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Systematic Review

What Is the Evidence for the Side-Lying Position for Feeding Preterm Infants?

Park, Jinhee, PhD, RN; Pados, Britt Frisk, PhD, RN, NNP-BC; Thoyre, Suzanne M., PhD, RN, FAAN

Section Editor(s): Gephart, Sheila

doi: 10.1097/ANC.0000000000000529
Evidence-Based Practice Briefs

Background: Side-lying position is an increasingly common feeding strategy used by parents, nurses, and feeding therapists to support oral feeding in preterm infants. Better understanding of the research evidence on the effect of the side-lying position will help clinicians make informed decisions and guide future research in this important area.

Purpose: To identify and summarize the available evidence on the effect of side-lying position on oral feeding outcomes in preterm infants.

Methods/Search Strategy: PubMed, CINAHL, Web of Science and PsycINFO were searched for (“preterm” OR “premature”) AND “feed*” AND “position*”. The full text of 47 articles was reviewed to identify eligible studies that use a quasi-experimental or experimental design to examine the intervention effectiveness; 4 studies met criteria.

Findings/Results: Four studies compared the effect of the side-lying position with either the semi-upright, cradle-hold, or semi-reclined positions on various feeding outcomes. The findings were conflicting: 2 studies found the side-lying position to be beneficial for supporting physiologic stability during feeding compared with the semi-upright position whereas 2 studies did not find significant differences in any of their outcomes between the side-lying position and other feeding positions. However, this finding should be interpreted cautiously because of various methodological weaknesses and limited generalizability.

Implications for Practice: This review does not provide strong or consistent evidence that the side-lying position improves preterm infants' oral feeding outcomes.

Implications for Research: A large randomized controlled trial with a diverse group of preterm infants is needed to determine the effects of the side-lying position and identify infants who would receive the most benefit.

Video Abstract Available at

Boston College William F. Connell School of Nursing, Chestnut Hill, Massachusetts (Drs Park and Pados); and School of Nursing, University of North Carolina at Chapel Hill (Dr Thoyre).

Correspondence: Jinhee Park, PhD, RN, Boston College William F. Connell School of Nursing, Maloney Hall 369, 140 Commonwealth Ave, Chestnut Hill, MA 02467 (

Work occurred at Boston College William F. Connell School of Nursing.

The authors declare no conflicts of interest.

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© 2018 by The National Association of Neonatal Nurses