[size=20px]A 3-month old, former 30 weeks’ gestation premature infant is discharged home with a feeding tube for supplemental enteric feeds. His parents inquire about best positioning for sleep.

 

To reduce the risks of mortality you recommend positioning:

 

A Prone

 

B Lateral decubitus

 

C Supine

 

D With the head of the bed elevated

 

E Trendelenburg[/size]

B

Correct answer

C Supine

 

It is estimated that 3500 infants die each year from sleep-related infant deaths. In 2016 the American Academy of Pediatrics published consensus guidelines for infant (< 12 months) safe sleep practices. Recommendations were developed to reduce the risks for sleep-related suffocation, asphyxia or entrapment as well as SIDS (sudden infant death syndrome). Since no randomized clinical trials are available these recommendations are based on case-control studies.

 

 

Most importantly, infants should be placed supine (wholly on the back) for every sleep by every caregiver until the child reaches 1 year of age - “Back to sleep”. Specifically, the risk of SIDS outweighs the benefit of prone or lateral sleep position on gastroesophageal reflux and should only be considered in infants with upper airway disorders which pose a high risk of death from GERD. There is no evidence to suggest that infants with a feeding tube are at increased risk of aspiration if positioned supine. Elevating the head of the bed does not reduce GER and may promote sliding to the foot of the crib posing compromise of respiration. Of note, once an infant can roll from supine to prone or vice versa, the infant can be allowed to remain in that sleep position.

 

 

Other recommendations include use of a firm sleep surface without soft objects or loose bedding. A pacifier was actually judged protective as long as not attached to a string or other toy.