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Advocates of back sleeping point out that the practice of putting babies on their stomach was introduced only in the past 30 years -- and only in certain Western countries -- based on limited evidence that it helps increase the survival of premature infants.
Whatever the explanation, it is hard to argue with the results achieved in so many studies. European researchers are therefore baffled as to why there has been no major public-service campaign to alter infant sleeping habits in the U.S., where three-fourths of all babies are still placed on their stomach. American doctors have two main areas of concern. While lying on their back, babies may vomit or choke more easily, says Dr. Susan Orenstein, a pediatrician at the University of Pittsburgh Medical Center. This is a particular risk with premature or underweight infants. In addition, she says, it is not fully clear from the European studies whether it is the sleeping position or some other factor that accounts for the drop in SIDS rates. For example, more parents might bundle up their babies, which could lead to overheating. Says Orenstein: "We need to be sure that the supine position has significant benefits that we cannot obtain any other way before we advocate a wide-scale switch in sleeping position in the U.S."
Last year a task force of the American Academy of Pediatrics decided to buck this conservative position and recommend that healthy, full-term babies be placed on their side or back. The decision was not widely publicized, however, and continues to be controversial. "We don't have U.S. data to support it," says SIDS Alliance spokeswoman Phipps Cohe. Maybe so, but crib-death specialists in other countries wonder if there isn't a more emotional reason for American foot dragging. Says New Zealand pediatrician Shirley Tonkin: "There is reluctance on the part of medical people to admit that what they had been recommending in the past could be harmful."