From 1989 to 1991, several studies from other countries, primarily the Netherlands, Australia and New Zealand, reported a strong statistical association between the prone sleeping position and the occurrence of SIDS. Admittedly, there were problems with this data. First it was from countries with SIDS rates much higher than in the US. It was also complicated by many confounding factors, well recognized themselves as important sleep stressors, namely cosleeping, overheating and soft bedding. Finally the data was clearly retrospective in nature. However the sheer volume and consistency of it was persuasive. Additionally, in the Netherlands an increase in SIDS was seen following a nationwide change in sleeping position from predominantly supine to prone. Also in the UK and New Zealand, the reverse was reported, an abrupt decline in SIDS rates following a societal change from prone to supine.

Based on all of this evidence, in 1992 an AAP Task Force on Infant Positioning and SIDS recommended that healthy infants be put to sleep on their side or back. In 1994, a nationwide public relations campaign titled "Back to Sleep" was initiated to promote the supine sleeping position. Subsequently, the side-lying position, inherently unstable in infants, was discouraged. The result of these efforts was a clear decrease in SIDS rates accompanied by an increase in supine sleeping.



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