The Safe to Sleep campaign, formerly known as the Back to Sleep campaign, is an initiative backed by the US
National Institute of Child Health and Human Development
The ''Eunice Kennedy Shriver'' National Institute of Child Health and Human Development (NICHD) is one of the National Institutes of Health (NIH) in the United States Department of Health and Human Services. It supports and conducts research aime ...
(NICHD) at the US
National Institutes of Health
The National Institutes of Health, commonly referred to as NIH (with each letter pronounced individually), is the primary agency of the United States government responsible for biomedical and public health research. It was founded in the late ...
to encourage parents to have their
infants
An infant or baby is the very young offspring of human beings. ''Infant'' (from the Latin word ''infans'', meaning 'unable to speak' or 'speechless') is a formal or specialised synonym for the common term ''baby''. The terms may also be used to ...
sleep on their backs (
supine position
The supine position ( or ) means lying horizontally with the face and torso facing up, as opposed to the prone position, which is face down. When used in surgical procedures, it grants access to the peritoneal, thoracic and pericardium, pericardi ...
) to reduce the risk of
Sudden Infant Death Syndrome
Sudden infant death syndrome (SIDS) is the sudden unexplained death of a child of less than one year of age. Diagnosis requires that the death remain unexplained even after a thorough autopsy and detailed death scene investigation. SIDS usuall ...
, or SIDS. The target age group of the campaign is 0–1 years of age, because this is when babies are at the greatest risk of experiencing SIDS.
Since "Safe to Sleep" was launched in 1994, the incidence of SIDS has declined by more than 50%.
However, there has been a rise in infant sleep-related suffocation events.
Consequently, the campaign has broadened its goal to focus on safe sleep conditions and further preventative measures.
History
In 1992, the
American Academy of Pediatrics
The American Academy of Pediatrics (AAP) is an American professional association of pediatricians, headquartered in Itasca, Illinois. It maintains its Department of Federal Affairs office in Washington, D.C.
Background
The Academy was founded ...
(AAP) issued the recommendation that babies sleep on their backs or sides to reduce the risk of SIDS (a revised statement in 1996 retracted the side-sleeping option). NICHD launched the "Back to Sleep" campaign in 1994 to spread the message.
The campaign was successful in that it significantly reduced the percentage of babies sleeping on their stomachs (
prone position
Prone position () is a body position in which the person lies flat with the chest down and the back up. In anatomical terms of location, the dorsal side is up, and the ventral side is down. The supine position is the 180° contrast.
Etymolo ...
). It was found, however, that a significant portion of
African-American
African Americans (also referred to as Black Americans and Afro-Americans) are an Race and ethnicity in the United States, ethnic group consisting of Americans with partial or total ancestry from sub-Saharan Africa. The term "African American ...
babies were still sleeping on their stomachs; in 1999, an African-American baby was 2.2 times more likely to die of SIDS than a white baby. Thus, then
Secretary
A secretary, administrative professional, administrative assistant, executive assistant, administrative officer, administrative support specialist, clerk, military assistant, management assistant, office secretary, or personal assistant is a w ...
of
Health and Human Services
The United States Department of Health and Human Services (HHS) is a cabinet-level executive branch department of the U.S. federal government created to protect the health of all Americans and providing essential human services. Its motto is ...
Donna Shalala
Donna Edna Shalala ( ; born February 14, 1941) is an American politician and academic who served in the Carter and Clinton administrations, as well as in the U.S. House of Representatives from 2019 to 2021. Shalala is a recipient of the Presid ...
and
Tipper Gore
Mary Elizabeth "Tipper" Gore (née Aitcheson; born August 19, 1948) is an American social issues advocate, activist, photographer and author who was the second lady of the United States from 1993 to 2001. She was married to Al Gore, the 45th vi ...
refocused the "Back to Sleep" campaign on minority babies.
Campaign
In 1985 Davies reported that in Hong Kong, where the common Chinese habit was for
supine infant sleep position (face up), SIDS was a rare problem. In 1987 the Netherlands started a campaign advising parents to place their newborn infants to sleep on their backs (supine position) instead of their stomachs (prone position).
This was followed by infant supine sleep position campaigns in the United Kingdom (as "Back to Sleep"), New Zealand, and Australia in 1991, the U.S. and Sweden in 1992, and Canada in 1993.
[
This advice was based on the epidemiology of SIDS and physiological evidence which showed that infants who sleep on their back have lower arousal thresholds and less ]slow-wave sleep
Slow-wave sleep (SWS), often referred to as deep sleep, consists of stage three of non-rapid eye movement sleep. It usually lasts between 70 and 90 minutes and takes place during the first hours of the night. Initially, SWS consisted of both St ...
(SWS) compared to infants who sleep on their stomachs. Thus, these infants are more easily awakened. However, the arousal thresholds have been shown to be higher during SWS causing infants to be less easily awakened.
In human infants sleep develops rapidly during early development. This development includes an increase in non-rapid eye movement sleep
Non-rapid eye movement sleep (NREM), also known as quiescent sleep, is, collectively, sleep stages 1–3, previously known as stages 1–4. Rapid eye movement sleep (REM) is not included. There are distinct electroencephalographic and other cha ...
(NREM sleep) which is also called quiet sleep (QS) during the first 12 months of life in association with a decrease in rapid eye movement sleep
Rapid eye movement sleep (REM sleep or REMS) is a unique phase of sleep in mammals and birds, characterized by random rapid movement of the eyes, accompanied by low muscle tone throughout the body, and the propensity of the sleeper to dream ...
(REM sleep) which is also known as active sleep (AS). In addition, slow wave sleep (SWS) which consists of stage 3 and stage 4 NREM sleep appears at 2 months of age and it is theorized that some infants have a brain-stem defect which increases their risk of being unable to arouse from SWS (also called deep sleep) and therefore have an increased risk of SIDS due to their decreased ability to arouse from SWS.
Studies have shown that preterm infants, full-term infants, and older infants have greater time periods of quiet sleep and also decreased time awake when they are positioned to sleep on their stomachs, meaning these babies are harder to wake when sleeping on their tummy. In both human infants and rats, arousal thresholds have been shown to be at higher levels in the electroencephalography
Electroencephalography (EEG) is a method to record an electrogram of the spontaneous electrical activity of the brain. The biosignals detected by EEG have been shown to represent the postsynaptic potentials of pyramidal neurons in the neocortex ...
(EEG) during slow-wave sleep.
In 1992 a SIDS risk reduction strategy based upon lowering arousal thresholds during SWS was implemented by the American Academy of Pediatrics (AAP) which began recommending that healthy infants be positioned to sleep on their back (supine position) or side (lateral position), instead of their stomach (prone position), when being placed down for sleep. In 1994, a number of organizations in the United States combined to further communicate these non-prone sleep position recommendations and this became formally known as the "Back To Sleep" campaign. In 1996 the AAP further refined its sleep position recommendation by stating that infants should only be placed to sleep in the supine position and not in the prone or lateral positions.
Since the launch of the campaign the incidence of SIDS has declined by more than half, however, 3,400 babies, ages 0-1, die per year from SIDS and sleep-related suffocation events despite the implementation of this campaign. The AAP and further research has shown that there are preventative measures that can be taken to control environmental factors to prevent such adverse events.
SIDS risk factors
Risk factors for SIDS can be divided into three major categories: maternal, infant, and environmental factors. The factors mentioned below are modifiable and preventable to help decrease the occurrence of SIDS and sleep-related suffocation events.
Preventative measures
Several precautions focused on controlling environmental factors can be taken to minimize the risk of SIDS and sleep-related suffocation events. Per the safe to sleep campaign these are the following preventative measures that can be taken to decrease the rate of SIDS and sleep-related suffocation events.
* Sleeping on back
* Sleeping on a firm/hard surface
* Nothing in the crib or bassinet other than the baby
** No stuffed toys, loose blankets and/or crib bumpers
* Room sharing
** It is important to note this is different from sharing a bed with an infant. This entails sleeping in the same room as one's baby but making sure the baby has a safe sleeping space free of the aforementioned risk factors.
* Use of a pacifier while baby is sleeping
** The concept behind the use of a pacifier during sleep is that these babies do not sleep as deeply and might be more easily arousable thus less likely to have an adverse sleep related event.
* Tummy time
** Regular tummy time helps to strengthen babies core, neck, and shoulder muscles. These muscle groups are essential in helping babies to turn their head and bodies to avoid suffocating during sleep.
* Avoiding sleep in a car seat outside of the car
** A car seat is only safe to sleep in while in the car.
* Avoiding sleep in an inclined chair such as Rock 'n Play Sleeper, rocking swings etc. without constant supervision
* Breastfeeding
* Regular prenatal care
* No smoking during pregnancy
* Avoid secondhand smoke exposure
* Up-to-date immunizations
See also
* Sudden infant death syndrome
Sudden infant death syndrome (SIDS) is the sudden unexplained death of a child of less than one year of age. Diagnosis requires that the death remain unexplained even after a thorough autopsy and detailed death scene investigation. SIDS usuall ...
*Tummy time
Tummy time is a colloquialism for placing infants in the prone position while awake and supervised, to encourage development of the neck and Thorax, trunk muscles and prevent Plagiocephaly, skull deformations.
In 1992, the American Academy of Pe ...
*Plagiocephaly
Plagiocephaly, also known as flat head syndrome, is a condition characterized by an asymmetrical distortion (flattening of one side) of the skull. A mild and widespread form is characterized by a flat spot on the back or one side of the head cause ...
*United States Department of Health and Human Services
The United States Department of Health and Human Services (HHS) is a cabinet-level executive branch department of the U.S. federal government created to protect the health of all Americans and providing essential human services. Its motto is ...
References
External links
Safe Sleep For Your Baby
SIDS African American Outreach Brochure
{{DEFAULTSORT:Safe to Sleep
National Institutes of Health
Children's health in the United States
Health campaigns