Circumstances Leading to a Change to Prone Sleeping in Sudden Infant Death Syndrome Victims

Abstract

ABSTRACT.Context. In addition to usual prone sleeping, unaccustomed prone sleeping represents a significant risk factor for sudden infant death syndrome (SIDS). However, little information is available regarding the circumstances leading caretakers to change the infant's sleep position to prone position in SIDS victims.Objective. To determine, in a population of SIDS victims, the timing of a change to prone sleeping and the reason for that change in infants who were originally nonprone sleepers.Design and Setting. Case series analysis from a questionnaire administered between 1991 and 1997 to parents and other caretakers of SIDS victims in the province of Quebec (Canada).Subjects. One hundred fifty-seven SIDS cases occurring in the province during the study.Results. Of the 157 SIDS cases studied, 139 were found in the prone position, although only 93 infants usually slept prone. Of the 64 nonprone sleepers, 34 had been changed to prone by the parents or another caretaker before death, and 18 had apparently turned to prone for the first time. In the 34 cases changed to prone, the change occurred <1 week before death for 21 infants; for 16 of those infants, death occurred the first or second time that they slept prone. In 56% of the cases changed from a nonprone to prone sleeping position, a caretaker other than the parents had precipitated the change.Conclusions. Ongoing campaigns to decrease the risk of SIDS should emphasize the risk of unaccustomed prone sleeping to both parents and secondary caretakers. Pediatrics 2000;106(6). URL: http://www.pediatrics.org/ cgi/content/full/106/6/e86; sleep position, first time prone, day care, secondary caretaker.ABBREVIATION. SIDS, sudden infant death syndrome. I t is well recognized that prone sleeping is a significant risk factor for sudden infant death syndrome (SIDS). In the past several years, the incidence of SIDS has decreased significantly in countries where successful national campaigns were instituted to reduce prone sleeping. [1][2][3][4] Despite the marked reduction in prone sleeping world-wide, some studies have shown that the prevalence of prone sleeping increases after the second month of life. 5-8 More importantly, it has been reported in a few case series that some SIDS victims who were usually nonprone sleepers were put to sleep in the prone position shortly before they died. 9,10 There are also anecdotal reports of infants dying the first time that they were put prone to sleep, 11 or when they turned prone for the first time. [12][13][14] More recently, 3 case-control studies from the Scandinavian countries, The Netherlands, and New Zealand have highlighted the high risk of prone sleeping in infants who are usually nonprone sleepers. [15][16][17] However, the duration that the prone position was used before death, the caretaker who initiated the change in position, and the reasons for this decision remain uncertain. Such information is crucial for orienting campaigns to further reduce the incidence of SIDS.The objective of our study was to determine, in o...

Influence of Sleep Position Experience on Ability of Prone-Sleeping Infants to Escape From Asphyxiating Microenvironments by Changing Head Position

“…1,3,20 Certainly, the present findings support this concept. These same findings indicate, however, that even with substantial pronesleep experience, some infants are still unable to protect their airway fully.…”

“…[1][2][3] That is to say, SIDS risk is greatly increased over that of infants who are used to sleeping prone. Furthermore, when SIDS infants who are inexperienced in prone sleep are found lying prone at death, they are more likely to be found face down than infants who are used to prone sleep.…”

Sleep position alters arousal processes maximally at the high‐risk age for sudden infant death syndrome

“…As all infants routinely slept supine at home, infants in our study were ‘naïve’ prone sleepers at the time of each study. It has been suggested that infants who are inexperienced in prone sleeping are at increased risk of SIDS if they are placed prone (Cote et al. , 2000; Paluszynska et al.…”

Physician Recommendations Regarding SIDS Risk Reduction: A National Survey of Pediatricians and Family Physicians

“…Many parents change the infant's sleep position at 2 to 4 months (when the infant is at highest risk for SIDS), often because of concerns about sleep quality and infant comfort. 40,41 Changing the position from supine to prone places the infant at extremely high risk for SIDS. 42,43 It is therefore important for physicians to address the infant's sleep environment at every wellchild visit for the first year of life, especially in the first 6 months, the age by which most SIDS deaths occur.…”