Tuesday, November 23, 2010

Best position for baby to sleep

I have had an influx of parents asking what I recommend to be the best position for their child to sleep in.

Now, of course, when you search this on google, anyone would find the advice on the 'back to sleep' campaign that was created in 1994 to help avoid Sudden Infant Death Syndrome (SIDS). But what about best for the back, spine and skull?

In adults, we see a lot of back and neck pain that can easily be related to sleeping in the prone (on the front) position. This is because of the lower back having to arch, and the neck being turned to one side. So, naturally, it makes sense that this is the same case in children. Sleeping on the front is not advised, with the back in mind. Consequently, sleeping on the back or side can be seen as a good position for the developing spine.

Lying on the side?
Interestingly lying on the side position has shown in a few studies to increase the likelihood of SIDS, but the research is still divided. The main understanding is that the risk of SIDS is significantly reduced by lying on either the side or back. The American Academy of Paediatrics has advised that if the child is sleeping on the side, the arm on the 'dependent' downside arm should be put in front of the child and out at a 90 degree angle. This aims to decrease the likelihood of the infant rolling onto the front - which is what the research seems to show is the risk to sleeping on the side - rolling onto the front and creating breathing problems.

In my opinion, sleeping on the side is fine, but everytime the child is placed back into the cot/bed, then they should be placed on the opposite side. This avoids preference of head position and turning. Keeping stimulus equal from side to side is important for the child's neurological development.

Sleeping on the back is obviously recommended, but this has created an increase in positional plagiocephaly (flattening of the skull) over the years of its recommendation. This is a benign condition and the head will normalise once the child has begun to sit. But this can also be balanced out by giving the child enough tummy time - when awake.

Shall I use the wedge support?
The use of supporting wedges to help the child stay, particularly on the side position, has not been shown to be of any value. The AAP Task Force does not recommend their use. They suggest that for a child to sleep on their side, put the dependent arm out and support the back of the child against the side of the cot.
The child sleeping on their back does not need any support.

Should healthy babies ever be placed on their front?
It is vital for the development of the strength of the neck, shoulder girdle and back for the child to be placed on the front. However, this must be done when the child is awake, and in a happy alert state. The younger the child, the more they will probably complain. This is not that it may be particularly uncomfortable - its just hard work! The head is heavy and its hard to keep it up all the time! 'Tummy time' is very important, but it doesn't have to be for such long periods of time - even a minute at a time if it has to be.

Recommended reading
http://www.nichd.nih.gov/sids/sids_qa.cfm - Questions and Answers on the 'back to sleep' campaign from the Task Force by the American Academy of Pediatrics