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Can sleep position kill your baby?

April 14, 2007

Matthew Vasey, MD



Which way do you sleep best? Is it on your stomach, on your side, on your back, well no matter which way we sleep as an adult, suddenly dying from being in that position isn't so much of a concern. An infant, however, is faced with the recognized catastrophe referred to as sudden infant death syndrome or SIDS. This is the story where a mother or father comes in to wake their baby after a period of sleep to find that their baby has suddenly, died. A clear cut explanation for how or why SIDS affects infants in their sleep remains to be established. Theories do exist as to a mechanism of death for these infants, but for all practical purposes remains mostly academic. The important thing that we can do is try to learn from these tragedies. Here is what we know:

1. SIDS is more common in babies born before term, than those babies delivered at term (1)
2. The younger the infant is, the more likely occurrence of SIDS (1)
3. The "odds ratio" for SIDS in prone sleeping is 13.9 in babies delivered at full term and 48.4 in preterm infants. (2) The "odds ratio" is a coined medical statistical term similar in concept to gambling odds. This means your term baby is 13.9 times more likely, and your preterm baby is 48.4 times more likely to die suddenly in their sleep if you put them to bed on their stomach than if you were to put you baby to bed on their back.

A sleep study of premature born infants prior to initial discharge from the neonatal hospital concluded that these infants slept longer, woke up less and experienced more periods without breathing when sleeping on their stomachs compared to backs. (3) If Charles Darwin were to comment on the issue, I believe he would say something along the lines of babies have been programmed to wake themselves up from life threatening sleeping events such as apnea episodes. (dangerous periods during sleep without breathing, a possible explanation for SIDS) If you sleep infants on their stomach you blunt their instincts to wake themselves up and survive another day. (4) The literature clearly shows that there is a reduced risk of SIDS when your baby sleeps on his or her back.


References:

1. Malloy MH, Hoffman HJ. Prematurity, sudden infant death syndrome, and age of death. Pediatrics. 1995; 96:464-471.
2. Oyen, N, Markestad T, Skjaerven R, et al. Combined effects of sleeping position and prenatal risk factors in sudden infant death syndrome: the Nordic epidemiological SIDS study. Pediatrics. 1997;100:613-621.
3. Bhat, R, Hannam, S, Pressler, R, et al. Effect of prone and supine position on sleep, apneas and arousal in preterm infants. Pediatrics. 2006;118:101-107.
4. Horne, R, Bandopadhayay, P, Virkovic J, et al. Effects of age and sleep position on arousal from sleep in preterm infants. Sleep. 2002;25:746-750.
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