Percentage of babies placed to sleep on their backs levels off

December 07, 2009

The rate of babies being placed on their backs to sleep--a sleep position associated with a dramatic decrease in the risk of sudden infant death syndrome (SIDS)--has reached a plateau since 2001, according to a report in the December issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals. In addition, racial disparities remain in infant sleeping position.

SIDS is a leading cause of infant death, according to background information in the article. The Back to Sleep campaign, launched in 1994, encouraged parents to place infants to sleep in the supine position (on their backs) and was associated with a dramatic decrease in the SIDS rate. However, African American infants continue to have more than twice the rate of SIDS as white infants.

Eve R. Colson, M.D., of Yale University School of Medicine, New Haven, Conn., and colleagues analyzed data from the National Infant Sleep Position Study, a nationally representative telephone survey conducted annually between 1993 and 2007. Caregivers--usually mothers--of infants age 7 months and younger were asked if there was a position in which they usually placed the baby to sleep, along with other questions about demographics; mothers' concerns about the infant choking or being uncomfortable; and physician advice they had received about sleeping position.

Between 1993 and 2000, more babies were placed to sleep on their backs and fewer on their stomachs (prone position), but a plateau was reached for all races in 2001. Between 2003 and 2007, there was no significant yearly increase in supine sleep. Babies were more likely to be placed to sleep on their backs if they were first-born or born full-term, or if their mothers were not African American, had a higher education level, did not live in Southern states and were completing the survey in later years.

"The effect of these variables was reduced when variables related to maternal concerns about infant comfort, choking and advice from physicians were taken into account," the authors write. Although only 10 percent of mothers reported concerns about their infants choking, mothers who did not report this concern had five times the odds of placing babies on their backs to sleep. Almost 38 percent of mothers reported a concern about their infants' comfort, and those who did not report this concern had four times the odds of choosing supine sleep position.

One-third of mothers reported receiving advice from their clinician to use only the supine sleeping position, one-third reported being given other advice and one-third reported receiving no advice. Those who were advised by their clinician to place their baby to sleep on his or her back had three times the odds of doing so.

"There have been changes in factors associated with sleep position, and maternal attitudes about issues such as comfort and choking may account for much of the racial disparity in practice," the authors conclude. "To decrease sudden infant death syndrome rates, we must ensure that public health measures reach the populations at risk and include messages that address concerns about infant comfort and choking."
(Arch Pediatr Adolesc Med. 2009;163[12]:1122-1128. Available pre-embargo to the media at

Editor's Note: This study was supported in part by a grant from the National Institute of Child Health and Human Development. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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