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Article Outline

 

Sudden infant death syndrome (SIDS), the second most common cause of death in children 1 to 12 months of age, is the sudden death of an infant less than a year-old from an unknown cause. Research has shown that putting infants to sleep in the supine position (on their backs) dramatically decreases death from SIDS. Deaths from SIDS have decreased up to 50% in countries that have instituted programs encouraging putting infants to sleep on their backs. Even infants put to sleep on their sides are more than 6.5 times more likely to die from SIDS. In spite of the evidence and the recommendations by groups such as the American Academy of Pediatrics (“Back to Sleep”) that encourage placing infants on their backs to sleep, many parents still place their infants on their stomachs or sides, possibly due to fears that infants will aspirate if they sleep on their backs. Unfortunately, many health care providers, including nursery staff, do not recommend to parents that they place their infants to sleep on their backs.

The purpose of this study was to describe how infants are positioned for sleep in hospital nurseries. Nursery staff (n = 96) and mothers (n = 579) from eight hospitals in California participated in this study. Researchers visited the hospitals at random times of the day over seven weeks. At each visit, nursery staff completed a questionnaire on knowledge, procedures, and recommendations for infant sleep positioning. Mothers completed a questionnaire on advice they'd received regarding infant positioning, the positions they observed nursery staff using, and in what position they placed their infants. Results showed that 68% of the staff typically placed infants on their sides and 65% advised new mothers to place their infants either on their side or back, even though 72% knew that the back position was associated with lower incidence of SIDS. Ninety-one percent of the nursery staff preferred the side position because of concerns with aspiration. Forty-four percent of mothers reported that they did not receive advice on positioning their infants, and 63% observed their infants placed on their sides or prone. Mothers who observed nursery staff placing infants on their sides or prone were more likely to place their infants in these non-recommended positions.

This research is an example of how difficult it can be to translate what the evidence shows to actual clinical practice. Research clearly shows that infants placed exclusively on their backs to sleep have a much lower occurrence of SIDS and that infants sleeping in the supine position is not associated with aspiration or respiratory problems in infants. Primary care providers need to evaluate what position the mothers they see use and provide them with information and encouragement to place their infants only on their backs for sleeping.