sids? not sids? a new look at sudden infant death syndrome
TRANSCRIPT
SIDS? Not SIDS?A New Look at Sudden Infant
Death Syndrome
Explanation of Concepts and Definitions
• Sleep Position:
There are generally three positions in which babies sleep: 1) supine, i.e. on the back, 2) prone, i.e. on the stomach, and 3) on the side. The supine sleep position is promoted by AAP and the Cribs for Kids Campaign.
• Sleep Surface:
The surface on which a baby is placed for sleep constitutes a sleep surface. Ideally, infants should sleep in a crib on a firm mattress that meets current federal safety standards.
• Soft Bedding:
This can include any type of bedding other than a firm, tight-fitting mattress in a crib that meets current safety standards. Examples include: pillows, quilts, comforters, sheepskins, stuffed toys, blankets, waterbeds, soft mattresses, sofas, and other soft products.
Explanation of Concepts and Definitions
• Bedsharing:
When an infant sleeps with others in an adult bed.
• Co-sleeping:
Involves the infant sleeping in its own space, such as in a safety-approved crib, but adjacent to the parent or caregiver.
• Roomsharing:
When the baby sleeps in its own crib in the same room as the parents.
• Safe Sleep Environment:
This involves a combination of proper sleep position (supine) on a firm mattress, in a safety-approved crib, with no soft bedding or blankets in the crib, in a smoke-free environment.
autopsy
examination of the scene of death
review of the case history
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The sudden death of an infant under one year of age which remains unexplained after the performance of a complete post-mortem investigation including:
Sudden Infant Death SyndromeICD-9 Definition
The umbrella under which falls:
• Sudden Infant Death Syndrome• Accidental Suffocation
• Entrapment• Asphyxia • Neglect
• Homicide• Hypothermia/hyperthermia
• Metabolic disorders• Unknown
Can be explained or unexplained; natural/undetermined
SUID: Sudden UnexpectedInfant Death
The overwhelming majority of babies who die from SUID/SIDS are discovered in an
unacceptable sleep position or sleep location!
FACT!
• FACT: Half of the infants in the U.S. who die from sudden unexpected death do so while sleeping with their parents– Bedsharing and infant death is very different in
the U.S. than it is in other cultures– If babies routinely sleep with their parents in
other cultures, they: • Use a firm mat on the floor• Have a separate mat for the infant• Do not use soft bedding
Bedsharing and Infant Death
Triple Risk Model to Explain SIDS
Critical period of development
Underlying Vulnerability
Modifiable Pre- and
Post-NatalEnvironmental
Stressors
HIGHEST RISK FOR
SIDS
PossibleBrainstem Abnormality
(Filiano and Kinney, modified)
First 6 months
Prone/Side Sleep Position
NicotineExposure
SoftBedding
Overheating
Bed sharing
Trachea
Trachea
Esophagus
Esophagus
Anatomy and Physiology
In the supine position, the trachea lies on top of theesophagus. Anything regurgitated or refluxed from theesophagus has to go against gravity to be aspirated into the trachea.
Permission to use figure granted by First Candle/SIDS Alliance.
Babies at Risk •African American babies (2x greater risk) •Mothers who smoke during pregnancy
(3x greater risk)•Babies who breathe secondhand smoke
(2.5x greater risk)•Babies who sleep on their tummies
(5x greater risk)•Babies put on their tummies to sleep who usually sleep on their backs
(18-20x greater risk)•Babies who sleep with parent(s) in adult bed(40x greater risk)
Bed Sharing with Siblings, Soft Bedding Increase SIDS Risk −
Chicago Infant Mortality Study, Pediatrics, May, 2003
• Sleeping on soft bedding: increased SIDS risk 5 times
• Sleeping on the stomach: increased SIDS risk 5 times
• SIDS victims were 5.4 times more likely to have shared a bed with other children.
• Sleeping on the stomach on soft bedding: increased risk of SIDS 21 times
SIDS is NOT Suffocation
Although SIDS is different from suffocation, all the measures we use for SIDS risk reduction also help to prevent accidental deaths such as positional asphyxia, overlay, and entrapment.
These are 100% PREVENTABLE deaths!
Unsafe Sleep Environment:Soft Bedding
Unsafe Sleep Environment
What is wrong with this picture?
Jennifer Lopez’s nursery
What is wrong with these pictures?
Unsafe Sleep Environment
April 15, 1992The American Academy of Pediatrics recommended that healthy infants:
“when being put down for sleep, be positioned on their back or side.”
December 1996 A revised statement by the AAP stated:
“Back is best.”
November 1998Cribs for Kids® begins in Pittsburgh, PA.
October 2005AAP recommends:
“Separate but proximate sleeping environment.”
October 2011AAP Revised Recommendations Released
Back to Sleep Timeline
SIDS Death Rate and Sleep Position 1988 – 2003(per 1000 Live Births)
NEW AAP POSITION STATEMENTOCTOBER 2011
• Always place your baby on his or her back for every sleep time.• Always use a firm sleep surface. Car seats and other sitting devices are not
recommended for routine sleep.• The baby should sleep in the same room as the parents, but not in the same
bed (room-sharing without bed-sharing).• Keep soft objects or loose bedding out of the crib. This includes pillows,
blankets, and bumper pads.• Wedges and positioners should not be used.• Pregnant woman should receive regular prenatal care.• Don’t smoke during pregnancy or after birth.• Breastfeeding is recommended.• Offer a pacifier at nap time and bedtime.• Avoid covering the infant’s head or overheating.• Do not use home monitors or commercial devices marketed to reduce the risk
of SIDS.• Infants should receive all recommended vaccinations.• Supervised, awake tummy time is recommended daily to facilitate
development and minimize the occurrence of positional plagiocephaly
(flat heads).
Additions to AAP Position Statement OCTOBER 2011
• Breastfeeding is recommended and is associated with a reduced risk of SIDS.
• Infants should be immunized. Evidence suggests that immunization reduces the risk of SIDS by 50 percent.
• Bumper pads should not be used in cribs. There is no evidence that bumper pads prevent injuries, and there is a potential risk of suffocation, strangulation or entrapment.
Safe-Sleep Survival Kit $74.99
Contact Information
Regina WashingtonREMSA/Safe Kids Washoe County
450 Edison WayReno, NV 89502
Office - (775) 858-5700, ext. 3139Fax – (775) 858-5735
Email – [email protected] – www.safekidswc.com