Infant Sleep Position & Head Control

Statement of Duane F. Alexander, M.D., Director, National Institute of Child Health and Human Development (NICHD)

A study appearing in the October 2001 issue of Developmental and Behavioral Pediatrics reported that premature infants who sleep on their backs gain the ability to lift their heads at a slightly slower rate than do premature infants who sleep on their stomachs. This was an isolated finding noted at 56 weeks postconceptional PCA age and there were no differences between infants who slept on their stomachs and infants who slept on their backs or sides, in terms of global development status either at 56 weeks PCA, or on follow-up evaluation at 92 weeks PCA.

This important finding does not in any way affect the recommendation of the American Academy of Pediatrics, the NICHD, and other organizations that all healthy infants should be placed on their backs to sleep, at bed time and at nap time, to reduce the risk of Sudden Infant Death Syndrome (SIDS). The study authors stressed that placing infants on their backs to sleep is still the most effective way to reduce an infant's risk of SIDS. Unless an infant's pediatrician advises to the contrary, healthy infants should always be placed on their backs to sleep.

To compensate for a delay in an infant's ability to lift his or her head while on the stomach, the study authors suggested that infants be placed on their stomachs for play periods, only when they are awake, and only under adult supervision. The NICHD-led Back to Sleep public education campaign encourages parents and caregivers to provide infants with adult-supervised "tummy time" to help develop neck and shoulder muscles. Since the Back to Sleep campaign was launched in 1994, there has been a 44 percent decrease in SIDS in the United States.

The study authors arrived at their findings after analyzing data on more than 200 prematurely born infants who participated in the Collaborative Home Infant Monitoring Evaluation Study (CHIME), a longitudinal study of infants on cardiorespiriatory monitors, which was conducted at five medical centers in the U.S., and funded by the NICHD.


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