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Profile of SIDS Risk Shifts After Launch of Back-to-Sleep Campaign


After the launch of the Back-to-Sleep campaign in 1994, the rate of Sudden Infant Death Syndrome declined by more than 50 percent, and then plateaued. In a study in the April 2012 Pediatrics, researchers examine whether the predominant risk factors involved in SIDS deaths have changed in the Back-to-Sleep era. 

The study, "Risk Factor Changes for Sudden Infant Death Syndrome After Initiation of Back-to-Sleep Campaign​," published online March 26, examined SIDS deaths in San Diego from 1991 to 2008. In that time period, the percentage of infants who died of SIDS after being placed to sleep in the prone position decreased from 85.4 percent to 30.1 percent. The proportion of other risk factors for SIDS changed relative to each other since the initiation of the Back-to-Sleep campaign, but virtually all SIDS infants had at least one risk factor. The percentage of SIDS infants bed-sharing at the time of death increased from 19.2 percent to 37.9 percent, especially among infants younger than 2 months, and the percentage found in an adult bed increased from 23.4 percent to 45.4 percent. Ninety-nine percent of SIDS infants had at least one intrinsic risk factor (such as male gender or prenatal exposure to cigarettes) or one extrinsic risk factor (such as prone sleep position or soft bedding); 75 percent had at least one of each type of risk factor. The majority (57 percent) had at least two extrinsic and one intrinsic risk factor. Prone sleep remains the most significant risk factor for SIDS, but study authors found that sleeping on adult mattresses and bed-sharing have emerged as additional prominent risks. 

Study authors conclude that SIDS prevention campaigns should emphasize the importance of avoiding multiple and simultaneous risks.​


The American Academy of Pediatrics is an organization of 60,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit

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