A recently published Yale study reveals several key insights into why caregivers continue to put infants in unsafe sleeping positions, even though such positions have been linked to sudden infant death syndrome.

Yale School of Medicine professor Eve Colson MED ’89, along with researchers at Boston University, published the study in the September issue of the journal Pediatrics. Their research links social norms, education, perceived control and attitudes to the incidence of SIDS in infants, which remains the “leading cause of postnatal infant death in the United States,” according to the paper.

The research not only gives physicians an idea of the measures they must take to ensure that caregivers understand the risks associated with infant sleeping position, but will provide a basis for educational interventions.

“The back sleep recommendation first came from the American Academy of Pediatrics in 1992,” said Colson, the lead author of the study.

According to neonatologist Michael Goodstein, progress in educating families about appropriate sleeping positions has stagnated. After the initial recommendation by the AAP in 1992, the rate of SIDS in the United States fell by nearly 53 percent.

This decrease correlated with an increase in the proportion of parents who chose the back sleeping position for their infants. Since then, however, little progress has been made, Goodstein said. It is this stagnation, Colson said, that prompted her and the researchers to conduct their study.

The researchers distributed surveys to 32 U.S. hospitals across the country to collect a nationally representative sample of mothers with infants between the ages of two and six months.

They oversampled Hispanic and African-American mothers, as the incidence of SIDS in infants of those ethnicities is significantly higher, although further research is needed to explain this statistic, according to the paper.

Those oversampled groups accounted for approximately 25 percent of the approximately 3,000 surveys collected. The surveys asked a series of questions about infants’ normal sleeping positions and the information and intentions of mothers with regard to these positions.

The results of the study showed that approximately 70 percent of caregivers placed infants on their backs, though this was not exclusively the case.

According to Goodstein, a number of factors could account for these decisions.

“When a baby is fussy, most parents will do almost anything to get them to sleep,” he said. “Babies do sleep deeper on their tummies, but it’s dangerous.”

He went on to explain that regardless of how frequently a baby sleeps on its back, an individual instance of stomach sleeping risks terrible consequences.

The study did show, however, that one of the most critical factors in caregivers choosing to put an infant to sleep on its back was their confidence in the importance of that position.

“Friends and family might recommend that the baby be placed on the stomach or side,” Colson said. “It could be that family or friends recommend what they did with their own children.”

According to the National Institutes of Health, over 2,000 infants died from SIDS in 2010, the last year for which such statistics are available.

Madison Mahoney madison.mahoney@yale.edu