Infant Sleep Repositioning Still Best Bet Against SIDS

Eight years ago a major campaign was launched to protect infants from a silent killer called sudden infant death syndrome (SIDS). Today, physicians are hailing the effort a success.

Since 1992, the American Academy of Pediatrics has recommended that infants be placed in a non-prone position (other than stomach) when sleeping to reduce the risk of SIDS. As a result, the SIDS rate has dropped 44% since 1992, according to the most recent report issued by the American Academy of Pediatrics. In March 2000, the American Academy of Pediatrics Task Force on Infant Sleep Position and Sudden Infant Death Syndrome released its latest findings to the public.

The report states that while sleeping on the back is preferred and presents the least amount of risk to infants, side sleeping is also recommended as long as the infant’s dependent arm is brought forward in an effort to prevent the child from rolling onto his or her stomach. However, the report cautions parents that while side sleeping is better than prone sleeping, it is not as safe as back sleeping.

Task Force Chairman Dr. John Kattwinkel said that at least 70% of infants in the United States were sleeping in the prone position in 1992 compared with 20% in 2000. “The word is out and it seems as though the majority of parents are listening to our recommendation.” Kattwinkel said from his office last week. Kattwinkel is also chair and professor, Neonatology Division, Department of Pediatrics, University of Virginia Health System.

Despite the American Academy of Pediatrics’ recommendations, research shows that SIDS remains a disease of unknown origin and, “is still responsible for more infant deaths in the United States than any other cause of death during infancy beyond the neonatal period,” according to the March 2000 AAP report.

SIDS is defined as “the sudden death of an infant under 1 year of age, which remains unexplained after a thorough case investigation, including performance of a complete autopsy, examination of the death scene, and review of the clinical history,” reports the AAP. Research indicates that occurrences of SIDS peak between 2 and 4 months old and decrease thereafter.

While the AAP reaffirms its back and side positioning recommendations as the most effective method to prevent SIDS, the March report also seeks to recognize other risk factors such as soft sleep surfaces and loose bedding, overheating, maternal smoking during pregnancy, bed sharing, and premature births.

Physicians around the country are adhering to the AAP strategies, primarily focusing on sleeping positions as a remedy to SIDS. Dr. Donna Bailey, a family physician in Rowlett, Texas, said she tells parents to place their children on their backs. “While there is some debate about whether parents should place their children on their backs or sides, the back is preferred in this office,” Bailey stated emphatically. “The American Academy of Pediatrics said it is the safest of the two positions for reducing SIDS.”

Bailey confirmed what research shows, that there has been a dramatic decrease in the incidences of SIDS since 1992. She said that while the majority of parents seem to follow the back sleeping advice, some obviously are ignoring it. “Physicians can’t force parents to listen, we can only strongly urge and hope they will make the right decision,” Bailey said. “SIDS drops off considerably at age 1 so I wouldn’t recommend allowing children to sleep any other way except on their backs until they reach that age,” Bailey added.

While the AAP recommendations are intended for sleeping children, Bailey commented that some parents mistakenly keep their children on their backs even when the children are awake. “Parents should actually put their children in the prone position during the waking hours to help the children strengthen muscles, muscles that are important for sitting up later on,” she explained. “Placing children in the prone position should only occur when they are awake,” Bailey reemphasized.

For optimal safety against SIDS, AAP recommends the following:

  • Place infants in non-prone position.
  • Use a crib that meets Consumer Product Safety Commission standards.
  • Don’t place infants on soft surfaces such as waterbeds or sofas.
  • Avoid soft materials in the infant’s sleeping environment such as pillows, stuffed animals, loose bedding, etc.
  • Don’t share a bed with infant
  • Avoid overheating infant with too much night clothing or by keeping the thermostat too high..
  • Observe “tummy time” while the infant is awake.
  • Avoid using sleep-positioning devices because “none have been tested sufficiently to show efficacy or safety.”
  • Don’t rely on home-monitoring devices such as electronic respiratory and cardiac monitors, to decrease SIDS. “There is no evidence that infants at increased risk of SIDS can be identified by in-hospital respiratory or cardiac monitoring.”
  • Continue observing the national campaign for reducing prone sleeping.


This story was originally published by ParenthoodWeb.com.