Educate about safe sleep practices to prevent SIDS
Repetitive messages could help lower death rate
Recently, Laura L. Reno, vice president of public affairs for the Baltimore-based nonprofit health organization First Candle, spoke with parents who were grieving the loss of their 4-month-old baby, who had died while sleeping in a crib.
Although the baby was put to bed on her back, which is the sleeping position recommended by the American Academy of Pediatrics in Elk Grove, IL, the parents were using a memory foam pad to keep her from getting a flat spot on the back of her head. When the baby rolled over, the pad conformed to her face and she died, reports Reno.
The parents knew the correct sleep position for infants, but they did not know that the use of the pad to position the baby was not safe. Currently, about 85% of parents put babies down to sleep on their backs, says Reno. Yet other safe sleep practices also must be followed, and education on these must be as vigilant as that provided regarding putting babies to bed on their backs, she adds.
For many years now parents have been taught to place babies on their backs when putting them down to sleep. The practice was shown by research to reduce the risk for Sudden Infant Death Syndrome (SIDS). A big educational campaign was initiated in 1994 under the leadership of the National Institute of Child Health and Human Development called "Back to Sleep."
Education regarding placing babies on their backs for sleeping began around 1992. According to the American Academy of Pediatrics, by 2001 there was a 53% decrease in the cases of SIDS.
Reno says her organization is tracking the child death reports from each state and finds it is rare for a baby to die while sleeping in a safe crib on his or her back. She says that while the numbers for SIDS have dropped tremendously, everyone needs to learn the definition of a safe sleep environment, including grandparents, child care providers, and babysitters.
First Candle is dedicated to helping babies survive and thrive, and it works to increase public participation and support in the fight against infant mortality. It was formerly called the National SIDS Foundation. Reno says SIDS is a catchall term for unexpected infant death; however, medical examiners now often assign other reasons for death, such as accidental suffocation.
The definition of SIDS is the sudden, unexpected death of an infant younger than 1 year old that after an autopsy, review of medical history, and death scene investigation, no other cause of death can be found, says Reno.
While the exact cause of SIDS has not yet been determined, many physicians and researchers think it is caused by several different factors, according to the National Institutes of Health in Bethesda, MD. "These factors may include problems with sleep arousal or an inability to sense a build-up of carbon dioxide in the blood. Almost all SIDS deaths occur without any warning or symptoms when the infant is thought to be sleeping," reports the NIH.
According to the NIH, babies between 2 and 4 months of age are more likely to die of SIDS, and about 90% of all cases occur by the time a baby is 6 months old. Also SIDS is more likely to occur in winter months. Babies born to Native American and African-American families are at a greater risk for SIDS.
Education on safe sleep practices
Research has uncovered certain practices parents and other caregivers can follow to create a safe sleep environment and reduce the risk of SIDS. Reno says it is important to educate every parent on best practices.
With more than 4 million families having babies each year in the United States, it is education that must be ongoing.
"While we have made progress in saving lives, it is still the leading cause of death for babies 1 month to 1 year of age. Safe sleep messages are not something that can ever go away," says Reno.
To lower the risk of SIDS, babies should be placed on their backs rather than on their stomachs or sides to sleep. Reno said First Candle is working nationwide to have nurses at hospitals demonstrate safe sleep practices, because these health care professionals play an influential role. Some nurses swaddle babies and put them on their sides, and many new moms will follow the example, she adds.
Babies need to sleep on a firm mattress and never on soft surfaces, including soft mattresses, sofa cushions, or waterbeds. There should be no loose bedding, such as blankets or pillows in the crib, or stuffed toys, bumper pads, or things to position the baby, says Reno.
"If babies are on a very firm surface in an empty crib and on their backs, once they wiggle around and start rolling over, they will still be as safe as possible, because there is nothing they can get their face next to," explains Reno.
To keep the baby warm during cold weather, Reno suggests the use of infant sleep sacks rather than loose blankets.
Overheating has been associated with SIDS, so the baby should not be bundled up for warmth but should be lightly clothed. The bedroom temperature should feel comfortable to an adult in light clothing.
While babies should not sleep with an adult, research shows that the risk of SIDS is reduced when the infant sleeps in the same room with the mother, according to the American Academy of Pediatrics.
"We promote room sharing — not bed sharing," says Reno. Mothers should have the crib or bassinette next to their bed, so after breastfeeding they can place the baby on his or her back in a safe area, she adds.
The American Academy of Pediatrics suggests the crib, bassinet or cradle conform to the safety standards set by the Consumer Product Safety Commission. Reno says First Candle realizes that part of the problem with compliance is that many parents cannot afford to purchase a good bed for their baby.
With the aid of an $11 million grant from the Bill & Melinda Gates Foundation, the organization will combine a crib distribution program with widespread public and professional education in Indiana, Washington, and the District of Columbia. The outcome of the safe sleep campaign will be evaluated, and First Candle will publish the results.
Getting the message out to all types of people is important, because infants are not always in the care of their parents, says Reno. The organization tells parents to tell everyone what their rules are for caring for the baby — that includes grandparents, babysitters, and child care providers.
First Candle has a program to train child care providers, because at one time 15% of all SIDS deaths occurred in child care. While the number is lower, there is still a way to go, says Reno. The most difficult audience to reach are in-home providers.
"We do the best we can to reach who we can, but it is up to the parents to make sure they trust the person caring for their child," says Reno.
Many times grandparents think they know what is best for the baby because they have already raised children, but they are not up-to-date on the best sleep practices. That is why parents must educate the baby's caregivers.
In addition to teaching good sleep practices, women need to know that good prenatal care helps prevent SIDS. Also, they need to be aware that smoking during pregnancy or exposing the baby to secondhand smoke after birth will increase the risk of SIDS.
A pregnancy timeline on the First Candle web site provides information on steps to take to reduce the risk of SIDS. "There are three things we want them to do while they are pregnant: get good and early prenatal care; don't smoke; and learn about how important safe sleep is," says Reno.
(Editor's note: October is Sudden Infant Death Syndrome Awareness Month.)
Recently, Laura L. Reno, vice president of public affairs for the Baltimore-based nonprofit health organization First Candle, spoke with parents who were grieving the loss of their 4-month-old baby, who had died while sleeping in a crib.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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