Since the “Back to Sleep” campaign to prevent SIDS, many babies have always slept on their backs - but new research suggests that maybe they should be given a chance to become acquainted with being face-down, under careful observations.

That’s because infants who are inexperienced at sleeping in the face-down position are less able than other infants to protect themselves from suffocation, according to a report in the medical journal Pediatrics.

Prone, face-down sleeping increases the risk of suffocation for babies, the authors remind readers, but normally infants escape suffocation by turning their heads to one side. However, it seems that babies may not learn this reflex if they always sleep supine.

Dr. Bradley T. Thach and colleagues from Washington University School of Medicine in St. Louis, Missouri, investigated whether infants inexperienced in prone sleeping had greater difficulty escaping from a potentially suffocating environment when sleeping prone, and whether age was a factor.

The team found that when placed prone and face down on soft bedding, all infants, regardless of age or experience, were aroused and attempted to escape from the mild asphyxia caused by re-breathing a limited amount of air around their face.

Infants who were experienced in the prone position performed better at protecting themselves than did inexperienced infants, the researchers report, and older infants performed significantly better than younger infants at keeping their head elevated for longer periods of time.

However, “Even with substantial prone-sleep experience, some infants are still unable to protect their airway fully,” the investigators write. “Accordingly, the prone position would continue to pose a risk for asphyxia. Back sleeping should continue to be strongly encouraged.”

It has been suggested that brief, very closely supervised ‘training’ periods of face-down sleeping might help infants who always sleep on their backs.

Asked about this idea, Thach told Reuters Health that he does recommend ‘tummy time’ for babies while they’re awake, and that prone sleep under close observation could be beneficial. “However, there would be a chance for disaster if (the baby’s) caretaker were to be distracted.”

Thach pointed out that this strategy has not been proven to be effective for training babies to avoid suffocating.

Overall, he said, the take-home message is: “Caretakers must make it absolutely clear to daycare providers, baby sitters, grand parents etc. that baby (should) not be placed prone for sleep and that baby be closely observed at all times during Tummy Time to make sure that baby does not fall asleep.”

Also, he added, a baby’s ability to lift his or her head does not mean that there is no longer a risk of suffocation during prone sleep.

“Also this study reinforces other basic tenets of ” Back to Sleep”: no soft bedding in crib, and the side position is not safe due to risk of rolling to prone,” he concluded.

SOURCE: Pediatrics, December 2004.