Some Mothers Not Using "Back to Sleep" to Reduce Risk of SIDS

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The rate of babies being placed on their backs to sleep has reached a plateau since 2001, according to a new report in the December issue of Archives of Pediatrics & Adolescent Medicine.

Eve Colson MD, of the Yale University School of Medicine, and colleagues analyzed data from the National Infant Sleep Position Study. Caregivers of infants age 7 months and younger were asked in a telephone survey about infant sleeping position.

Between 1993 and 2000, more babies were placed to sleep on their backs, and fewer on their stomachs. However, from 2001 through 2007, there was no significant yearly increase in the back to sleep position.

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The survey also found racial and other demographic disparities in infant sleeping position. African American mothers were less likely to place infants to sleep on their backs and continue to have more than twice the rate of SIDS as white babies. Other mothers less likely to follow the Back to Sleep recommendations were those who had lower education levels, those who lived in the Southern states, and those who had children at an older age.

When asked for the reasoning behind their choice in sleep position, about 10% of mothers who did not use the Back to Sleep recommendations were concerned about infant choking. 38% of mothers cited infant comfort as a reason for their choice.

The mothers were asked if physician advice played a role in their infant sleep positioning. One third of respondents responded that they received information from their clinician to use only the back sleeping position for their infants. One third reported being given other advice, such as stomach or side sleeping for their babies. And one third did not receive any advice at all.

Infants are recommended to be placed on their backs while they sleep to decrease the risk sudden infant death syndrome (SIDS). The sleep position, introduced in 1994, is sponsored by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the Maternal and Child Health Bureau, the American Academy of Pediatrics, the SIDS Alliance, and the Association of SIDS and Infant Mortality Program. Since its inception, the rate of SIDS has declined by more than 50%, according to the NICHD.

“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.”

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