An infant who was born prematurely has been discharged to home. When discussing sleep positions, which condition would warrant avoidance of placing the infant on their back to sleep?

Placing infants on their back to sleep is widely recommended due to the "Back to Sleep" campaign (now called the "Safe to Sleep" campaign), which was initiated to reduce the risk of Sudden Infant Death Syndrome (SIDS). However, there are certain conditions where placing an infant on their back might not be appropriate, and they might need to be placed in a different position.

One such condition where avoidance of placing a premature infant on their back to sleep is warranted could be if the infant suffers from severe gastroesophageal reflux disease (GERD) that causes significant respiratory problems or if the infant has a condition that compromises airway protection, such as an upper airway anomaly or central hypoventilation syndrome. In some instances, if the child is at risk of aspiration (inhaling fluids or food into the lungs), they might need to be placed in a more upright position or on their side, though side-sleeping is generally not recommended for infants due to an increased SIDS risk compared to back sleeping.

Another condition is certain types of congenital muscular torticollis, where the infant's neck muscles are tightened causing a tilted or twisted neck, or plagiocephaly, a condition characterized by a flat head syndrome, where a specific sleep position might be advised by a healthcare provider to aid in correction.

It is critical, however, that any deviation from the recommended back-sleeping position be made under the guidance of a healthcare provider. Each case should be evaluated individually, taking into account the current health status, risks, and benefits.