Arch Dis Child. 1995 Jun;72(6):478-82.
Sleeping position and sudden infant death syndrome in Norway 1967-91.
Irgens LM1, Markestad T, Baste V, Schreuder P, Skjaerven R, Oyen N.
To investigate, in a population based national study, the association between sleeping position of infants and the occurrence of sudden infant death syndrome (SIDS).
A retrospective survey and registry based ecological study. A questionnaire based surveillance of sleeping position was obtained in a random sample (n = 34,799) and surveillance of SIDS was based on all infants born in Norway 1967-91, surviving the perinatal period. Variables studied from the questionnaire were usual sleeping position (placed), breast feeding at 3 months, and maternal smoking in pregnancy, and from the Medical Birth Registry maternal age, birth order, and birth weight.
Proportion of infants sleeping prone increased from 1970 (7.4%) to 1989 (49.1%) and dropped in 1990 (26.8%) and 1991 (28.3%). Occurrence of SIDS increased from 1970 (1.1/1000) to 1989 (2.0) before dropping in 1990 and 1991 (1.1). IMPLICATION AND RELEVANCE OF RESULTS: A cause effect relationship between prone sleeping and SIDS as suggested in previous studies is supported by the present; and so far only, national study of infants’ sleeping position.
J Pediatr. 1996 May;128(5 Pt 1):626-30.
Prone sleep position and the sudden infant death syndrome in King County, Washington: a case-control study.
Taylor JA1, Krieger JW, Reay DT, Davis RL, Harruff R, Cheney LK.
To determine whether the prone sleep position was associated with an increased risk of the sudden infant death syndrome (SIDS).
Population-based case-control study.
Case subjects were infants who died of SIDS in King County, Washington. Control subjects were randomly selected infants born in King County. Up to four control subjects were matched on date of birth to each case subject.
During the study period, November 1992 through October 1994, sleep-position data were collected on infants who died of SIDS by the King Count Medical Examiner’s Office during their investigation of the deaths. Parents of infants chosen as control subjects were contacted by telephone, and sleep position information was obtained. Infants who usually slept on their abdomen were classified as sleeping prone; those who usually slept on the side or back were categorized as sleeping nonprone. The adjusted odds ratio for prone sleep position as a risk factor for SIDS was calculated with conditional logistic regression after control for race, birth weight, maternal age, maternal marital status, household income, and maternal cigarette smoking during pregnancy.
Sleep position data were collected on 47 infants with SIDS (77% of eligible infants) and 142 matched control subjects; 57.4% of infants who died of SIDS usually slept prone versus 24.6% of control subjects (p < 0.00001). The unadjusted odds ratio for prone sleep position as a risk factor for SIDS was 4.69 (95% confidence interval: 2.17, 10.17). After control for potentially confounding variables, the adjusted odds ratio for prone sleep position was 3.12 (95% confidence interval: 1.08, 9.03).
Prone sleep position was significantly associated with an increased risk of SIDS among a group of American infants.
Arch Pediatr Adolesc Med. 1996 Aug;150(8):834-7.
Risk factors for the infant prone sleep position.
Taylor JA1, Davis RL.
To identify parental characteristics associated with infants being placed to sleep in the prone position.
Randomly selected King County, Washington, infants born on the same days as King County infants who died of sudden infant death syndrome between November 1992 and October 1994.
Parents of study infants responded to a telephone interview about sleep position in their infants. Parents were asked how they usually put their infants to bed during the previous 2 weeks, and if they were aware of any recent advice on sleep position in young infants. Demographic data were also collected during the telephone interview. Logistic regression was used to identify infant and parental characteristics associated with the prone sleep position.
Parents of 178 infants were interviewed; 28.1% responded that their infants usually slept prone, 66.9% slept nonprone, and 5% had no usual sleep position. Parents who were unaware of sleep position advice were more likely to place their infants prone than those who were aware of this advice (odds ratio, 3.5; 95% confidence interval, 1.5-7.8). Among parents who were aware of sleep position advice, mothers younger than 20 years were more than 10 times as likely to place their infants prone than were older mothers (odds ratio, 10.7; 95% confidence interval, 1.1-107.0). For those who were unaware of sleep position advice, single mothers were more likely to place their infants prone (odds ratio, 14.0; 95% confidence interval, 1.5-133.2). Single mothers and parents of low-birth-weight infants were more likely to be unaware of recent medical advice regarding optimal sleep position for infants.
The results of this study may provide direction to future efforts to encourage nonprone sleeping. Knowledge of the risk is associated with decreased use of prone sleep position. Single mothers should be targeted for intensive educational efforts regarding the hazards of prone sleeping. Among teenage mothers, awareness of the association between prone sleeping and sudden infant death syndrome may not be adequate to change behavior; educational interventions that are more focused for this age group may be needed.
Pediatrics. 2006 Aug;118(2):e243-50.
Barriers to following the supine sleep recommendation among mothers at four centers for the Women, Infants, and Children Program.
Colson ER1, Levenson S, Rybin D, Calianos C, Margolis A, Colton T, Lister G, Corwin MJ.
The risk for sudden infant death syndrome in black infants is twice that of white infants, and their parents are less likely to place them in the supine position for sleep. We previously identified barriers for parents to follow recommendations for sleep position. Our objective with this study was to quantify these barriers, particularly among low-income, primarily black mothers.
We conducted face-to-face interviews with 671 mothers, 64% of whom were black, who attended Women, Infants, and Children Program centers in Boston, Massachusetts, Dallas, Texas, Los Angeles, California, and New Haven, Connecticut. We used univariate analyses to quantify factors that were associated with choice of sleeping position and multivariate logistic regression to calculate adjusted odds ratios for the 2 outcome variables: "ever" (meaning usually, sometimes, or last night) put infant in the prone position for sleep and "usually" put infant in the supine position to sleep.
Fifty-nine percent of mothers reported supine, 25% side, 15% prone, and 1% other as the usual position. Thirty-four percent reported that they ever placed infants in the prone position. Seventy-two percent said that a nurse, 53% a doctor, and 38% a female friend or relative provided source of advice. Only 42% reported that a nurse, only 36% a doctor, and only 15% a female friend or relative recommended the supine position for sleep. When a female friend or relative recommended the prone position, mothers were more likely ever to place their infants in the prone position and less likely usually to choose supine compared with those who received no advice from friends or relatives. When a doctor or a nurse recommended a nonsupine position, the mothers were less likely to choose supine compared with those who received no advice from a doctor or a nurse. Mothers who trusted the opinion of a doctor or a nurse about infant sleeping position were more likely to place their infants in the supine position. Half of the mothers believed that infants were more likely to choke when supine, and they were less likely to place their infants supine. Mothers who believed that infants are more comfortable in the prone position (36%) were more likely to place their infants prone. Twenty-nine percent believed that having their infants sleep with an adult helps prevent sudden infant death syndrome, and only 43% believed that sudden infant death syndrome is related to sleeping position.
We identified specific barriers to placing infants in the supine position for sleep (lack of or wrong advice, lack of trust in providers, knowledge and concerns about safety and comfort) in low-income, primarily black mothers that should be considered when designing interventions to get more infants onto their back for sleep.
Int J Epidemiol. 2005 Aug;34(4):874-87. Epub 2005 Apr 20.
Infant sleeping position and the sudden infant death syndrome: systematic review of observational studies and historical review of recommendations from 1940 to 2002.
Gilbert R1, Salanti G, Harden M, See S.
Before the early 1990s, parents were advised to place infants to sleep on their front contrary to evidence from clinical research.
We systematically reviewed associations between infant sleeping positions and sudden infant death syndrome (SIDS), explored sources of heterogeneity, and compared findings with published recommendations.
By 1970, there was a statistically significantly increased risk of SIDS for front sleeping compared with back (pooled odds ratio (OR) 2.93; 95% confidence interval (CI) 1.15, 7.47), and by 1986, for front compared with other positions (five studies, pooled OR 3.00; 1.69-5.31). The OR for front vs the back position was reduced as the prevalence of the front position in controls increased. The pooled OR for studies conducted before advice changed to avoid front sleeping was 2.95 (95% CI 1.69-5.15), and after was 6.91 (4.63-10.32). Sleeping on the front was recommended in books between 1943 and 1988 based on extrapolation from untested theory.
Advice to put infants to sleep on the front for nearly a half century was contrary to evidence available from 1970 that this was likely to be harmful. Systematic review of preventable risk factors for SIDS from 1970 would have led to earlier recognition of the risks of sleeping on the front and might have prevented over 10 000 infant deaths in the UK and at least 50 000 in Europe, the USA, and Australasia. Attenuation of the observed harm with increased adoption of the front position probably reflects a “healthy adopter” phenomenon in that families at low risk of SIDS were more likely to adhere to prevailing health advice. This phenomenon is likely to be a general problem in the use of observational studies for assessing the safety of health promotion.
Ann Med. 1998 Aug;30(4):345-9.
Side sleeping position and bed sharing in the sudden infant death syndrome.
Scragg RK1, Mitchell EA.
In the last decade there have been major reductions in the sudden infant death syndrome (SIDS) rate following prevention programmes in Australasia, Europe and North America, mainly due to changing infants from the prone sleeping position onto their sides or backs. This report reviews previous SIDS observational studies with data on side sleeping position and bed sharing. The relative risk for SIDS calculated from previous studies for side vs back sleeping position is 2.02 (95% CI = 1.68, 2.43). This result suggests that further substantial decreases in SIDS could be expected if infants were placed to sleep on their backs. With regard to bed sharing, the summary SIDS relative risk is 2.06 (1.70, 2.50) for infants of smoking mothers and 1.42 (1.12, 1.79) for infants of nonsmoking mothers. Public health policy should be directed against bed sharing by infants whose mothers smoke as they carry an increased risk of SIDS from bed sharing in addition to their already increased risk from maternal smoking. For infants of nonsmoking mothers, who have a low absolute risk of SIDS, the 40-50% increase in risk needs to be balanced against other perceived benefits from bed sharing, such as increased breastfeeding.
Westcott WW. Inebriety in women and the overlaying of infants. The British Journal of Inebriety 1903;4i:65–68.
Abramson H. Accidental mechanical suffocation in infants. The Journal of Pediatrics1944;25:404–13.
Bowden KM. Sudden death or alleged accidental suffocation in babies. The Medical Journal of Australia 1950;1:65–72.
Davison H. Accidental infant suffocation. BMJ1945;2:251–52.
New York State Department of Health. Merchanical suffocation: leading cause of accidental death in early infancy. Health News1945;22:33–34.
Woolley PV. Mechanical suffocation during infancy. A comment on its relation to the total problem of sudden death. The Journal of Pediatrics 1945;26:572–75.
Werne J, Garrow I. Sudden deaths of infants allegedly due to merchanical suffocation. Am J Public Health 1947;37:675–87.
Werne J, Garrow I. Sudden apparently unexplained death during infancy. I Pathologic findings in infants found dead. Am J Pathol1953;29:633–53.
Polson CJ, Price DE. Suffocation by milk feeds.Lancet 1948;251:343.
Camps FE, Parish WE, Barrett AM, Coombs RRA, Gunther M. Hypersensitivity to milk and sudden death in infancy. Lancet 1960;276:1106–10.
Strimer R, Adelson L, Oseasohn R. Epidemiologic features of 1,134 sudden, unexpected infant deaths. A study in the Greater Cleveland Area from 1956 to 1965. JAMA 1969;209:1493–97.
Carpenter RG, Shaddick CW. Role of infection, suffocations and bottle-feeding in cot death: an analysis of some factors in the histories of 110 cases and their controls. Br J Prev Soc Med1965;19:1–7.
Hiley CMH. Back to Sleep: Cot death and Infant Care 1987–1994. Cambridge: University of Cambridge, 1995.
Greenland S, Rothman KJ. Measures of effect and measures of association. In: Rothman KJ, Greenland S (eds). Modern Epidemiology. Philadelphia: Lippincott-Raven, 1998, pp. 47–64
Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ2003;327:557–60.
Egger M, Davey SG, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ 1997;315:629–34.
Begg CB, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics 1994;50:1088–101.
Lau J, Antman EM, Jimenez-Silva J, Kupelnick B, Mosteller F, Chalmers TC. Cumulative meta-analysis of therapeutic trials for myocardial infarction. N Engl J Med 1992;327:248–54.
Trikalinos TA, Churchill R, Ferri M et al. Effect sizes in cumulative meta-analyses of mental health randomized trials evolved over time. J Clin Epidemiol 2004; 57:1124–30.
Ioannidis JP, Contopoulos-Ioannidis DG, Lau J. Recursive cumulative meta-analysis: a diagnostic for the evolution of total randomized evidence from group and individual patient data. J Clin Epidemiol 1999;52:281–91.
Dwyer T, Couper D, Walter SD. Sources of heterogeneity in the meta-analysis of observational studies: the example of SIDS and sleeping position. J Clin Epidemiol 2001;54:440–47.
Sharp SJ, Thompson SG. Analysing the relationship between treatment effect and underlying risk in meta-analysis: comparison and development of approaches. Stat Med2000;19:3251–74.
Thompson SG, Smith TC, Sharp SJ. Investigating underlying risk as a source of heterogeneity in meta-analysis. Stat Med 1997;16:2741–58.
Spock B. Baby and Child Care. London: The Bodley Head, 1958.
Illingworth RS. The Normal Child. London: J & A Churchill Ltd, 1968.
Shepard KS. Care of the Well Baby. Philadelphia: JP LIppincott Company, 1960.
Bax M, Bernal J. Your Child’s First Five Years. London: Heinemann Health Books, 1974.
Nelson WE. Mitchell-Nelson Textbook of Pediatrics. London: WB Saunders, 1945.
Nelson WE. Mitchell-Nelson Textbook of Pediatrics. London: WB Saunders Company,1950.
Nelson WE. Mitchell-Nelson Textbook of Pediatrics. London: WB Saunders Company,1959.
Zabriskie L. Mother and Baby in Pictures. London: JB Lippincott Company, 1953
Gordon M, Gordon R. A Baby in the House. A Guide to Practical Parenthood. London: Heinemann, 1966.
Nicholl JP, O’Cathain A, McGlashan ND. Sleeping positions and SIDS. Lancet 1988;3322:106.
Fleming PJ, Gilbert R, Azaz Y et al. Interaction between bedding and sleeping position in the sudden infant death syndrome: a population based case–control study. BMJ 1990;301:85–89.
Ponsonby AL, Dwyer T, Gibbons LE, Cochrane JA, Wang YG. Factors potentiating the risk of sudden infant death syndrome associated with the prone position. N Engl J Med 1993;329:377–82.
Markestad T, Skadberg B, Hordvik E, Morild I, Irgens LM. Sleeping position and sudden infant death syndrome (SIDS): effect of an intervention programme to avoid prone sleeping. Acta Paediatr 1995;84:375–78.
Klonoff-Cohen HS, Edelstein SL. A case–control study of routine and death scene sleep position and sudden infant death syndrome in Southern California. JAMA 1995;273:790–94.
Taylor JA, Krieger JW, Reay DT, Davis RL, Harruff R, Cheney LK. Prone sleep position and the sudden infant death syndrome in King County, Washington: a case–control study. J
Fleming PJ, Blair PS, Bacon C et al. Environment of infants during sleep and risk of the sudden infant death syndrome: results of 1993–5 case–control study for confidential inquiry into stillbirths and deaths in infancy. Confidential Enquiry into Stillbirths and Deaths Regional Coordinators and Researchers. BMJ1996;313:191–95.
Hauck FR, Moore CM, Herman SM et al. The contribution of prone sleeping position to the racial disparity in sudden infant death syndrome: the Chicago Infant Mortality Study. Pediatrics2002; 110:772–80.
Carpenter RG, Irgens LM, Blair PS et al. Sudden unexplained infant death in 20 regions in Europe: case control–study. Lancet 2004; 363:185–91.
Brooke H, Gibson A, Tappin D, Brown H. Case–control study of sudden infant death syndrome in Scotland, 1992–5. BMJ 1997;314:1516–20.
McGarvey C, McDonnell M, Chong A, O’Regan M, Matthews T. Factors relating to the infant’s last sleep environment in sudden infant death syndrome in the Republic of Ireland. Arch Dis Child 2003;88:1058–64.
Oyen N, Markestad T, Skaerven R et al. Combined effects of sleeping position and prenatal risk factors in sudden infant death syndrome: the Nordic Epidemiological SIDS Study. Pediatrics 1997;100:613–21.
Dwyer T, Ponsonby AL, Newman NM, Gibbons LE. Prospective cohort study of prone sleeping position and sudden infant death syndrome.Lancet 1991;337:1244–47.
Dwyer T, Ponsonby AL, Couper D, Cochrane J. Short-term morbidity and infant mortality among infants who slept supine at 1 month of age—a follow-up report. Paediatr Perinat Epidemiol1999;13:302–15.
Brackbill Y, Douthitt TC, West H. Psychophysiologic effects in the neonate of prone versus supine placement. J Pediatr1973;82:82–84.
Keitel HG, Cohn R, Harnish D. Diaper rash, self-inflicted excoriations, and crying in full-term newborn infants kept in the prone or
Hunt L, Fleming P, Golding J. Does the supine sleeping position have any adverse effects on the child? I. Health in the first six months. The ALSPAC Study Team. Pediatrics 1997;100:E11.
Byard RW, Beal SM. Gastric aspiration and sleeping position in infancy and early childhood.J Paediatr Child Health 2000;36:403–5.
Dewey C, Fleming P, Golding J. Does the supine sleeping position have any adverse effects on the child? II. Development in the first 18 months.ALSPAC Study Team. Pediatrics1998;101:E5.
Davis BE, Moon RY, Sachs HC, Ottolini MC. Effects of sleep position on infant motor development. Pediatrics 1998;102:1135–40.
Persing J, James H, Swanson J, Kattwinkel J. Prevention and management of positional skull deformities in infants. American Academy of Pediatrics Committee on Practice and Ambulatory Medicine, Section on Plastic Surgery and Section on Neurological Surgery. Pediatrics2003;112:199–202.
Persson S, Ekbom A, Granath F, Nordenskjold A. Parallel incidences of sudden infant death syndrome and infantile hypertrophic pyloric stenosis: a common cause? Pediatrics2001;108:E70.
Galland BC, Taylor BJ, Bolton DP. Prone versus supine sleep position: a review of the physiological studies in SIDS research. J Paediatr Child Health 2002;38:332–8.
Froggatt P. Epidemiological aspects of the Northern Ireland study. In: Bergman AB, Beckwith JB, Ray CG (eds). Sudden Infant Death Syndrome. Proceedings of the Second International Conference on Causes of Sudden Death in Infants. Seattle: University of Washington Press,1970, pp. 32–46.
McGlashan ND. Sudden infant deaths in Tasmania, 1980–1986: a seven year prospective study. Soc Sci Med 1989;29:1015–26.
Cameron MH, Williams AL. Development and testing of scoring systems for predicting infants with high-risk of sudden infant death syndrome in Melbourne. Aust Paediatr J 1986;22 (Suppl. 1):37–45.
Beal S. Sleeping position and SIDS. Lancet1988;2:512.
Tonkin SL. Epidemiology of cot deaths in Auckland. NZ Med J 1986;99:324–26.