Prather Pediatric and Allergy Center - Ask Doctor Brent

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Title: New Recommendations for Babies - Sleeping Position

Category: Child Care


Last year the American Academy of Pediatrics recommended that young babies, particularly those under three months old, be put to bed lying on their backs or on their sides. Prior to that it was always recommended to put young babies face down because of concern about regurgitation and choking. Now numerous studies are showing that infants do not regurgitate and choke when lying on their backs and that lying face down puts them at a very much higher risk of sudden infant death syndrome.

A recent study reviewing 80 SIDS deaths compared to 3,300 healthy infant controls, found several important factors. The increase in the SIDS risk seems to go up if the babies are very tightly wrapped in blankets. The risk goes up if they have colds or are placed on very soft mattresses or in overly warm bedrooms. The risk of SIDS increased about 20 fold if the infants were put face down on a very soft fluffy mattress. The risk was only three fold higher if they were on a firm ordinary mattress. Swaddling increased the risk for SIDS 12 times when the babies were wrapped very tightly in sheets or blankets and laid face down. Illnesses, such as upper respiratory infections increased the risk of SIDS 10 times when the babies were laid face down and had colds or fever or other minor illnesses. Heating of the infant's room up to 14 degrees higher than the unheated temperature increased the risk for SIDS 15 fold.

These studies were done by an Australian physician named Anne Louise Ponsonby at the University of Tasmania. The study was published recently in the New England Journal of Medicine. An editorial in the same issue of the Journal urged further ongoing investigations. The present feeling of the American Academy of Pediatrics and most other pediatric societies around the world is that babies should, based on all this evidence, be put to sleep lying on their backs or sides to minimize the risk of SIDS.