Pediatrics Mass. SIDS

Pediatrics – MA Center for Sudden Infant Death Syndrome (SIDS)

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Back to Sleep – Unexpected Benefits

The decreased risk of sudden infant death syndrome (SIDS) associated with non-prone sleep positions led the American Academy of Pediatrics in 1992 to recommend that infants be placed to sleep on their side or back; two years later the "Back to Sleep" campaign was launched, and now the supine sleep position is recommended. As the prevalence of infants sleeping prone decreased from 70% in 1992 to 17% in 1998, SIDS rates in the U.S. decreased by about 40%. Still, some parents and physicians have been concerned that non-prone sleep positions may be associated with trouble sleeping and gastro-esophageal reflux, and perhaps aspiration as well.

To determine whether non-prone positions might be associated with various health problems (other than SIDS), researchers in Massachusetts and Ohio studied 9,773 infants who had been enrolled at birth and followed for the first six months of life. Among these, 3,733 had been reported to have the same sleep position at 1, 3 and 6 months of age, and these infants were the subject of further analysis. Included in outcomes studied were fever, cough, respiratory problems (wheezing and trouble breathing), trouble sleeping, spitting up or vomiting, and outpatient visits for ear infections, colic, seizures or accidents/injuries.

Over the six-month period of observation for each of the infants, the authors found no symptoms or outpatient visits to be more frequent among infants sleeping on the side or supine than among infants sleeping prone. Indeed, some outcomes were actually less common among infants sleeping on their side or supine - fever at one month of age was about half as common compared to prone sleepers, stuffy nose was about 25% less frequent at 6 months of age, and trouble sleeping was about 30-40% less common at 6 months of age. Outpatient visits for ear infections at 3 and 6 months were also reported about 25-33% less frequently among infants sleeping supine and a similar effect was seen at 3 months for infants sleeping on their sides.

The authors argue that these findings serve as reassurance that placing infants to sleep on the side or back does not increase any of a wide range of health risks. "Of particular importance is the fact that the study sample was sufficiently large for most health outcomes to rule out even modest increases in risk. A secondary observation of a decrease in reported ear infections associated with infants sleeping in the side and supine positions warrants further study." Finally, they note, "conclusions about possible health risks associated with supine sleep have limited the degree to which some health care providers advocate and some parents comply with Back to Sleep recommendations. Our findings should lead to more widespread adoption of this important public health intervention." (Hunt CE et al: Arch Pediatr Adolesc Med, May 2003, 157:469-474)

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Call: 617.414.7437 or 800.641.7437
Fax: 617.414.5555


Boston Medical Center
Department of Pediatrics
MA Center for Sudden Infant Death Syndrome
Dowling Building
4th floor, Room 4204
771 Albany Street
Boston, MA 02118


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