Why “Back to Sleep” Still Matters: A Lifesaving Habit for Babies

Why “Back to Sleep” Still Matters: A Lifesaving Habit for Babies

By Monica Bykov, RN, IBCLC, NCS - 

It’s one of the first things parents are told in the hospital: “Always place your baby on their back to sleep.” This simple instruction may seem like a small detail, but it’s one of the most important steps you can take to protect your baby’s health and safety during sleep.

The “Back to Sleep” recommendation isn’t just tradition—it’s backed by decades of research and public health data. Since its introduction in the 1990s, this guidance has helped reduce Sudden Infant Death Syndrome (SIDS) rates by more than half in the United States alone [1].

What Is “Back to Sleep”?

The phrase “Back to Sleep” refers to placing your infant on their back every time they sleep—whether it’s a short nap or a full night’s rest. The recommendation applies until the baby is able to roll over both ways on their own.

This sleeping position significantly lowers the risk of SIDS, a sudden and unexplained death that typically occurs in otherwise healthy infants under 12 months of age during sleep.

Why Is Sleeping on the Back Safer?

Babies who sleep on their stomachs or sides are at a higher risk for SIDS. Researchers believe that stomach sleeping can:

  • Obstruct a baby's airway

  • Make it harder for them to wake up if they aren't getting enough oxygen

  • Increase the chances of breathing in their own exhaled air (carbon dioxide), especially on soft bedding [2]

Back sleeping keeps the airway open and reduces the risk of these events. It also allows babies to move their heads more freely and respond better to their environment as their nervous system matures [3].

Common Concerns—and What the Evidence Shows

What if my baby spits up while sleeping on their back?
This is a frequent concern, but studies show that healthy babies are less likely to choke while sleeping on their backs. In fact, back-sleeping infants are better able to clear fluids because their airway sits above the esophagus—the tube that carries food to the stomach [4].

Won’t back sleeping flatten my baby’s head?
Positional plagiocephaly (flat head syndrome) can happen, especially if a baby spends too much time in one position. But this is typically mild and temporary. You can reduce the risk by offering plenty of supervised tummy time during the day and varying your baby's head position when awake [5].

The Numbers Speak for Themselves

Before the “Back to Sleep” campaign began in 1994, more than 4,000 infants died of SIDS each year in the U.S. By 2019, that number had dropped to around 1,250 annually [6]. The improvement is directly tied to increased awareness and safe sleep education.

Still, about 1 in 5 babies who die of SIDS were last placed on their stomachs to sleep. This shows how critical it is to share this message widely—with parents, grandparents, babysitters, and daycare providers.

Safe Sleep Goes Beyond Positioning

In addition to back sleeping, here are other key safe sleep practices recommended by the American Academy of Pediatrics (AAP) [7]:

  • Use a firm, flat mattress in a crib or bassinet without soft bedding

  • Keep pillows, blankets, bumpers, and stuffed animals out of the sleep space

  • Share a room (not a bed) with your baby for the first 6 to 12 months

  • Avoid overheating—dress your baby in light sleep clothing and keep the room at a comfortable temperature

  • Offer a pacifier at nap time and bedtime once breastfeeding is established

Final Thoughts

As a nurse and newborn care expert, I’ve worked with thousands of families who want nothing more than to give their babies the best start in life. While the early months can be overwhelming, choosing safe sleep habits—like always placing your baby on their back—can offer peace of mind and real protection.

It’s a simple habit with profound benefits. When in doubt, just remember: back is best.

References

  1. Willinger, M., Hoffman, H. J., & Hartford, R. B. (1994). Infant Sleep Position and Risk for Sudden Infant Death Syndrome: Report of Meeting Held January 13 and 14, 1994, National Institutes of Health, Bethesda, MD. Pediatrics, 93(5), 820–824.

  2. Moon, R. Y., & AAP Task Force on Sudden Infant Death Syndrome. (2016). SIDS and Other Sleep-Related Infant Deaths: Updated 2016 Recommendations. Pediatrics, 138(5), e20162938.

  3. Thach, B. T. (2001). Some aspects of clinical relevance in the maturation of respiratory control in infants. Biol Neonate, 79(3-4), 249–256.

  4. Malloy, M. H., & Hoffman, H. J. (1995). Relationship of Sudden Infant Death Syndrome to Spontaneous Cardiopulmonary Resuscitation During Sleep. Pediatrics, 95(4), 539–543.

  5. Laughlin, J., Luerssen, T. G., Dias, M. S., & AAP Section on Neurological Surgery. (2011). Prevention and Management of Positional Skull Deformities in Infants. Pediatrics, 128(6), 1236–1241.

  6. Centers for Disease Control and Prevention (CDC). (2020). Sudden Unexpected Infant Death and Sudden Infant Death Syndrome. https://www.cdc.gov/sids/data.htm

  7. American Academy of Pediatrics (2016). Safe Sleep Guidelines. https://www.aap.org