|Study Links Factors to Choice of Infant Sleep Position
Researchers funded by the National Institutes of Health have
identified three principal factors linked to whether caregivers
place infants to sleep on their backs. Those three factors are:
whether they received a physician's recommendation to place infants
only on their backs for sleep, fear that the infant might choke
while sleeping on the back, and concerns for an infantís comfort
while sleeping on the back.
A large body of research has shown that placing infants on their backs to sleep
reduces the risk of Sudden Infant Death Syndrome (SIDS), the leading
cause of death during the first year of life in the United States.
"Placing infants on their backs for sleep remains the single most effective means
we know to reduce the risk of sudden infant death syndrome," said Marian Willinger,
Ph.D., Special Assistant for SIDS research at the Eunice Kennedy Shriver National
Institute of Child Health and Human Development (NICHD), which funded the analysis. "For
the vast majority of infants, concerns about choking while back sleeping are
Dr. Willinger noted that certain conditions might prompt a physician to consider
recommending against back placement. However, such recommendations are arrived
at only after careful deliberation and after taking into account all the potential
risks and benefits for the infant involved.
The survey also found that after increasing steadily, the proportion of infants
placed to sleep on their backs leveled off in the years since 2001.
The study appears in the December issue of Archives of Pediatric and Adolescent
Medicine. Its lead author is Eve R. Colson, M.D., of Yale University School of
The NICHD launched the Back to Sleep campaign in 1994. The campaign urges parents
and caregivers to place infants to sleep on their backs. Since the campaign began,
the prevalence of babies being placed for sleep on their backs has increased
from roughly 25 percent to roughly 70 percent. Corresponding with the increase
in back sleeping, the SIDS rate has decreased by more than 50 percent.
To conduct the study, the scientists analyzed data from 1993 to 2007, obtained
from the National Infant Sleep Position Study, an annual national phone survey.
They found that the proportion of babies placed to sleep on their backs steadily
increased between 1993 and 2001 but did not change after 2001.
The survey asked nighttime caregivers (mostly mothers): "Do you have a position
you usually place your baby in?"
The researchers found that families who placed their infants on their backs were
unlikely to say that they were concerned about their baby choking, or were unlikely
to say that they were concerned that their baby would be uncomfortable on their
back. These families also were likely to report that their doctor recommended
back placement as the sole sleep position.
Conversely, caregivers who were concerned about infant choking, about infant
comfort, and who had not received a recommendation for back-only placement from
their physician were less likely to indicate that they had placed their infants
to sleep on their backs.
The researchers also reported that African-American infants are placed to sleep
on their backs less often than whites or Hispanics. The researchers showed that
maternal attitudes about issues such as comfort and choking, and doctor recommendation
for back sleeping contributed to much of the disparity in back placement between
African-Americans and other groups.
A greater proportion of African-American infants than white or Hispanic infants
die from SIDS each year.
The researchers concluded that reducing overall SIDS death rates depends on making
sure families get back-sleeping advice from their physicians, and addressing
concerns about choking and comfort.
Dr. Willinger noted that Back to Sleep Campaign materials address concerns about
choking. She added that the campaign, which has a continuing education program
for nurses, is in the final stages of preparation of a similar program for pharmacists,
who often serve to reinforce health advice in many communities.
Similarly, the campaign will continue its work with practitioner groups to urge
all health care professionals who come in contact with newborn infants to urge
caregivers to place infants to sleep on their backs. In the study, the researchers
reported that between 2003-2007, only 53.6 percent reported that their doctors
had advised them to put their babies on their backs only.
Dr. Willinger explained that some caregivers may choose not to place infants
on their backs for sleep because of concern that the infants might sleep less
soundly. She added that if infants are consistently placed on their backs for
sleep, they should become accustomed to sleeping in that position.
Recent studies have shown that infants placed on their sides were more likely
to roll on to their stomachs and the current recommendation is for caregivers
to place infants to sleep exclusively on their backs. Before this was discovered,
however, the initial recommendation was that infants be placed on their backs
or sides to sleep.
"Some health professionals may not be aware of the change," Dr. Willinger said. "We're
continuing our efforts to make sure that they know — and know to tell their patients — that
infants sleep safest on their backs."
"We know that it is really important for health care providers to tell families
that they should place their infants on the back to sleep," said the study's
lead author, Dr. Colson. " We can't equivocate, or the message gets lost. And
we need to serve as role models, placing infants to sleep on their backs, beginning
the minute infants are born in our hospital nurseries and pediatric units."
Information on reducing the risk of Sudden Infant Death Syndrome is available
on the NICHD Web site. Steps parents and caregivers can take to reduce SIDS Risk
- Always place babies on their backs to sleep — Infants who sleep on their
backs are less likely to die of SIDS than babies who sleep on their stomachs
or sides. Placing your baby on his or her back to sleep is the number
one way to reduce the risk of SIDS.
- Use the back sleep position every time — Infants who usually sleep on
their backs but who are then placed on their stomachs, like for a nap,
are at very high risk for SIDS. So it is important for babies to sleep
on their backs every time, for naps and at night.
- Place your baby on a firm sleep surface, such as a safety-approved crib
mattress covered with a fitted sheet — Never place an infant to sleep
on a pillow, quilt, sheepskin, or other soft surface. Information on crib
safety and regulatory requirements for infant cribs is available from
the Consumer Product Safety Commission at http://www.cpsc.gov/info/cribs/index.html.
- Keep soft objects, toys, and loose bedding out of an infantís sleep area Ė Donít
use pillows, blankets, quilts, sheepskins, or pillow-like bumpers in your
baby's sleep area. Keep all items away from the infantís face.
- Avoid letting your baby overheat during sleep Ė Dress your infant in light
sleep clothing and keep the room at a temperature that is comfortable
for an adult.
- Think about using a clean, dry pacifier when placing your infant down
to sleep, but donít force the baby to take it. (If youíre breastfeeding,
wait until your child is 1 month old, or is used to breastfeeding before
using a pacifier.)
In addition to Dr. Colson, other authors of the study were Denis Rybin, Theodore
Colton and Michael J. Corwin of Boston University; Lauren Smith, of the
Massachusetts Department of Public Health; and George Lister, of University
of Texas Southwestern Medical Center at Dallas.
The NICHD sponsors research on development, before and after birth; maternal,
child, and family health; reproductive biology and population issues;
and medical rehabilitation. For more information, visit the Instituteís
Web site at http://www.nichd.nih.gov/.
The National Institutes of Health (NIH) — The Nation's
Medical Research Agency — includes 27 Institutes and
Centers and is a component of the U.S. Department of Health and
Human Services. It is the primary federal agency for conducting
and supporting basic, clinical and translational medical research,
and it investigates the causes, treatments, and cures for both
common and rare diseases. For more information about NIH and
its programs, visit www.nih.gov.