J Perinat Educ. 2004 Winter; 13(1): 10–20. doi: 10.1624/105812404X109357 PMCID: PMC1595182 PMID: 17273371 Supine and Prone Infant Positioning: A Winning Combination Martha Wilson Jones, RN, BSN Author information Copyright and License information Disclaimer This article has been cited by other articles in PMC.
Go to: Abstract Since 1992, the optimal sleeping position for infants in the United States has been supine. This position has been shown to greatly reduce the rate of Sudden Infant Death Syndrome (Skadberg, Morild, & Markestad, 1998). However, the supine position may lead to other unintended consequences or complications. Through a review of literature, this article explores some of the complications associated with the “Back to Sleep” campaign in the U.S. and discusses educational strategies for perinatal educators. Keywords: infant, sleep, head molding, supine sleep position
Prior to the 1990s, nearly all infants in the United States were placed for sleep in the prone or “tummy” position (Willinger et al., 1998). In 1992, the American Academy of Pediatrics (AAP) published a position statement recommending that all infants be placed in nonprone positioning for sleep with the intended purpose of decreasing the incidence of Sudden Infant Death Syndrome (SIDS). In 1996, the AAP position was amended to promote supine sleep as the preferred position. Although lateral-sleeping position confers a lower risk when compared to prone positioning, it still has a higher risk when compared to supine sleeping position (AAP, 1996). Over the past 10 years, the AAP, U.S. Public Health Service, SIDS Alliance, and the Association of SIDS and Infant Mortality Programs have provided much education to the general public, including the well-known “Back to Sleep” campaign (AAP, 1996). Sometimes, as changes occur in medical practice, unanticipated sequelae appear in other areas. Following the change to supine sleeping, pediatricians, pediatric therapists, neurosurgeons, and plastic surgeons noted some new trends in their various practice areas, as illustrated in the case studies described below. Following the case studies, this article will review the literature relating to trends and the research supporting the supine sleep position, and will present an overview of information on the prevention of SIDS. Strategies will also be provided for perinatal educators to use in the education of their patients regarding the information presented here.
Go to: Case Presentations Baby Girl A was born at a local hospital and then transferred to a neonatal intensive care unit in Virginia. The birth was by cesarean section due to breech presentation. Apgar scores were 3 at 1 minute and 8 at 5 minutes. Her birth weight was 1,050 grams at 30 weeks gestation, reflecting intrauterine growth restriction that was thought to be the result of the mother's pregnancy-induced hypertension. The infant had mild respiratory distress requiring mechanical ventilation for 1 day. She spent 5 days in the neonatal intensive care unit where tube feedings were successfully established and her respiratory status remained stable. She was then transferred to a Level II step-down unit at another hospital to continue her convalescence before being discharged to return home with her parents. The infant presented to the neonatal follow-up clinic at 6 months of age. Physical examination revealed an obvious left torticollis. Her head position was tilted to the left, and she was unable to fully rotate her head to the right beyond approximately 30° from midline (see Figure 1). She also had plagiocephaly (a form of abnormal postnatal head molding), with occiput flattening noted on the posterior left side of her skull. When observing the infant's head from a posterior-superior orientation, the examiner noted her forehead to be asymmetrical, with the right side of her forehead appearing flattened when compared to the left. Her left ear appeared to be anterior to her right ear (see Figure 2).
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SIDS or Sudden Infant Death Syndrome is common in children who sleep prone. I understand this is especially so for the younger children where there is a lower predisposition for tummy-sleepers to turn on their backs to sleep when their breathing gets disrupted. Is this a cultural phenomena? I would like to know better.