Not All Parents Put Babies to Sleep on Back

Study Shows Advice on SIDS Prevention Isn't Being Heeded

Reviewed by Louise Chang, MD on December 07, 2009
From the WebMD Archives

Dec. 7, 2009 -- Despite warnings that it is safest to place a baby to sleep on his or her back, the number of caregivers doing so has not increased in recent years, according to a new report.

The National Institute of Child Health and Human Development's "Back to Sleep" campaign began in 1994 after compelling evidence showed that babies who slept on their backs had a much lower risk for sudden infant death syndrome (SIDS). In the U.S., SIDS is the No. 1 cause of death in children under age 1.

Since the campaign began, the number of babies being put to sleep on their backs jumped from 25% to 70%. But the number of caregivers heeding the advice has not changed since 2001, say Yale School of Medicine researchers.

The researchers looked at how 15,000 caregivers positioned their babies to sleep since the campaign launch, using information from the National Infant Sleep Position Study, an annual telephone survey of about 1,000 households with infants. The survey asks nighttime caregivers of babies 7 months old and younger: "Do you have a position you usually place your baby in?"

The study also revealed a racial disparity in sleeping positions. "We ... found that African Americans still lag behind caregivers of other races by about 20 percent in following this practice," Eve Colson, MD, associate professor of pediatrics at Yale School of Medicine, says in a news release.

Choosing Sleep Positions

Colson and her team recently identified three key factors associated with a caregiver's choice of an infant's sleeping position:

  • Whether the caregiver was told by a doctor to place the baby to sleep on the back
  • Concerns for the baby's comfort
  • Fear of the infant choking while sleeping

While a third of the caregivers surveyed said their doctor did recommend putting their babies to sleep on the back, others said they either were given other advice or did not receive a recommendation at all.

More than a third of those surveyed said they didn't think the baby would be comfortable sleeping on his or her back. Those who did not bring up this concern were four times more likely to follow the Back to Sleep guidelines.

Ten percent of caregivers said they thought their infant might choke while sleeping on his or her back. However, those who did not report this concern were much more likely to put their babies in the back position.

"For the vast majority of infants, concerns about choking while back sleeping are unfounded," Marian Willinger, PhD, special assistant for SIDS research at the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), emphasizes in a news release. "Placing infants on their backs for sleep remains the single most effective means we know to reduce the risk of sudden infant death syndrome."

Willinger notes that in certain health conditions, a doctor may recommended against back sleeping, but only after carefully weighing the risks and benefits to the infant.

Babies Who Sleep on Their Backs

The study revealed that babies were more likely to be put to sleep on their backs if:

  • They were the first-born child
  • They were not premature
  • Their mothers did not live in the Southern U.S.
  • Their mothers had a higher education level
  • Their mothers were not African-American

The researchers urge all health care providers to make sure caregivers are told that it's safest to place infants to sleep exclusively on their backs, and that concerns about choking and discomfort are discussed. Doing so, they say, will help reduce the overall SIDS death rate.

"We can't equivocate, or the message gets lost," says Colson. "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."

The findings appear in the December issue of the Archives of Pediatrics and Adolescent Medicine.

Show Sources


News release, National Institute of Child Health and Human Development.

News release, American Medical Association.

News release, Yale University.

Colson, E. Archives of Pediatrics and Adolescent Medicine. Dec. 1, 2009: vol 163: pp 1122-1128.

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