Back to Sleep campaign

Sudden infant death syndrome killed 5,000 to 6,000 American infants a year before the campaign, and it was the leading cause of death between one month and one year of age. Researchers had noticed that babies in other countries who were put to sleep on their backs were less likely to die of SIDS. NICHD-funded research on European infants, and then a large study in Chicago, supported the observation. Many health care providers feared that babies on their backs might choke if they spat up in the night, so the studies also had to show that back sleeping did not raise the risk of other problems.

In 1992 the American Academy of Pediatrics recommended that infants not be placed on their stomachs to sleep. Two years later the National Institute of Child Health and Human Development formed a coalition with the Health Resources and Services Administration, the academy, the SIDS Alliance and the Association of SIDS Program Professionals to launch Back to Sleep. Its first message allowed back or side sleeping. After further studies the academy advised that all infants sleep on their backs unless there was a medical reason not to.

Practice changed quickly. In 1992, 70 percent of infants slept on their stomachs; in 1995, 29 percent did. SIDS deaths fell from 4,891 in 1992 to 3,279 in 1995, according to preliminary federal data, with drops of 12 percent in 1994 and 18.5 percent in 1995, the largest annual declines then observed in the United States. SIDS slipped from the second to the third leading cause of infant death, and its decline accounted for about a third of the fall in infant mortality in 1995, to 7.5 deaths per 1,000 live births.

By the campaign's tenth anniversary in 2004, SIDS rates had fallen by about half for both Black and white infants, but the rate for African American infants was still twice that for white infants. In 2003 NICHD had joined three national African American women's organizations in a program aimed at that gap. The campaign now runs as Safe to Sleep and also covers other sleep-related infant deaths.