HOB elevation

The AAP does not recommend elevating the HOB for infants. Not even those with reflux.

"Elevating the head of the infant's crib while the infant is supine is not recommended. It is ineffective in reducing gastroesophageal reflux; in addition,it might result in the infant sliding to the foot of the crib into a position that might compromise respiration." AAP, 2011.

http://pediatrics.aappublications.org/content/pediatrics/early/2011/10/12/peds.2011-2284.full.pdf

I didn't mean to write a lengthy post but....

I am well aware of the AAP guidelines on safe sleep environments. In my 30 years of level 3 NICU experience I have seen just a handful of babies go home in elevated, prone positions for sleep. Not just for reflux but for airway management of conditions like laryngomalacia or Pierre robin syndrome.

We too recently had a head cooling baby that was pretty brain damaged and had a hard time handling secretions. He would turn blue and desat as soon as he was laid flat so he went home on a wedge. I'm not sure the brand or anything our OTs handle ordering them.

We have had Neuro kids go home elevated. Our OT/PT set up some sort of wedge for them.

As we all know, there is always an exception to every rule. Neuro kids, trached kids are just a few.