Side-lying is always best because preterm infants are always more stable in side-lying.  FALSE 

This is actually not true.  Side-lying may indeed help infants be more stable in their oxygenation and breathing coordination, but it is not a blanket statement. In a review article by Park and colleagues (2018), the data were not clear that it always was better.  They found that in some cases there were not benefits.  In the Dawson article (2013), the researchers found that infants who were switched from side-lying to semi-supine feedings had similar coordination of suck/swallow breathe.  It is important to note that these infants were on average 37 weeks at the time of the study and were only taking 20-25% of their volumes orally.  I would offer a few other opinions – things that I don’t think have been directly studied.  One – remember that we typically feed infants right- or left-handed – depending on our handedness, and most of us are right- handed.  So, babies fed in side-lying are often consistently fed laying on their left (or right) side.  We also know that the lower jaw is moveable and that preterm infants have lower muscle tone.  I worry about the potential for a cross-bite developing in infants who are fed for months in side-lying.  Gravity is always pressing downward (think about our very real attempts at keeping a baby’s head from flattening!).  If gravity pushes against the moveable jaw, there is a potential for the jaw to develop “off center”.  Second, side-lying is designed to help a baby learn to suck, swallow and breathe in a coordinated fashion.  Once they can do this consistently, we should let them take over control of the s/s/b sequence.  We should not use an intervention if the baby no longer needs it.  And finally, parents and babies should have the opportunity to interact during a feeding.  Parents love to look into their baby’s eyes, coo at them, and “be connected”.  Side-lying can interfere with this.  At a minimum, side-lying can affect a parent’s perception of their infant.  If my baby can’t be fed like a “regular” baby, does that mean my baby is not “normal”?  These are real things parents have said to me over the years. So, think about it – and if the baby is showing good s/s/b coordination in side-lying and is eating well – consider trying to feed the baby in typical cradle hold.  If they struggle, you can always put them back.  But by changing this before the family takes the baby home, we can avoid the potential problems with cross bites as well as support the attachment process. 

 

Dawson, J. A., L. R. Myers, A. Moorhead, S. E. Jacobs, K. Ong, F. Salo, S.  Murray, S. Donath, and P. G. Davis. 2013. ‘A randomised trial of two techniques for bottle feeding preterm infants’, J Paediatr Child Health, 49: 462-66. 

Park, J., B. F. Pados, and S. M. Thoyre. 2018. ‘Systematic Review: What Is the Evidence for the Side-Lying Position for Feeding Preterm Infants?’, Adv Neonatal Care, 18: 285-94.