers keep me in business.”

Of course, it is not typically rational for a non-expert to challenge orthodoxy. So call me crazy.

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23 Responses to The back-sleep ideologues

  1. asdf says:

    Like most people we followed the advice doctors gave, even knowing it might not be the be all end all. The baby didn’t like being on their stomach anyway, seemed to have a harder time sleeping. It’s possible at this point that’s just because of the habit we’ve formed though.

    Other then doing tummy time not sure what we would do. She just doesn’t want to sleep on her stomach. We’d have to force her with a lot of sleepless nights. Is that really best at this point?

    • asdf says:

      Perhaps put another way. Is there enough good evidence of widespread problems associated with back sleeping to force an unpleasant change at this point?

      My parents don’t appear to have been given any advice and I just slept on whatever side. Turned out fine.

    • Ken in NH says:

      We have 4 children and our rule was to place however they best slept and tell the pediatrician none of his business if he asked. If your child sleeps best on her back then so be it. I suspect the problem with tummy sleeping are the same with back sleeping: parental negligence. In other words, tummy sleepers were left alone for long stretches of time and may even be ignored when struggling which led to suffocation (or SIDS officially). Those same type of parents are told, in no uncertain terms, that they must place their children on their back to sleep. These parents do so religiously but are still negligent and the child spends too much time on their back flattening their head and causing other problems, but, hey, SIDS decreased, a little, maybe.

  2. baconbacon says:

    Rule of thumb: When an article reporting “science” mixes raw numbers (3,500 sleep related deaths) with related, but not directly mathematically related (could drop SIDS by up to 50%) its a sham.

    After scaring you with “numbers” the money quote is

    “But parents should never share the bed with a sleeping baby, as that puts the infant at risk for suffocation or strangulation. ”

    If you google SIDS deaths you end up at the CDC website where they have a nifty little graph showing that accidental suffocation or strangulation accounts for 25% of those deaths, and the rate is 20 per 100,000 infants, or 0.02%. Because some of these accidental suffocation events occurred while not sleeping in the parents bed the real rate is lower, and perhaps substantially lower.

    So why does this event become the focus of the article? Because co sleeping is the most common offense, with >60% of parents reporting it, vs 20% of mothers who put their baby to sleep on their stomach or side, and 40% who leave loose clothing/bedding/soft toys in the crib. So co-sleeping is done the most, and is probably the least “risky” action cited by the article and it is forbidden. A parent should NEVER do it, which sets the standard that any behavior, no matter how minimal the risk is, can be framed as dangerous, and so justify invasion.

    Finally there is no mention of any possible benefits of any of these behaviors, which of course would be necessary for a ‘scientific’ analysis of the situation.

  3. Jeff R says:

    As someone with sleep apnea who hasn’t slept on his back in over a decade, I find this advice strange, also. But I know nothing of infant physiology so I am not in a position to challenge this orthodoxy.

  4. Gary Steinmetz says:

    While correlation isn’t causation, don’t data show that babies who sleep on their backs are less likely to die from SIDS?

    • Arnold Kling says:

      No. The data show that since doctors started insisting on back sleeping, deaths are down. But many other factors also have changed.

      • RobertB says:

        Which other factors do you believe accounted for all of the decrease in SIDS incidence over the period when back-sleeping became the recommendation, and what evidence supports this conclusion?

        • Mark Bahner says:

          “Which other factors do you believe accounted for all of the decrease in SIDS incidence over the period when back-sleeping became the recommendation, and what evidence supports this conclusion?”

          There’s certainly been a huge growth in infant monitors…

  5. Charlie says:

    As a parent of a 4 and 1 year old I bristle when you say this because the advice from all of medical people is sleep on back and that has sunk into my bones. But I’m glad you harp on this because it is the same point you make elsewhere about little to no evidence driving advice.

    It helps me see you critiques in a broader light and understand why the experts would just dismiss you as a crank. Your critiques seem valid but when they go against consensus it is hard to not fall into the crank category.

  6. Carleton Walker says:

    I am curious why you say this leads to sleep problems until the age of 4? The peak of SIDS is 6 months of age and tapers down to non existent at 1 year of age and I was not aware that it mattered much whether children slept on their backs after the age of 1.

    • baconbacon says:

      Because the child’s sleep habits are ingrained to some degree by those first 6-12 months, making it difficult for them to sleep well (and specifically to fall asleep well) in a different position.

  7. Handle says:

    How did human beings survive in a state of nature without access to modern sleep-approach epidemiology? It just seems really unlikely that the human animal would be measurably susceptible to a natural, comfortable way of sleeping that no one would have ever avoided until now. Even a small chance that it would harm babies would mean selective pressures that over thousands of generations would have probably weeded out vulnerable phenotypes.

    • baconbacon says:

      This only holds if you assume that our ancestors were being put down to sleep the way that we do. I doubt that this was the case.

      • MikeP says:

        Indeed. If I had to guess, I would think babies slept next to or on their mothers for thousands of generations. That very stimulus from outside could have kept babies’ sleep from being too deep and keep them from SIDS.

        Put them in a crib in a quiet room, and that external stimulus isn’t there. Yet for most of the dozens of generations since babies started sleeping apart from parents, total infant mortality was large enough that SIDS would not have been a significant cause.

  8. Slocum says:

    Ha! When my kids (now in their 20s) were born, the ‘experts’ were *certain* that back-sleeping was deadly. When the first baby was still in the hospital, a nurse tried to rip me a new one when she saw I had laid her on her back — and she wasn’t sleeping. And then, of course, the experts did a 180 (literally) on their mandate. Personally, I doubt it makes that much difference and once the kid is a few month old, they’ll be able to roll over and sleep any damn way they want anyway.

  9. Ron Middleston says:

    My wife is a doctor and we paid zero attention to what position our girls were sleeping in. All we cared about was that they were sleeping. The risks from asphyxiation due to suffocating arising from crib design, blankets, pillows, etc seemed much more salient, and once we eliminated those it was time to thank god that they were unconscious and try to catch some z’s ourselves.

  10. edgar says:

    Dr Kling has good company in this heresy:

    “Until causal mechanisms are documented and risk/benefit ratios are identified, it may be more appropriate to regard the BTSC as investigational rather than as confirmed preventive therapy. In that context, the decision to place a child in the supine or prone position to sleep should be a personal and ethical choice that rests with the properly informed parent and not with the health care provider.”

  11. PenskeFile says:

    With the growth in baby monitoring devices and cameras for the home in the last couple of years, I would expect that we might be able to start gathering evidence on this question. I would hope so anyway,

  12. Bob Walsh says:

    35 years ago when my son was a baby we were told babies should always sleep on their stomachs. Now they say the opposite. I find it strange that we have been raising babies for may thousands of years but we haven’t figured this out yet.

  13. pbird says:

    My kids are all in their 40s. We put them down on their tummies to sleep because there is a real danger of aspirating vomit even if the child was well burped. They still burp up a bit. Also, they tend to wake easier on their backs because of the startle reaction in which they throw out their arms if there is a nose. I didn’t lose any babies from tummy sleeping and in fact, they flat out did not sleep if laid down on their backs.

  14. Mark Bahner says:


    This, like many medical questions, seems like a question that’s very amenable to big data. Get a million, or a couple million, couples signed up to a study. Have them able to answer confidential questions over a period of 5 years or 10 years. If there are significant differences, they should appear with several million couples responding.

    It’s a very clear question…whether the baby is sleeping on its back or not. It’s not like ADHD or something where the symptoms may not be clear.

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