Listen Dr. Andrew Prayle a Consultant Peadiatrician share his knowledge
Karine: Parents of infants with Pierre Robin sequence often ask why they are asked to position their babies to sleep on their back when this goes against the back to sleep campaign. As a specialist respiratory paediatrician could you explain to them why?
Dr. Prayle: Yes of course and this is a question that comes up in clinic all the time, umm and you’re exactly right, for most babies the safest way to put the baby to sleep is to lie them on their back and we’ve known for a long time that that reduces the chance of sudden infant death syndrome, which of course everybody would like to avoid. I think the thing to say about children with Pierre Robin sequence is that their anatomy of their mouth, tongue and upper airway, the tubes they breathe through is different and so they have specific advice that we ask people to follow and the reason for that is that the jaw is small and that means that the tongue is further back in the mouth and therefore if you lie a child with Pierre Robin Sequence on their back, there is a chance that the tongue falls back into the airway and stops the child from being able to breathe. What we’ve found with experience of many babies is that if you lie the baby on their side that prevents the tongue from falling backwards and the result of that is their breathing is much more comfortable and that’s the reason why we advise side lying. Then as the child grows, usually the chin grows, the jaw grows bigger and that pulls the tongue forward and that means that when the child is bigger they no longer have to lie on their side they can then lie on their back, erm and that usually happens about the same age that the child is able to move themselves around a little bit so they get into a comfortable position by themselves and at that stage their breathing is safe whatever position they adopt usually.
Karine: Could you explain how sleep studies are used to guide sleep positioning in infants with Pierre Robin Sequence?
Dr. Prayle: So different Cleft Centres are organise the work they do differently in ours our team of specialist nurses bring our oxygen monitors and organise an overnight oximetry study, which is a type of sleep study and in this study the oxygen levels of a baby are measured overnight, perhaps one night, sometimes for more than one night and we can use the number of times the oxygen levels drop, not to a dangerous level, but by a small level, to indicate how well the child can maintain their own airway and breath for themselves. So what you find in a child with Pierre Robin Sequence who’s got difficulties with breathing, especially when on their back is the tongue falls backwards, the child continues to try to breathe but they are not breathing as effectively as their tongue is in the way and then as a consequence of that oxygen levels drop from a very healthy baseline, not to a dangerous level hopefully but a small drop and that triggers the child to take more effort in their breathing erm perhaps wake up a bit helps their breathing as well and the oxygen levels recover to normal and what we tend to do is over the course of the night is look at how many times that would happen in the night and if that’s happening a lot that tells me that we would probably advise continuing side lying or even for children who need it things such as a nasal phalangeal airway and erm actually if that sleep study is reassuring and there aren’t a large frequent number of drops, then what we can do is advise that the current position that the child is lying in is appropriate and what we tend to say is that we use sleep studies to decide is a nasal phalangeal airway necessary, we can also use it to decide do we need to continue to advise side lying or we can use it to say well actually your child has Pierre Robin Sequence but the breathing appears comfortable irrespective of the position they adopt, in which case we would usually say the child can lie on their back and because we can do a series of sleep studies you can imagine a pattern for many babies is they initially need to have a nasal phalangeal airway erm and then we can say we’ll take the nasal phalangeal airway out using the sleep study as a guide is that a good decision or do we continue to use the nasal phalangeal airway or not and then we can use the sleep study later on to say well actually this is reassuring and your child whatever position they adopt in bed is good for them.
