Infant Sleep Position and Risk for Sudden Infant Death Syndrome: Report of Meeting Held January 13 and 14, 1994, National Institutes of Health, Bethesda, MD

Abstract

Objective. To evaluate the current knowledge on the relationship between infant sleep position and sudden infant death syndrome (SIDS), and to determine how the information can be used to guide further activities in the United States. Methods. Data from international vital statistics, epidemiologic studies of SIDS risk factors, and studies of outcomes of public health interventions that advocated nonprone sleeping to reduce the risk for SIDS were discussed at a meeting held by the National Institute of Child Health and Human Development (NICHD) with cosponsorship from the National Institute on Deafness and Other Communication Disorders (NIDCD), and the National Center for Health Statistics (NCHS) on January 13, and 14, 1994. Results. Trends in postneonatal mortality and SIDS rates from 1980 through 1992 were evaluated for Australia, Britain, New Zealand, the Netherlands, Norway, Sweden, and the United States. All of the countries that experienced a rapid decline in prone sleeping also had reductions of approximately 50% in their SIDS rates. Postneonatal mortality rates dropped as well, with the reduction in SIDS being the primary contributor to the reported declines. The major behavioral change in all targeted populations was in sleep position. No significant changes were observed in the proportion of parents who smoked cigarettes, or in breast-feeding. Preliminary data from population-based studies showed there were no reported adverse outcomes associated with a change to side or back sleep position, such as an increase in deaths due to aspiration or in apparent life-threatening events. Conclusion. The overwhelming opinion of the assembled experts was that the evidence justified greater effort to reach parents with the American Academy of Pediatrics' recommendation that healthy infants, when being put down to sleep, be positioned on their side or back.

Home Cardiorespiratory Monitoring in Infants at Risk for Sudden Infant Death Syndrome (SIDS), Apparent Life-Threatening Event (ALTE) or Brief Resolved Unexplained Event (BRUE)

“…The evidence that in several countries the recommendation to avoid this sleeping position in the first year of life has been accompanied by a significant reduction in SIDS rate is per se a strong demonstration that the prone position has a role in SIDS development [10][11][12][13][14]. Several well conducted epidemiological studies have clearly shown that, compared to the supine position, the prone position is associated with a 1.7-12.9-fold increased risk of SIDS [36].…”

“…First of all, the evidence is that only a low number of children experiencing ALTE or BRUE die from SIDS (0-7%). Moreover, while the incidence of SIDS has decreased after the introduction of recommendations for safe infant sleeping, the incidence of ALTE has remained unchanged or even increased [10][11][12][13][14]. ALTE, BRUE and SIDS, although disorders of the first year of life, differ significantly in age-at-event.…”

“…SIDS is a dramatic condition that was not uncommon in the last century but that has significantly declined in recent years due to the introduction of preventive measures such as the use of safe sleeping conditions for infants [10][11][12]. In the USA, in 1990, when the American Academy of Pediatrics had not yet issued a recommendation for safe sleeping, SIDS rates were 130.3 per 100,000 live births.…”

The provision of the baby box was associated with safe sleep practices in a low-resource community: a randomized control trial in Ecuador

“…In the late 1980s and early 1990s researchers in several European countries and New Zealand found many SUIDs were linked to the prone sleep position, which was followed by mass public health campaigns promoting “Back to Sleep”, whereby parents and care givers were instructed to place their infants in a supine or face up position to sleep [ 3 – 5 ]. These strategies led to a dramatic reduction in infant deaths and increased scrutiny of the sleep environment in other countries.…”

Modifiable risk factors for sudden infant death syndrome: When will we ever learn?

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Although the incidence of sudden infant death syndrome in the United States has declined in recent years, 1 the rate of decline continues to lag substantially behind other industrialized countries where SIDS prevention initiatives have been implemented. 2 The study by Skadberg et al 3 in this issue of The Journal provides yet another excellent example of the remarkable long-term success of a national campaign aimed at avoidance of prone sleeping and decreased SIDS incidence. The authors demonstrated a 98% decrease in prone sleep positioning and a 91% decrease in SIDS rate in a demographically representative county of Norway.

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