Infant sleeping position and the sudden infant death syndrome: systematic review of observational studies and historical review of recommendations from 1940 to 2002
Open Access
- 20 April 2005
- journal article
- review article
- Published by Oxford University Press (OUP) in International Journal of Epidemiology
- Vol. 34 (4), 874-887
- https://doi.org/10.1093/ije/dyi088
Abstract
Background Before the early 1990s, parents were advised to place infants to sleep on their front contrary to evidence from clinical research. Methods We systematically reviewed associations between infant sleeping positions and sudden infant death syndrome (SIDS), explored sources of heterogeneity, and compared findings with published recommendations. Results By 1970, there was a statistically significantly increased risk of SIDS for front sleeping compared with back (pooled odds ratio (OR) 2.93; 95% confidence interval (CI) 1.15, 7.47), and by 1986, for front compared with other positions (five studies, pooled OR 3.00; 1.69–5.31). The OR for front vs the back position was reduced as the prevalence of the front position in controls increased. The pooled OR for studies conducted before advice changed to avoid front sleeping was 2.95 (95% CI 1.69–5.15), and after was 6.91 (4.63–10.32). Sleeping on the front was recommended in books between 1943 and 1988 based on extrapolation from untested theory Conclusions Advice to put infants to sleep on the front for nearly a half century was contrary to evidence available from 1970 that this was likely to be harmful. Systematic review of preventable risk factors for SIDS from 1970 would have led to earlier recognition of the risks of sleeping on the front and might have prevented over 10 000 infant deaths in the UK and at least 50 000 in Europe, the USA, and Australasia. Attenuation of the observed harm with increased adoption of the front position probably reflects a ‘healthy adopter’ phenomenon in that families at low risk of SIDS were more likely to adhere to prevailing health advice. This phenomenon is likely to be a general problem in the use of observational studies for assessing the safety of health promotion.Keywords
This publication has 85 references indexed in Scilit:
- Measuring inconsistency in meta-analysesBMJ, 2003
- Preventing sudden infant deaths — the slow diffusion of an ideaHealth Policy, 1996
- Prone sleep position and the sudden infant death syndrome in King County, Washington: A case-control studyThe Journal of Pediatrics, 1996
- Further evidence supporting a causal relationship between prone sleeping position and SIDSJournal of Paediatrics and Child Health, 1992
- Psychophysiologic effects in the neonate of prone versus supine placementThe Journal of Pediatrics, 1973
- Epidemiology of sudden unexpected death in infants ('cot death') in Northern Ireland.Journal of Epidemiology and Community Health, 1971
- Role of Infection, Suffocation, and Bottle-feeding in Cot Death: An Analysis of Some Factors in the Histories of 110 Cases and their ControlsJournal of Epidemiology and Community Health, 1965
- Mechanical suffocation during infancyThe Journal of Pediatrics, 1945
- Accidental mechanical suffocation in infantsThe Journal of Pediatrics, 1944
- INEBRIETY IN WOMEN AND THE OVERLAYING OF INFANTS.*British Journal of Inebriety, 1903