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


CONCLUSIONS
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. What is 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.
Division of Nursing, Midwifery and Social Work, University of Manchester, Jean Mc Farlane Building, Oxford Road, Manchester, M13 9PL, UK. karen.davies-3@manchester.ac.uk.
Karen
http://orcid.org/0000-0002-8983-8357
K
Davies
Paediatric ENT Department, Royal Manchester Children's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, M13 9WL, UK.|Respiratory and Allergy Centre, Institute of Inflammation and Repair, Faculty of Biology Medicine and Health, University of Manchester, Manchester, UK.
Iain A
IA
Bruce
Cleft and Craniofacial Clinical Research Centre, Division of Dentistry, University of Manchester, Manchester, M15 6FH, UK.
Patricia
P
Bannister
Division of Nursing, Midwifery and Social Work, University of Manchester, Jean Mc Farlane Building, Oxford Road, Manchester, M13 9PL, UK.
Peter
P
Callery
D002972:Cleft Palate; D006801:Humans; D007223:Infant; D007224:Infant Care / Q000379:methods; D009720:Nurse Clinicians; D017410:Practice Guidelines as Topic; D016684:Prone Position / Q000502:physiology; D036301:Qualitative Research; D012307:Risk Factors; D012890:Sleep / Q000502:physiology*; D013398:Sudden Infant Death / Q000209:etiology / Q000517:prevention & control*; D016683:Supine Position / Q000502:physiology*; D011795:Surveys and Questionnaires; D006113:United Kingdom
Cleft palate; Infants; Safe sleeping positions