In 1992, the American Academy of Pediatrics recommended that newborns be placed supine or on the side (nonprone) for sleeping to decrease the incidence of sudden infant death syndrome (SIDS). In 1994, the Academy reiterated its stance on nonprone sleep positioning for newborns. Also in 1994 the "Back to Sleep" campaign was launched, which was a national effort aimed at informing parents, physicians, and other caregivers of the importance of placing infants to sleep in a nonprone position.
Now, three studies report on the progress of the Back to Sleep educational project and on the incidence of SIDS. Finding from the U.S. National Infant Sleep Position Study showed that in 1992, 70% of nighttime caregivers placed their infant to sleep prone, but that fell to 24% by 1996. Between 1992 and 1996, supine placements increased from 13% to 35%, and side placements increased from 14% to 39% (Willinger and others, 1998). The authors also investigated risk factors for use of the prone position. Among the strongest factors were black race and the mother having had a previous child. Overall, the authors note, prone sleep position declined by 66% between 1992 and 1996, and SIDS rates declined about 38% during the same period. Although the decline in SIDS correlates with the decline in prone sleep position, causality cannot be proved.
A second report describes a prospective longitudinal study of over 7,500 mother of term infants (Lesko and others, 1998). Among these infants, 18% slept prone at one month of life, but by 3 months of age, prone sleeping had increased to 29%. Sleeping prone was associated with non-Hispanic black mother or Hispanic mothers, young maternal age, less education, and higher parity. These findings have implications for pediatric interventions, since strategies focused on counseling parents before delivery or around the time of birth may not carry over to the third month of life, when the risk of SIDS peaks.
A third study showed remarkably similar findings to the one above. The authors interviewed 394 mothers shortly after delivery and again at 3 to 7 months postpartum. When interviewed shortly after delivery, 137 mothers (35%) reported that they intended to place the infant down for sleep in a prone position, 243 (62%) said they would place their infants in a nonprone position, and 14 (4%) said they did not know or had not thought about which sleep position they would use. At 8 to 7 months postpartum, on the night prior to the follow-up interview, 157 mothers (40%) had placed their infants in the prone position. Predictors of prone sleep included poverty, black race, presence of the infant's grandmother in the home, and the mother's stated intent to place her infant prone (Brenner and others, 1998).
It is evident from these studies that health care professionals play an important role in educating families with young infants about the risk of SIDS in infants placed in a prone sleeping position. Nurses are in an optimal position to inform parents of newborns being discharged from the nursery or mother-baby care center about the importance of newborn sleep position. Since role modeling is a powerful educational tool, newborns should be placed supine in the hospital bassinets. Perinatal nurses should also discuss sleep position with new parents. New parents and parents of newborns are in a taking-in phase wherein information about their newborn's welfare.
For information in English and Spanish, including a video, on sleep position and SIDs risk reduction, call the "Back to Sleep" campaign at 1-800-505-CRIB.
Brenner, R.A. and others: Prevalence and predictors of the prone sleep position among inner-city infants, JAMA 280(4): 341-346, 1998.
Leske, S.M. and others: Changes in sleep position during infancy: a prospective longitudinal assessment, JAMA 280(4): 336-340, 1998.
Taylor JA and others: Prone sleep position and the sudden infant death syndrome in King County, Washington: a case-control study, J Pediatr 128(5):626-630, 1996.
Willinger, M. and others: Factors associated with the transition to nonprone sleep positions of infants in the United States: the National Infant Sleep Position Study, JAMA 280(4): 329-335, 1998.
See Chapter 13 in Nursing Care of Infants and Children, 6th edition.
See Chapter 11 in Essentials of Pediatric Nursing, 5th edition.
March 15, 2002