*Belly up = bankrupt, obsolete
A baby’s sleep position—whether on the back or the belly, in and of itself, may not be a huge deal—
provided, of course, that each baby spends ample time on the belly while awake. The reasons for this are discussed below. What IS a huge deal, however, is the fear about prone positioning (on the tummy) instilled in the minds of many parents as a result of never-ending cautions issued by countless health professionals in response to the “Back to Sleep” campaign. Unfortunately, too many parents now believe that putting a baby on its belly, while awake or asleep, could be dangerous and might even cause a baby to die of SIDS (Sudden Infant Death Syndrome), in spite of the fact that pediatricians have tried to undo some of the damage caused by in “supervised” Tummy Time to offset the consequences that have been caused by not enough time on the belly.
Any single death from SIDS is one too many. This is especially true in the minds and hearts of any parent who has lived through this unfathomably heartbreaking loss. Even discussing this subject is complicated, especially when we talk about “trade-offs” that can appear callous and indifferent. After all, saving lives is always a good thing, and in raising questions about any aspect of “back-to-sleep” policy, it’s important to form an understanding of what lies buried under layers of a campaign that was originally fueled by good intentions, millions of Congressionally appropriated dollars, and professional policies that, by default, always remain above question.
The graph below shows the rate of SIDS between 1989 and 2006, based on statistics from the Centers for Disease Control.
This chart reveals that SIDS had already been declining during the five years prior to the launching of the “Back to Sleep” campaign. This massive public education effort cautioned all parents to always place their babies to sleep on their backs (supine position). This was essentially a precautionary measure, since it was believed that a baby might not be as able to lift its head and rescue itself during a breathing emergency if lying on the belly (prone). Statistics gathered from other countries also suggested that more deaths may have occurred in babies sleeping prone than supine, although, as you will see, the difference was remarkably small.
At the same time that parents were warned not to place their babies on their stomachs to sleep, they were also told to remove all bedding and stuffed toys from the sleeping environment. Just how large a role this played in the initial drop in SIDS deaths due to removal of objects that could contribute to suffocation, will never be known, even though it can be impossible in many cases to distinguish between suffocation or SIDS as the cause of death. In fact, we still don’t know what SIDS is, since it is, by definition, the lack of any diagnosis. Even if removing puffy bedding and stuffed toys played a role in the drop in deaths, any decrease in the number of deaths has been credited to back sleeping, and nothing else.
This next graph shows the number of babies during the same period of 1989 to 2006 who did NOT die of SIDS, based on the identical statistics.
People are often quite surprised to discover that at its peak in 1989, on 0.12% (or twelve-hundredths of one percent) of infant deaths were attributed to SIDS. Said another way—99.88% of all babies that year (and fewer in the years that followed) never died of SIDS. The odds of a baby dying of SIDS is equivalent to tossing ten quarters and having them all come up heads. This means that parents can put their babies to sleep in whatever position the baby seems to prefer (most babies do appear to sleep better on their bellies) while letting out a giant sigh of relief, along with that gnawing “SIDS fear” that’s been lurking in the background of their minds.
One last detail: The warnings were so successful that 85% of babies now sleep on their backs, yet the rate of SIDS since 2001 has hardly budged. This means that the majority of SIDS deaths today are among babies sleeping on their backs. This has caused the campaign’s name to be changed to “Safe Sleep,” with greater emphasis being given by the medical policy makers on other factors such as encouraging breastfeeding and discouraging smoking.
After watching this video, you’ll wonder
why anyone would suggest that infants
should never be placed on their bellies.
It’s rather absurd to imagine a baby at birth placed on its back atop the mother’s body. We all understand in those early moments of life that it is through the front of the body that the baby is connected with the mother, who, let us not forget, is one with the earth.
Babies who sleep on their backs tend to also be restricted on their backs much of the while awake, whether on a flat surface or in some sort of carrier or device. Evidence is piling up that many such babies are developing a lengthy list of developmental delays and other issues, compared to their prone-sleeping counterparts. (1,2, 3, 4, 5).
This isn’t surprising. On the back, a newborn is physically disconnected from whatever surface upon which she is lying. She startles easily in this position and doesn’t sleep as soundly. One reason babies are swaddled, is to provide a sense of physical security and connection when they’re on their backs.
On her belly, a baby’s body more naturally settles in and connects through gravity to whatever surface she’s lying on—a parent’s body, a blanket on the floor, a mattress of some sort—each of which represents the Earth’s gravitational and energetic field.
This surface provides a stable anchor into which she can surrender her weight and feel grounded—held, in fact—by this all-new world in which she finds herself. As her tiny body engages against this surface, she’s likely to be aware of multiple sensations occurring inside her skin, a different experience than taking in external stimuli from outside of herself, as when she’s lying on her back.
Identifiable scientific principles are at work that explain WHY belly-to-earth activity is so necessary (the subject of a later post) but for now, here’s a bit of backstory for context:
—About ten years after the Back-to-Sleep campaign was launched, AAP launched an additional policy recommendation they called “Tummy Time.” This came about as an attempt to offset the 600% increase (8) in the number of babies who had developed flat areas on their heads known as plagiocephaly or brachycephaly—or simply “flat heat syndrome.” Current recommendations today at websites such as the Mayo Clinic recommend that by 4-months of age, one should aim for a baby spending at least 20 minutes a day lying on the tummy. (9) This leaves 23 hours and 40 minutes of each day spent lying supine or reclining in some sort of sitting device. Unfortunately for many babies, especially those who are not “worn” frequently in cloth carriers upon a parent’s body, this is just too little and too late.
— More recently, doctors and pediatric therapists have begun to double down on their efforts to get babies to do even more “tummy time.” This comes in response to mounting evidence that supine (on the back) sleepers exhibit more motor and other developmental delays than prone (on the belly) sleepers (1-5). In fact, typical ages for accomplishing certain milestones of gross motor skills such as rolling over, sitting up, crawling, and walking have been adjusted to match this “new normal.”
I have observed this repeatedly. Babies who have ample opportunities to move “against” the earth or some proxy surface of the earth, display many signs of greater physical activity and strength, from a very early age. Most especially, they are activating the deepest core muscles that will be called on to support the upright spine. Thus, the seeds are planted for natural, healthy development in all the ways that build a strong and flexible body, develop a fully functioning nervous system, and establish natural mechanical components that will support naturally aligned posture and good health in the months and years to come.
Instinctive, belly-to-earth neurodevelopmental movements
in the first few months of life
should be the focus of close attention and study.
Until then, here’s one final, very important thought to keep in mind:
The very best kind of “tummy time”
is when a baby’s sweet belly is in contact
with the mother’s or father’s body—
Kathleen Porter is a posture and movement coach. She is the author of Natural Posture for Pain-Free Living: The Practice of Mindful Alignment (Inner Traditions, 2006 & 2013) and Healthy Posture for Babies and Children (July 2017). She has traveled the world researching and observing populations who live in naturally aligned bodies and who move, work and age with ease. She is the creator of UpRightNOW, an online program she is developing for adults and children alike, and her company Natural Posture Solutions manufactures several small posture aids.
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(1) American Academy of Pediatrics Task Force on Infant Positioning and SIDS: Positioning and SIDS. Pediatrics 89:1120– 1126, 1992 (Erratum in Pediatrics 90:264, 1992).
(8) Argenta LC, David LR, Wilson JA, Bell WO: An increase in infant cranial deformity with supine sleeping position. J Craniofac Surg 7:5–11, 1996.
(9) Jay L. Hoecker, M.D. Mayo Clinic: What’s the Importance of Tummy Time for a Baby? http://www.mayoclinic.org/healthy-lifestyle/infant-and-toddler-health/expert-answers/tummy-time/faq-20057755
(10) Bradley B. Randall, David S. Paterson, Elisabeth A. Haas, Kevin G. Broadbelt, Jhodie R. Duncan, Othon J. Mena, Henry F. Krous, Felicia L. Trachtenberg, and Hannah C. Kinney. Potential Asphyxia and Brainstem Abnormalities in Sudden and Unexpected Death in Infants. Pediatrics, November 2013
(12) James J. McKenna* and Thomas McDade. Paediatric Respiratory Reviews. (2005) 6, 134–152
(13) Ralph Pelligra, Glenn Doman, and Gerry Leisman. A Reassessment of the SIDS Back to Sleep Campaign. TheScientificWorldJOURNAL(2005) 5, 550–557 ISSN 1537-744X; DOI 10.1100/tsw.2005.71
(15) Togari, H., Kato, I., Saito, N., and Yamaguchi, N. (2000) The healthy human infant tends to sleep in the prone rather than the supine position. Early Hum. Dev. 59(3), 151–158.
(16) Heather Catchpole. ABC http://www.abc.net.au/science/articles/2003/12/10/1006190.htm
(17) Nils J. Bergman. Proposal for mechanisms of protection of supine sleep against sudden infant death syndrome: an integrated mechanism review. International Pediatric Review Foundation. 2014.
(18) Nils J. Bergman.Hypothesis on supine sleep, sudden infant death syndrome reduction and association with increasing autism incidence. World Journal of Clinical Pediatrics. 5 (3) 330-342. August, 2016.