MONDAY, May 12, 2003 (HealthDayNews) -- Placing infants on their back when they sleep apparently does more than cut the risk of sudden infant death syndrome (SIDS).
The practice seems to lead to fewer fevers, stuffy noses and ear infections, according to a study in the new issue of Archives of Pediatrics & Adolescent Medicine.
"The good news is that no health outcome that we evaluated was any worse in [an] infant sleeping on the back," says Dr. Carl Hunt, lead author of the paper, which he researched while at the Medical College of Ohio in Toledo.
"There's no price to pay by having infants sleep on their back," adds Hunt, now director of the National Center on Sleep Disorders Research.
Several studies have shown that placing infants to sleep on their back reduces the risk of SIDS, which is the death of a baby that remains a mystery even after an autopsy and a thorough medical history. Children up to the age of six months are at greatest risk for SIDS.
In 1992, the American Academy of Pediatrics (AAP) recommended that infants be placed to sleep on their side or back to reduce this risk. The National Institute of Child Health and Human Development (NICHD) followed suit in 1994, and both strategies appear to have been successful. The number of U.S. infants being placed to sleep on their stomach decreased from 70 percent in 1992 to 17 percent in 1998. And death rates from SIDS in the United States decreased by about 40 percent during the same time period.
Despite this demonstrated benefit, some parents still choose to place their infants on their stomach out of fear the child will choke and a belief that children on their stomach sleep better.
"Depending on various family characteristics, there are still, even in the best of circumstances, 10 percent or more of infants still sleeping routinely on their stomachs. And in some subgroups, that goes into the 30 to 35 percent range," Hunt says. "We still have work to do to get the percentage of children who are sleeping on their back up into the 95 percent range."
The new study is the first in the United States to look at health issues related to sleep position of infants. Smaller studies in the United Kingdom and Australia have found similar, positive results, the researchers say.
The researchers analyzed information on 3,733 infants who were part of the Infant Care Practices Study conducted in eastern Massachusetts and in Toledo, Ohio, between 1995 and 1998. All the mothers reported that their children were always placed to sleep in the same position -- the majority on their back, followed by side and then stomach.
The mothers were surveyed when their babies were one, three and six months old, to see if the infants had had any symptoms in the prior week, such as fever, cough, wheezing, stuffy nose, trouble breathing, trouble sleeping, spitting up, diarrhea and vomiting. Outpatient medical visits and visits to emergency rooms or clinics were also assessed for the prior month.
"We were able to show that there was a decreased probability of fever at one month, stuffy nose at six months and trouble sleeping at six months, as well as ear infection at three and six months" for infants sleeping on their backs, reports Marian Willinger, a co-author of the study and special assistant for SIDS at the National Institute of Child Health & Human Development.
"That's a real bonus because ear infections are a source of morbidity in young children. It's painful to the child, and it means missed days of work for parents. It's a whole slew of things," Willinger says.
"There is always the caveat that we're not measuring everything. This is based on parental report," Willinger adds. "[But] for the ear infection, we did ask for outpatient visits, so it wasn't just parents, and very often the maternal report is quite accurate and we were asking in relative real time."
The study, Willinger says, is "reinforcing. It's saying there aren't any major, adverse health effects, so we feel quite comfortable."
The researchers aren't sure why sleeping on the stomach might increase the risk of some health problems. Some scientists have speculated that infants who sleep on their stomach have higher temperatures in their mouth and throat, which may be conducive to the growth of bacteria.
On the other hand, children sleeping on their back also swallow more frequently, indicating they may be clearing their passages more effectively and thereby reducing the chance for blockage.
Whatever the reason, the message is clear. "It's very important that babies are always placed on their back for every sleep by every caregiver," Willinger stresses.
Dr. John Kattwinkel, professor of pediatrics at the University of Virginia, says, "This is a very interesting study and dispels some previous myths about the hazards of back sleeping.
"There had been a report from England several years ago suggesting possible hazards from sleeping supine, but this has now been contradicted," he says. "Sleeping on the back is far safer than sleeping on the stomach for infants. With very rare exceptions, all infants should be put to sleep on their backs."
More information
For more on "Back to Sleep" campaigns, visit the American Academy of Pediatrics or the National Institute of Child Health and Human Development.
