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Physician and nurse recommendations and media messages associated with placing infants on their backs to sleep

Center for Advancing Health

Rates of back sleep position increase, but still require improvement

Recommendations by physicians and nursery staff, as well as print and broadcast media messages, are associated with the increase of caregivers' decisions to place infants on their backs for sleep, according to an article in the April 26 issue of The Journal of the American Medical Association (JAMA).

Marian Willinger, PhD, from the National Institute of Child Health and Human Development in Bethesda, Md., and colleagues report data from telephone interviews of night-time caregivers of infants younger than seven months old. The telephone interviews of caregivers randomly sampled from around the country were conducted to assess which factors may influence a caregiver's choice of infant sleep position after the implementation of the 1994 "Back to Sleep" campaign, which recommended against placing healthy babies on their stomachs (prone) for sleep. The goal of the campaign is to reduce the risk of sudden infant death syndrome (SIDS).

The researchers found that between 1994 and 1998 placement of children on their stomachs for sleep decreased from 44 percent to 17 percent among white infants and from 53 percent to 32 percent among black infants. Placement of children on their backs for sleep for this period increased from 27 percent to 58 percent among white infants and from 17 percent to 31 percent among black infants. During the same period, the caregivers who reported receiving recommendations for placing infants on their back for sleep from at least one source more than doubled from 38 percent to 79 percent. From 1995 to 1998, 86 percent of caregivers who placed infants on their stomachs for sleep reported receiving only recommendations to not put infants on their stomachs for sleep.

Physician recommendation of "back not front" for sleep had the strongest influence on caregivers' decision to place the infant on his or her back for sleep. Caregivers who were given this recommendation by a physician were three times more likely to place the infants they were caring for on their backs for sleep than caregivers who did not get a recommendation from any source. Caregivers who were given this recommendation by a physician, a nurse, heard it on radio or television, and also read about it were six times more likely to place the infants they were caring for on their backs for sleep than caregivers who did not get a recommendation from any source.

"Motivation strongly influences the choice of prone [on the stomach] position in the current environment; thus, clinicians should discuss the reasons for choice of sleep position with the caregiver," the authors write. "Supine [on the back] placement is increasing but has not reached desired levels. Findings from the survey suggest that reinforcement of the supine recommendation by the infant's physician, with support from other sources, is the most effective means of influencing adoption of supine placement."

Citing previous studies, the authors note: "The adoption of the 'Back to Sleep' message and the subsequent declines in the SIDS rate have been rapid in all countries that implemented public education campaigns. In the United States, the prevalence of prone sleep [sleeping on the stomach] decreased from about 70 percent in 1992 to about 24 percent among infants younger than eight months in 1996, and the SIDS rates declined by 38 percent."

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This study was supported in part by a grant from the National Institute of Child Health and Human Development.

To contact Marian Willinger, PhD, call Ruth Dubois or John McGrath at 301-496-5133. If you would like to request a copy of the article, please call the Science News Department at 312-464-5374 or 5904. For more information, contact the AMA's Brian Pace at 312-464-4311, email: Brian_Pace@ama-assn.org.

Posted by the Center for the Advancement of Health http://www.cfah.org. For information about the Center, call Petrina Chong, pchong@cfah.org 202-387-2829.

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