1. Kennedy, Maureen Shawn MA, RN
  2. Ferri, Richard S. PhD, ANP, ACRN, FAAN
  3. Sofer, Dalia

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Since 1992 the American Academy of Pediatrics (AAP) has recommended placing infants on their backs during sleep, in order to decrease the risk of sudden infant death syndrome (SIDS). Since then, says the AAP, the incidence of SIDS has decreased by 50%. But not everyone is following the recommendations noted in the AAP's "Back to Sleep" campaign. According to two recent studies, most neonatal nurses don't place infants on their backs when putting them to sleep, even if they are aware of the AAP guidelines.


One study, published in Nursing Research, questioned 96 newborn nursery nurses and 579 mothers of newborns at eight hospitals in California. While 72% of the nurses were aware that the supine position has been shown to lower the risk of SIDS, only 30% said they most often placed infants in this position. Fear that the supine position may lead to aspiration was the primary reason nurses cited for disregarding the AAP guideline. As for parent teaching, about 65% of the nurses said they advised new mothers to place their infants on their "side" or on their "side or back"; only 34% said they recommend exclusive supine placement. By contrast, 75% of the women who received the AAP recommendations said they usually place their infants on their backs.


Another study, published in MCN, The American Journal of Maternal/Child Nursing reported similar results: an anonymous survey of 528 nurses at 58 Missouri hospitals found that while 96% of the nurses were aware that the supine position is recommended by the AAP, more than a third continued to place infants in the lateral position. In this study as in the previous one, nearly half of the nurses said they worried that placing infants on their backs may increase the risk of aspiration. Nurses with fewer years of experience were more likely to follow the AAP guidelines than those with more experience.



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"We support the AAP recommendations," says Catherine Witt, president of the National Association of Neonatal Nurses. But the reason nurses don't follow them, she says, may be that for so many years they were taught that the side position was also acceptable. "It's hard to change mindsets," she says.


But that's exactly what the researchers of the two studies recommend: educating nurses in the value of the supine position, and encouraging them to teach parents the same.-Dalia Sofer


Stastny P, et al. Nurs Res 2004; 53(2):122-9; Bullock L, et al. MCN Am J Matern Child Nurs 2004; 29(3):172-7.