"Back to sleep" Campaign: What did we forget?

The American Academy of Pediatrics (AAP) ‘Back to Sleep' (BTS) campaign has recommended that parents place their infants in the supine position for sleep to prevent Sudden Infant Death Syndrome (SIDS). They also recommend that infants spend "some" time in Tummy Time (TT) while awake to prevent head deformity. Interestingly the AAP has not defined “some” in their guidelines. Research has shown that after the BTS guidelines were initiated, infant motor milestones were achieved later, and abnormalities in head shape increased. The sample in this mixed-method study consisted of 119 inner-city mothers of newborns from a hospital postpartum unit and 9 health care providers. Mothers were surveyed relative to knowledge sources and behaviors about infant positioning during awake and sleep time. Providers participated in a focus group discussion about parental knowledge and behaviors relative to infant positioning.

Findings showed that most mothers (99.7%) reported receiving information about positioning the infant while asleep - on his/her back. However, only 61% of the mothers received any information about positioning when the infant is awake, and only 18% received information about “tummy time,” Their information was not guideline-based and differed among the mothers. Providers were not aware of existing guidelines and reported that unless there is a problem they do not have the time to educate the mothers about infant positioning during awake time. The outcomes of this study suggest that with the implementation of BTS guidelines, there has been a need for parental education about positioning infants during sleep and awake times.