Infant Sleep Position Practices 2 Years Into the “Back to Sleep” Campaign

Abstract

Since the 1992 American Academy of Pediatrics (AAP) recommendation to put babies to sleep in the nonprone position and the subsequent 1994 "Back to Sleep" campaign, the U.S. rate of sudden infant death syndrome (SIDS) has decreased more than 40%. This study reports sleep position practices in the greater Philadelphia area during 1996 and 1997. Four hundred and ten parents of infants 6 months of age or less answered a questionnaire by interview in Philadelphia clinics and private pediatric offices from December 1995 through February 1997. Sleep position practices and other SIDS risk factors were measured among demographic groups and compared with reported rates in a similar population from 1993 and 1994. Data were analyzed by Chi square after analysis of correlation coefficients. Significance is reported at p < 0.05. Seventy-two percent of all infants surveyed slept nonprone (NP) compared to 31.8% in 1993 and 59.1% in 1994. The population was 61% African-American (AA), 62% clinic patients. The breast feeding rate was 31%, maternal smoking 17%, and cosleeping 46%. AA infants (67% vs. 82%), infants receiving care at a clinic (66% vs. 84%), and infants > 3 months old (65% vs. 76%) are less likely to be placed nonprone. Most parents who place infants on their back report it was recommended by a medical professional (56%). The majority of those placing infants prone do so because their infant is more comfortable or sleeps better (65%), although 73% said their physician/nurse discussed sleep position with them. Nonprone sleeping continues to increase since the initiation of the "Back to Sleep" campaign. Disparity between some demographic groups persists. An excessive number of African-American families and clinic families still choose a prone sleep position. Many who do so cite increased infant comfort, despite knowledge of the AAP recommendation.

Infant Sleep Environments Depicted in Magazines Targeted to Women of Childbearing Age

“…Phrases such as "cocooning," "rest assured," "protective," "security," and "endless bonding" imply that comfort is equivalent to safety. Comfort is cited frequently by parents and other caregivers as the primary reason for placing infants prone, 16,[28][29][30][31] and the implication of comfort displayed in these advertisements is likely to be a powerful influence. Unfortunately, many of these pictures portray unsafe sleep environments, such as bed-sharing with another child or sleeping on a soft surface.…”

Absolute Change in Cause-Specific Infant Mortality for Blacks and Whites in the US: 1983–2002

“…SIDS is a condition, like RDS, for which a specific innovation had a large beneficial impact on infant survival. Following the recommendation by the American Academy of Pediatrics (AAP) that infants not be put to sleep in a prone position and the ''back to sleep'' campaign (mounted nationwide in 1994) (Gibson et al 2000;Frohna 2001, 2002;Willinger et al 1998), the SIDS rate dropped by more than one-third among singleton births. Research demonstrates that babies put to sleep in the supine position were at significantly lower risk of death from SIDS (Li et al 2003;Ottolini et al 1999).…”

Intrathoracic petechiae in SIDS: a retrospective population-based 15-year study

“…More than a quarter (28%) of the group I face-down group was African-American infants compared to only 12% of group II face-other cases ( Table 1, P = 0.004). This is perhaps not surprising given that studies have shown African-American mothers place their infants prone for sleep more often than whites or Asians [23][24][25].…”