question: why is it safe for babies to sleep on their back when they are always spitting up when if an adult passes out drunk its safer to roll them on their side to prevent choking
comment: Sleeping on the stomach is dangerous because of smothering/asphyxia. Small babies don't have the strength or coordination to move their heads into a position where breathing is possible. Laying on their back with head turned allows both breathing and adequate room/safety for vomit to pool.
passages: In the 1958 edition of his best-selling book "The Common Sense Book of Baby and Child Care", pediatrician Dr Benjamin Spock warned against placing a baby on its back, writing, "if [an infant] vomits, he's more likely to choke on the vomitus." However, later studies have shown that placing a young baby in a prone position increases the risk of sudden infant death syndrome (SIDS). A 2005 study concluded that "systematic review of preventable risk factors for SIDS from 1970 would have led to earlier recognition of the risks of sleeping on the front and might have prevented over 10,000 infant deaths in the UK and at least 50,000 in Europe, the USA, and Australasia."
   Sleeping on the back has been found to reduce the risk of SIDS. It is thus recommended by the American Academy of Pediatrics and promoted as a best practice by the US National Institute of Child Health and Human Development (NICHD) "Safe to Sleep" campaign. The incidence of SIDS has fallen in a number of countries in which this recommendation has been widely adopted. Sleeping on the back does not appear to increase the risk of choking even in those with gastroesophageal reflux disease. While infants in this position may sleep more lightly this is not harmful. Sharing the same room as one's parents but in a different bed may decrease the risk by half.
   In 1992, the American Academy of Pediatrics (AAP) issued the recommendation that babies sleep on their backs or sides to reduce the risk of SIDS (a statement that was later revised in 1996 to say that only the back was safest). NICHD launched the "Back to Sleep" campaign in 1994 to spread the message.
   Since 1992, the American Academy of Pediatrics has recommended that infants be placed to sleep on their backs to reduce the risk of sudden infant death syndrome (SIDS), also called crib death. SIDS is the sudden and unexplained death of a baby under 1 year of age. Even though there is no way to know which babies might die of SIDS, recommendations include:
  
  BULLET::::- Always place the baby on his or her back to sleep, even for naps. This is the safest sleep position for a healthy baby to reduce the risk of SIDS.
   In 1992, the first National Infant Sleep Position (NISP) Household Survey was conducted to determine the usual position in which U.S. mothers placed their babies to sleep: lateral (side), prone (stomach), supine (back), 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.
  
  Section::::See also.
  
  BULLET::::- Tummy time
  
  BULLET::::- Plagiocephaly
  
  BULLET::::- United States Department of Health and Human Services
  
  Section::::External links.
  
  BULLET::::- Safe Sleep For Your Baby
   Cot side
  
  Cot sides are raised sides fitted to a bed to stop the occupant from falling out of bed. They occur:
  
  BULLET::::- In toddler beds; however in infant beds the sides are to prevent intentional, rather than accidental, exit.
  
  BULLET::::- In normal beds, where the occupant temporarily (due to age or infirmary) cannot be relied on exiting the bed safely.
  
  BULLET::::- In hospitals where a patient cannot be trusted to stay in bed. Here they are detachable.
   In 1992 a SIDS risk reduction strategy based upon lowering arousal thresholds during SWS was implemented by the American Academy of Pediatrics (AAP) which began recommending that healthy infants be positioned to sleep on their back (supine position) or side (lateral position), instead of their stomach (prone position), 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.
   Some mothers worry if the baby rolls over during the night. However, by the time the baby is able to roll over by herself, the risk for SIDS is much lower. During the time of greatest risk, 2 to 4 months of age, most babies are not able to turn over from their backs to their stomachs.
  
  Section::::Car seats.
   An unconscious person, a person who is assessed on the Glasgow Coma Scale (GCS) at eight or below, in a supine position (on the back) may not be able to maintain an open airway as a conscious person would. This can lead to an obstruction of the airway, restricting the flow of air and preventing gaseous exchange, which then causes hypoxia, which is life-threatening. Thousands of fatalities occur every year in casualties where the cause of unconsciousness was not fatal, but where airway obstruction caused the patient to suffocate. The cause of unconsciousness can be any reason from trauma to intoxication from alcohol.
   First aid organisations were similarly slow in adopting the idea of the recovery position, with 1930s and 1940s first aid manuals from the British Red Cross and St John Ambulance both recommending lying a patient on their back. The 1938 British Red Cross First Aid Manual goes so far as to instruct "place the head in a such as position that the windpipe is kept straight, keeping the head up if the face is flushed, and in line with the body if it is pale". By contrast, the St. John manual advocated turning the head to the side, but it was not until the 1950 40th edition of the St. John Manual that it was added "if breathing is noisy (bubbling through secretions), turn the patient into the three-quarters prone position", which is very similar to a modern recovery position.
   Placing an infant to sleep while lying on the stomach or the side increases the risk. This increased risk is greatest at two to three months of age. Elevated or reduced room temperature also increases the risk, as does excessive bedding, clothing, soft sleep surfaces, and stuffed animals. Bumper pads may increase the risk of SIDS due to the risk of suffocation. They are not recommended for children under one year of age as this risk of suffocation greatly outweighs the risk of head bumping or limbs getting stuck in the bars of the crib.
   In 1992, the American Academy of Pediatrics recommended babies sleep on their backs to prevent Sudden Infant Death Syndrome (SIDS). Although the rate of SIDS decreased by 50% since the Safe to Sleep campaign started in 1994, an unintended consequence was that babies missed out on the twelve or so hours they used to spend in the prone position and there was a sharp increase in skull deformations in infants. Along with tummy time, rotating the direction infants lie in their crib as well as avoiding too much time in car seats, carriers, and bouncers are behaviors recommended to alleviate the associated risks of infants sleeping in a supine position.
   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 (SWS) 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 (NREM sleep) which is also called quiet sleep (QS) during the first 12 months of life in association with a decrease in rapid eye movement sleep (REM sleep) which is also known as active sleep (AS). In addition, slow wave sleep (SWS) 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 (also called deep sleep) and therefore have an increased risk of SIDS due to their decreased ability to arouse from SWS.
   In 1985 Davies reported that in Hong Kong, where the common Chinese habit was for supine infant sleep position (face up), SIDS was a rare problem. In 1987 the Netherlands started a campaign advising parents to place their newborn infants to sleep on their backs (supine position) instead of their stomachs (prone position). This was followed by infant supine sleep position campaigns in the United Kingdom (as "Back to Sleep"), New Zealand, and Australia in 1991, the U.S. and Sweden in 1992, and Canada in 1993.
   In children, a sitting flexed position was as successful as lying on the side with respect to obtaining non-traumatic CSF, CSF for culture, and cell count. There was a higher success rate in obtaining CSF in the first attempt in infants younger than 12 months in the sitting flexed position.
   Safe to Sleep
  
  The Safe to Sleep campaign, formerly known as the Back to Sleep campaign, is an initiative backed by the US National Institute of Child Health and Human Development (NICHD) at the US National Institutes of Health to encourage parents to have their infants sleep on their backs (supine position) to reduce the risk of sudden infant death syndrome, or SIDS. Since "Safe to Sleep" was launched in 1994, the incidence of SIDS has declined by more than 50%.
  
  Section::::History.
   Spock advocated that infants should not be placed on their back when sleeping, commenting in his 1958 edition that "if [an infant] vomits, he's more likely to choke on the vomitus." This advice was extremely influential on health-care providers, with nearly unanimous support through to the 1990s. Later empirical studies, however, found that there is a significantly increased risk of sudden infant death syndrome (SIDS) associated with infants sleeping on their abdomens. Advocates of evidence-based medicine have used this as an example of the importance of basing health-care recommendations on statistical evidence, with one researcher estimating that as many as 50,000 infant deaths in Europe, Australia, and the US could have been prevented had this advice been altered by 1970, when such evidence became available.
   Some parents pose threats to infants due to their behaviors and conditions, such as smoking or drinking heavily, taking drugs, a history of skin infections, obesity, or any other specific risk-increasing traits. In addition, there are certain dangerous behaviors that increase SIDS and should be avoided whether placing a baby in a crib or co-sleeping: infants should always sleep on their backs on a firm surface (not waterbeds, pillows, recliners, or couches), mattresses should intersect the bedframe tightly, there should be no stuffed animals or soft toys near the baby, blankets should be light, a baby's head should never be covered, and other SIDS risk factors should be avoided.
   Swaddling was supposed to keep babies on their back, in order to prevent SIDS. Swaddling itself is not seen as a protective factor for SIDS. Swaddling may even increases the risk when babies sleep in the prone position; it reduces the risk if they sleep in the supine position. A recent study demonstrated now, that swaddling is apparently a risk factor for SIDS, although the opposite was often previously assumed: Of the babies who died of SIDS, 24% were swaddled; in the control-groups only 6% were swaddled.
  
  Section::::Psychological and physiological effects.:Documented negative effects.
   The campaign was successful in that it significantly reduced the percentage of babies sleeping on their stomachs (prone position). 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 Services Donna Shalala and Tipper Gore refocused the "Back to Sleep" campaign on minority babies.
  
  Section::::History.:Campaign.
   The earliest recognition that placing unconscious patients on their side would prevent obstruction of the airway was by Robert Bowles, a doctor at the Victoria Hospital in Folkestone, England. In 1891 he presented a paper with the title "'On Stertor, Apoplexy, and the Management of the Apoplectic State'" in relation to stroke patients with noisy breathing from airway obstruction (also known as stertor).
   The decline in death due to sudden infant death syndrome (SIDS) is said to be attributable to having babies sleep in the supine position. It is believed that in the prone position babies are more at risk to re-breathe their own carbon dioxide. Because of the immature state of their central chemoreceptors, infants do not respond to the subsequent respiratory acidosis that develops. Typical non-infants realize autonomic responses of increased rate and depth of respiration (hyperventilation, yawning).
  
  Section::::Obstructive sleep apnea.
   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 (EEG) during slow-wave sleep.
   In the 1998 article entitled "Does the Supine Sleeping Position Have Any Adverse Effects on the Child? II. Development in the First 18 Months" by Dewey, Fleming, Golding, and the ALSPAC Study Team the objective of the study was "To assess whether the recommendations that infants sleep supine could have adverse consequences on their motor and mental development." They used the Denver Developmental Screening Test (DDST) and studied infants at 6 and 18 months. According to the study, at 6 months of age, the infants who were placed to sleep in the prone position had statistically significant higher social skills scores, gross motor scores, and total development scores than those infants who were put to sleep in the supine position. In the 2005 article entitled "Influence of supine sleep positioning on early motor milestone acquisition" by Majnemer and Barr they used the Alberta Infant Motor Scale Scores (AIMS Scores) to analyze the impact of infant sleep position. They reported that "Typically developing infants who were sleep-positioned in supine had delayed motor development by age 6 months, and this was significantly associated with limited exposure to awake prone positioning." But, the authors also note that awake prone (stomach) positioning is associated with prone (stomach) sleeping. No studies have been conducted which compare supine sleeping infants who have regular awake prone positioning to prone sleeping infants who have regular awake prone positioning.
   BULLET::::- Positional Plagiocephaly – IN 1992, to decrease the incidence of SIDS, the American Academy of Pediatrics initiated the “Back to Sleep” campaign, which recommended that babies be put to sleep on their backs. While this almost halved the number of SIDS deaths, the campaign appeared to also help raise plagiocephaly incidence fivefold, to roughly one in sixty live births. Plagiocephaly is simply the flattening of one area of the skull, generally one babies tend to favor as they lie. While treatment is often as simply as repositioning the baby during sleep, in more pronounced cases helmet therapy may be put to use. In most cases, plagiocephaly is quite minor and easily resolved, with many more pediatric plastic surgeons becoming familiar with helmet therapy for more advanced cases.
  
presuppositions: It is definitely not safe for babies to sleep on their back. It is not safe for babies to sleep on their back. It is unsafe for babies to sleep on their back. It doesn't seem safe for babies to sleep in their back.  It is not safe for babies to sleep on their back. It is not safe for babies to sleep on their back.
corrections: The safest way for babies to sleep is on their back with their head turned to the side. The safest way for babies to sleep is on their back with their head turned to the side. The safest way for babies to sleep is on their back with their head turned to the side. The safest way for babies to sleep is on their back with their head turned to the side. The safest way for babies to sleep is on their back with their head turned to the side. The safest way for babies to sleep is on their back with their head turned to the side.
raw_presuppositions: It is definitely not safe for babies to sleep on their back. It is not safe for babies to sleep on their back. It is unsafe for babies to sleep on their back. It doesn't seem safe for babies to sleep in their back.  It is not safe for babies to sleep on their back. It is not safe for babies to sleep on their back. It is safe for babies to sleep on their back.
raw_corrections: The safest way for babies to sleep is on their back with their head turned to the side. The safest way for babies to sleep is on their back with their head turned to the side. The safest way for babies to sleep is on their back with their head turned to the side. The safest way for babies to sleep is on their back with their head turned to the side. The safest way for babies to sleep is on their back with their head turned to the side. The safest way for babies to sleep is on their back with their head turned to the side. The safest way for babies to sleep is on their back with their head turned to the side.