Infants and children with respiratory distress may be more comfortable and breathe more easily when placed in positions other than lying on their back such as being supported over someone’s shoulder, sitting upright or on their front with their legs bent up. However, different positions may also be associated with negative outcomes. For example, lying on the front is linked with sudden infant death syndrome. When children with severe respiratory distress are put in hospital, treatment may include additional oxygen or assisted ventilation which may damage the lungs. Positioning may improve breathing and reduce the possibility of lung damage. Therefore the review authors searched the medical literature for controlled clinical trials comparing two or more body positions in the management of infants and children hospitalised with acute respiratory distress.
Lying on the front (the prone position) was better than on the back (the supine position) for oxygenating the blood but the difference was small. The increase in oxygen saturation on average increased by 2%. We based this finding on the comparison of eight studies (183 children, 153 preterm and 95 ventilated) measuring this outcome. The rapid rate of breathing with respiratory distress was slightly lower in the prone position (on average four breaths/min lower) based on five studies (100 infants aged up to one month, 59 ventilated). There were no obvious differences with other positions. We assessed a total of 23 studies. However, as most of the 560 children in these studies were preterm babies and mostly (70%) ventilated by machine, the benefits of prone positioning may be most relevant to these infants.
***It is important to remember that these children were hospitalised. Therefore, given the association of the prone position with sudden infant death syndrome (SIDS), the prone position should not be used for children unless they are in hospital and their breathing is constantly monitored.
Infants and children were measured for only short time periods, varying from five minutes after a 15-minute settling in period to a median of two days. The small changes in oxygenation are not as meaningful as measures of death, illness and patterns of recovery. Only five studies looked at children older than one year and results for positions such as 'head elevated' compared with 'lying flat' are limited by the small numbers.