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Infant Sleep Position and Associated Health Outcomes
Carl E. Hunt, MD;
Samuel M. Lesko, MD, MPH;
Richard M. Vezina, MPH;
Rosha McCoy, MD;
Michael J. Corwin, MD;
Frederick Mandell, MD;
Marian Willinger, PhD;
Howard J. Hoffman, MA;
Allen A. Mitchell, MD
Arch Pediatr Adolesc Med. 2003;157:469-474.
Background The incidence of sudden infant death syndrome has decreased in the United States as the percentage of infants sleeping prone has decreased, but persisting concerns about the safety of supine sleeping likely contribute to prone sleeping prevalence rates that remain higher than 10%.
Objective To document health outcomes in infants aged 1 to 6 months in relation to sleep position.
Design Prospective cohort study.
Setting Massachusetts and Ohio, from February 21, 1995, to December 31, 1998.
Study Participants A total of 3733 infants with consistent sleep positions at ages 1, 3, and 6 months.
Main Outcome Measures Descriptive statistics and multiple logistic regression analysis relating sleep position at each follow-up age to symptoms in the prior week (fever, cough, wheezing, stuffy nose, trouble breathing or sleeping, diarrhea, vomiting, or spitting up) and outpatient visits in the prior month (ear infection, breathing problem, vomiting, spitting up, colic, seizure, accident, or injury).
Results No symptoms or outpatient visits were significantly more common among infants sleeping on the side or supine than in infants sleeping prone, and 3 symptoms were less common: (1) fever at 1 month in infants sleeping in the supine (adjusted odds ratio [OR], 0.56; 95% confidence interval [CI], 0.34-0.93) and side positions (OR, 0.48; 95% CI, 0.28-0.82); (2) stuffy nose at 6 months in the supine (OR, 0.74; 95% CI, 0.61-0.89) and side positions (OR, 0.82; 95% CI, 0.68-0.99); and (3) trouble sleeping at 6 months in the supine (OR, 0.57; 95% CI, 0.44-0.73) and side positions (OR, 0.69; 95% CI, 0.53-0.89). Also, outpatient visits for ear infections were less common at 3 and 6 months in infants sleeping in the supine position (OR, 0.64; 95% CI, 0.46-0.88; and OR, 0.73; 95% CI, 0.58-0.92, respectively) and at 3 months in the side position (OR, 0.68; 95% CI, 0.49-0.96).
Conclusions No identified symptom or illness was significantly increased among nonprone sleepers during the first 6 months of life. These reassuring results may contribute to increased use of the supine position for infant sleeping.
From the Department of Pediatrics, Medical College of Ohio, Toledo (Drs Hunt and McCoy); Slone Epidemiology Center, Boston University (Drs Lesko, Corwin, and Mitchell and Mr Vezina), Department of Pediatrics, Boston University School of Medicine (Drs Corwin and Mitchell), and Department of Pediatrics, Children's Hospital, Harvard Medical School (Dr Mandell), Boston, Mass; and National Institute of Child Health and Human Development(Dr Willinger) and National Institute on Deafness and Other Communication Disorders (Mr Hoffman), National Institutes of Health, Department of Health and Human Services, Bethesda, Md. Dr Hunt is now affiliated with the National Center on Sleep Disorders Research, National Heart, Lung, and Blood Institute, Bethesda.
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