Author(s): Elinor A. Graham, MD, MPH, Harborview Medical Center, Seattle, WA

Date Authored: November 1, 1998

Infant sleeping
Photo by World Bank Photo Collection (cc license)

Different cultures have very different ways of positioning babies when they lay them down to sleep. This was first found to be of significance when it was noted that Asian babies, who primarily are placed on their back or sides to sleep, had lower rates of Sudden Infant Death Syndrome than European American infants who were more likely to be placed on their stomachs.

During the winter of 1997-1998 we surveyed a convenient sample of 82 adults from different ethnic groups in our Children and Teens clinic and asked them how they would place a newborn baby down to sleep. We found that there were distinct differences among the ethnic groups. The Amharic, Tigrinean and Somali speaking adults from East Africa primarily placed babies on their sides, or a combination of a side position alternating with a back position. Of the 38 East African adults surveyed only 4 (11%) said that they ever placed the baby on the stomach. This was an interesting contrast to the 19 Spanish speaking adults who were interviewed. Six of them would place the baby on their stomach (32%) although the preferred position was the side sleeping position. Of the 25 Cambodian adults interviewed 5 (20%) would have placed the baby on the stomach and again the side or back positions were preferred with 11 placing the baby on the side and 9 on their back.

The survey suggested that the current medical recommendation that babies be placed primarily on their back, is not consistent with cultural practices in local ethnic groups where the side position is commonly used and often the preferred position. In all ethnic groups surveyed some individuals (11% to 32%) said they would place a baby on their stomach. The survey suggests that it is important that providers talk to parents about the preferred sleep position and reinforce the cultural tendencies to place the babies on the side and back and discourage positioning the baby on the stomach.