Advice, Mothers’ Beliefs Associated With Infant Sleep Position


Mothers who believe their babies are uncomfortable or more likely to choke when sleeping on their backs are more likely to place them in other positions, thereby increasing their risk for sudden infant death syndrome (SIDS), according to a report in the April issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals. In contrast, those who receive consistent advice from physicians, nurses and the media to place their babies to sleep on their backs are likely to follow this recommendation.

Despite the success of public education efforts promoting supine (back) sleeping as a way to lower SIDS risk, two important problems remain, according to background information in the article. More infants in all racial and ethnic groups are being placed on their backs to sleep, but African American infants remain less likely than white infants to be placed supine. In addition, the national rate of supine sleeping has reached a plateau, with nearly one-fourth of all infants (and half of African American infants) being placed in other sleeping positions.

Isabelle Von Kohorn, M.D., of Yale University, New Haven, Conn., and colleagues conducted face-to-face interviews with 2,299 predominantly African American mothers of infants younger than 8 months between 2006 and 2008. The mothers reported what advice they had received and their personal beliefs about infant sleep position.

A total of 1,408 mothers (61 percent) reported usually placing their infants on their backs to sleep, 489 (21 percent) usually placed them on their sides, 390 (17 percent) usually placed them on their stomachs and 12 (0.5 percent) used another position.

Most mothers received no advice from family, friends or the media about sleep position; physicians reportedly advised women to use only supine sleep positions for their infants 56 percent of the time. Women who had higher advice scores—meaning they received advice from multiple sources that recommended placing babies to sleep on their backs—were more likely to use the supine sleep position. “For example, of the 559 mothers who had a negative advice score, 36 percent (202 mothers) placed their infants supine, whereas of the 439 mothers with an extremely positive advice score, 85 percent (373 mothers) usually placed their infant supine to sleep,” the authors write.

Most mothers reported clear beliefs about choking and comfort in relation to sleep position. Most (1,443 or 63 percent) believed that their infants were most comfortable in a position other than on their backs and most (1,280 or 56 percent) believed their infants were more likely to choke on their backs. Those who held either of these beliefs were less likely to place their infants on their backs to sleep.

“When accounting for mothers’ beliefs, we do not see a racial or ethnic difference in propensity for supine infant sleep,” the authors conclude. “Increasing advice for exclusively supine sleep, especially through the media, and addressing mothers’ concerns about infant comfort and choking are critical to getting more infants on their back to sleep.”

(Arch Pediatr Adolesc Med. 2010;164[4]:363-369.