Use of Supine Sleep Position for Infants Has Plateaued Since 2001

Laurie Barclay, MD

December 07, 2009

December 7, 2009 — The rate of positioning babies on their backs for sleep to reduce risk for sudden infant death syndrome (SIDS) has reached a plateau since 2001, according to the results of a study released today in the December issue of the Archives of Pediatrics & Adolescent Medicine.

"[SIDS] remains the leading cause of postneonatal death in the United States," write Eve R. Colson, MD, from Yale University School of Medicine in New Haven, Connecticut, and colleagues from the National Infant Sleep Position Study. "Placing the infant to sleep in the supine position has been associated with the dramatic decrease in the SIDS rate since the Back to Sleep Campaign began in 1994. Despite this decrease, African American infants continue to have more than twice the incidence of SIDS as white infants."

Using annual nationally representative telephone surveys from 1993 through 2007, this study aimed to determine trends and factors associated with choice of infant sleeping position in the 48 contiguous states of the United States. Each year, approximately 1000 interviews were conducted with nighttime caregivers of infants born within the preceding 7 months. The primary study endpoint was the percentage of infants who were usually placed in the supine position to sleep.

For all infants, supine sleep increased (P < .001) and prone sleep decreased (P < .001) during the 15-year study period, and there was no significant difference in trend by race. However, a plateau has been reached for all races since 2001.

Time, maternal race other than black, higher maternal educational level, not living in southern states, first-born infant, and full-term infant were all associated with increased supine sleep between 1993 and 2007. However, the effect of these factors was attenuated after adjustment for variables related to maternal concerns about infant comfort, choking, and advice from physicians.

There was no significant annual increase in supine sleep between 2003 and 2007. Race was no longer a significant predictor, and choice of sleep position was almost entirely explained by caregiver concern about comfort, choking, and advice.

"Since 2001, supine sleep has reached a plateau, and there continue to be racial disparities," the study authors write. "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."

Limitations of this study include use of telephone surveys, which could result in underrepresentation of minority and low-income care providers; reliance on caregiver report; and underrepresentation of parents of young infants.

"To reduce death rates, we must ensure that public health measures reach the populations at highest risk and include messages that address concerns about infant comfort or choking," the study authors conclude. "We must remain vigilant about tracking trends in and parental attitudes about infant care practices, as we are seeing evidence of slippage in adherence to the recommendations."

This study was supported in part by a grant from the National Institute of Child Health and Human Development. The study authors have disclosed no relevant financial relationships.

Arch Pediatr Adolesc Med. 2009;163:1122-1128.

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