The “Back to Sleep” campaign—launched by the American Academy of Pediatrics (AAP) in 1994—was introduced as a means of educating parents and caregivers about the importance of putting babies to sleep on their backs—every time. Babies who sleep on their backs have a reduced risk for sudden infant death syndrome (better known as SIDS).

Since SIDS is the leading cause of death for healthy infants between 1 month and 1 year of age, the AAP recommends that parents and caregivers position babies on their backs at every bedtime and naptime until the age of 1.

It’s impossible to overemphasize the importance of back sleeping during every sleep time. Babies who usually sleep on their backs but who are placed on their stomachs (called “unaccustomed tummy sleepers”) even once are 18 times more likely to die from SIDS. This tends to happen most often during naptime and when a baby is in the care of a non-parent caregiver (e.g., sitter, grandparent) who doesn’t know the importance of putting babies on their backs to sleep. Keep in mind that “back to sleep” is the opposite of what many grandparents were told to do during their parenting days. It’s important to make sure that any caregiver knows and follows “back to sleep” guidelines.

Once your baby can roll over consistently—a skill which usually develops between 4 and 7 months of age—she may choose not to stay on her back all night long. If she rolls herself to her side or to her stomach, it is okay for you to leave her in that position. However, you should continue to place your baby to sleep on her back.

Researchers still don’t know why stomach-sleeping increases a baby’s risk of SIDS. It could have to do with jaw positioning and/or airway compression, “re-breathing” expelled, oxygen-depleted air, or neurological development. So while the “until age 1” recommendation may seem overly cautious—after all, the peak age for SIDS death risk is 2 to 4 months—if there is ever a case to be made for an ounce of prevention, this would be it.

While “back to sleep” is perhaps the most important SIDS prevention tip, parents should also:

• Avoid soft bedding. Use a firm sleep surface, such as a safety-approved crib mattress covered by a fitted sheet. Skip the pillows, quilts, crib bumpers, and soft stuffed toys.
• Avoid overheating. Set the room temperature in a range that is comfortable for a lightly clothed adult, and dress the baby in a single layer of clothing or a sleep sack. Signs of overheating include sweating, damp hair, flushed cheeks, heat rash, and rapid breathing.
• Remember “tummy time”—while baby is awake. To avoid the development of a flat spot on your baby’s head, limit the amount of time she spends reclining in car seats, swings, and similar hard surfaces. Give her lots of time to play on her tummy while she’s awake. (But, if she falls asleep while playing, be sure to roll her over to her back.)

Medical exceptions to “back to sleep” may be necessary for infants with chronic gastroesophageal reflux disease (GERD) or certain upper airway malformations. If your child is affected by either of these conditions, please discuss her best sleep position with her health care provider.

Click here to read more about SIDS prevention and safe sleeping habits.