Although placing infants to sleep on their backs has been found to greatly reduce the risk of Sudden Infant Death Syndrome (SIDS), 41 percent of those who responded to the survey said that their infants' physicians had not made a recommendation on infant sleep position.
"Physicians can greatly help to increase back sleeping by advising parents and caregivers to place infants to sleep on their backs," said Dr Duane Alexander, MD, Director of the National Institute of Child Health and Human Development (NICHD), which funded the study.
The analysis also found that the number of infants being put to sleep on their stomachs continues to drop. But a significant portion of the population is still placing infants to sleep on their stomachs - despite having been told that back sleeping reduces the risk of SIDS.
Marian Willinger, PhD, of NICHD's Pregnancy and Perinatology Branch, led the research team that reported the findings, which appear in the April Journal of the American Medical Association.
Other members of the research team are from the National Institute on Deafness and Other Communication Disorders (NIDCD), the Harvard School of Medicine, and the Boston University School of Medicine.
SIDS strikes nearly 3 000 babies each year. SIDS is the sudden, unexplained death of an infant in the first year of life. The causes of SIDS are still unclear, and it is not currently possible to predict which infants might fall victim to SIDS.
Back sleeping has been found to significantly reduce the risk of SIDS. Since the dissemination of the recommendation to place infants to sleep on their backs or sides, the SIDS rate has fallen almost 40 percent.
The NISP study is an annual telephone survey of night time caregivers of infants under eight months of age conducted in the 48 contiguous states to assess infant care practices and to help evaluate the dissemination of the Back to Sleep Campaign messages.
This campaign, which encourages that infants be placed to sleep on their backs to reduce the risk of SIDS, was launched in 1994 by the NICHD, in partnership with other agencies of the American Public Health Service, the AAP, the SIDS Alliance, and the Association of SIDS and Infant Mortality Programs.
This report examines the factors that determine sleep position choice between 1994 and 1998. The study found that physicians had the greatest influence on whether or not caregivers placed infants to sleep on their backs.
In fact, caregivers that were advised by physicians to put infants on their backs to sleep were about three times more likely to do so than were caregivers not given a recommendation.
Significant racial disparities remain in sleep position choice. Between 1994 and 1998, stomach placement had decreased from 44 percent to 17 percent among white infants, and from 53 to 32 percent among black infants. African American infants are 2,2 times more likely to die from SIDS than are white infants.
Specifically, caregivers who put infants to sleep on their stomachs said that the baby liked it or slept better that way. They also feared the infants might choke on their own vomit.
The researchers added that studies in England and Australia had shown that there were no increases in breathing problems that might be due to choking for infants placed on their backs.
In contrast, both studies had found that parents reported that there were more breathing problems in infants placed to sleep on their stomachs.
"Motivation strongly influences the choice of prone position in the current environment; thus clinicians should discuss the reasons for choice of sleep position with the caregiver," the authors wrote.