Introduction: Since the 1992 American Academy of Pediatrics recommendation to put babies to sleep non-prone and 1994 `Back to Sleep' campaign, the rate of sudden infant death syndrome has decreased >30%. We examined factors that may affect the rate of non-prone sleeping in Philadelphia.

Methods: 399 parents of infants ≤ 6mo old were interviewed in Philadelphia clinics and private offices from 12/95-12/96. Data was analyzed by chi square with significance* at p<0.05.

Results: 72.4% of infants sleep non-prone (NP) compared to 20.7% in 1992, 31.8% in 1993 and 59.1% in 1994 in Philadelphia. NP sleeping did not change during the study period (p=0.67). The survey group was 62% African American (AA), 62% clinic patients, and 50% male, 31% breastfed (BF), 17% maternal smoker and 45% co-slept. All correlation coefficients were <0.5 between groups.Table

Table 1
Full size table

There was no difference in NP sleep rate by sex, gestation, maternal age, or number of siblings. The majority of parents who place infants on their back/side do so because it was recommended by the medical profession (56%). The majority of parents who place infants prone do so because their infant is more comfortable/sleeps better (65%), although, 72% of this group said their doctor / nurse discussed sleep position with them.

Conclusion: Non-prone sleeping continues to increase in Philadelphia since the initiation of the `Back to Sleep' campaign, but disparity between groups exists. African Americans, medical assistance families, bottle feeders, and smokers are more likely to chose the prone position. Many parents who choose the prone position do so for infant comfort despite knowledge of the current recommendation.