University of Virginia Health System

 Infants Who Sleep On Back Have Fewer Ear Infections

< May 13, 2003 >A team of researchers reports that infants who are placed to sleep on their backs are less likely to develop fevers, get stuffy noses, or develop otitis media (ear infection).

The current study shows not only are no adverse health effects found from placing infants to sleep on their backs, but that the practice may confer specific benefits for infants' health. Placing infants to sleep on their backs has been found to reduce the risk of Sudden Infant Death Syndrome (SIDS).

The study is reported in the Archives Of Pediatrics & Adolescent Medicine.

Support for the study was provided by the National Institute of Child Health and Human Development (NICHD) and the National Institute on Deafness and other Communication Disorders (NIDCD), both part of the National Institutes of Health (NIH).

"Placing infants to sleep on their backs not only reduces their risk of Sudden Infant Death Syndrome, but also appears to reduce the risk for fever, stuffy nose, and ear infections," said Dr. Duane Alexander, director of the NICHD, in a press statement.

Dr. James F. Battey Jr., director of the NIDCD, said, "Otitis media causes suffering in infants and young children, costs the American public an estimated $5 billion dollars per year, and results in overuse of antibiotics."

The research shows that putting infants on their backs to sleep is saving lives, and it is now revealing an additional benefit, the reduction of otitis media in infants, Dr. Battey said.

The researchers are not sure why back sleepers had fewer symptoms than did stomach sleepers. They suggest one possibility is that stomach sleepers have higher mouth and throat temperatures than do back sleepers. These higher temperatures may be more favorable to the bacteria involved in colds and otitis media.

US Study Confirms International Findings

In the 1980s, several countries conducted studies that found placing infants to sleep on their backs reduced the risk of SIDS. By 1992, Australia, New Zealand, and the United Kingdom had campaigns urging parents and caregivers not to place infants to sleep on their stomachs.

The study authors noted that in the US in 1992, roughly 70 percent of US infants were placed to sleep on their stomachs. The NICHD-sponsored Back to Sleep campaign, begun in 1994, urges parents and caregivers to place infants to sleep on their backs, to reduce SIDS risk.

As of 1998, when the study authors finished their analysis, the percentage of stomach sleeping had declined to 17 percent. By this time, the SIDS rate also dropped by about 40 percent.

In the US, however, many physicians and caregivers still have reservations about placing infants to sleep on their backs. For example, some fear that an infant sleeping on his or her back might be more likely to choke on vomit. Others believe that infants would sleep better on their stomachs.

The researchers undertook the study to rule out the possibility that US infants would react any differently to back sleeping than did infants in other countries.

Dr. Carl E. Hunt, head of the National Center on Sleep Disorders Research at the National Heart, Lung, and Blood Institute (NHLBI), and colleagues analyzed information collected on 3,733 US infants whose mothers reported that their infants were always placed to sleep in the same position. The information collection began in 1995.

At that time, the American Academy of Pediatrics (AAP) advised parents and caregivers to place infants to sleep on their backs or sides. The study authors asked the mothers who participated whether their infants had been placed to sleep on their backs, stomachs, or sides.

Based on more recent information showing that side sleeping may also increase the risk of SIDS, the AAP later revised its recommendation to say that infants should be placed to sleep only on their backs.

When the infants were 1, 3, and 6 months of age, the researchers questioned the infants' mothers about whether the infants had such symptoms as fever, cough, wheezing, stuffy nose, trouble breathing, trouble sleeping, and vomiting.

Sleeping on the Back Wards Off Infections

The researchers found, that, at one month of age, infants sleeping on their backs were less likely to have come down with a fever than were infants sleeping on their stomachs.

At 6 months, back sleepers were less likely to develop a stuffy nose than were stomach sleepers. At 3 months and 6 months, back sleepers needed to visit a physician less often for ear infections than did stomach sleepers.

Moreover, at 6 months, the mothers of back sleepers reported fewer instances in which their infants had trouble sleeping than did the mothers of stomach sleepers. None of the infants in the study was reported to have choked on their vomit.

"No identified symptom or illness was significantly increased among nonprone [not on the stomach] sleepers during the first 6 months," the study authors concluded. "These reassuring results may contribute to increased use of the supine [on the back] position for infant sleeping."

Always consult your physician for more information.

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What Is Otitis Media (OM)?

Otitis media is inflammation located in the middle ear. Otitis media can occur as a result of a cold, sore throat, or respiratory infection.

Facts about otitis media:

• About 75 percent of children have at least one episode of otitis media by the time they are 3 years of age.
  
  
• Nearly half of these children have three or more episodes by the time they are 3 years of age.
  
  
• Otitis media can also affect adults, although it is primarily a condition that occurs in children.
  
  
• Otitis media is the most common diagnosis for children in the US.
  
  
• About 30 million visits to the pediatrician each year are due to otitis media.
  
  
• Otitis media occurs most often in children younger than 7 years of age and even more frequently in children between the ages of 6 months and 3 years.
  
  
• Otitis media is more common in boys than girls.
  
  
• Otitis media occurs more often in the winter and early spring.
  

Who Is At Risk for Getting Ear Infections?

While any child may develop an ear infection, the following are some of the factors that may increase your child's risk of developing ear infections:

• being around someone who smokes
  
  
• family history of ear infections
  
  
• a poor immune system
  
  
• spends time in a daycare setting
  
  
• absence of breastfeeding
  
  
• having a cold
  
  
• Bottle fed while laying on his/her back
  

What Causes Otitis Media?

Middle ear infections are usually a result of a malfunction of the eustachian tube, a canal that links the middle ear with the throat area.

The eustachian tube helps to equalize the pressure between the outer ear and the middle ear. When this tube is not working properly, it prevents normal drainage of fluid from the middle ear, causing a buildup of fluid behind the eardrum.

When this fluid cannot drain, it allows for the growth of bacteria and viruses in the ear that can lead to acute otitis media.

Reasons that the eustachian tube may not work properly include a cold or allergy which can lead to swelling and congestion of the lining of the nose, throat, and eustachian tube (this swelling prevents the normal flow of fluids)or a malformation of the eustachian tube.

Always consult your physician for more information

Online Resources

(Our Organization is not responsible for the content of Internet sites.)

American Academy of Otolaryngology

American Academy of Pediatrics

Centers for Disease Control and Prevention (CDC)

National Heart, Lung, and Blood Institute (NHLBI)

National Institute of Allergy and Infectious Diseases (NIAID), part of NIH

National Institute of Child Health and Human Develoment (NICHD)

National Institute on Deafness and Other Communication Disorders (NIDCD)

National Institutes of Health (NIH)