Anybody who has had a baby since 1994 has heard of Back to Sleep – a U.S. government sponsored parent education campaign that has reduced SIDS (or crib deaths) by over 50% since the program’s start.

In 2006, Back to Sleep was updated to include recommendations for NICU and preemies. But recent studies have found that nurses have not always been given the tools needed to implement Back to Sleep guidelines in the hospital and this has affected their teaching.

Take this Back to Sleep quiz to see if you know the facts about SIDS prevention and Back to Sleep guidelines.

True or False:
1) The only thing I need to know about Back to Sleep is that my baby should sleep on his back.
2) Secondhand cigarette smoke increases the risk of SIDS.
3) Back to Sleep guidelines are recommended until a baby is 1 years old, even if the baby is big or rolling over on their own.
4) Crib quilts, small pillows, bumpers and stuffed toys are never safe, even if they are not touching the baby’s face.
5) My baby will wake up if a blanket or soft toy is making it difficult for her to breathe.
6) I should not place my baby on his back to sleep if I’m worried about his head flattening.
7) Both boys and girls are at risk for SIDS.
8) Pillows should never be placed directly under an infant who needs to sleep with her head elevated for reflux or respiratory problems.
9) If I can’t use blankets on my baby, then I should keep the room warm or dress him extra warm.
10) I should swaddle my newborn or preemoe and put a hat on her while she sleeps so she doesn’t get cold.
11) Since pacifiers are a part of SIDS prevention, I should force my baby to use one and put it back in his mouth if it falls out when he’s asleep.
12) Using a positioning roll to keep a baby on his side is a safe alternative to back sleeping and will prevent choking if the baby spits up.

Answers:
1) FALSE. There is so much more to know! Read on!
2) TRUE. It’s not just about the smoke, it's the chemicals in the smoke that remain long after the smoke is gone (third hand smoke). This doesn’t just apply to smoking in a house or car while the baby is present. People who step outside to smoke trap smoke in their clothes. Car fabrics and car seats absorb smoke, even if the smoker cracks the window. This exposure increases the risk of SIDS as well as asthma, allergies, and ear infections.
3) TRUE. Being big or healthy does not reduce the risk of SIDS. Back to Sleep can be a struggle when your baby starts rolling over around 4 to 7 months, but you still need to try to return your baby to his back.
4) TRUE. SIDS doesn’t just happen when the baby’s face is covered. It’s believed that soft items close to the baby’s nose and mouth combined with the way a sleeping baby breathes can lead to SIDS deaths. Pushing cute bedding and toys to the bottom of the crib doesn’t protect the baby – even very new babies can get themselves into some unusual positions and places. It’s not uncommon for a baby to move around the crib while half asleep or crying, then fall back asleep someplace unexpected. Older babies can travel in the crib while still asleep. The picture at the top of this post is an example of how your baby's crib should look when your baby is sleeping in it.
5) FALSE. It’s believed that SIDS deaths occur because the baby cannot sense that he is not getting enough oxygen and reflexively wake up until after 1 year of age.
6) FALSE. Change the focus to worrying about pressure on your baby's head while he's awake, not while he's asleep. Increasing tummy time and changing how and where you position your baby while he is awake will prevent head flattening. Flip the head and foot of the crib often if your baby tends to turn her head to one side more than the other.
7) TRUE. SIDS affects more boys than girls, but baby girls are still at risk.
8) TRUE. Elevate the head of the bed, not the baby! We had to elevate the crib head for both of my babies, and we found the easiest way was to have a piece of MDF (or plywood) cut to the size of the crib mattress then put that under the mattress. We used folded blankets and a pillow between the wood and crib frame to create a wedge. Sleep wedges that are meant to go under a baby’s face can also be purchased.
9) FALSE. Being overly warm increases the risk of SIDS. Keep room temperature between 68 and 72 degrees, basically an adult should be comfortable in short sleeves. Dress baby in a properly fitting sleeper, with a onesie or tee shirt underneath if needed. Keep the crib away from windows and out of drafts.
10) FALSE. This one is hard for NICU grads, where the baby was always swaddled, wearing a hat, and there might even have been a blanket draped over the head of the bassinet. A baby should not wear a hat while sleeping. It’s a lot easier for parents to control the lighting, room temperature, and drafts at home then it is in a hospital.
11) FALSE. While pacifier use has been shown to reduce the risk of SIDS, not every baby is soothed by a paci so it shouldn’t be forced. Breastfed babies should be offered the paci after a month of successful breastfeeding (don’t worry – nothing will be as good as Mom at that point). Remember, this is about SIDS prevention. Anti-pacifier philosophy is a leftover from “Before We Knew Better” when compared to your baby’s life. It’s okay to limit paci use to only as your baby is falling asleep. That’s the time when it’s effective in reducing the risk of SIDS. When it falls out of baby’s mouth, leave it out. Pacifier as the baby is falling asleep and pacifier to soothe in other situations are two different things. Some parents are concerned about baby’s getting hooked on the paci even if its use is limited. There are a lot of resources out there dealing with how to get a baby or toddler off the paci. I’d rather have a two year old with a pacifier or a kid with braces than the other possibility. Of course, there is no guarantee that the pacifier will prevent SIDS death, but it’s a simple and cheap way to reduce a baby’s risk.
12) FALSE. A healthy baby will turn their head to the side if they spit up, many already sleep with their head turned while on their back. The concern with positioning wedges is that a baby can flip (even newborns can flip sometimes) or slide and wind up in a potentially dangerous position. If you have a preemie or baby with medical concerns, talk to your pediatrician about safe sleep positioning for your baby.

Reducing the Risk of SIDS in Childcare is a free online course for parents, caregivers, and healthcare professionals interested in learning to create a safe sleep environment for infants. Use code SIDSCCP to access the course for free.

Helping Baby Back to Sleep describes Back to Sleep guidelines and answers FAQ's.