Back To Sleep changes to Safe To Sleep

Reducing the Risk of SIDS

Room sharing without bedsharing.

Photo courtesy of 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 about 70 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.

2011 SIDS Recommendations

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

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

Like the advice from the AAP, the FDA offered 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 warned that they have "not 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, the 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 replaced the original Back to Sleep campaign.

In addition to continuing to educate parents about the importance 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.

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Article Sources
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  2. Centers for Disease Control and Prevention (CDC). Sudden Unexpected Infant Death and Sudden Infant Death Syndrome: Data and Statistics. Updated April 28, 2021.

  3. Task Force on Infant Positioning and SIDS. Positioning and SIDSPediatrics. 1992;89:1120-1126

  4. Task Force on Infant Sleep Position and Sudden Infant Death Syndrome. Changing Concepts of Sudden Infant Death Syndrome: Implications for Infant Sleeping Environment and Sleep PositionPediatrics. 2000;105(3):650-656. doi:10.1542/peds.105.3.650

  5. Task Force on Sudden Infant Death Syndrome. The Changing Concept of Sudden Infant Death Syndrome: Diagnostic Coding Shifts, Controversies Regarding the Sleeping Environment, and New Variables to Consider in Reducing RiskPEDIATRICS. 2005;116(5):1245-1255. doi:10.1542/peds.2005-1499

  6. Task Force on Sudden Infant Death Syndrome. SIDS and Other Sleep-Related Infant Deaths: Expansion of Recommendations for a Safe Infant Sleeping EnvironmentPEDIATRICS. 2011;128(5):e1341-e1367. doi:10.1542/peds.2011-2285

  7. U.S. Food & Drug Administration (FDA). Baby Products with SIDS Prevention Claims. Updated October 17, 2019.

  8. Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). Safe Infant Sleep Basics: Key Moments in Safe to Sleep® History: 2004–2013.

  9. TASK FORCE ON SUDDEN INFANT DEATH SYNDROME. SIDS and Other Sleep-Related Infant Deaths: Updated 2016 Recommendations for a Safe Infant Sleeping EnvironmentPediatrics. 2016;138(5):e20162938. doi:10.1542/peds.2016-2938

  10. Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). Myths and Facts About SIDS and Safe Infant Sleep.