In 1992, the American Academy of Pediatrics issued the recommendation that babies sleep on their backs or sides to reduce the risk of SIDS. 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. It was found, however, that a significant portion of 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 of Health and Human ServicesDonna Shalala and Tipper Gore 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, SIDS was a rare problem. In 1987 the Netherlands started a campaign advising parents to place their newborn infants to sleep on their backs instead of their stomachs. This was followed by infant supine sleep position campaigns in the United Kingdom, 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 shows that infants who sleep on their back have lower arousal thresholds and less slow-wave sleep compared to infants who sleep on their stomachs. In human infants sleep develops rapidly during early development. This development includes an increase in non-rapid eye movement sleep which is also called quiet sleep during the first 12 months of life in association with a decrease in rapid eye movement sleep which is also known as active sleep. In addition, slow wave sleep 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 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. In both human infants and rats, arousal thresholds have been shown to be at higher levels in the electroencephalography 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 which began recommending that healthy infants be positioned to sleep on their back or side, instead of their stomach, 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. In 1992, the first National Infant Sleep Position Household Survey was conducted to determine the usual position in which U.S. mothers placed their babies to sleep: lateral, prone, supine, other, or no usual position. According to the 1992 NISP survey, 13.0% of U.S. infants were positioned in the supine position for sleep. According to the 2006 NISP survey 75.7% of infants were positioned in the supine position to sleep.
