Emily Oster

3 min Read Emily Oster

Emily Oster

New Research on Back Sleeping and SIDS

Strong support for putting babies to sleep on their backs

Emily Oster

3 min Read

As befitting a book on babies, Cribsheet has a sizable chunk of content on sleeping. How long kids sleep, when they nap, sleep training and so on. I devote a chapter to safe sleep — notably, sleep position, sleep location and whether you can have stuff in the crib.

In that segment, I talk through the “Back to Sleep” recommendation which says, simply, that babies should be put to sleep on their back to reduce the risk of SIDS. This recommendation is widely credited with big reductions in infant mortality since its implementation in the early 1990s. In Cribsheet I argue that the constellation of evidence strongly supports the back sleeping recommendation. But I also note that there is no single smoking gun data source. The conclusion is based on a combination of small scale studies of SIDS deaths and evidence on variation in SIDS rates over time.

I get questions on this, often from parents who want to know if this evidence is really convincing. Their own parents remember advice to put infants to sleep on their stomachs and they often note that babies sometimes sleep better that way. What I’ve generally been able to say in response is that the circumstantial evidence is very compelling but not completely ironclad.

Then, a couple of weeks ago, a new working paper was released that (in my view) adds substantially to this evidence base, and strongly supports the back sleeping recommendation.

You can find the paper here if you want to look at the whole thing. The authors (Onur Altindag, Jane Greve and Erdal Tekin) do a simple but powerful analysis using data from Denmark. Prior to December 1991, official governmental guidelines suggested infants should be put to sleep on their stomach. After December, 1991 these guidelines abruptly switched to suggest infants be put to sleep on their back or side.

This change in recommendation was implemented in many countries. And, broadly, there have been reductions in SIDS deaths beginning in 1992, in line with this timing. However, they are slow and it’s been difficult to isolate the back sleeping effect from overall time trends.

These authors are able to make use of the fact that, in Denmark, there is a robust home visiting program from nurses. The Home Visiting Program (as it is called) began in 1937 and by 1962 reached most families. There were (are!) multiple home nurse visits in the first year and this is a key way many pediatric guidelines are conveyed. Notably, in this case, the changed guidelines on sleep position were immediately shared by these visiting nurses. This sharp timing change lets the researchers look at whether there is a resulting sharp change in SIDS deaths.

The paper uses a technique economists call “regression discontinuity” but which in lay terms may be better understood (in this case) as “graphing over time.” That is: the authors look at SIDS mortality rates before and after December 1991. The key graph is below.


What you see here is the sharp drop in SIDS mortality rate after December 1991. The drop amounts to, on average, a decrease of 11 SIDS deaths per 10,000 births. The authors also see a drop in overall infant mortality, which is about 13 deaths per 10,000 births (about 17% of the pre-period mean). (This may be slightly larger than the SIDS number because not all SIDS deaths are classified correctly).

Notably — and part of what makes this paper convincing — the graph below shows the no impact on non-SIDS infant deaths. If there was something else driving these improvements over time, we’d expect to see it show up here, and we do not.

The effects of back sleeping are larger for more vulnerable infants (low birth weight, preterm) and for families who likely have fewer resources (e.g. mothers who are less educated). This is consistent with the overall higher risk for these groups, and possibly with the fact that this was a more important source of information for them.

This stands out for me as an important step in really nailing this relationship and in making clear the magnitude. This is not just significant, it’s big. Based on the existing evidence, you should already have been putting infants on their back to sleep. This new data should further convince you that was the right thing to do.

(Final note: this work is a big advertisement for home nurse visiting. I’ve talked about this before, and even written a paper with some suggestive discussion of a possible role for this in explaining differences in mortality risks across the US versus Europe. I wish we had more of these!).

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Milestones. We celebrate them in pregnancy, in parenting, and they’re a fun thing to celebrate at work too. Just a couple years ago I couldn’t have foreseen what this community would grow into. Today, there are over 400,000 of you here—asking questions, making others feel seen wherever they may be in their journey, and sharing information that supports data > panic. 

It has been a busy summer for the team at ParentData. I’d love to take a moment here to celebrate the 400k milestone. As I’ve said before, it’s more important than ever to put good data in the hands of parents. 

Share this post with a friend who could use a little more data, and a little less parenting overwhelm. 

📷 Me and my oldest, collaborating on “Expecting Better”

Milestones. We celebrate them in pregnancy, in parenting, and they’re a fun thing to celebrate at work too. Just a couple years ago I couldn’t have foreseen what this community would grow into. Today, there are over 400,000 of you here—asking questions, making others feel seen wherever they may be in their journey, and sharing information that supports data > panic.

It has been a busy summer for the team at ParentData. I’d love to take a moment here to celebrate the 400k milestone. As I’ve said before, it’s more important than ever to put good data in the hands of parents.

Share this post with a friend who could use a little more data, and a little less parenting overwhelm.

📷 Me and my oldest, collaborating on “Expecting Better”
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I spend a lot of time talking people down after they read the latest panic headline. In most cases, these articles create an unnecessary amount of stress around pregnancy and parenting. This is my pro tip for understanding whether the risk presented is something you should really be worrying about.

Comment “link” for an article with other tools to help you navigate risk and uncertainty.

#emilyoster #parentdata #riskmanagement #parentstruggles #parentingstruggles

I spend a lot of time talking people down after they read the latest panic headline. In most cases, these articles create an unnecessary amount of stress around pregnancy and parenting. This is my pro tip for understanding whether the risk presented is something you should really be worrying about.

Comment “link” for an article with other tools to help you navigate risk and uncertainty.

#emilyoster #parentdata #riskmanagement #parentstruggles #parentingstruggles
...

Here’s why I think you don’t have to throw away your baby bottles.

Here’s why I think you don’t have to throw away your baby bottles. ...

Drop your toddlers favorite thing right now in the comments—then grab some popcorn.

Original thread source: Reddit @croc_docs

Drop your toddlers favorite thing right now in the comments—then grab some popcorn.

Original thread source: Reddit @croc_docs
...

Just keep wiping.

Just keep wiping. ...

Dr. Gillian Goddard sums up what she learned from the Hot Flash  S e x  Survey! Here are some key data takeaways:

🌶️ Among respondents, the most common s e x u a l frequency was 1 to 2 times per month, followed closely by 1 to 2 times per week
🌶️ 37% have found their sweet spot and are happy with the frequency of s e x they are having
🌶️ About 64% of respondents were very or somewhat satisfied with the quality of the s e x they are having

Do any of these findings surprise you? Let us know in the comments!

#hotflash #intimacy #midlifepleasure #parentdata #relationships

Dr. Gillian Goddard sums up what she learned from the Hot Flash S e x Survey! Here are some key data takeaways:

🌶️ Among respondents, the most common s e x u a l frequency was 1 to 2 times per month, followed closely by 1 to 2 times per week
🌶️ 37% have found their sweet spot and are happy with the frequency of s e x they are having
🌶️ About 64% of respondents were very or somewhat satisfied with the quality of the s e x they are having

Do any of these findings surprise you? Let us know in the comments!

#hotflash #intimacy #midlifepleasure #parentdata #relationships
...

Should your kid be in a car seat on the plane? The AAP recommends that you put kids under 40 pounds into a car seat on airplanes. However, airlines don’t require car seats.

Here’s what we know from a data standpoint:
✈️ The risk of injury to a child on a plane without a carseat is very small (about 1 in 250,000)
✈️ A JAMA Pediatrics paper estimates about 0.4 child air crash deaths per year might be prevented in the U.S. with car seats 
✈️ Cars are far more dangerous than airplanes! The same JAMA paper suggests that if 5% to 10% of families switched to driving, then we would expect more total deaths as a result of this policy. 

If you want to buy a seat for your lap infant, or bring a car seat for an older child, by all means do so! But the additional protection based on the numbers is extremely small.

#parentdata #emilyoster #flyingwithkids #flyingwithbaby #carseats #carseatsafety

Should your kid be in a car seat on the plane? The AAP recommends that you put kids under 40 pounds into a car seat on airplanes. However, airlines don’t require car seats.

Here’s what we know from a data standpoint:
✈️ The risk of injury to a child on a plane without a carseat is very small (about 1 in 250,000)
✈️ A JAMA Pediatrics paper estimates about 0.4 child air crash deaths per year might be prevented in the U.S. with car seats
✈️ Cars are far more dangerous than airplanes! The same JAMA paper suggests that if 5% to 10% of families switched to driving, then we would expect more total deaths as a result of this policy.

If you want to buy a seat for your lap infant, or bring a car seat for an older child, by all means do so! But the additional protection based on the numbers is extremely small.

#parentdata #emilyoster #flyingwithkids #flyingwithbaby #carseats #carseatsafety
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SLEEP DATA 💤 PART 2: Let’s talk about naps. Comment “Link” for an article on what we learned about daytime sleep!

The first three months of life are a chaotic combination of irregular napping, many naps, and a few brave or lucky souls who appear to have already arrived at a two-to-three nap schedule. Over the next few months, the naps consolidate to three and then to two. By the 10-to-12-month period, a very large share of kids are napping a consistent two naps per day. Over the period between 12 and 18 months, this shifts toward one nap. And then sometime in the range of 3 to 5 years, naps are dropped. What I think is perhaps most useful about this graph is it gives a lot of color to the average napping ages that we often hear. 

Note: Survey data came from the ParentData audience and users of the Nanit sleep monitor system. Both audiences skew higher-education and higher-income than the average, and mostly have younger children. The final sample is 14,919 children. For more insights on our respondents, read the full article.

SLEEP DATA 💤 PART 2: Let’s talk about naps. Comment “Link” for an article on what we learned about daytime sleep!

The first three months of life are a chaotic combination of irregular napping, many naps, and a few brave or lucky souls who appear to have already arrived at a two-to-three nap schedule. Over the next few months, the naps consolidate to three and then to two. By the 10-to-12-month period, a very large share of kids are napping a consistent two naps per day. Over the period between 12 and 18 months, this shifts toward one nap. And then sometime in the range of 3 to 5 years, naps are dropped. What I think is perhaps most useful about this graph is it gives a lot of color to the average napping ages that we often hear.

Note: Survey data came from the ParentData audience and users of the Nanit sleep monitor system. Both audiences skew higher-education and higher-income than the average, and mostly have younger children. The final sample is 14,919 children. For more insights on our respondents, read the full article.
...

Happy Father’s Day to the Fathers and Father figures in our ParentData community! 

Tag a Dad who this holiday may be tricky for. We’re sending you love. 💛

Happy Father’s Day to the Fathers and Father figures in our ParentData community!

Tag a Dad who this holiday may be tricky for. We’re sending you love. 💛
...

“Whilst googling things like ‘new dad sad’ and ‘why am I crying new dad,’ I came across an article written by a doctor who had trouble connecting with his second child. I read the symptoms and felt an odd sense of relief.” Today we’re bringing back an essay by Kevin Maguire of @newfatherhood about his experience with paternal postpartum depression. We need to demystify these issues in order to change things for the better. Comment “Link” for a DM to read his full essay.

#parentdata #postpartum #postpartumdepression #paternalmentalhealth #newparents #emilyoster

“Whilst googling things like ‘new dad sad’ and ‘why am I crying new dad,’ I came across an article written by a doctor who had trouble connecting with his second child. I read the symptoms and felt an odd sense of relief.” Today we’re bringing back an essay by Kevin Maguire of @newfatherhood about his experience with paternal postpartum depression. We need to demystify these issues in order to change things for the better. Comment “Link” for a DM to read his full essay.

#parentdata #postpartum #postpartumdepression #paternalmentalhealth #newparents #emilyoster
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What does the data say about children who look more like one parent? Do they also inherit more character traits and mannerisms from that parent? Let’s talk about it 🔎

#emilyoster #parentdata #parentingcommunity #lookslikedaddy #lookslikemommy

What does the data say about children who look more like one parent? Do they also inherit more character traits and mannerisms from that parent? Let’s talk about it 🔎

#emilyoster #parentdata #parentingcommunity #lookslikedaddy #lookslikemommy
...

SLEEP DATA 💤 We asked you all about your kids’ sleep—and got nearly 15,000 survey responses to better understand kids’ sleep patterns. Comment “Link” for an article that breaks down our findings!

This graph shows sleeping location by age. You’ll notice that for the first three months, most kids are in their own sleeping location in a parent’s room. Then, over the first year, this switches toward their own room. As kids age, sharing a room with a sibling becomes more common. 

Head to the newsletter for more and stay tuned for part two next week on naps! 🌙

#parentdata #emilyoster #childsleep #babysleep #parentingcommunity

SLEEP DATA 💤 We asked you all about your kids’ sleep—and got nearly 15,000 survey responses to better understand kids’ sleep patterns. Comment “Link” for an article that breaks down our findings!

This graph shows sleeping location by age. You’ll notice that for the first three months, most kids are in their own sleeping location in a parent’s room. Then, over the first year, this switches toward their own room. As kids age, sharing a room with a sibling becomes more common.

Head to the newsletter for more and stay tuned for part two next week on naps! 🌙

#parentdata #emilyoster #childsleep #babysleep #parentingcommunity
...

Weekends are good for extra cups of ☕️ and listening to podcasts. I asked our team how they pod—most people said on walks or during chores. What about you?

Comment “Link” to subscribe to ParentData with Emily Oster, joined by some excellent guests.

#parentdata #parentdatapodcast #parentingpodcast #parentingtips #emilyoster

Weekends are good for extra cups of ☕️ and listening to podcasts. I asked our team how they pod—most people said on walks or during chores. What about you?

Comment “Link” to subscribe to ParentData with Emily Oster, joined by some excellent guests.

#parentdata #parentdatapodcast #parentingpodcast #parentingtips #emilyoster
...

Humility. That’s why. That’s the whole reason.

#emilyoster #secondbaby #parentingjokes #parentinghumor

Humility. That’s why. That’s the whole reason.

#emilyoster #secondbaby #parentingjokes #parentinghumor
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Bug season is upon us. Besides annoyance, this can bring up safety concerns, particularly with ticks. They are carriers of diseases, most notably Lyme disease. So what’s the best course of action?

Prevention is key! I suggest:
⭐ Regular tick checks
⭐ Using bug sprays with DEET 
⭐ Wearing long sleeves and pants in the woods

Some parents worry about DEET, but repellants with up to 30% DEET are recommended by both the CDC and AAP. The data says you’re in the clear, so go for it. Enjoy your summer!

#parentdata #emilyoster #tickseason #bugbites #bugspray

Bug season is upon us. Besides annoyance, this can bring up safety concerns, particularly with ticks. They are carriers of diseases, most notably Lyme disease. So what’s the best course of action?

Prevention is key! I suggest:
⭐ Regular tick checks
⭐ Using bug sprays with DEET
⭐ Wearing long sleeves and pants in the woods

Some parents worry about DEET, but repellants with up to 30% DEET are recommended by both the CDC and AAP. The data says you’re in the clear, so go for it. Enjoy your summer!

#parentdata #emilyoster #tickseason #bugbites #bugspray
...