New parents are told again and again how important sleeping position is for newborns and babies under one year of age. The reason is simple: educating mothers and fathers about the risk of SIDS, sudden infant death syndrome, which is linked to sleeping position. Yet some parents still do not know this important fact--and it's extremely likely that some caregivers--grandparents, babysitters, even daycare workers--are ignorant of the advice given by the Back to Sleep Campaign, which, through teaching parents and caregivers about the best sleeping position for infants for SIDS prevention, has lowered the incidence of infants dying from SIDS by as much as 50 percent. Let your caregiver know that he or she must put a baby under one year old to bed in the recommended sleeping position even for a short nap.

It should be stated right off that there is not really any such thing as SIDS prevention--yet.  SIDS cannot yet be prevented--according to what researchers know, the risk can only be reduced. While this is disturbing to know for many parents, it's good news that the Back to Sleep campaign has been so successful in reducing the incidence of SIDS.

Crib death, another name for sudden infant death syndrome, is known to be the most common cause of mortality in babies in their first year of life. Most cases occur between the ages of 2 and 4 months. And by six months, 90 percent of SIDS cases occur. After 6 months, the risk decreases, but does not go away, and parents are still strongly advised to put the baby to sleep on her back. SIDS usually happens when babies are asleep.  Generally, the infant cannot be roused even if treated immediately with CPR.  A frightening thought to most parents, SIDS happens across the globe, crossing racial, national, class and socioeconomic boundaries.

The cause of SIDS remains a mystery, to the agony of the parents whose babies still die of SIDS, despite the efforts and partial success of the Back to Sleep Campaign. Sudden infant death syndrome has been researched all over the world, and theories abound, but nothing has been conclusively shown. One promising hypothesis is that when they're on their stomachs (in the prone position), if they fall into a deep sleep--the particular kind of sleep infants are known for when the're not in REM--babies' immature respiratory systems can't adjust successfully to pockets of CO2 that build up or other breathing obstructions. Some individuals speculate that toxins in the bedding and mattresses cause SIDS in some cases. There's a good chance that there are multiple causes for multiple cases, all of which are lumped together under the term "SIDS."

Despite not knowing what causes SIDS, researchers are aware of certain risk factors that increase an infant's risk of dying of SIDS.

The risk of SIDS happening to a baby is higher in:

• young mothers under 20 years of age
• mothers who experienced prenatal care that was substandard
• mothers who used drugs, smoked or drank alcohol during pregnancy
• low-birthweight infants
  
• babies who were exposed to cigarette smoke after their birth
• babies of American Indian/Native Alaskan descent
• babies of African American descent
• babies who get too hot while sleeping, due to being bundled up or simply hot weather
• babies who sleep on their stomachs, either during the night or during naps
  

The American Academy of Pediatrics has stated definitively that the best sleeping position for infants under one year of age--indeed, the only recommended sleeping position--is on her back. The National Institutes of Health shows in this PDF document what a safe sleep environment for a baby looks like.

• Always, at naps or at nighttime, put your baby to bed on her back.
• Furthermore, make sure her feet are at the crib's base.
• Do not dress your baby in baggy sleepwear. Onesies, footies or other sleepwear should be close-fitting.
• The crib mattress should be firm and of the type approved for infant safety.
• One fitted sheet should cover the mattress without folding or bunching.
• In cold weather, do not put your baby to bed bundled up in clothing or blankets. You can stretch a light baby blanket over the baby--but the blanket should be tucked into the mattress sides and reach no higher than her chest.
  
• Keep all toys, pillows, quilts, and other plush objects outside the crib while baby is napping or asleep.
• Make a list of these rules so caregivers can follow them.
  

Gastroesophageal reflux disease, or GERD, afflicts some babies. In some cases, babies experience an uncomfortable degree of reflux--a certain amount actually being normal for infants due to their immature digestive systems. Formerly, some physicians would advise parents to allow babies suffering with severe cases to sleep on their stomachs. Only rarely is this still advised. Doctors prefer to recommend parents elevate an infant's upper body by raising the head of the crib using specially shaped props. The moral of the story? Even in such a case, put your baby to sleep on her back unless advised otherwise by her pediatrician.