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How long should babies be placed on their backs?

Date: 97-08-07

In response to a question about a 7-month old baby who struggles to turn onto her stomach during sleep. She is concerned about this because of the increased risk for SIDS. How long should babies be placed on their backs?

This is a good question. Unfortunately, I do not think we have solid information on how long back sleeping should be done to decrease the risk of SIDS for an infant. The general answer to the question would probably be that babies should be encouraged to sleep on their backs during as much of the first year as possible. However, as Lisa pointed out, babies often can roll over on their own after about 6-months of age. We assume, that since babies can roll, they are better able to protect themselves from whatever it is about prone sleeping which increases SIDS risk. Data from Australia, and some other countries who have successfully instituted 'back to sleep', show that the greatest reduction in SIDS for back sleepers is 2-4 months of age. This suggests that back sleeping has its greatest effect during the peak incidence of SIDS, and has less protective effect for older infants.

Therefore, it is probably not as important to keep your baby supine at all times during sleep at 7-months of age. I think the answer is that you have to do the best you can, and find a compromise between always watching your baby and re-turning to the back on the one hand, and permitting a more normal family routine on the other.

I hope this helps. Thank you.

Tom Keens
Children's Hospital Los Angeles

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