Sleeping Position: Change in Practice, Advice, and Opinion in the Newborn Nursery - sudden infant death syndrome prevention

Journal of Family Practice, May, 2001 by John E. Jr Delzell, Robert L. Jr Phillips, Patricia G. Schnitzer, Bernard Ewigman

* OBJECTIVES Sudden infant death syndrome (SIDS) is a major cause of infant mortality and is associated with the prone sleeping position. Our goal was to determine changes in newborn nursery policies and practices regarding infant sleeping position between 1992 and 1999.

* STUDY DESIGN We conducted telephone interviews with the head nurses in all of the newborn nurseries in Missouri.

* POPULATION In 1992 there were 79 hospitals in Missouri with newborn nurseries; in 1999 that number had decreased to 75.

* OUTCOMES MEASURED During the interviews, we solicited nursery infant sleep position policy and practice, head nurses' opinions about the supine sleep recommendation, and nurses advice to parents regarding sleep position.

* RESULTS In 1992, 32% of the nurseries used the prone position for sleep, and 58% of the head nurses interviewed disagreed with the recommendations of the American Academy of Pediatrics (AAP). By 1999, all newborn nurseries in Missouri placed infants on their backs or sides for sleep. The rate of disagreement with the AAP recommendation had decreased, with 25% of respondents indicating that they disagreed.

* CONCLUSIONS From 1992 to 1999 nurseries in Missouri have changed from predominantly using prone and lateral positioning to lateral and supine positioning for newborns. Some nurses continue to voice concern about placing infants on their backs and expressed a willingness to place babies prone. Since there is agreement between nurses' usual infant positioning and the advice given to parents, and because both are important influences on infant positioning by parents, future campaigns to decrease SIDS should emphasize correcting nursing positioning behavior and advising parents to increase infant supine positioning.

* KEYWORDS Sudden infant death; supine position; knowledge, attitudes, practice; sleep; guidelines. (J Fam Pract 2001; 50:448)

* Submitted, revised, February 26, 2001. From the Center for Family Medicine Science, Department Of Family and Community Medicine, University of Missouri-Columbia (J.E.D., P.G.S., B.E.) and the American Academy of Family Physicians Center for Policy Studies in Family Practice and Primary Care, Washington, DC (R.L.P.). Reprint requests should be addressed to John E. Delzell, Jr, MD, MSPH, Center for Family Medicine Science, Department of Family and Community Medicine, University of Missouri-Columbia, MA 303 Health Sciences Center, DC032.00, Columbia, MO 65212. E-mail: delzellj@health.missouri.edu.