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Infant Sleep Position
and Associated Health Outcomes
Carl E. Hunt, MD; Samuel M.
Lesko, MD, MPH; Richard M. Vezina, MPH;
Rosha McCoy, MD; Michael J. Corwin,
MD; Frederick Mandell, MD;
Marian Willinger, PhD; Howard J. Hoffman,
MA; Allen A. Mitchell, MD
Arch Pediatr Adolesc Med. 2003;157:469-474.
Background The incidence of sudden
infant death syndrome has decreased in the
United States as the percentage of infants
sleeping prone has decreased, but persisting concerns
about the safety of supine sleeping likely
contribute to prone sleeping prevalence rates
that remain higher than 10%.
Objective To document health outcomes in
infants aged 1 to 6 months in relation to
sleep position.
Design Prospective cohort study.
Setting Massachusetts and Ohio, from February
21, 1995, to December 31, 1998.
Study Participants A total of 3733 infants
with consistent sleep positions at ages 1, 3,
and 6 months.
Main Outcome Measures Descriptive statistics
and multiple logistic regression analysis
relating sleep position at each follow-up age
to symptoms in the prior week (fever, cough, wheezing,
stuffy nose, trouble breathing or sleeping,
diarrhea, vomiting, or spitting up) and
outpatient visits in the prior month (ear
infection, breathing problem, vomiting, spitting up,
colic, seizure, accident, or injury).
Results No symptoms or outpatient visits were
significantly more common among infants
sleeping on the side or supine than in
infants sleeping prone, and 3 symptoms were less common:
(1) fever at 1 month in infants sleeping in the
supine (adjusted odds ratio [OR], 0.56; 95%
confidence interval [CI], 0.34-0.93) and side
positions (OR, 0.48; 95% CI, 0.28-0.82); (2) stuffy
nose at 6 months in the supine (OR, 0.74; 95% CI,
0.61-0.89) and side positions (OR, 0.82; 95%
CI, 0.68-0.99); and (3) trouble sleeping at 6
months in the supine (OR, 0.57; 95% CI, 0.44-0.73)
and side positions (OR, 0.69; 95% CI, 0.53-0.89).
Also, outpatient visits for ear infections
were less common at 3 and 6 months in infants
sleeping in the supine position (OR, 0.64; 95% CI,
0.46-0.88; and OR, 0.73; 95% CI, 0.58-0.92,
respectively) and at 3 months in the side
position (OR, 0.68; 95% CI, 0.49-0.96).
Conclusions No identified symptom or illness
was significantly increased among nonprone
sleepers during the first 6 months of life.
These reassuring results may contribute to increased
use of the supine position for infant sleeping.
From the Department of Pediatrics, Medical
College of Ohio, Toledo (Drs Hunt and McCoy); Slone
Epidemiology Center, Boston University (Drs Lesko,
Corwin, and Mitchell and Mr Vezina), Department of
Pediatrics, Boston University School of Medicine (Drs
Corwin and Mitchell), and Department of Pediatrics,
Children's Hospital, Harvard Medical School (Dr
Mandell), Boston, Mass; and National Institute of Child
Health and Human Development(Dr Willinger) and National
Institute on Deafness and Other Communication Disorders
(Mr Hoffman), National Institutes of Health, Department
of Health and Human Services, Bethesda, Md. Dr Hunt is
now affiliated with the National Center on Sleep
Disorders Research, National Heart, Lung, and Blood
Institute, Bethesda.
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Arch Pediatr Adolesc Med. 2003;157:413.
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