A study by Yale School of Medicine researchers and their colleagues found that the practice of placing babies on their backs to help prevent the incidence of sudden infant death syndrome (SIDS) has reached a plateau.

Published in the December issue of the Archives of Pediatric and Adolescent Medicine, the study is based on data from the National Infant Sleep Position Study, which is conducted through an annual telephone survey of about 1,000 households with infants. According to the study, the researchers tracked behavior change after the National Institute of Child Health and Human Development initiated the “Back to Sleep” campaign in 1994.

“We looked at the behavior of 15,000 caregivers over the last 15 years and found that, although there was an increase in caregivers following the guidelines, in the last five years, the number of people putting babies on their back to sleep has leveled off,” said lead author Eve Colson, MD, associate professor of pediatrics at Yale School of Medicine. “We also found that African Americans still lag behind caregivers of other races by about 20% in following this practice.”

The study identified three key factors linked to whether caregivers place infants on their backs to sleep, including: whether the caregiver received a physician’s recommendation to place the baby only on the back for sleep, fear that the infant might choke, and concerns for the infant’s comfort. In the past 5 years, these factors have become even more important than race in determining whether parents will follow the recommended guidelines, according to Colson.

“If we can teach people that comfort and choking are not issues and if we can make sure that doctors advise their patients that the back is the only safe position for infant sleep, then we may be able to overcome this leveling-off of the practice that we have seen over the last five years,” said Colson. “For the first time, we have identified modifiable factors—comfort, choking, and advice—that can be used in public health campaigns to decrease the incidence of SIDS and possibly to bridge the racial gap.”

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