Supine infant positioning—Yes, but there’s more to it

,

Applied Evidence

Supine infant positioning—Yes, but there’s more to it

J Fam Pract. 2011 October;60(10):605-608

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References

1. Willinger M, Hoffman HJ, Hartford RB. Infant sleep position and risk for sudden infant death syndrome: report of a meeting held January 13 and 14, 1994, National Institutes of Health, Bethesda, MD. Pediatrics. 1994;93:814-819.

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Plagiocephaly and brachycephaly: Vary position for feeding, sleeping

Plagiocephaly and brachycephaly may occur as a consequence of prolonged supine positioning. Indeed, the incidence of plagiocephaly has increased since 1992, due largely to widespread adoption of the supine sleeping position.¹⁸ Plagiocephaly and/or brachycephaly is also more likely to occur in the first 4 months of life in infants who are male, firstborn, or who exhibit limited head rotation or low activity levels.¹⁹ Feeding with a bottle only and with the child’s head persistently placed to one side can lead to plagiocephaly.²⁰

Delayed achievement of motor milestones is also associated with plagiocephaly, and tummy time to facilitate motor skill development helps protect against the deformity.²⁰ Varying the head position when laying the infant down for sleep is also protective.²¹ One systematic review has shown considerable evidence that molding therapy with a helmet may reduce skull asymmetry more effectively than repositioning therapy.²²

FAST TRACK

Advise parents who bottle feed to alternate the feeding position to guard against plagiocephaly.

What you’ll need to do. Ask parents about their infant’s activity level, and encourage tummy time to protect against plagiocephaly. Also advise parents who bottle feed to alternate the feeding position between left and right arms.

Torticollis: Assess neck function in weeks after birth

Not only do infants with CMT display a head tilt to one side, but they also often have rotation of the head to the opposite side with the chin appearing to jut out.²³ This postural deformity—primarily resulting from unilateral shortening and fibrosis of the sternocleidomastoid muscle²⁴—is detectable at birth or shortly thereafter. CMT occurs in 1 of every 300 live births.²⁵ Torticollis discovered at birth is likely related to a constrained intrauterine position. In one study, 1 in 6 newborns were born with torticollis, and mothers reported that the infants had felt “stuck” in the same position for several weeks before birth.²⁶ The consequent restricted neck range of motion puts infants at risk of developing cranial deformations that may be prevented by changing their sleeping positions.²⁶

What you’ll need to do. Check for limited neck function in the early weeks after birth and recommend neck motion exercises, if necessary, to encourage full head turning to both sides.¹⁹ Both torticollis and plagiocephaly due to static supine positioning can be largely eliminated with early written instructions about the value of tummy time when a baby is awake and supervised and the value of changing sleep positions.¹² If repositioning or other forms of physical therapy fail to resolve the condition, surgical correction may be necessary.²⁷

Did you know?

Newer evidence indicates that the rebreathing of exhaled gases in the face-down position and the inability of the infant to reflexively lift his or her head may play a role in sudden infant death syndrome.²⁸
Nearly 13% of infants are still placed prone for sleep, according to an estimate from the National Infant Sleep Survey.²⁹
Resources are available from Pathways Awareness (www.pathwaysawareness.org), a not-for-profit foundation, to educate parents (and healthcare professionals) about early detection and intervention of motor delays in children. (The author is a member of the foundation’s Physicians’ Roundtable.)

Acknowledgement

I would like to acknowledge the review and comments of John F. Sarwark, MD.

CORRESPONDENCE
Russell Robertson, MD, Rosalind Franklin University of Medicine and Science, 3333 Green Bay Road North, Chicago, IL 60064; russell.robertson@rosalindfranklin.edu