Public health advice or action is often needed before the evidence supporting that advice or action is conclusive. The initial recommendation not to place infants prone to sleep was made on the basis of the findings from case-control studies that showed that infants who were placed prone to sleep were at an increased risk of sudden infant death syndrome (SIDS).1 No randomized controlled study was undertaken. A dramatic decline in SIDS mortality rates was observed in the Netherlands,2 New Zealand,3 and the United Kingdom (Avon, England).4 This provided additional information for various authorities in other countries, including the American Academy of Pediatrics, to also recommend the supine sleeping position for healthy infants (“Back to Sleep” campaign).5 There was concern that deaths from aspiration of gastric contents would increase, but this was not seen. However, an unexpected consequence of the Back to Sleep campaign has been the epidemic of positional or deformational plagiocephaly.6 Thus, any public health intervention has to balance the benefits against the harms.
Mitchell EA. Sudden Infant Death SyndromeShould Bed Sharing Be Discouraged?. Arch Pediatr Adolesc Med. 2007;161(3):305-306. doi:10.1001/archpedi.161.3.305