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Does the supine sleeping position have any adverse effects on the child? II. Development in the first 18 months.
C Dewey1, P Fleming, J Golding
1Institute of Child Health, University of Bristol, Bristol, United Kingdom.
Insights
Infants sleeping on their front showed slightly better motor and social skills at 6 months. However, these developmental advantages were temporary and did not outweigh the health risks of tummy sleeping.
Area of Science:
- Pediatric developmental science
- Public health interventions
- Infant sleep safety
Background:
- The Back to Sleep Campaign recommended supine infant sleep to reduce Sudden Infant Death Syndrome (SIDS).
- Concerns arose regarding potential adverse effects on infant motor and mental development from supine sleeping recommendations.
Purpose of the Study:
- To evaluate if recommending supine infant sleep positions impacts motor and mental development.
- To assess the long-term developmental consequences of infant sleeping positions.
Main Methods:
- Prospective cohort study of infants born in the UK before, during, and after the Back to Sleep Campaign.
- Developmental assessments using standardized questionnaires and the Denver Developmental Screening Test at 6 and 18 months.
- Analysis adjusted for 27 potential confounding factors using multiple regression.
Main Results:
- At 6 months, infants sleeping prone scored higher in gross motor, social skills, and total development compared to supine sleepers.
- These developmental differences were transient and not significant at 18 months of age.
- Adjustments for 27 factors confirmed the initial findings.
Conclusions:
- Supine sleeping may be associated with a transient reduction in developmental scores at 6 months.
- The temporary developmental disadvantage does not outweigh the proven health benefits of supine sleeping.
- The findings support maintaining the Back to Sleep Campaign's public health message.
Objective:
To assess whether the recommendations that infants sleep supine could have adverse consequences on their motor and mental development.
Design:
A prospective study of infants, delivered before, during, and after the Back to Sleep Campaign in the United Kingdom, followed to 18 months of age.
Subjects:
The children were participants of the Avon Longitudinal Study of Pregnancy and Childhood born to mothers resident in the three former Bristol-based health districts of Avon, with expected date of delivery from April 1, 1991 to December 31, 1992. Questionnaires were completed on sleeping position at 4 to 6 weeks of age and sets of standardized questions on development at 6 and 18 months.
Main Outcome Measures:
Social, communication, fine and gross motor, and total developmental scales based on the Denver Developmental Screening Test at 6 and 18 months.
Results:
After adjustment for 27 factors using multiple regression, 3 of the 10 scales and subscales significantly distinguished between front and back sleeping position. At 6 months of age, infants put to sleep on their front had a mean score 0.38 SD (95% confidence interval [CI]: 0.28, 0.49) higher on the gross motor scale, 0.11 SD (95% CI: 0.00, 0.23) higher in the social skills scale, and a total development score 0.20 SD (95% CI: 0.10, 0.30) higher than those on their backs. These differences were no longer apparent at 18 months.
Conclusions:
There is some evidence that putting infants to sleep in the supine position results in a reduced developmental score at 6 months of age, but this disadvantage appears to be transient. Weighing this against the adverse health effects demonstrated with the prone sleeping position, these results should not change the message of the Back to Sleep Campaign.