Abstract
This study examined whether forced postural change from prone to supine during toddlers’ nap, a preventative measure taken in Japan for sudden unexplained death in childhood (SUDC), disturbs toddlers’ sleep. When the "Back to Sleep" campaign (BSC) was introduced to Japan in 1996, its recommendations were also applied to infants aged 1 year old and over with the expectation that the BSC recommendations may also contribute to a decrease in the occurrence rate of SUDC. Since then, Japanese nurseries have routinely conducted sleeping position checks and positional adjustments of toddlers every 5–10 min during naps. A total of 52 toddlers (age 18.4 ± 3.3 months, means ± SD) were continuously monitored for 8 h during daytime at nursery schools for wake-sleep status and body position (prone, supine and lateral) with actigraphs and 3-orthogonal-axis accelerometers. Out of the 52 toddlers, 24 toddlers adopted prone positions during naps, which were adjusted by nursery staff back to supine. When nursery staff manually changed the toddlers position from prone to supine, the toddlers either did not wake or woke only briefly (3.1 ± 4.9 min) and returned to sleep soon after the positional change. Our study indicates that manual change of toddlers’ sleeping position from prone to supine, a potential SUDC prevention method, does not disturb toddlers’ sleep during their naps.
Highlights
This study examined whether forced postural change from prone to supine during toddlers’ nap, a preventative measure taken in Japan for sudden unexplained death in childhood (SUDC), disturbs toddlers’ sleep
When the BSC was introduced to Japan in 1996, unlike in the US, its recommendations were applied to infants aged 1 year old and over with the expectation that the BSC recommendations may contribute to a decrease in the occurrence rate of S UDC20
The proportion of toddlers found to be in a prone position at least once during nap was a relatively high 46% (24 out of the 52 toddlers), indicating that toddlers between 1 and 2 years of age can change their body position from supine to prone, a possible risk factor for S UDC5
Summary
This study examined whether forced postural change from prone to supine during toddlers’ nap, a preventative measure taken in Japan for sudden unexplained death in childhood (SUDC), disturbs toddlers’ sleep. Crandall and Devinsky have emphasized the importance of epidemiologically evaluating the risk of SUDC, as well as the need for research into possible preventative measures for this category of deaths[5] They summarized that SUDC most frequently occurs in boys aged 1–3 years who are born full term as singletons (63–64%), and that victims are usually found unresponsive in the prone position (75%) with their faces down (50%) mostly during sleep (> 95%) in the winter (> 40%)[5,6,7]. We observed the wake-sleep status and body positions of 52 toddlers between 1 and 2 years of age using actigraphy and accelerometers respectively to examine whether body positional change during naps disturbs their sleep
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