The advice of a pediatrician to place infants on their backs to sleep appears to be the single most important motivator in getting parents to follow these recommendations, according to a University of Texas Southwestern researcher.

The researchers also note that pediatricians’ advice to place infants on their backs to sleep seems to be a key reason that the rate of sudden infant death syndrome (SIDS) has plummeted since the “Back to Sleep” campaign was launched by the National Institute of Child Health and Human Development in 1994.

“We know that placing infants on their backs to sleep is by far the single most effective way to reduce the risk of SIDS, but the number of deaths has leveled off in recent years,” said coauthor George Lister, MD, chairman of pediatrics at UT Southwestern. “We wanted to know why in order to develop practical advice that caregivers will follow.”

The study, appearing in the December issue of Archives of Pediatric and Adolescent Medicine, identifies three reasons a caregiver might not follow the recommendation: concerns for an infant’s comfort; fear that the infant might choke while sleeping on their back; and whether a physician advised the caregiver to always place an infant on their back to sleep.

“Our findings suggest that a physician’s counsel makes a substantial difference when a caregiver is determining whether to place an infant to sleep on its tummy, side, or back,” said Lister.

The researchers analyzed data obtained from the National Infant Sleep Position Study from 1993 to 2007 to learn which factors influence a caregiver’s decision whether to follow the recommendation. The annually conducted national phone study involves interviewing caregivers of infants born within the past 7 months. More than 1,000 interviews were conducted each year.

The study showed that between 2003 and 2007 only about 54% of study participants reported that a physician advised them to put their infants to sleep only on their backs. Additionally, the study found that while the number of babies placed to sleep on their backs increased substantially between 1993 and 2001, this number has since stabilized.

According to Lister, families who adhered to the “Back to Sleep” recommendation were unlikely to express concerns about their baby choking or being uncomfortable sleeping in that position. These families were more likely, though, to report that a physician recommended the practice as the only option.

African-American infants were found to be less likely to be placed to sleep on their backs than either Hispanics or whites.

“We estimate that there would have been at least 700 fewer deaths of African-American infants over a 5-year period if they were placed on their backs to sleep at the same rate as white infants,” said Lister.

“Physicians need to be proactive by consistently telling parents and caregivers that infants must always be placed on their backs and on a firm mattress to sleep, even for naps,” Lister said. “They must also continue to remind caregivers to remove extra blankets, pillows, and stuffed animals from the crib during sleep time.”

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