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Use Of Wedges To Promote Side Sleeping

Wedges are not recommended to keep babies on their sides.
Sleeping on the back is associated with the lowest risk for SIDS.
Sleeping on the stomach is associated with the highest risk.
Sleeping on the side is in between. Since its risk is higher
than back sleeping, the use of a wedge to keep the baby on the
side is not recommended.

Epidemiological data from many countries now indicate that sleeping on the stomach (prone) carries the highest risk for SIDS. Obviously this is not the cause of SIDS, since most babies who sleep on their stomachs do not die from SIDS, and many who do not sleep on their stomachs still die from SIDS. However, there is an increased risk from prone sleeping. We do not know the cause of SIDS, and we do not know how prone sleeping increases the SIDS risk.

A number of countries have now published their results suggesting that sleeping on the side carries a higher risk than sleeping on the back, though not nearly as high as sleeping on the stomach. The reason for the increased risk from side sleeping MAY be that it is the most unstable position, and some babies will roll onto their stomachs, the highest risk position.

It would seem that some wedging devices might prevent a side sleeping baby from rolling onto the stomach. However, most parents place a single wedge in the back, which only insures that the baby will roll onto the stomach. There are some "double wedges" available, which place a small wedge in front and a largely wedge in back. Presumably, babies can not roll in either direction. I think we have to say that this does constrain the baby's movement during sleep. Does this affect the baby's safety or risk for SIDS? The answer to this is not known.

What about back sleeping? Many people fear this because they believe that if a baby regurgitates some stomach contents, the baby will not be able to spit it out if he/she is sleeping on the back. Thus the baby will aspirate it into the lungs and develop pneumonia or die. Data from countries where back sleeping is common do not show an increase in aspiration. In fact, Australians presented a study of 2 babies who died from aspiration. Both slept on their stomachs. That is, presumably, the baby's face was in the pool of vomitus, which caused the aspiration. Therefore, back sleeping appears to be safe. An otherwise healthy baby who regurgitates appears to be able to handle his/her own secretions in any position. Therefore, back sleeping does not seem to be a condition one has to avoid.

Therefore, if back sleeping is safe, and if there are unknown risks to restraining a baby's movements by double wedges, I would recommend back sleeping.

I hope this helps. Thank you.

Tom Keens
Children's Hospital Los Angeles

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