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safetosleep.nichd.nih.gov

Back to Sleep

Also: Safe to Sleep (from 2012)

“Back to Sleep”

National campaign launched in 1994, led by NICHD, telling caregivers to put healthy infants to sleep on their backs to reduce sudden infant death syndrome. Broadened to all sleep-related infant deaths as Safe to Sleep in 2012.

Years
1994–now
Country
United States
Topic
Infant sleep
Asks people to
Substitute
Strategy
Simple instruction
Channel
Clinical settingPackagingPrintRadioTV
Audience
Parents
Nighttime caregivers of infants, plus physicians and nursery nurses as messengers

Evidence

ObservationalPositive

National Infant Sleep Position Study 1994-1998: prone placement fell from 44% to 17% (white infants) and 53% to 32% (black infants). A physician's 'supine not prone' advice was the strongest predictor of supine placement (OR 3.37); hearing it from all four sources raised the odds further (OR 6.01). The persistent racial gap is part of the record. US SUID fell 44.6% from 1990 to 1998 (154.6 to about 92 per 100,000 births by 2015) but only 7% from 1999 to 2015, while SIDS coded deaths gave way to suffocation and 'unknown cause' codes (Erck Lambert 2018). SIDS fell 38.9% in 1991-96 with no rise in aspiration deaths (Malloy 2002). Supine placement plateaued from 2001 with a persisting racial gap explained largely by worries about comfort and choking and by physician advice (Colson 2009). Gains were unequal: the education and race gaps in SIDS widened after the campaign (Pickett 2005), and AI/AN and Black infants keep the highest SUID rates (Parks 2017). In 2016 PRAMS, 78% of mothers used back sleep but only 32% a separate approved surface; provider advice was associated with 12-28% higher use (Hirai 2019). Side effect: positional plagiocephaly rose, prompting tummy-time advice.

Sponsor (who paid)

Credits (who made it)

Not recorded yet.

Related campaigns

Sources

  1. Willinger M et al. Factors associated with caregivers' choice of infant sleep position, 1994-1998. JAMA 2000;283(16):2135-42 evaluation · 2000 · DOI 10.1001/jama.283.16.2135 · PMID 10791506
  2. Safe to Sleep campaign sponsor
  3. Willinger M et al. Factors associated with the transition to nonprone sleep positions of infants in the United States: the National Infant Sleep Position Study. JAMA 1998 evaluation · 1998 · DOI 10.1001/jama.280.4.329 · PMID 9686549
  4. Pollack HA et al. Infant sleep placement after the back to sleep campaign. Pediatrics 2002 evaluation · 2002 · DOI 10.1542/peds.109.4.608 · PMID 11927704
  5. Malloy MH et al. Age at death, season, and day of death as indicators of the effect of the back to sleep program on sudden infant death syndrome in the United States, 1992-1999. Arch Pediatr Adolesc Med 2004 evaluation · 2004 · DOI 10.1001/archpedi.158.4.359 · PMID 15066876
  6. Malloy MH. Trends in postneonatal aspiration deaths and reclassification of sudden infant death syndrome: impact of the 'Back to Sleep' program. Pediatrics 2002 evaluation · 2002 · DOI 10.1542/peds.109.4.661 · PMID 11927712
  7. Erck Lambert AB, Parks SE, Shapiro-Mendoza CK. National and State Trends in Sudden Unexpected Infant Death: 1990-2015. Pediatrics 2018 evaluation · 2018 · DOI 10.1542/peds.2017-3519 · PMID 29440504
  8. Colson ER et al. Trends and factors associated with infant sleeping position: the National Infant Sleep Position Study, 1993-2007. Arch Pediatr Adolesc Med 2009 evaluation · 2009 · DOI 10.1001/archpediatrics.2009.234 · PMID 19996049
  9. Parks SE, Erck Lambert AB, Shapiro-Mendoza CK. Racial and Ethnic Trends in Sudden Unexpected Infant Deaths: United States, 1995-2013. Pediatrics 2017 evaluation · 2017 · DOI 10.1542/peds.2016-3844 · PMID 28562272
  10. Pickett KE, Luo Y, Lauderdale DS. Widening social inequalities in risk for SIDS. Am J Public Health 2005 evaluation · 2005 · DOI 10.2105/AJPH.2004.059063 · PMID 16254231
  11. Hirai AH et al. Prevalence and Factors Associated With Safe Infant Sleep Practices. Pediatrics 2019 evaluation · 2019 · DOI 10.1542/peds.2019-1286 · PMID 31636142
  12. Trachtenberg FL et al. Risk factor changes for SIDS after initiation of Back-to-Sleep campaign. Pediatrics 2012 evaluation · 2012 · DOI 10.1542/peds.2011-1419 · PMID 22451703
  13. Moon RY, Biliter WM. Infant sleep position policies in licensed child care centers after Back to Sleep campaign. Pediatrics 2000 evaluation · 2000 · DOI 10.1542/peds.106.3.576 · PMID 10969105
  14. Gibson E et al. Infant sleep position practices 2 years into the Back to Sleep campaign. Clin Pediatr 2000 evaluation · 2000 · DOI 10.1177/000992280003900505 · PMID 10826076
  15. Moon RY (AAP Task Force). SIDS and other sleep-related infant deaths: expansion of recommendations. Pediatrics 2011 reference · 2011 · DOI 10.1542/peds.2011-2284 · PMID 22007004
  16. Marshall JM, Shahzad F. Safe Sleep, Plagiocephaly, and Brachycephaly. Pediatr Ann 2020 reference · 2020 · DOI 10.3928/19382359-20200922-02 · PMID 33034660
  17. NICHD Safe to Sleep campaign history sponsor
  18. NICHD spotlight: outreach efforts to different audiences sponsor
  19. NICHD: Collaborating to Improve the Health of Native Babies sponsor
  20. Randall LL et al. The Aberdeen Indian Health Service infant mortality study: design, methodology, and implementation. 2001 evaluation · 2001 · DOI 10.5820/aian.1001.2001.1 · PMID 11484150
  21. McCulloch K et al. Prevalence of SIDS risk factors before and after Back to Sleep in North Dakota Caucasian and American Indian infants. Clin Pediatr 2000 evaluation · 2000 · DOI 10.1177/000992280003900705 · PMID 10914305
  22. Rasinski KA et al. SIDS risk reduction education program in primarily black urban communities (Chicago). Pediatrics 2003 evaluation · 2003 · DOI 10.1542/peds.111.4.e347 · PMID 12671150
  23. Colson ER et al. Barriers to following the supine sleep recommendation among WIC mothers. Pediatrics 2006 evaluation · 2006 · DOI 10.1542/peds.2005-2517 · PMID 16882769
  24. Herman S, Adkins M, Moon RY. Knowledge and beliefs of African-American and American Indian parents about infant safe sleep. J Community Health 2015 evaluation · 2015 · DOI 10.1007/s10900-014-9886-y · PMID 24859736
  25. Stiffler D et al. Considerations in Safe to Sleep messaging: learning from African-American mothers. J Spec Pediatr Nurs 2019 evaluation · 2019 · DOI 10.1111/jspn.12277 · PMID 31742922
  26. Prone Infant Sleeping Despite the "Back to Sleep" Campaign evaluation · 1999 · DOI 10.1001/archpedi.153.5.512 · PMID 10323633
  27. A Reassessment of the SIDS Back to Sleep Campaign reference · 2005 · DOI 10.1100/tsw.2005.71 · PMID 16075152
  28. International Trends in Sudden Infant Death Syndrome: Stabilization of Rates Requires Further Action reference · 2008 · DOI 10.1542/peds.2007-0135 · PMID 18762537
  29. Qualitative Analysis of Infant Safe Sleep Public Campaign Messaging evaluation · 2017 · DOI 10.1177/1524839917690339 · PMID 29161896
  30. Effectiveness of the ‘Back-to-Sleep’ campaigns among healthcare professionals in the past 20 years: a systematic review evaluation · 2016 · DOI 10.1136/bmjopen-2016-011435 · PMID 27694485
  31. “Safe to Sleep” Campaign: Preventing Sudden Unexpected Infant Death sponsor · 2012 · DOI 10.1111/j.1751-486x.2012.01779.x
  32. Message Dissemination Strategies of the Safe to Sleep Campaign to Reduce Infant Mortality history · 2013

Research notes

Updated 2026-10-23 (sleep campaign search): the decline is now sourced to Erck Lambert 2018 (SUID down 44.6% 1990-98, then 7% 1999-2015 as deaths moved from the SIDS code to suffocation and unknown-cause codes); NICHD's own 'more than 50%' figure was seen only in search summaries. The earlier UK, New Zealand, Australian and Dutch campaigns are now related cases. Outreach to African American families (NICHD resource kit, sorority and NAACP training summits, the Mississippi outreach project from 2006) has no published outcome evaluation; the Healthy Native Babies Project (from 2002) has process data only; local evaluations of outreach to Black families are in the sources (Chicago 2003, WIC 2006, Herman 2015, Stiffler 2019). Founding partners per NICHD history (MCHB, AAP, SIDS Alliance/First Candle, AOPO) not verified. Reuse terms checked 2026-10-23 by an AI research pass for #47; not yet reviewed by a person.

Record cases/back-to-sleep.json, updated 2026-10-23· Link to this campaign