Tummy Time Gets a Time Out

Here's the skinny on Tummy Time and the practice of putting infants to sleep on their backs.   

Putting babies on their backs has cut the incidence of SIDS in half and that's truly remarkable.  But it's also messed up many a baby's motor skills and flatten heads since the American Academy of Pediatric's 1992 "Back to Sleep" campaign. 

Check out the numbers for yourself, impressive graph.  In 1992 a mere 13% of babes slept on their backs compared to over 75% as of 2006.  That's an enormous shift in parental behavior - the kind of intervention that's only fantasy for public health peeps.
Read the smart write-up of the tummy time phenomenon at Slate.  It beautifully illustrates a neglected aspect of health intervention:

The cure for one ailment leads to others.  There are always "side effects." 

Collateral damage. Unintended consequences.  The domino effect, wings of the butterfly, the universe in balance. There are no fool-proof protocols anywhere. 

The Back to Sleep/Tummy Time interests me beyond the huge behavioral shift and the domino effect. A treatment or cure shouldn't be confused with an underlying cause. 

Yes, back sleeping has resulted in far fewer SIDS deaths.  But this doesn't mean tummy sleeping causes SIDS.  It increases the risk, yes, but is still not the cause. Instead, research has begun to identify a host of complex neurological and physiological differences in infants who succumb to sudden infant death.

Sometimes it's very difficult to separate an indirect factor from an underlying cause.  In fact, entire books have been written about this very topic.  Entirely new statistical techniques and models have emerged in the past decade or so and taken these mind-numbingly complicated relationships to dizzying degree - and frankly nearly sunk my dissertation (another story!).  But for our purposes, let's just remember there are more indirect  (e.g., sleeping on the stomach) and underlying causes (e.g., neurological delays).   

So now hopefully I can rest more easily now that I got that off my mind.....


JoyMama said...

Yes, but will you rest on your back, belly or side? :-)

I think the campaign name/slogan "Back to Sleep" is one of the more brilliant ones I have ever heard. Short, memorable, descriptive, and a pun on top of that!

My older (neurotypical) daughter *hated* tummy-time. She also didn't roll over until 5 months, preferred a weird sitting-while-paddling motion rather than crawling, and walked on the late side.

My younger daughter (with a host of developmental delays) *loved* tummy-time. We called her "the amazing flying baby" because she was so quick to be able to lift her head and legs while on her tummy. She rolled over at the ripe old age of 11 weeks, and walked three months earlier than her sister had.

Ya never know.

Polly Palumbo, Ph.D. said...

All my kids despised tummy time but loved sleeping on their stomachs, go figure!!! After I'd dutifully put them Back to Sleep (you're right-fantastic name!) they'd flip over.

Myself, I sleep every which way. The older I get I'm just thankful for a solid night's rest!!! Thought I'd won the lottery as I couldn't remember getting woken up but then my 5 year-old has taken to middle-of-the-night request such as more light, warmer blanket and last night, could I please clip his finger nails?!!

Sarah Grady said...

Our son would only sleep on his stomach, but we were told that once they are old enough to roll over, it wasn't a big deal anymore. (essentially - don't go in and try and make a baby sleep on their back when they will just roll back over). I was so conflicted over it, but eventually sleep won out, and he slept on his stomach.

Polly Palumbo, Ph.D. said...

I recall the don't worry response too. But still, as a new parent it was unsettling seeing them on their tummies!

TherExtras said...

How odd it sounds to be unsettled over "seeing them on their tummies" - since the mindset was just the opposite when ours were babes.

On the developmental side, for typically developing children I believe the emphasis on sleep-position only applies to babies before they are mobile via rolling.

For atypically-developing infants - another whole post.

Thanks for parsing the stats on this one, too, Polly. Barbara

Polly Palumbo, Ph.D. said...

Hey Barbara! Good to hear from you and yes, how times and sleeping positions change. Yes, absolutely, by the time a baby can roll over, it's all good, no?

TherExtras said...

You will forgive me, Polly, for NOT agreeing to such a blanket statement including "absolutely" and "it's all good"? I was referring to your "dutifully put them Back to Sleep" - fine if they were unable to roll. But I see no point in rolling a baby who can roll back to a preferred position.

I felt a bit remiss in finding you had posted and I had not visited. Have been a little less present in the blog world lately, and perhaps too dependent on post-notification via twitter. Mea culpa. Barbara

Polly Palumbo, Ph.D. said...

Missed but not remissed!

Diane said...

OH. THANK. GOODNESS. Something reasonable and realistic. My kids were born before these campaigns, thankfully, and slept like champs on their backs.
You're a Goddess! Now I can reassure moms of the Back to Sleep era. Thank you!

Polly Palumbo, Ph.D. said...

Thanks, Diane. You can rest easily now it seems!