• J E Delzell, R L Phillips, P G Schnitzer, and B Ewigman.
• Center for Family Medicine Science, Department of Family and Community Medicine, University of Missouri-Columbia, MO 65212, USA. delzellj@health.missouri.edu
• J Fam Pract. 2001 May 1;50(5):448.

ObjectiveSudden infant death syndrome (SIDS) is a major cause of infant mortality and is associated with the prone sleeping position. The goal of this study was to determine changes in newborn nursery policies and practices regarding infant sleeping position between 1992 and 1999.Study DesignThe researchers conducted telephone interviews with the head nurses in all of the newborn nurseries in Missouri.PopulationIn 1992 there were 79 hospitals in Missouri with newborn nurseries; in 1999 that number had decreased to 75.Outcomes MeasuredDuring the interviews, the researchers solicited nursery infant sleep position policy and practice, head nurses' opinions about the supine sleep recommendation, and nurses' advice to parents regarding sleep position.ResultsIn 1992, 32% of the nurseries used the prone position for sleep, and 58% of the head nurses interviewed disagreed with the recommendations of the American Academy of Pediatrics (AAP). By 1999, all newborn nurseries in Missouri placed infants on their backs or sides for sleep. The rate of disagreement with the AAP recommendation had decreased, with 25% of respondents indicating that they disagreed.ConclusionsFrom 1992 to 1999 nurseries in Missouri have changed from predominantly using prone and lateral positioning to lateral and supine positioning for newborns. Some nurses continue to voice concern about placing infants on their backs and expressed a willingness to place babies prone. Since there is agreement between nurses' usual infant positioning and the advice given to parents, and because both are important influences on infant positioning by parents, future campaigns to decrease SIDS should emphasize correcting nurses' positioning behavior and advising parents to increase infant supine positioning.

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