Head Games

Parents are being told to sleep babies on their backs to avoid SIDS. The medical establishment has ignored the unintended consequences -- and that's making one Tempe company very, very successful

That's just what Marin did. When she had a second baby, another little boy, she let him sleep on his tummy.

"After that," she says, "I thought, to hell with what they're saying."


After sleeping on their backs and also spending hours 
there at play, some babies’ heads flattened dramatically.
courtesy of Cranial Technologies
After sleeping on their backs and also spending hours there at play, some babies’ heads flattened dramatically.
Some doctors referred plagiocephaly cases for surgery.
courtesy of Cranial Technologies
Some doctors referred plagiocephaly cases for surgery.

Before 1992, normal, healthy babies just didn't get misshapen heads.

There were exceptions, but they were rare: A tiny number of babies are born with a defect that causes a misshapen head, accompanied by brain problems so severe they require surgery. And sometimes, pediatric neurosurgeons like Kim Manwaring, who works at Phoenix Children's Hospital, would treat babies who'd been adopted out of orphanages in Russia or China. After weeks of lying flat on their backs, neglected in their cribs as they waited for adoptive parents, the babies' heads were often flat and asymmetrical.

They, too, were sometimes treated with surgery.

But oddly shaped heads were the anomaly. "It wasn't typical to find them in a highly motivated home environment," Manwaring says.

That all changed in 1992, thanks to the public health campaign that, at first glance, seemed to bear absolutely no connection to head shape: the effort to wipe out Sudden Infant Death Syndrome.

For nearly a century, SIDS had been a horrifying mystery. Every year, thousands of American babies were put down to sleep, healthy and happy. And then they'd simply never wake up.

There was never a cry for help. Never a cough. Worst of all for the grieving families, there was never an explanation.

In 1969, the medical community agreed on a name for it: Sudden Infant Death Syndrome, or SIDS. But the official-sounding title was only an attempt to categorize the inexplicable. Scientists still had no idea what caused the deaths. They didn't even know if there was a single cause, or a group.

There were plenty of theories. Doctors in the 1930s thought the affected babies might have enlarged immune system glands. Later speculation centered on a milk allergy. In the 1970s, a researcher who was a particular favorite of the National Institutes of Health managed to convince thousands of mothers that they could save their babies only by hooking them up to pricey "apnea monitors" that beeped whenever the wearer took an especially long pause between breaths. The theory helped sell lots of monitors. It did not cause the SIDS rate to decline.

In the 1980s, the United States government poured $221 million into SIDS research, according to the National Institute for Child Health and Development. Still, SIDS deaths held firm at approximately 5,500 annually.

In 1992, though, the American Academy of Pediatrics came up with a simple directive: Put your babies to sleep on their backs.

Research from Great Britain, New Zealand and Australia had shown a link between babies who slept on their stomachs and babies who died of SIDS. When those governments told parents to sleep their babies on their backs instead, each nation's SIDS rate plummeted.

The Americans decided to follow suit. "We were nervous, because it was so different from what we did in the past," says John Kattwinkel, chairman of the Academy's SIDS task force. "Telling people to put their babies on their backs was pretty radical. But we were convinced it was the right thing to do."

The gutsy decision paid off when the American SIDS rate dropped dramatically. Seventy percent of American babies used to sleep on their stomachs; that number dropped to less than 30 percent, and the SIDS rate declined right along with it.

After 1994, when the National Institute for Child Health and Development rolled out a public health campaign to spread the word further, the deaths decreased even more. Between 1991 and 1996, the SIDS rate plummeted 43 percent, the biggest decline since the Centers for Disease Control started keeping SIDS records.

It was a wonderful thing -- so wonderful that no one seemed to notice that another problem had developed as a result.

The incidence of skull deformity had previously been estimated at one in every 300 babies. But after back-sleeping became common, doctors believe it climbed to more than one in 60. "We saw a huge acceleration in referrals," says Manwaring, the neurosurgeon. "It was like a flood."

For many doctors, who were used to seeing only congenital deformities and extreme cases, that meant surgery. The back of the head was cut open, a bone was taken out, and the head was reshaped. It was harrowing for the babies -- and their parents.

"It worked pretty well," Manwaring says. "But it was definitely major surgery."


A normal infant sleeps for 16 hours, every day, and American babies tend to spend far more time on their backs. They might be shuffled from a car seat to a stroller to a swing, then back to the car seat again, all before being put down for a nap. In every instance, their heads rest flat against something solid. The American Academy of Pediatrics also cautioned against pillows and too-soft mattresses.

For the hypervigilant, the Back to Sleep campaign seemed to ask for nothing less than all back, all the time. One Maryland study, a few years after Back to Sleep, found that 28 percent of parents reported never putting their babies on their stomachs, even when they were awake.

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