A new book casts doubt on the widely used "Back to Sleep'' approach to preventing sudden infant death syndrome (SIDS), but Minnesota experts are urging parents to read the book cautiously and not abandon proven techniques that make babies safer.

"The Back to Sleep position is the reason for the majority of [the] drop" in infant deaths recently, said Dr. Patrick Carolan, who directs the Minnesota Sudden Infant Death Center at Children's Hospital in Minneapolis.

When Minnesota releases its annual vital statistics report later this month, it will show that annual SIDS cases have fallen to 28 in 2010, down from 100 in 1991. Officials credit this progress to one of the most effective public health campaigns in U.S. history -- the movement to place infants to sleep on their backs instead of their tummies.

Trouble is, the approach has also raised the number of infants who develop a shortening of the neck muscles, called torticollis, or a flattening on one side of the head, called plagiocephaly.

Alabama physical therapist Stephanie Pruitt is one of the first health care providers to claim that the medical establishment got it wrong. She argues that any life-saving benefits of the Back to Sleep campaign need to be weighed against the physical and developmental problems it has caused.

Some of these problems can be serious and cause learning disorders if untreated, said Pruitt, who wrote "The Truth About Tummy Time."

14 recommendations

In addition, parents think there is only one recommendation -- to place children on their backs -- when in fact the American Academy of Pediatrics created 14 recommendations in its Back to Sleep campaign, Pruitt said.

Other recommendations are even more effective, she said, such as creating safe sleeping environments that include firm mattresses so babies don't suffocate.

Another problem is that parents take the Back to Sleep recommendation too far and keep babies on their backs when they are awake, even though they need daily "tummy time" to develop their muscles and coordination, she said.

Many doctors argue, however, that the developmental problems are treatable and cause mostly brief delays for babies in muscle strength and developmental milestones such as taking their first steps. "These are not permanent delays," Carolan said.

State survey data shows that 81 percent of mothers placed their infants to sleep on their backs in 2009, up from 78 percent in 2004.

Fears of backlash

Doubts about Back to Sleep recommendations could alter that rate -- just as unproven fears about vaccines have persuaded some parents to refuse shots for their children, said Mary Jo Chippendale, coordinator of the Minnesota Department of Health's women and infant health unit. "There is a concern you will see sort of a backlash," she said.

Chippendale said there are other ways to prevent flat spots on babies' heads. One way is to have them sleep one direction in their cribs one evening, and the opposite direction the next. That way, when babies turn to look at visual stimuli, they'll be resting on different parts of their heads, she said.

Pruitt also questions the decline in SIDS deaths that has made the Back to Sleep campaign influential. She claimed the drop is due to doctors classifying fewer deaths as SIDS, which is a catch-all category for unexplained infant deaths, and more of them to specific causes such as suffocation.

Carolan agreed that coding explains some of the drop. But a review of infant mortality in Minnesota over the past two decades still suggests a 50 percent decline in actual SIDS deaths, he said.

Pruitt stressed that her message doesn't necessarily contradict the Back to Sleep campaign. If parents make sure their children have enough tummy time during the day, she said, the risk of developmental problems by placing them on their backs to sleep will be lower.

Jeremy Olson • 612-673-7744