Guidance recommends ‘back to sleep’ positioning for infants from birth in order to reduce the risk of
sudden infant death. Exceptions have been made for babies with severe respiratory difficulties where
lateral positioning may be recommended, although uncertainty exists for other conditions affecting the
upper airway structures, such as cleft palate. This paper presents research of (i) current advice on sleep
positioning provided to parents of infants with cleft palate in the UK; and (ii) decision making by
clinical nurse specialists when advising parents of infants with cleft palate. A qualitative descriptive
study used data from a national survey with clinical nurse specialists from 12 regional cleft centres in
the UK to investigate current practice. Data were collected using semi-structured telephone interviews
and analysed using content analysis. Over half the regional centres used lateral sleep positioning based
on clinical judgement of the infants’ respiratory effort and upper airway obstruction. Assessment relied
upon clinical judgement augmented by a range of clinical indicators, such as measures of oxygen
saturation, heart rate and respiration.