National efforts to reduce the incidence of Sudden Infant Death Syndrome (SIDS) by placing healthy infants on their backs or sides to sleep appear to have been extremely successful.
In 1992, the American Academy of Pediatrics (AAP) recommended placing healthy infants to sleep on their sides or backs, based on studies showing that infants who were placed to sleep on their stomachs were at greater risk for SIDS. In 1994, the NICHD, in partnership with other agencies of the U.S. Public Health Service, the AAP, the SIDS Alliance, and the Association of SIDS and Infant Mortality Programs, launched the Back to Sleep Campaign, a national campaign that encourages that infants be placed to sleep on their backs.
The first of the three studies, the National Infant Sleep Position (NISP) Study, found that between 1992 and 1996, the prevalence of U.S. infants being placed to sleep on their stomachs has dropped by 66 percent. Although a cause-and-effect relationship cannot be conclusively proven, the rate of SIDS dropped by 38 percent during that period.
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National efforts to reduce the incidence of Sudden Infant Death Syndrome (SIDS) by placing healthy infants on their backs or sides to sleep appear to have been extremely successful.
In 1992, the American Academy of Pediatrics (AAP) recommended placing healthy infants to sleep on their sides or backs, based on studies showing that infants who were placed to sleep on their stomachs were at greater risk for SIDS. In 1994, the NICHD, in partnership with other agencies of the U.S. Public Health Service, the AAP, the SIDS Alliance, and the Association of SIDS and Infant Mortality Programs, launched the Back to Sleep Campaign, a national campaign that encourages that infants be placed to sleep on their backs.
The first of the three studies, the National Infant Sleep Position (NISP) Study, found that between 1992 and 1996, the prevalence of U.S. infants being placed to sleep on their stomachs has dropped by 66 percent. Although a cause-and-effect relationship cannot be conclusively proven, the rate of SIDS dropped by 38 percent during that period.
The proportion of babies placed prone was higher for older babies. The Boston study found that while only 18 percent of the infants in the study were sleeping prone at 1 month of age, 29 percent were sleeping prone by 3 months of age. The peak incidence of SIDS is between 2 to 4 months of age. In the District of Columbia study, approximately a third of the mothers who first said they intended to place their infants in a non-prone sleep position, ended up placing their infants prone at 3 months of age.
In the NISP study, 1,000 telephone interviews were conducted each spring, from 1992 through 1996, with nighttime caregivers in households having an infant younger than 8 months. During this time, the proportion of babies being placed prone to sleep declined from 70 percent to 24 percent. Simultaneously, the proportion of infants placed to sleep on their backs increased from 13 percent to 35 percent; and the proportion of infants placed to sleep on their sides also increased from 15 percent to 39 percent
"The success in reducing prone sleeping and SIDS deaths has been accomplished through collaborations between the Federal government, health professionals, concerned families, and industry." Dr. Willinger, said. "Nonetheless, our work is not done. We need a better understanding of why some caregivers still do not place infants to sleep on their backs."
"It seems reasonable that efforts intended to further reduce the prevalence of prone sleeping should be designed to target the population groups who are at particular risk for using this practice," the authors wrote. They recommended that medical practitioners who see infants at well-child visits during the first few weeks of life stress the importance of placing infants to sleep on their backs and keeping them there.
Forty percent of the 394 mothers indicated at the follow-up interview that they had placed their infant to sleep in the prone position on the night before the interview.
Mothers who saw nurses placing their infants to sleep in the prone position in the hospital during the postpartum stay, were also more likely to place their infants prone.
"Ideally, hospitals should adopt and implement policies on infant sleep position that are consistent with current recommendations and should monitor compliance with policies once adopted," the authors wrote.
Approximately a third of the mothers who, shortly after birth, said that they intended to place their infants to sleep on either their backs or sides later indicated that they had placed their infants to sleep in the prone position. The most common reason the mothers cited for placing infants in the prone position was infant comfort.
"Therefore, counseling and reinforcement on the importance of the supine (back) sleep position should continue beyond the initial hospital stay, and, when possible, be directed to both the primary care giver and other extended family members, such as grandmothers," the authors wrote.
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