Safe sleeping positions: practice and policy for babies with cleft palate

Karen Davies,Patricia Bannister,Iain A Bruce,Peter Callery

doi:10.1007/s00431-017-2893-0

Abstract

Guidance recommends ‘back to sleep’ positioning for infants from birth in order to reduce the risk of sudden infant death. Exceptions have been made for babies with severe respiratory difficulties where lateral positioning may be recommended, although uncertainty exists for other conditions affecting the upper airway structures, such as cleft palate. This paper presents research of (i) current advice on sleep positioning provided to parents of infants with cleft palate in the UK; and (ii) decision making by clinical nurse specialists when advising parents of infants with cleft palate. A qualitative descriptive study used data from a national survey with clinical nurse specialists from 12 regional cleft centres in the UK to investigate current practice. Data were collected using semi-structured telephone interviews and analysed using content analysis. Over half the regional centres used lateral sleep positioning based on clinical judgement of the infants’ respiratory effort and upper airway obstruction. Assessment relied upon clinical judgement augmented by a range of clinical indicators, such as measures of oxygen saturation, heart rate and respiration.Conclusion: Specialist practitioners face a clinical dilemma between adhering to standard ‘back to sleep’ guidance and responding to clinical assessment of respiratory effort for infants with cleft palate. In the absence of clear evidence, specialist centres rely on clinical judgement regarding respiratory problems to identify what they believe is the most appropriate sleeping position for infants with cleft palate. Further research is needed to determine the best sleep position for an infant with cleft palate.Whatis Known• Supine sleep positioning reduces the risk of sudden infant death in new born infants.• There is uncertainty about the benefits or risks of lateral sleep positioning for infants with upper airway restrictions arising from cleft palate.What is New• Variability exists in the information/advice provided to parents of infants with cleft palate regarding sleep positioning.• Over half the national specialist centres for cleft palate in the UK advise positioning infants with CP in the lateral position as a routine measure to reduce difficulties with respiration.

Highlights

A number of risk factors contribute to sudden and unexpected death in infants [16, 33]
In the absence of clear evidence, specialist centres rely on clinical judgement regarding respiratory problems to identify what they believe is the most appropriate sleeping position for infants with cleft palate
There is uncertainty about the benefits or risks of lateral sleep positioning for infants with upper airway restrictions arising from cleft palate

Summary

Introduction

A number of risk factors contribute to sudden and unexpected death in infants [16, 33]. There is evidence of significantly increased risks associated with the alternative positions of prone and lateral positioning [2, 26, 31]. The guidance gives little indication that certain conditions may benefit from an alternative sleeping position and evidence about exceptions to the standard advice is limited. Previous research suggests that a supine position may not be appropriate for infants with Pierre Robin sequence (PRS). In this condition, lateral or prone positioning may be recommended [11] with some evidence suggesting that prone positioning can relieve respiratory difficulties in 70% of cases [34]. In the absence of definitive evidence, advice on sleeping positions can be confusing for parents of children with CP and health professionals, as illustrated by the following comment from a parent recorded on a UK online forum [5] (posted 23/01/ 2011):

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Discussion

Conclusion