Working Together to Reduce Infant Sleep-Related … · · 2018-02-02Working Together to Reduce Infant Sleep-Related Deaths: ... staff in newborn nurseries and ... hours of life
90
Treat with confidence. Trusted answers from the American Academy of Pediatrics. Treat with confidence. Trusted answers from the American Academy of Pediatrics. Working Together to Reduce Infant Sleep-Related Deaths: WHAT YOU NEED TO KNOW NOW Michael Goodstein, MD, FAAP
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Working Together to Reduce Infant Sleep-Related Deaths
WHAT YOU NEED TO KNOW NOW
Michael Goodstein MD FAAP
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Disclaimer I have documented that I have no financial relationships to disclose or conflicts of interest
to resolve I have documented that my presentation will not involve discussion of unapproved or off-
label experimental use of a product drug or device Statements and opinions expressed are those of the author and not necessarily those of
the American Academy of Pediatrics Mead Johnson sponsors programs such as this to give healthcare professionals access to
scientific and educational information provided by experts The presenter has complete and independent control over the planning and content of the presentation and is not receiving any compensation from Mead Johnson for this presentation The presenterrsquos comments and opinions are not necessarily those of Mead Johnson In the event that the presentation contains statements about uses of drugs that are not within the drugs approved indications Mead Johnson does not promote the use of any drug for indications outside the FDA-approved product label
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Objectives for Todayrsquos Talk
Definition of sudden unexpected infant death (SUID) and sudden infant death syndrome (SIDS)
Statistics on SIDS and accidental sleep deaths Pathophysiology of SIDS 2016 AAP recommendations SIDS risk reduction and
suffocation prevention Safe sleep modeling and education in the hospital
setting
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Infant Mortality Rates for the Five Leading Causes of Infant Death in the United States 2005 and 2011
24000 deaths per year
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US Post-Neonatal Mortality 2015
United States Department of Health and Human Services (US DHHS) Centers for Disease Control and Prevention (CDC) National Center for Health Statistics (NCHS) Division of Vital Statistics (DVS) Linked Birth Infant Death Records 2007-2015 as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program on CDC WONDER On-line Database Accessed at httpwondercdcgovlbd-currenthtml on Dec 27 2017
Chart1
Incidence per 100000 live births
1
2
2
2
6
6
6
7
13
36
78
Sheet1
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FACT 3700 babies in the US die suddenly and unexpectedly each year
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What is SUID or SUDI
Sudden Unexpected Infant Death o Occurs in a previously healthy infanto Can be explained or unexplained
o Most unobserved during sleepenvironment Sleep-related deaths SIDS represents a subcategory of SUID
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Some Causes of Deaths that Occur Suddenly and Unexpectedly during Infancy
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What is SIDS ICD-10 definition The sudden death of an infant
under one year of age which remains unexplained after the performance of a complete post-mortem investigation including o Performance of a complete autopsyo Examination of the death sceneo Review of the case history
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SIDS FACTS The leading cause of death in
infants from 1 month to 1 year of age (post-neonatal infant mortality)
A diagnosis of exclusion The cause of death is assigned only after ruling out other causes
Peak time of occurrence1-4 months
Higher incidence in males No longer see a higher
frequency in colder months
Percent distribution of SIDS by age at death United States 2004-2006
AAP Task Force on SIDS SIDS and other sleep-related infant deaths expansion of recommendations for a safe infant sleeping environment Pediatrics 2011128(5)e1341-e1367
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SIDS FACTS
Higher incidence in preterm and low birth weight infants
Associated witho Young maternal ageo Maternal smoking with pregnancyo Late or no prenatal care
2-3 times more common in African-American American Indian and Alaska Native children
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Triple Risk Model to Explain SIDS
Critical Developmental
Period
Vulnerable Infant Exogenous
Stressors(eg brainstem dysfunction)
First 6 months
bull Proneside sleep position
bull Soft beddingbull Overbundling
overheatingbull Bed sharing
Intrinsic risk factors
bull Smokingbull Prematuritybull Alcohol and
illicit drugsbull Hypoxiabull Growth
restriction
SIDS
Extrinsic risk factors
Adapted from Filiano and Kinney 1994
bull Bed sharing + smoking
andor alcohol
Modifiable Risk Factors
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Paterson DS Krous HF Kinney HC et al JAMA 2006
Serotonin receptor binding density lower in SIDS cases compared to controls
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Adapted from Kinney and Thach 2009
An Example of SIDS Pathogenesis
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2016 AAP Recommendations Infant Sleep Safety Recommendations are to reduce
the risk of SIDS and sleep-related suffocation asphyxia and entrapment
Recommendations should be used consistently until 1 year of ageo Most epidemiological studies upon
which these recommendations are based include infants up to 1 year of age
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Strength of Recommendation
Scale based on the Strength of Recommendation Taxonomy (SORT)
A There is good quality patient-oriented evidence B There is inconsistent or limited quality patient-
oriented evidence C The recommendation is based on consensus
disease-oriented evidence usual practice expertopinion or case series for studies ofdiagnosis treatment prevention orscreening
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Recommendations Change as the Evidence Evolves Statistics and risk factors may change
o New risks emerge (eg side positioning)o Different levels of risk
Policies and procedures may changeo Better death scene investigationso Diagnostic shift
Unintended consequenceso Plagiocephaly development o New tummy time recommendations
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2016 SIDS Task Force Policy Statement Level A Recommendations Back to sleep for every sleep Use a firm sleep surface Keep soft objects and loose bedding out of the crib Room-sharingmdashInfant on separate sleep surface Breastfeeding is recommended Consider offering a pacifier at nap time and bedtime Avoid smoke exposure during pregnancy and after birth Avoid alcohol and illicit drug use during pregnancy and
after birth
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2016 SIDS Task Force Policy Statement Level A Recommendations Avoid overheating Pregnant women should receive regular prenatal care Do not use home cardiorespiratory monitors as a strategy
for reducing the risk of SIDS Health care professionals staff in newborn nurseries and
NICUs and child care providers should endorse the SIDS risk-reduction recommendations from birth
Media and manufacturers should follow safe-sleep guidelines in their messaging and advertising
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2016 SIDS Task Force Policy Statement Level B Recommendations Avoid commercial devices that are inconsistent with
safe sleep recommendations Supervised awake tummy time is recommended to
facilitate development and to minimize development of positional plagiocephaly (flattening of skull)
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2016 SIDS Task Force Policy Statement Level C Recommendations Continue research and surveillance on the risk factors
causes and pathophysiological mechanisms of SIDS and other sleep-related infant deaths with the ultimate goal of eliminating these deaths entirely
There is no evidence to recommend swaddling as a strategy to reduce the risk of SIDS
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Correct Safe Sleep Environment
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We Need to Move Beyond Back to Sleep
Shersquos on her back to sleep
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Sleep Position for Healthy Newborns
Skin-to-skin care is recommended for all mothers and newborns regardless of feeding or delivery method immediately following birtho Mom should be medically stable
awake and able to respond to baby When mother needs to sleep or take
care of other needs infant should be placed supine in a bassinet
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Sleep Position in Newborn Nursery Infants in the newborn nursery
and infants who are rooming in with their parents should be placed in the supine position as soon as they are ready to be placed in the bassinet o No evidence that placing infants
on the side during the first few hours of life promotes clearance of amniotic fluid and decreases the risk of aspiration
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Sleep Position and Reflux Infants with gastroesophageal (GE) reflux
should be kept supineo Unless the risk of death from complications
of GE reflux is greater than the risk of SIDS
Supine position does not increase the risk of choking and aspiration in infants with GE reflux o Protective airway mechanisms
Do NOT elevate the head of the infantrsquos cribo Ineffective in reducing GE refluxo Infant may slide to the foot of the cribmdashmay
compromise respiration
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The Truth About Supine Sleep and Aspiration Ending the Fallacy Orientation of the Trachea to the Esophagus
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Title
Text
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Infant Sleep Location
Infants should sleep in parentsrsquo room close to parentsrsquo bed but on a separate surface designed for infants
Ideally for the first year of life but at least for the first 6 months
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Room-Share How Long Yoursquore Kidding Right
2011 ldquoall sleep recommendations are to be followed until 1 year of agerdquo
2016 ldquoroom-sharing without bed-sharinghellipideally until 1 year of age but at least for the first 6 monthsrdquo
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Supporting Data
3 case-control studies comparing sleeping in a separate room vs room-sharingo Tappin (Scotland) AOR 326 (95 CI 103-1035)
bull Protection is significant for smoker motherso Blair (England) AOR 1049 (95 CI 426-2581)
bull Protection is significant for both smoker and nonsmoker mothers
o New Zealand Cot Death study AOR 285(95 CI 204-385)
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More Recent Data
New Zealand SUDI studyo 64 protection with room-sharing AOR 036
(95 CI 019-071)
Estimate of 50 reduction is very conservative
None of the case-control studies stratify by age (months)
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Why is Room-Sharing Protective
SIDSmdashfailure to arouse More small awakenings during the night
o Stirrings movement not fully awake Postulation protective effect from small awakenings Room-sharing facilitates breastfeeding
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Room-Sharing and Sleep Quality
Volkovich room-sharing vs solitary sleepo Room-sharing mothers with more sleep disturbanceso Infants with similar sleep quality
Mao Mindell room-sharing infantsmdashmore awakenings
Montgomery-Downs Doan sleep quality in breastfeeding mothers gt to formula feeding motherso Exclusive breastfeeding = 30 min more sleep
More study needed
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Insight Study (Paul 2017)
Sleep questionnaire at 4 9 12 and 30 monthso Sleep duration overnight behaviorso Compared early vs late independent infants
At 4 monthso Equal sleep durationo Early group had better sleep consolidationo Longest stretch 46 minutes
Paul IM Hohman EE Loken E et al Mother-infant room-sharing and sleep outcomes in the INSIGHT study Pediatrics 2017140(1)e20170122
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Insight Study (Paul 2017)
At 9 monthso Longer sleep duration (40 minnight) o Better consolidation (100 min)
At 30 monthso Longer sleep duration (45 minnight)
Room-sharing 4 times more likely to transition to bed sharing overnight
Paul IM Hohman EE Loken E et al Mother-infant room-sharing and sleep outcomes in the INSIGHT study Pediatrics 2017140(1)e20170122
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Insight Commentary (Hauck Moon)
Late room-sharing mean 7 hours longest sleep Is early consolidation desirable Differences related to bedtime routines
o Early bedtimeo Number of night feedso Feeding back to sleep
Focus on the routine not early separation
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Feeding the Baby at Night Acknowledgment that parents may fall
asleep while feeding babyo Safer to feed on bed than on sofa
couch or armchair if you might fall asleep
o No pillows sheets blankets or other items that could obstruct infant breathing or cause overheating should be in bed
o Return infant back to separate sleep surface as soon as parent awakens
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Say NO to Couches Sofas and Cushioned Armchairs Never place a baby for sleep on these surfaces Never sleep with a baby on these surfaces One of the MOST dangerous places for an infant
(OR 51-669)
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High-Risk Bed Sharing Situations Age lt4 months Preterm or low birth weight Smoked during pregnancy Bed sharer is current smoker (even if not
smoking in bed) Bed sharer has usedis using meds or
substances that could impair alertness or arousal
Bed sharer is not parent (including other children)
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Bedsharing in Low-Risk Breastfed Infants
Blair et al AOR 16 (95 CI 096-27) o Age lt14 weekso Parents No cigarettes or alcoholo Independent of feeding method
Carpenter et al AOR 51 (95 CI 23-114) o Age lt3 months o Parents did not smokeo Mother No alcohol or drugso Breastfed infants
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Independent Review (Dr Robert Platt)
Very small numbers of low-risk babieso 24 in Blairrsquos studyo 12 in Carpenterrsquos study
Does not believe that data support definitive differences in 2 studies
Some evidence of increased risk in this group but cannot say how large the increased risk is
Cannot conclude that bed sharing in this group is safe
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Bed Sharing
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Bed Sharing
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Bed Sharing with Overlay
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Bed Sharing with Overlay
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Bed Sharing with Overlay
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Couch Sleeping
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Couch Sleeping
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Couch Sleeping
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Unsafe Bedding NISP Trends 1993-2102
Shapiro-Mendoza CK Colson ER Willinger M Rybin DV Camperlengo L Corwin MJ Trends in infant bedding use National Infant Sleep Position study 1993ndash2010 Pediatrics 2015135(1)10-17
Decrease from 86 to 55 Rate of decline decreases
2001-10 835 for teen mothers Predictors of adjusted OR
gt15
o Young motherso Non-white race
ethnicityo Less than college
education
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Why Use Soft Bedding
ComfortWarmtho Extrapolation of own feelingso Misinterpret firm with taut
bull Soft + taut ne firm
Safetyo Blankets pillows rolls to prevent falls
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Soft Bedding for Older Infants
Many parents recognize soft bedding is a risk Increased complacency as baby gets older Soft bedding is THE most important risk factor for
infants 4-12 months old (Colvin 2015) Infants roll into bedding and cannot extract
themselves
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To Swaddle or Not to Swaddle That is the Question Pros
o Calms the infant promotes sleep decreases number of awakenings
o Encourages use of the supine position
Conso Increased respiratory rate and
reduced functional residual lung capacity
o Exacerbates hip dysplasia if the hips are kept in extension and adduction
o ldquoLooserdquo swaddling becomes loose bedding
o Overheating especially if the head is covered or the infant has infection
o Effects on arousability to an external stimulus remain unclear (conflicting data) There may be minimal effects of routine swaddling on arousal
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Swaddling
There is insufficient evidence to recommend routine swaddling as a strategy to reduce the incidence of SIDS
Swaddling must be correctly applied to avoid the possible hazards
Swaddling does not reduce the necessity to follow recommended safe sleep practices Ambrogio Lorenzettis Madonna and Child (1319)
Wikipedia
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McDonnell E Moon RY Infant deaths and injuries associated with wearable blankets swaddle wraps and swaddling J Pediatr 20141641152-1156
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SwaddlingmdashMore Questionshellip
Pease 2016 Pediatrics Pooled OR = 138
o Prone = 1299 o Side = 316o Supine = 193
Increased risk with age Limitations
o Heterogeneity definitions other risk factorsPease AS Fleming PJ Hauck FR et al Swaddling and the risk of sudden infant death syndrome a meta-analysis Pediatrics 2016137(6)e20153
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wwwhealthychildrenorg
Swaddling (wrapping a light blanket snuggly around a baby) may help calm a crying baby If you swaddle your baby be sure to place him on his back to sleep Stop swaddling your baby when he starts to roll
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Pacifiers
AAP recommendation Consider offering a pacifier at nap time and bedtime
Studies consistently demonstrate a protective effect of pacifiers on SIDS
Mechanism unknowno Dislodge within 15 to 60 minuteso Decreased arousal threshold
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Pacifiers and Breastfeeding Well-designed trials
o 2 found no association among term infants
o 1 found no association among preterm infants
o 1 found slightly decreased breastfeeding duration at one month if pacifier introduced in first week of life but NO difference if pacifier introduced after one month
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Baby Friendly USA Pacifiers
Breastfeeding babies should not be given pacifiers by the staff of the facility with the exception of o Limited use to decrease pain during procedures when
the baby cannot safely be held or breastfed (pacifiers used should be discarded after these procedures)
o Babies who are being tube-fed in NICUo Other rare specific medical reasons
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Addressing Sleep Deprivation
Give parents tools to cope with fussy babies
Sleep-deprived parents may make poor judgments
Make use of tools o Swaddling side carrying
shushing swinging and sucking
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Overcoming Barriers to Change What Parents are Sayinghellip
Prone positioning fear of choking Baby sleeps ldquobetterrdquo on stomach Soft things are safer for the baby SIDS is ldquoGodrsquos willrdquo Why bother Recommendations keep changing
anyway Vigilance sleep with baby for protection
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Factors Associated With Choice of Infant Sleep Position 3300 mothers from 32 hospitals 77 usually use supine position 49 exclusive use supine position Most likely to use prone
o African-American motherso Mothers with lt high school educationo Lack of perceived controlo Personal attitudesocietal norms
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
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A continuum starting in childhoodo Secondary school baby sitting classes
Pre-pregnancy Pregnancyprenatal education
o Prior to baby showerhellipldquowrong giftsrdquo In-hospital education and modeling
o Include family friends baby sitters Re-enforcement in the doctorrsquos office
o Especially between 1 to 4 months Grandparents They hold great power The general public (day cares religious leaders)
A Lifetime of Infant Sleep Safety
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The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Chart1
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
14
139
13
13
12
13
117
17
103
269
087
386
074
353
077
531
072
557
067
644
062
666
056
716
057
711
053
728
056
701
055
722
055
757
057
703
055
721
054
741
051
728
048
042
04
039
Sheet1
Sheet1
ampA
Page ampP
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
Sheet2
Pre-AAP recommendation Post-AAP RecommendationBack to SleepSafe to Sleep Campaign
Sheet3
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Infant Sleep Safety
Requires a consistent and repetitive message in the community to prevent accidental deaths
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Safe Sleep Nurse Modeling
People trust nurses Whatever the nurse does must
be correct and it will be imitated in the home
Fact supine positioning in the nursery can almost DOUBLE its use in the home
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Physician Advocacy
Srivatsa 1997 HCP education to new familieshellip34 reduction in prone sleeping
Eron 2009 Study of Central NY state physicianshellip30 identified incorrect safest sleep positionhellip30 do not discuss with families
Colson 2009 Only 13 mothers advised by MD to use supine positionhellip3 times more likely to position the baby properly
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Healthcare Provider Advice to New Mothers Safe Sleep
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Chart1
Column1
[]
[]
[]
55
25
20
Sheet1
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Mason Clinical Peds 713
Bundled interventiono Nursing education policy model behavior safe sleep
video posters in rooms declaration of safe sleep practice
Safe sleep environment uarr from 25 to 58 Intention in home 95 supine none ldquoco-sleepingrdquo
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Bundled Intervention = Behavior Change
QUESTION GROUP p-value
ISS Study NISP
Behavior Questions n = 490 n = 1046
Baby routinely placed to sleep on back 925 73 lt 0001
Baby routinely sleeps in bassinetcrib 995 71 lt 00001
Baby sleeps under a thin sheet 992 86 lt 0001
Baby given a pacifier for sleep 741 84 lt 0001Goodstein MH Bell T Krugman SD Improving infant sleep safety through a comprehensive hospital-based program Clinical Pediatrics 201554(3)212-221
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o Baseline Safe sleep 49 of 264 infants o Post 312 of 234 infants (P lt 001) o Extra blankets most common o Baseline 77 vs 44 post-intervention o Mean number of unsafe items reduced by 50 (P lt 001)
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Washington DC
2 urban DC nurseries 26 did not believe or unsure that infant positioning
was associated with SIDS Top 3 factors influencing sleep position
o 56 PERSONAL PREFERENCE Why non-supine Clinical experience (25)
o Increase risk aspirationo Decrease sleep and comfort
Bartow KL Nursesrsquo knowledge and adherence to sudden infant death syndrome prevention guidelines Pediatr Nurs 201642(1)7-13
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Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
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TodaysBaby QI Safe Sleep Teaching
QI intervention median = 160 days Mothers reported receiving information 72 to 95
(increase of 24-57) 94 babies observed supine (plus 24) 88 infants in safe sleep environment
o Increase of 33 Gains maintained up to 12 months
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
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Social Media and Risk-Reduction Training Study (SMART) Cluster randomization 4 groups Safe sleep or breast feeding education Nursing QI and social media (mobile health) N = 1600 1263 responses (79) Safe sleep NQI and MHealth
o Supine sleep 925 o Room-sharing 859o No soft bedding 819o Pacifier use 762
Moon RY Hauck FR Colson ER et al The effect of nursing quality improvement and mobile health interventions on infant sleep practices a randomized clinical trial JAMA 2017318(4)351-359
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Hospital Initiative ComponentswwwcribsforkidsorgHospitalInitiativeToolkit INTRODUCTORY LETTER HOSPITAL INITIATIVE TOOL KIT
INSTRUCTIONS ORGANIZATIONAL CHART HOSPITAL POLICY ACKNOWLEDGMENT FORM (Engl amp
Span) SAFE SLEEP EDUCATIONAL FLIP CHART
NONCOMPLIANCE WAIVER (Engl amp Span)
NURSING EDUCATION MODULE
SAFE SLEEP POSTERS DOOR HANGERS (Engl amp Span) GRADUATION CERTIFICATE SAMPLE LETTER TO HOSPITALS SAMPLE LETTER TO PROVIDERS INFANT SAFE SLEEP BROCHURES
(Engl amp Span) PRESS KIT
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All materials available on-lineo No major costs to the hospital
Easy on-line access for documentation
NO FEE FOR PARTICIPATION
wwwCribsforKidsorgHospitalInitiative
Tiffany Price (tpricecribsforkidsorg)
The National Safe Sleep Hospital Certification Program
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Coordinated Education Efforts Work
TNmdash25 reduction in infant sleep-related deaths in 2 years
SDmdashOver 7915 Pack lsquon Plays distributed since 2012 Infant mortality rate decreased from 86 (2012) to 48 (2016)
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Coordinated Education Efforts Work
2009 to 2015 38 decrease in infant mortality Decreased from 135 to 84 per 1000 SUID decreased gt50 Decrease in racial disparityhttphealthybabiesbaltimorecomhome
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And Finallyhellip
Health care providers should have open frank nonjudgmental conversations with families about their sleep practices
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Encouraging Parents to Take Action
According to the Social Learning Theory parents are more likely to recall and comply with instructions when
the health care provider
Uses a positive tone Provides adequate information Allows the parent to ask most of the questions
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Motivational Interviewing
ldquoa collaborative goal-oriented style of communication with particular attention to the language of changerdquo
o Strengthen personal motivation and commitment to a specific goal
o Explore onersquos reasons for change (barriers)o Patient generates own solutions
bull More likely to feel realisticbull Planting seeds of change
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Impact of Eliminating Sleep-Related Deaths
Every week we lose 70 children which is equivalent to 4 kindergarten classrooms
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Thank You
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Contact Information
mgoodsteinwellspanorg
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Visit Pediatric Care Online today for additional information on this and other topics
httppediatriccaresolutionsaaporgPediatric Care Online is a convenient electronic resource for immediate expert help with
virtually every pediatric clinical information need with must-have resources that are included in a comprehensive reference library and time-saving clinical tools
Donrsquot have a subscription to PCOThen take advantage of a free trial today
Call Mead Johnson Nutrition at 888363-2362 orfor more information go to
httppediatriccaresolutionsaaporgSSFree_Trialaspx
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
IMR over time Finland vs US
Slide Number 1
Disclaimer
Objectives for Todayrsquos Talk
Infant Mortality Rates for the Five Leading Causes of Infant Death in the United States 2005 and 2011
US Post-Neonatal Mortality 2015
FACT
What is SUID or SUDI
Some Causes of Deaths that Occur Suddenly and Unexpectedly during Infancy
What is SIDS
SIDS FACTS
SIDS FACTS
Triple Risk Model to Explain SIDS
Paterson DS Krous HF Kinney HC et al JAMA 2006
An Example of SIDS Pathogenesis
2016 AAP Recommendations Infant Sleep Safety
Strength of Recommendation
Recommendations Change as the Evidence Evolves
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
Correct Safe Sleep Environment
We Need to Move Beyond Back to Sleep
Sleep Position for Healthy Newborns
Sleep Position in Newborn Nursery
Sleep Position and Reflux
The Truth About Supine Sleep and Aspiration Ending the Fallacy
Title
Infant Sleep Location
Room-Share How Long Yoursquore Kidding Right
Supporting Data
More Recent Data
Why is Room-Sharing Protective
Room-Sharing and Sleep Quality
Insight Study (Paul 2017)
Insight Study (Paul 2017)
Insight Commentary (Hauck Moon)
Feeding the Baby at Night
Say NO to Couches Sofas and Cushioned Armchairs
High-Risk Bed Sharing Situations
Bedsharing in Low-Risk Breastfed Infants
Independent Review (Dr Robert Platt)
Bed Sharing
Bed Sharing
Bed Sharing with Overlay
Bed Sharing with Overlay
Bed Sharing with Overlay
Couch Sleeping
Couch Sleeping
Couch Sleeping
Unsafe Bedding NISP Trends 1993-2102
Why Use Soft Bedding
Soft Bedding for Older Infants
To Swaddle or Not to Swaddle That is the Question
Swaddling
SwaddlingmdashIs it Safe
SwaddlingmdashMore Questionshellip
wwwhealthychildrenorg
Pacifiers
Pacifiers and Breastfeeding
Baby Friendly USA Pacifiers
Addressing Sleep Deprivation
Overcoming Barriers to Change What Parents are Sayinghellip
Factors Associated With Choice of Infant Sleep Position
Slide Number 65
What is Working
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Infant Sleep Safety
Safe Sleep Nurse Modeling
Physician Advocacy
Healthcare Provider Advice to New Mothers Safe Sleep
Mason Clinical Peds 713
Bundled Intervention = Behavior Change
Hospital Unsafe Sleep Persists
Washington DC
TodaysBaby QI Safe Sleep Teaching
TodaysBaby QI Safe Sleep Teaching
Social Media and Risk-Reduction Training Study (SMART)
The National Safe Sleep Hospital Certification Program
Coordinated Education Efforts Work
Coordinated Education Efforts Work
And Finallyhellip
Encouraging Parents to Take Action
Motivational Interviewing
Impact of Eliminating Sleep-Related Deaths
Thank You
Contact Information
Slide Number 89
IMR over time Finland vs US
Column1
correct advice
55
incorrect advice
25
no advice
20
correct advice
incorrect advice
no advice
SIDS Rate
Percent Back Sleeping
1988
14
1989
139
1990
13
1991
13
1992
12
13
1993
117
17
1994
103
269
1995
087
386
1996
074
353
1997
077
531
1998
072
557
1999
067
644
2000
062
666
2001
056
716
2002
057
711
2003
053
728
2004
056
701
2005
055
722
2006
055
757
2007
057
703
2008
055
721
2009
054
741
2010
051
728
2011
048
2012
042
2013
04
2014
039
httpwwwcdcgovNCHSdatanvsrnvsr58nvsr58_19pdf
Xu JQ Kochanek KD Murphy SL Tejada-Vera B Deaths Final data for
2007
National vital statistics reports vol 58 no 19 Hyattsville MD
National Center for Health Statistics 2010
1988
1988
1989
1989
1990
1990
1991
1991
1992
1992
1993
1993
1994
1994
1995
1995
1996
1996
1997
1997
1998
1998
1999
1999
2000
2000
2001
2001
2002
2002
2003
2003
2004
2004
2005
2005
2006
2006
2007
2007
2008
2008
2009
2009
2010
2010
2011
2012
2013
2014
Incidence per 100000 live births
Maternal Complications
1
Malignant Neoplasm
2
MVA
2
Short gestation
2
CNS infections
6
Intentional Injury
6
GI Infections
6
SepsisInfection
7
Respiratory Diseases
13
Congenital Malformations
36
SUID
78
Maternal Complications
Malignant Neoplasm
MVA
Short gestation
CNS infections
Intentional Injury
GI Infections
SepsisInfection
Respiratory Diseases
Congenital Malformations
SUID
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Disclaimer I have documented that I have no financial relationships to disclose or conflicts of interest
to resolve I have documented that my presentation will not involve discussion of unapproved or off-
label experimental use of a product drug or device Statements and opinions expressed are those of the author and not necessarily those of
the American Academy of Pediatrics Mead Johnson sponsors programs such as this to give healthcare professionals access to
scientific and educational information provided by experts The presenter has complete and independent control over the planning and content of the presentation and is not receiving any compensation from Mead Johnson for this presentation The presenterrsquos comments and opinions are not necessarily those of Mead Johnson In the event that the presentation contains statements about uses of drugs that are not within the drugs approved indications Mead Johnson does not promote the use of any drug for indications outside the FDA-approved product label
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Objectives for Todayrsquos Talk
Definition of sudden unexpected infant death (SUID) and sudden infant death syndrome (SIDS)
Statistics on SIDS and accidental sleep deaths Pathophysiology of SIDS 2016 AAP recommendations SIDS risk reduction and
suffocation prevention Safe sleep modeling and education in the hospital
setting
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Infant Mortality Rates for the Five Leading Causes of Infant Death in the United States 2005 and 2011
24000 deaths per year
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
US Post-Neonatal Mortality 2015
United States Department of Health and Human Services (US DHHS) Centers for Disease Control and Prevention (CDC) National Center for Health Statistics (NCHS) Division of Vital Statistics (DVS) Linked Birth Infant Death Records 2007-2015 as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program on CDC WONDER On-line Database Accessed at httpwondercdcgovlbd-currenthtml on Dec 27 2017
Chart1
Incidence per 100000 live births
1
2
2
2
6
6
6
7
13
36
78
Sheet1
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
FACT 3700 babies in the US die suddenly and unexpectedly each year
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
What is SUID or SUDI
Sudden Unexpected Infant Death o Occurs in a previously healthy infanto Can be explained or unexplained
o Most unobserved during sleepenvironment Sleep-related deaths SIDS represents a subcategory of SUID
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Some Causes of Deaths that Occur Suddenly and Unexpectedly during Infancy
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
What is SIDS ICD-10 definition The sudden death of an infant
under one year of age which remains unexplained after the performance of a complete post-mortem investigation including o Performance of a complete autopsyo Examination of the death sceneo Review of the case history
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
SIDS FACTS The leading cause of death in
infants from 1 month to 1 year of age (post-neonatal infant mortality)
A diagnosis of exclusion The cause of death is assigned only after ruling out other causes
Peak time of occurrence1-4 months
Higher incidence in males No longer see a higher
frequency in colder months
Percent distribution of SIDS by age at death United States 2004-2006
AAP Task Force on SIDS SIDS and other sleep-related infant deaths expansion of recommendations for a safe infant sleeping environment Pediatrics 2011128(5)e1341-e1367
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
SIDS FACTS
Higher incidence in preterm and low birth weight infants
Associated witho Young maternal ageo Maternal smoking with pregnancyo Late or no prenatal care
2-3 times more common in African-American American Indian and Alaska Native children
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Triple Risk Model to Explain SIDS
Critical Developmental
Period
Vulnerable Infant Exogenous
Stressors(eg brainstem dysfunction)
First 6 months
bull Proneside sleep position
bull Soft beddingbull Overbundling
overheatingbull Bed sharing
Intrinsic risk factors
bull Smokingbull Prematuritybull Alcohol and
illicit drugsbull Hypoxiabull Growth
restriction
SIDS
Extrinsic risk factors
Adapted from Filiano and Kinney 1994
bull Bed sharing + smoking
andor alcohol
Modifiable Risk Factors
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Paterson DS Krous HF Kinney HC et al JAMA 2006
Serotonin receptor binding density lower in SIDS cases compared to controls
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Adapted from Kinney and Thach 2009
An Example of SIDS Pathogenesis
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
2016 AAP Recommendations Infant Sleep Safety Recommendations are to reduce
the risk of SIDS and sleep-related suffocation asphyxia and entrapment
Recommendations should be used consistently until 1 year of ageo Most epidemiological studies upon
which these recommendations are based include infants up to 1 year of age
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Strength of Recommendation
Scale based on the Strength of Recommendation Taxonomy (SORT)
A There is good quality patient-oriented evidence B There is inconsistent or limited quality patient-
oriented evidence C The recommendation is based on consensus
disease-oriented evidence usual practice expertopinion or case series for studies ofdiagnosis treatment prevention orscreening
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Recommendations Change as the Evidence Evolves Statistics and risk factors may change
o New risks emerge (eg side positioning)o Different levels of risk
Policies and procedures may changeo Better death scene investigationso Diagnostic shift
Unintended consequenceso Plagiocephaly development o New tummy time recommendations
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
2016 SIDS Task Force Policy Statement Level A Recommendations Back to sleep for every sleep Use a firm sleep surface Keep soft objects and loose bedding out of the crib Room-sharingmdashInfant on separate sleep surface Breastfeeding is recommended Consider offering a pacifier at nap time and bedtime Avoid smoke exposure during pregnancy and after birth Avoid alcohol and illicit drug use during pregnancy and
after birth
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
2016 SIDS Task Force Policy Statement Level A Recommendations Avoid overheating Pregnant women should receive regular prenatal care Do not use home cardiorespiratory monitors as a strategy
for reducing the risk of SIDS Health care professionals staff in newborn nurseries and
NICUs and child care providers should endorse the SIDS risk-reduction recommendations from birth
Media and manufacturers should follow safe-sleep guidelines in their messaging and advertising
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
2016 SIDS Task Force Policy Statement Level B Recommendations Avoid commercial devices that are inconsistent with
safe sleep recommendations Supervised awake tummy time is recommended to
facilitate development and to minimize development of positional plagiocephaly (flattening of skull)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
2016 SIDS Task Force Policy Statement Level C Recommendations Continue research and surveillance on the risk factors
causes and pathophysiological mechanisms of SIDS and other sleep-related infant deaths with the ultimate goal of eliminating these deaths entirely
There is no evidence to recommend swaddling as a strategy to reduce the risk of SIDS
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Correct Safe Sleep Environment
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
We Need to Move Beyond Back to Sleep
Shersquos on her back to sleep
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Sleep Position for Healthy Newborns
Skin-to-skin care is recommended for all mothers and newborns regardless of feeding or delivery method immediately following birtho Mom should be medically stable
awake and able to respond to baby When mother needs to sleep or take
care of other needs infant should be placed supine in a bassinet
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Sleep Position in Newborn Nursery Infants in the newborn nursery
and infants who are rooming in with their parents should be placed in the supine position as soon as they are ready to be placed in the bassinet o No evidence that placing infants
on the side during the first few hours of life promotes clearance of amniotic fluid and decreases the risk of aspiration
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Sleep Position and Reflux Infants with gastroesophageal (GE) reflux
should be kept supineo Unless the risk of death from complications
of GE reflux is greater than the risk of SIDS
Supine position does not increase the risk of choking and aspiration in infants with GE reflux o Protective airway mechanisms
Do NOT elevate the head of the infantrsquos cribo Ineffective in reducing GE refluxo Infant may slide to the foot of the cribmdashmay
compromise respiration
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
The Truth About Supine Sleep and Aspiration Ending the Fallacy Orientation of the Trachea to the Esophagus
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Title
Text
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Infant Sleep Location
Infants should sleep in parentsrsquo room close to parentsrsquo bed but on a separate surface designed for infants
Ideally for the first year of life but at least for the first 6 months
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Room-Share How Long Yoursquore Kidding Right
2011 ldquoall sleep recommendations are to be followed until 1 year of agerdquo
2016 ldquoroom-sharing without bed-sharinghellipideally until 1 year of age but at least for the first 6 monthsrdquo
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Supporting Data
3 case-control studies comparing sleeping in a separate room vs room-sharingo Tappin (Scotland) AOR 326 (95 CI 103-1035)
bull Protection is significant for smoker motherso Blair (England) AOR 1049 (95 CI 426-2581)
bull Protection is significant for both smoker and nonsmoker mothers
o New Zealand Cot Death study AOR 285(95 CI 204-385)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
More Recent Data
New Zealand SUDI studyo 64 protection with room-sharing AOR 036
(95 CI 019-071)
Estimate of 50 reduction is very conservative
None of the case-control studies stratify by age (months)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Why is Room-Sharing Protective
SIDSmdashfailure to arouse More small awakenings during the night
o Stirrings movement not fully awake Postulation protective effect from small awakenings Room-sharing facilitates breastfeeding
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Room-Sharing and Sleep Quality
Volkovich room-sharing vs solitary sleepo Room-sharing mothers with more sleep disturbanceso Infants with similar sleep quality
Mao Mindell room-sharing infantsmdashmore awakenings
Montgomery-Downs Doan sleep quality in breastfeeding mothers gt to formula feeding motherso Exclusive breastfeeding = 30 min more sleep
More study needed
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Insight Study (Paul 2017)
Sleep questionnaire at 4 9 12 and 30 monthso Sleep duration overnight behaviorso Compared early vs late independent infants
At 4 monthso Equal sleep durationo Early group had better sleep consolidationo Longest stretch 46 minutes
Paul IM Hohman EE Loken E et al Mother-infant room-sharing and sleep outcomes in the INSIGHT study Pediatrics 2017140(1)e20170122
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Insight Study (Paul 2017)
At 9 monthso Longer sleep duration (40 minnight) o Better consolidation (100 min)
At 30 monthso Longer sleep duration (45 minnight)
Room-sharing 4 times more likely to transition to bed sharing overnight
Paul IM Hohman EE Loken E et al Mother-infant room-sharing and sleep outcomes in the INSIGHT study Pediatrics 2017140(1)e20170122
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Insight Commentary (Hauck Moon)
Late room-sharing mean 7 hours longest sleep Is early consolidation desirable Differences related to bedtime routines
o Early bedtimeo Number of night feedso Feeding back to sleep
Focus on the routine not early separation
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Feeding the Baby at Night Acknowledgment that parents may fall
asleep while feeding babyo Safer to feed on bed than on sofa
couch or armchair if you might fall asleep
o No pillows sheets blankets or other items that could obstruct infant breathing or cause overheating should be in bed
o Return infant back to separate sleep surface as soon as parent awakens
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Say NO to Couches Sofas and Cushioned Armchairs Never place a baby for sleep on these surfaces Never sleep with a baby on these surfaces One of the MOST dangerous places for an infant
(OR 51-669)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
High-Risk Bed Sharing Situations Age lt4 months Preterm or low birth weight Smoked during pregnancy Bed sharer is current smoker (even if not
smoking in bed) Bed sharer has usedis using meds or
substances that could impair alertness or arousal
Bed sharer is not parent (including other children)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bedsharing in Low-Risk Breastfed Infants
Blair et al AOR 16 (95 CI 096-27) o Age lt14 weekso Parents No cigarettes or alcoholo Independent of feeding method
Carpenter et al AOR 51 (95 CI 23-114) o Age lt3 months o Parents did not smokeo Mother No alcohol or drugso Breastfed infants
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Independent Review (Dr Robert Platt)
Very small numbers of low-risk babieso 24 in Blairrsquos studyo 12 in Carpenterrsquos study
Does not believe that data support definitive differences in 2 studies
Some evidence of increased risk in this group but cannot say how large the increased risk is
Cannot conclude that bed sharing in this group is safe
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Unsafe Bedding NISP Trends 1993-2102
Shapiro-Mendoza CK Colson ER Willinger M Rybin DV Camperlengo L Corwin MJ Trends in infant bedding use National Infant Sleep Position study 1993ndash2010 Pediatrics 2015135(1)10-17
Decrease from 86 to 55 Rate of decline decreases
2001-10 835 for teen mothers Predictors of adjusted OR
gt15
o Young motherso Non-white race
ethnicityo Less than college
education
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Why Use Soft Bedding
ComfortWarmtho Extrapolation of own feelingso Misinterpret firm with taut
bull Soft + taut ne firm
Safetyo Blankets pillows rolls to prevent falls
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Soft Bedding for Older Infants
Many parents recognize soft bedding is a risk Increased complacency as baby gets older Soft bedding is THE most important risk factor for
infants 4-12 months old (Colvin 2015) Infants roll into bedding and cannot extract
themselves
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
To Swaddle or Not to Swaddle That is the Question Pros
o Calms the infant promotes sleep decreases number of awakenings
o Encourages use of the supine position
Conso Increased respiratory rate and
reduced functional residual lung capacity
o Exacerbates hip dysplasia if the hips are kept in extension and adduction
o ldquoLooserdquo swaddling becomes loose bedding
o Overheating especially if the head is covered or the infant has infection
o Effects on arousability to an external stimulus remain unclear (conflicting data) There may be minimal effects of routine swaddling on arousal
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Swaddling
There is insufficient evidence to recommend routine swaddling as a strategy to reduce the incidence of SIDS
Swaddling must be correctly applied to avoid the possible hazards
Swaddling does not reduce the necessity to follow recommended safe sleep practices Ambrogio Lorenzettis Madonna and Child (1319)
Wikipedia
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
McDonnell E Moon RY Infant deaths and injuries associated with wearable blankets swaddle wraps and swaddling J Pediatr 20141641152-1156
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
SwaddlingmdashMore Questionshellip
Pease 2016 Pediatrics Pooled OR = 138
o Prone = 1299 o Side = 316o Supine = 193
Increased risk with age Limitations
o Heterogeneity definitions other risk factorsPease AS Fleming PJ Hauck FR et al Swaddling and the risk of sudden infant death syndrome a meta-analysis Pediatrics 2016137(6)e20153
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
wwwhealthychildrenorg
Swaddling (wrapping a light blanket snuggly around a baby) may help calm a crying baby If you swaddle your baby be sure to place him on his back to sleep Stop swaddling your baby when he starts to roll
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers
AAP recommendation Consider offering a pacifier at nap time and bedtime
Studies consistently demonstrate a protective effect of pacifiers on SIDS
Mechanism unknowno Dislodge within 15 to 60 minuteso Decreased arousal threshold
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers and Breastfeeding Well-designed trials
o 2 found no association among term infants
o 1 found no association among preterm infants
o 1 found slightly decreased breastfeeding duration at one month if pacifier introduced in first week of life but NO difference if pacifier introduced after one month
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Baby Friendly USA Pacifiers
Breastfeeding babies should not be given pacifiers by the staff of the facility with the exception of o Limited use to decrease pain during procedures when
the baby cannot safely be held or breastfed (pacifiers used should be discarded after these procedures)
o Babies who are being tube-fed in NICUo Other rare specific medical reasons
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Addressing Sleep Deprivation
Give parents tools to cope with fussy babies
Sleep-deprived parents may make poor judgments
Make use of tools o Swaddling side carrying
shushing swinging and sucking
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Overcoming Barriers to Change What Parents are Sayinghellip
Prone positioning fear of choking Baby sleeps ldquobetterrdquo on stomach Soft things are safer for the baby SIDS is ldquoGodrsquos willrdquo Why bother Recommendations keep changing
anyway Vigilance sleep with baby for protection
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Factors Associated With Choice of Infant Sleep Position 3300 mothers from 32 hospitals 77 usually use supine position 49 exclusive use supine position Most likely to use prone
o African-American motherso Mothers with lt high school educationo Lack of perceived controlo Personal attitudesocietal norms
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
A continuum starting in childhoodo Secondary school baby sitting classes
Pre-pregnancy Pregnancyprenatal education
o Prior to baby showerhellipldquowrong giftsrdquo In-hospital education and modeling
o Include family friends baby sitters Re-enforcement in the doctorrsquos office
o Especially between 1 to 4 months Grandparents They hold great power The general public (day cares religious leaders)
A Lifetime of Infant Sleep Safety
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Chart1
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
14
139
13
13
12
13
117
17
103
269
087
386
074
353
077
531
072
557
067
644
062
666
056
716
057
711
053
728
056
701
055
722
055
757
057
703
055
721
054
741
051
728
048
042
04
039
Sheet1
Sheet1
ampA
Page ampP
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
Sheet2
Pre-AAP recommendation Post-AAP RecommendationBack to SleepSafe to Sleep Campaign
Sheet3
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Infant Sleep Safety
Requires a consistent and repetitive message in the community to prevent accidental deaths
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Safe Sleep Nurse Modeling
People trust nurses Whatever the nurse does must
be correct and it will be imitated in the home
Fact supine positioning in the nursery can almost DOUBLE its use in the home
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Physician Advocacy
Srivatsa 1997 HCP education to new familieshellip34 reduction in prone sleeping
Eron 2009 Study of Central NY state physicianshellip30 identified incorrect safest sleep positionhellip30 do not discuss with families
Colson 2009 Only 13 mothers advised by MD to use supine positionhellip3 times more likely to position the baby properly
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Healthcare Provider Advice to New Mothers Safe Sleep
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Chart1
Column1
[]
[]
[]
55
25
20
Sheet1
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Mason Clinical Peds 713
Bundled interventiono Nursing education policy model behavior safe sleep
video posters in rooms declaration of safe sleep practice
Safe sleep environment uarr from 25 to 58 Intention in home 95 supine none ldquoco-sleepingrdquo
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bundled Intervention = Behavior Change
QUESTION GROUP p-value
ISS Study NISP
Behavior Questions n = 490 n = 1046
Baby routinely placed to sleep on back 925 73 lt 0001
Baby routinely sleeps in bassinetcrib 995 71 lt 00001
Baby sleeps under a thin sheet 992 86 lt 0001
Baby given a pacifier for sleep 741 84 lt 0001Goodstein MH Bell T Krugman SD Improving infant sleep safety through a comprehensive hospital-based program Clinical Pediatrics 201554(3)212-221
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
o Baseline Safe sleep 49 of 264 infants o Post 312 of 234 infants (P lt 001) o Extra blankets most common o Baseline 77 vs 44 post-intervention o Mean number of unsafe items reduced by 50 (P lt 001)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Washington DC
2 urban DC nurseries 26 did not believe or unsure that infant positioning
was associated with SIDS Top 3 factors influencing sleep position
o 56 PERSONAL PREFERENCE Why non-supine Clinical experience (25)
o Increase risk aspirationo Decrease sleep and comfort
Bartow KL Nursesrsquo knowledge and adherence to sudden infant death syndrome prevention guidelines Pediatr Nurs 201642(1)7-13
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
TodaysBaby QI Safe Sleep Teaching
QI intervention median = 160 days Mothers reported receiving information 72 to 95
(increase of 24-57) 94 babies observed supine (plus 24) 88 infants in safe sleep environment
o Increase of 33 Gains maintained up to 12 months
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Social Media and Risk-Reduction Training Study (SMART) Cluster randomization 4 groups Safe sleep or breast feeding education Nursing QI and social media (mobile health) N = 1600 1263 responses (79) Safe sleep NQI and MHealth
o Supine sleep 925 o Room-sharing 859o No soft bedding 819o Pacifier use 762
Moon RY Hauck FR Colson ER et al The effect of nursing quality improvement and mobile health interventions on infant sleep practices a randomized clinical trial JAMA 2017318(4)351-359
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Hospital Initiative ComponentswwwcribsforkidsorgHospitalInitiativeToolkit INTRODUCTORY LETTER HOSPITAL INITIATIVE TOOL KIT
INSTRUCTIONS ORGANIZATIONAL CHART HOSPITAL POLICY ACKNOWLEDGMENT FORM (Engl amp
Span) SAFE SLEEP EDUCATIONAL FLIP CHART
NONCOMPLIANCE WAIVER (Engl amp Span)
NURSING EDUCATION MODULE
SAFE SLEEP POSTERS DOOR HANGERS (Engl amp Span) GRADUATION CERTIFICATE SAMPLE LETTER TO HOSPITALS SAMPLE LETTER TO PROVIDERS INFANT SAFE SLEEP BROCHURES
(Engl amp Span) PRESS KIT
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
All materials available on-lineo No major costs to the hospital
Easy on-line access for documentation
NO FEE FOR PARTICIPATION
wwwCribsforKidsorgHospitalInitiative
Tiffany Price (tpricecribsforkidsorg)
The National Safe Sleep Hospital Certification Program
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
TNmdash25 reduction in infant sleep-related deaths in 2 years
SDmdashOver 7915 Pack lsquon Plays distributed since 2012 Infant mortality rate decreased from 86 (2012) to 48 (2016)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
2009 to 2015 38 decrease in infant mortality Decreased from 135 to 84 per 1000 SUID decreased gt50 Decrease in racial disparityhttphealthybabiesbaltimorecomhome
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
And Finallyhellip
Health care providers should have open frank nonjudgmental conversations with families about their sleep practices
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Encouraging Parents to Take Action
According to the Social Learning Theory parents are more likely to recall and comply with instructions when
the health care provider
Uses a positive tone Provides adequate information Allows the parent to ask most of the questions
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Motivational Interviewing
ldquoa collaborative goal-oriented style of communication with particular attention to the language of changerdquo
o Strengthen personal motivation and commitment to a specific goal
o Explore onersquos reasons for change (barriers)o Patient generates own solutions
bull More likely to feel realisticbull Planting seeds of change
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Impact of Eliminating Sleep-Related Deaths
Every week we lose 70 children which is equivalent to 4 kindergarten classrooms
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Thank You
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Contact Information
mgoodsteinwellspanorg
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Visit Pediatric Care Online today for additional information on this and other topics
httppediatriccaresolutionsaaporgPediatric Care Online is a convenient electronic resource for immediate expert help with
virtually every pediatric clinical information need with must-have resources that are included in a comprehensive reference library and time-saving clinical tools
Donrsquot have a subscription to PCOThen take advantage of a free trial today
Call Mead Johnson Nutrition at 888363-2362 orfor more information go to
httppediatriccaresolutionsaaporgSSFree_Trialaspx
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
IMR over time Finland vs US
Slide Number 1
Disclaimer
Objectives for Todayrsquos Talk
Infant Mortality Rates for the Five Leading Causes of Infant Death in the United States 2005 and 2011
US Post-Neonatal Mortality 2015
FACT
What is SUID or SUDI
Some Causes of Deaths that Occur Suddenly and Unexpectedly during Infancy
What is SIDS
SIDS FACTS
SIDS FACTS
Triple Risk Model to Explain SIDS
Paterson DS Krous HF Kinney HC et al JAMA 2006
An Example of SIDS Pathogenesis
2016 AAP Recommendations Infant Sleep Safety
Strength of Recommendation
Recommendations Change as the Evidence Evolves
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
Correct Safe Sleep Environment
We Need to Move Beyond Back to Sleep
Sleep Position for Healthy Newborns
Sleep Position in Newborn Nursery
Sleep Position and Reflux
The Truth About Supine Sleep and Aspiration Ending the Fallacy
Title
Infant Sleep Location
Room-Share How Long Yoursquore Kidding Right
Supporting Data
More Recent Data
Why is Room-Sharing Protective
Room-Sharing and Sleep Quality
Insight Study (Paul 2017)
Insight Study (Paul 2017)
Insight Commentary (Hauck Moon)
Feeding the Baby at Night
Say NO to Couches Sofas and Cushioned Armchairs
High-Risk Bed Sharing Situations
Bedsharing in Low-Risk Breastfed Infants
Independent Review (Dr Robert Platt)
Bed Sharing
Bed Sharing
Bed Sharing with Overlay
Bed Sharing with Overlay
Bed Sharing with Overlay
Couch Sleeping
Couch Sleeping
Couch Sleeping
Unsafe Bedding NISP Trends 1993-2102
Why Use Soft Bedding
Soft Bedding for Older Infants
To Swaddle or Not to Swaddle That is the Question
Swaddling
SwaddlingmdashIs it Safe
SwaddlingmdashMore Questionshellip
wwwhealthychildrenorg
Pacifiers
Pacifiers and Breastfeeding
Baby Friendly USA Pacifiers
Addressing Sleep Deprivation
Overcoming Barriers to Change What Parents are Sayinghellip
Factors Associated With Choice of Infant Sleep Position
Slide Number 65
What is Working
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Infant Sleep Safety
Safe Sleep Nurse Modeling
Physician Advocacy
Healthcare Provider Advice to New Mothers Safe Sleep
Mason Clinical Peds 713
Bundled Intervention = Behavior Change
Hospital Unsafe Sleep Persists
Washington DC
TodaysBaby QI Safe Sleep Teaching
TodaysBaby QI Safe Sleep Teaching
Social Media and Risk-Reduction Training Study (SMART)
The National Safe Sleep Hospital Certification Program
Coordinated Education Efforts Work
Coordinated Education Efforts Work
And Finallyhellip
Encouraging Parents to Take Action
Motivational Interviewing
Impact of Eliminating Sleep-Related Deaths
Thank You
Contact Information
Slide Number 89
IMR over time Finland vs US
Column1
correct advice
55
incorrect advice
25
no advice
20
correct advice
incorrect advice
no advice
SIDS Rate
Percent Back Sleeping
1988
14
1989
139
1990
13
1991
13
1992
12
13
1993
117
17
1994
103
269
1995
087
386
1996
074
353
1997
077
531
1998
072
557
1999
067
644
2000
062
666
2001
056
716
2002
057
711
2003
053
728
2004
056
701
2005
055
722
2006
055
757
2007
057
703
2008
055
721
2009
054
741
2010
051
728
2011
048
2012
042
2013
04
2014
039
httpwwwcdcgovNCHSdatanvsrnvsr58nvsr58_19pdf
Xu JQ Kochanek KD Murphy SL Tejada-Vera B Deaths Final data for
2007
National vital statistics reports vol 58 no 19 Hyattsville MD
National Center for Health Statistics 2010
1988
1988
1989
1989
1990
1990
1991
1991
1992
1992
1993
1993
1994
1994
1995
1995
1996
1996
1997
1997
1998
1998
1999
1999
2000
2000
2001
2001
2002
2002
2003
2003
2004
2004
2005
2005
2006
2006
2007
2007
2008
2008
2009
2009
2010
2010
2011
2012
2013
2014
Incidence per 100000 live births
Maternal Complications
1
Malignant Neoplasm
2
MVA
2
Short gestation
2
CNS infections
6
Intentional Injury
6
GI Infections
6
SepsisInfection
7
Respiratory Diseases
13
Congenital Malformations
36
SUID
78
Maternal Complications
Malignant Neoplasm
MVA
Short gestation
CNS infections
Intentional Injury
GI Infections
SepsisInfection
Respiratory Diseases
Congenital Malformations
SUID
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Objectives for Todayrsquos Talk
Definition of sudden unexpected infant death (SUID) and sudden infant death syndrome (SIDS)
Statistics on SIDS and accidental sleep deaths Pathophysiology of SIDS 2016 AAP recommendations SIDS risk reduction and
suffocation prevention Safe sleep modeling and education in the hospital
setting
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Infant Mortality Rates for the Five Leading Causes of Infant Death in the United States 2005 and 2011
24000 deaths per year
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
US Post-Neonatal Mortality 2015
United States Department of Health and Human Services (US DHHS) Centers for Disease Control and Prevention (CDC) National Center for Health Statistics (NCHS) Division of Vital Statistics (DVS) Linked Birth Infant Death Records 2007-2015 as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program on CDC WONDER On-line Database Accessed at httpwondercdcgovlbd-currenthtml on Dec 27 2017
Chart1
Incidence per 100000 live births
1
2
2
2
6
6
6
7
13
36
78
Sheet1
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
FACT 3700 babies in the US die suddenly and unexpectedly each year
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
What is SUID or SUDI
Sudden Unexpected Infant Death o Occurs in a previously healthy infanto Can be explained or unexplained
o Most unobserved during sleepenvironment Sleep-related deaths SIDS represents a subcategory of SUID
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Some Causes of Deaths that Occur Suddenly and Unexpectedly during Infancy
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
What is SIDS ICD-10 definition The sudden death of an infant
under one year of age which remains unexplained after the performance of a complete post-mortem investigation including o Performance of a complete autopsyo Examination of the death sceneo Review of the case history
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
SIDS FACTS The leading cause of death in
infants from 1 month to 1 year of age (post-neonatal infant mortality)
A diagnosis of exclusion The cause of death is assigned only after ruling out other causes
Peak time of occurrence1-4 months
Higher incidence in males No longer see a higher
frequency in colder months
Percent distribution of SIDS by age at death United States 2004-2006
AAP Task Force on SIDS SIDS and other sleep-related infant deaths expansion of recommendations for a safe infant sleeping environment Pediatrics 2011128(5)e1341-e1367
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
SIDS FACTS
Higher incidence in preterm and low birth weight infants
Associated witho Young maternal ageo Maternal smoking with pregnancyo Late or no prenatal care
2-3 times more common in African-American American Indian and Alaska Native children
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Triple Risk Model to Explain SIDS
Critical Developmental
Period
Vulnerable Infant Exogenous
Stressors(eg brainstem dysfunction)
First 6 months
bull Proneside sleep position
bull Soft beddingbull Overbundling
overheatingbull Bed sharing
Intrinsic risk factors
bull Smokingbull Prematuritybull Alcohol and
illicit drugsbull Hypoxiabull Growth
restriction
SIDS
Extrinsic risk factors
Adapted from Filiano and Kinney 1994
bull Bed sharing + smoking
andor alcohol
Modifiable Risk Factors
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Paterson DS Krous HF Kinney HC et al JAMA 2006
Serotonin receptor binding density lower in SIDS cases compared to controls
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Adapted from Kinney and Thach 2009
An Example of SIDS Pathogenesis
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
2016 AAP Recommendations Infant Sleep Safety Recommendations are to reduce
the risk of SIDS and sleep-related suffocation asphyxia and entrapment
Recommendations should be used consistently until 1 year of ageo Most epidemiological studies upon
which these recommendations are based include infants up to 1 year of age
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Strength of Recommendation
Scale based on the Strength of Recommendation Taxonomy (SORT)
A There is good quality patient-oriented evidence B There is inconsistent or limited quality patient-
oriented evidence C The recommendation is based on consensus
disease-oriented evidence usual practice expertopinion or case series for studies ofdiagnosis treatment prevention orscreening
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Recommendations Change as the Evidence Evolves Statistics and risk factors may change
o New risks emerge (eg side positioning)o Different levels of risk
Policies and procedures may changeo Better death scene investigationso Diagnostic shift
Unintended consequenceso Plagiocephaly development o New tummy time recommendations
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
2016 SIDS Task Force Policy Statement Level A Recommendations Back to sleep for every sleep Use a firm sleep surface Keep soft objects and loose bedding out of the crib Room-sharingmdashInfant on separate sleep surface Breastfeeding is recommended Consider offering a pacifier at nap time and bedtime Avoid smoke exposure during pregnancy and after birth Avoid alcohol and illicit drug use during pregnancy and
after birth
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
2016 SIDS Task Force Policy Statement Level A Recommendations Avoid overheating Pregnant women should receive regular prenatal care Do not use home cardiorespiratory monitors as a strategy
for reducing the risk of SIDS Health care professionals staff in newborn nurseries and
NICUs and child care providers should endorse the SIDS risk-reduction recommendations from birth
Media and manufacturers should follow safe-sleep guidelines in their messaging and advertising
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
2016 SIDS Task Force Policy Statement Level B Recommendations Avoid commercial devices that are inconsistent with
safe sleep recommendations Supervised awake tummy time is recommended to
facilitate development and to minimize development of positional plagiocephaly (flattening of skull)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
2016 SIDS Task Force Policy Statement Level C Recommendations Continue research and surveillance on the risk factors
causes and pathophysiological mechanisms of SIDS and other sleep-related infant deaths with the ultimate goal of eliminating these deaths entirely
There is no evidence to recommend swaddling as a strategy to reduce the risk of SIDS
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Correct Safe Sleep Environment
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
We Need to Move Beyond Back to Sleep
Shersquos on her back to sleep
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Sleep Position for Healthy Newborns
Skin-to-skin care is recommended for all mothers and newborns regardless of feeding or delivery method immediately following birtho Mom should be medically stable
awake and able to respond to baby When mother needs to sleep or take
care of other needs infant should be placed supine in a bassinet
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Sleep Position in Newborn Nursery Infants in the newborn nursery
and infants who are rooming in with their parents should be placed in the supine position as soon as they are ready to be placed in the bassinet o No evidence that placing infants
on the side during the first few hours of life promotes clearance of amniotic fluid and decreases the risk of aspiration
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Sleep Position and Reflux Infants with gastroesophageal (GE) reflux
should be kept supineo Unless the risk of death from complications
of GE reflux is greater than the risk of SIDS
Supine position does not increase the risk of choking and aspiration in infants with GE reflux o Protective airway mechanisms
Do NOT elevate the head of the infantrsquos cribo Ineffective in reducing GE refluxo Infant may slide to the foot of the cribmdashmay
compromise respiration
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
The Truth About Supine Sleep and Aspiration Ending the Fallacy Orientation of the Trachea to the Esophagus
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Title
Text
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Infant Sleep Location
Infants should sleep in parentsrsquo room close to parentsrsquo bed but on a separate surface designed for infants
Ideally for the first year of life but at least for the first 6 months
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Room-Share How Long Yoursquore Kidding Right
2011 ldquoall sleep recommendations are to be followed until 1 year of agerdquo
2016 ldquoroom-sharing without bed-sharinghellipideally until 1 year of age but at least for the first 6 monthsrdquo
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Supporting Data
3 case-control studies comparing sleeping in a separate room vs room-sharingo Tappin (Scotland) AOR 326 (95 CI 103-1035)
bull Protection is significant for smoker motherso Blair (England) AOR 1049 (95 CI 426-2581)
bull Protection is significant for both smoker and nonsmoker mothers
o New Zealand Cot Death study AOR 285(95 CI 204-385)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
More Recent Data
New Zealand SUDI studyo 64 protection with room-sharing AOR 036
(95 CI 019-071)
Estimate of 50 reduction is very conservative
None of the case-control studies stratify by age (months)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Why is Room-Sharing Protective
SIDSmdashfailure to arouse More small awakenings during the night
o Stirrings movement not fully awake Postulation protective effect from small awakenings Room-sharing facilitates breastfeeding
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Room-Sharing and Sleep Quality
Volkovich room-sharing vs solitary sleepo Room-sharing mothers with more sleep disturbanceso Infants with similar sleep quality
Mao Mindell room-sharing infantsmdashmore awakenings
Montgomery-Downs Doan sleep quality in breastfeeding mothers gt to formula feeding motherso Exclusive breastfeeding = 30 min more sleep
More study needed
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Insight Study (Paul 2017)
Sleep questionnaire at 4 9 12 and 30 monthso Sleep duration overnight behaviorso Compared early vs late independent infants
At 4 monthso Equal sleep durationo Early group had better sleep consolidationo Longest stretch 46 minutes
Paul IM Hohman EE Loken E et al Mother-infant room-sharing and sleep outcomes in the INSIGHT study Pediatrics 2017140(1)e20170122
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Insight Study (Paul 2017)
At 9 monthso Longer sleep duration (40 minnight) o Better consolidation (100 min)
At 30 monthso Longer sleep duration (45 minnight)
Room-sharing 4 times more likely to transition to bed sharing overnight
Paul IM Hohman EE Loken E et al Mother-infant room-sharing and sleep outcomes in the INSIGHT study Pediatrics 2017140(1)e20170122
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Insight Commentary (Hauck Moon)
Late room-sharing mean 7 hours longest sleep Is early consolidation desirable Differences related to bedtime routines
o Early bedtimeo Number of night feedso Feeding back to sleep
Focus on the routine not early separation
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Feeding the Baby at Night Acknowledgment that parents may fall
asleep while feeding babyo Safer to feed on bed than on sofa
couch or armchair if you might fall asleep
o No pillows sheets blankets or other items that could obstruct infant breathing or cause overheating should be in bed
o Return infant back to separate sleep surface as soon as parent awakens
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Say NO to Couches Sofas and Cushioned Armchairs Never place a baby for sleep on these surfaces Never sleep with a baby on these surfaces One of the MOST dangerous places for an infant
(OR 51-669)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
High-Risk Bed Sharing Situations Age lt4 months Preterm or low birth weight Smoked during pregnancy Bed sharer is current smoker (even if not
smoking in bed) Bed sharer has usedis using meds or
substances that could impair alertness or arousal
Bed sharer is not parent (including other children)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bedsharing in Low-Risk Breastfed Infants
Blair et al AOR 16 (95 CI 096-27) o Age lt14 weekso Parents No cigarettes or alcoholo Independent of feeding method
Carpenter et al AOR 51 (95 CI 23-114) o Age lt3 months o Parents did not smokeo Mother No alcohol or drugso Breastfed infants
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Independent Review (Dr Robert Platt)
Very small numbers of low-risk babieso 24 in Blairrsquos studyo 12 in Carpenterrsquos study
Does not believe that data support definitive differences in 2 studies
Some evidence of increased risk in this group but cannot say how large the increased risk is
Cannot conclude that bed sharing in this group is safe
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Unsafe Bedding NISP Trends 1993-2102
Shapiro-Mendoza CK Colson ER Willinger M Rybin DV Camperlengo L Corwin MJ Trends in infant bedding use National Infant Sleep Position study 1993ndash2010 Pediatrics 2015135(1)10-17
Decrease from 86 to 55 Rate of decline decreases
2001-10 835 for teen mothers Predictors of adjusted OR
gt15
o Young motherso Non-white race
ethnicityo Less than college
education
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Why Use Soft Bedding
ComfortWarmtho Extrapolation of own feelingso Misinterpret firm with taut
bull Soft + taut ne firm
Safetyo Blankets pillows rolls to prevent falls
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Soft Bedding for Older Infants
Many parents recognize soft bedding is a risk Increased complacency as baby gets older Soft bedding is THE most important risk factor for
infants 4-12 months old (Colvin 2015) Infants roll into bedding and cannot extract
themselves
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
To Swaddle or Not to Swaddle That is the Question Pros
o Calms the infant promotes sleep decreases number of awakenings
o Encourages use of the supine position
Conso Increased respiratory rate and
reduced functional residual lung capacity
o Exacerbates hip dysplasia if the hips are kept in extension and adduction
o ldquoLooserdquo swaddling becomes loose bedding
o Overheating especially if the head is covered or the infant has infection
o Effects on arousability to an external stimulus remain unclear (conflicting data) There may be minimal effects of routine swaddling on arousal
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Swaddling
There is insufficient evidence to recommend routine swaddling as a strategy to reduce the incidence of SIDS
Swaddling must be correctly applied to avoid the possible hazards
Swaddling does not reduce the necessity to follow recommended safe sleep practices Ambrogio Lorenzettis Madonna and Child (1319)
Wikipedia
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
McDonnell E Moon RY Infant deaths and injuries associated with wearable blankets swaddle wraps and swaddling J Pediatr 20141641152-1156
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
SwaddlingmdashMore Questionshellip
Pease 2016 Pediatrics Pooled OR = 138
o Prone = 1299 o Side = 316o Supine = 193
Increased risk with age Limitations
o Heterogeneity definitions other risk factorsPease AS Fleming PJ Hauck FR et al Swaddling and the risk of sudden infant death syndrome a meta-analysis Pediatrics 2016137(6)e20153
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
wwwhealthychildrenorg
Swaddling (wrapping a light blanket snuggly around a baby) may help calm a crying baby If you swaddle your baby be sure to place him on his back to sleep Stop swaddling your baby when he starts to roll
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers
AAP recommendation Consider offering a pacifier at nap time and bedtime
Studies consistently demonstrate a protective effect of pacifiers on SIDS
Mechanism unknowno Dislodge within 15 to 60 minuteso Decreased arousal threshold
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers and Breastfeeding Well-designed trials
o 2 found no association among term infants
o 1 found no association among preterm infants
o 1 found slightly decreased breastfeeding duration at one month if pacifier introduced in first week of life but NO difference if pacifier introduced after one month
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Baby Friendly USA Pacifiers
Breastfeeding babies should not be given pacifiers by the staff of the facility with the exception of o Limited use to decrease pain during procedures when
the baby cannot safely be held or breastfed (pacifiers used should be discarded after these procedures)
o Babies who are being tube-fed in NICUo Other rare specific medical reasons
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Addressing Sleep Deprivation
Give parents tools to cope with fussy babies
Sleep-deprived parents may make poor judgments
Make use of tools o Swaddling side carrying
shushing swinging and sucking
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Overcoming Barriers to Change What Parents are Sayinghellip
Prone positioning fear of choking Baby sleeps ldquobetterrdquo on stomach Soft things are safer for the baby SIDS is ldquoGodrsquos willrdquo Why bother Recommendations keep changing
anyway Vigilance sleep with baby for protection
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Factors Associated With Choice of Infant Sleep Position 3300 mothers from 32 hospitals 77 usually use supine position 49 exclusive use supine position Most likely to use prone
o African-American motherso Mothers with lt high school educationo Lack of perceived controlo Personal attitudesocietal norms
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
A continuum starting in childhoodo Secondary school baby sitting classes
Pre-pregnancy Pregnancyprenatal education
o Prior to baby showerhellipldquowrong giftsrdquo In-hospital education and modeling
o Include family friends baby sitters Re-enforcement in the doctorrsquos office
o Especially between 1 to 4 months Grandparents They hold great power The general public (day cares religious leaders)
A Lifetime of Infant Sleep Safety
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Chart1
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
14
139
13
13
12
13
117
17
103
269
087
386
074
353
077
531
072
557
067
644
062
666
056
716
057
711
053
728
056
701
055
722
055
757
057
703
055
721
054
741
051
728
048
042
04
039
Sheet1
Sheet1
ampA
Page ampP
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
Sheet2
Pre-AAP recommendation Post-AAP RecommendationBack to SleepSafe to Sleep Campaign
Sheet3
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Infant Sleep Safety
Requires a consistent and repetitive message in the community to prevent accidental deaths
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Safe Sleep Nurse Modeling
People trust nurses Whatever the nurse does must
be correct and it will be imitated in the home
Fact supine positioning in the nursery can almost DOUBLE its use in the home
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Physician Advocacy
Srivatsa 1997 HCP education to new familieshellip34 reduction in prone sleeping
Eron 2009 Study of Central NY state physicianshellip30 identified incorrect safest sleep positionhellip30 do not discuss with families
Colson 2009 Only 13 mothers advised by MD to use supine positionhellip3 times more likely to position the baby properly
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Healthcare Provider Advice to New Mothers Safe Sleep
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Chart1
Column1
[]
[]
[]
55
25
20
Sheet1
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Mason Clinical Peds 713
Bundled interventiono Nursing education policy model behavior safe sleep
video posters in rooms declaration of safe sleep practice
Safe sleep environment uarr from 25 to 58 Intention in home 95 supine none ldquoco-sleepingrdquo
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bundled Intervention = Behavior Change
QUESTION GROUP p-value
ISS Study NISP
Behavior Questions n = 490 n = 1046
Baby routinely placed to sleep on back 925 73 lt 0001
Baby routinely sleeps in bassinetcrib 995 71 lt 00001
Baby sleeps under a thin sheet 992 86 lt 0001
Baby given a pacifier for sleep 741 84 lt 0001Goodstein MH Bell T Krugman SD Improving infant sleep safety through a comprehensive hospital-based program Clinical Pediatrics 201554(3)212-221
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
o Baseline Safe sleep 49 of 264 infants o Post 312 of 234 infants (P lt 001) o Extra blankets most common o Baseline 77 vs 44 post-intervention o Mean number of unsafe items reduced by 50 (P lt 001)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Washington DC
2 urban DC nurseries 26 did not believe or unsure that infant positioning
was associated with SIDS Top 3 factors influencing sleep position
o 56 PERSONAL PREFERENCE Why non-supine Clinical experience (25)
o Increase risk aspirationo Decrease sleep and comfort
Bartow KL Nursesrsquo knowledge and adherence to sudden infant death syndrome prevention guidelines Pediatr Nurs 201642(1)7-13
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
TodaysBaby QI Safe Sleep Teaching
QI intervention median = 160 days Mothers reported receiving information 72 to 95
(increase of 24-57) 94 babies observed supine (plus 24) 88 infants in safe sleep environment
o Increase of 33 Gains maintained up to 12 months
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Social Media and Risk-Reduction Training Study (SMART) Cluster randomization 4 groups Safe sleep or breast feeding education Nursing QI and social media (mobile health) N = 1600 1263 responses (79) Safe sleep NQI and MHealth
o Supine sleep 925 o Room-sharing 859o No soft bedding 819o Pacifier use 762
Moon RY Hauck FR Colson ER et al The effect of nursing quality improvement and mobile health interventions on infant sleep practices a randomized clinical trial JAMA 2017318(4)351-359
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Hospital Initiative ComponentswwwcribsforkidsorgHospitalInitiativeToolkit INTRODUCTORY LETTER HOSPITAL INITIATIVE TOOL KIT
INSTRUCTIONS ORGANIZATIONAL CHART HOSPITAL POLICY ACKNOWLEDGMENT FORM (Engl amp
Span) SAFE SLEEP EDUCATIONAL FLIP CHART
NONCOMPLIANCE WAIVER (Engl amp Span)
NURSING EDUCATION MODULE
SAFE SLEEP POSTERS DOOR HANGERS (Engl amp Span) GRADUATION CERTIFICATE SAMPLE LETTER TO HOSPITALS SAMPLE LETTER TO PROVIDERS INFANT SAFE SLEEP BROCHURES
(Engl amp Span) PRESS KIT
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
All materials available on-lineo No major costs to the hospital
Easy on-line access for documentation
NO FEE FOR PARTICIPATION
wwwCribsforKidsorgHospitalInitiative
Tiffany Price (tpricecribsforkidsorg)
The National Safe Sleep Hospital Certification Program
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
TNmdash25 reduction in infant sleep-related deaths in 2 years
SDmdashOver 7915 Pack lsquon Plays distributed since 2012 Infant mortality rate decreased from 86 (2012) to 48 (2016)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
2009 to 2015 38 decrease in infant mortality Decreased from 135 to 84 per 1000 SUID decreased gt50 Decrease in racial disparityhttphealthybabiesbaltimorecomhome
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
And Finallyhellip
Health care providers should have open frank nonjudgmental conversations with families about their sleep practices
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Encouraging Parents to Take Action
According to the Social Learning Theory parents are more likely to recall and comply with instructions when
the health care provider
Uses a positive tone Provides adequate information Allows the parent to ask most of the questions
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Motivational Interviewing
ldquoa collaborative goal-oriented style of communication with particular attention to the language of changerdquo
o Strengthen personal motivation and commitment to a specific goal
o Explore onersquos reasons for change (barriers)o Patient generates own solutions
bull More likely to feel realisticbull Planting seeds of change
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Impact of Eliminating Sleep-Related Deaths
Every week we lose 70 children which is equivalent to 4 kindergarten classrooms
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Thank You
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Contact Information
mgoodsteinwellspanorg
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Visit Pediatric Care Online today for additional information on this and other topics
httppediatriccaresolutionsaaporgPediatric Care Online is a convenient electronic resource for immediate expert help with
virtually every pediatric clinical information need with must-have resources that are included in a comprehensive reference library and time-saving clinical tools
Donrsquot have a subscription to PCOThen take advantage of a free trial today
Call Mead Johnson Nutrition at 888363-2362 orfor more information go to
httppediatriccaresolutionsaaporgSSFree_Trialaspx
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
IMR over time Finland vs US
Slide Number 1
Disclaimer
Objectives for Todayrsquos Talk
Infant Mortality Rates for the Five Leading Causes of Infant Death in the United States 2005 and 2011
US Post-Neonatal Mortality 2015
FACT
What is SUID or SUDI
Some Causes of Deaths that Occur Suddenly and Unexpectedly during Infancy
What is SIDS
SIDS FACTS
SIDS FACTS
Triple Risk Model to Explain SIDS
Paterson DS Krous HF Kinney HC et al JAMA 2006
An Example of SIDS Pathogenesis
2016 AAP Recommendations Infant Sleep Safety
Strength of Recommendation
Recommendations Change as the Evidence Evolves
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
Correct Safe Sleep Environment
We Need to Move Beyond Back to Sleep
Sleep Position for Healthy Newborns
Sleep Position in Newborn Nursery
Sleep Position and Reflux
The Truth About Supine Sleep and Aspiration Ending the Fallacy
Title
Infant Sleep Location
Room-Share How Long Yoursquore Kidding Right
Supporting Data
More Recent Data
Why is Room-Sharing Protective
Room-Sharing and Sleep Quality
Insight Study (Paul 2017)
Insight Study (Paul 2017)
Insight Commentary (Hauck Moon)
Feeding the Baby at Night
Say NO to Couches Sofas and Cushioned Armchairs
High-Risk Bed Sharing Situations
Bedsharing in Low-Risk Breastfed Infants
Independent Review (Dr Robert Platt)
Bed Sharing
Bed Sharing
Bed Sharing with Overlay
Bed Sharing with Overlay
Bed Sharing with Overlay
Couch Sleeping
Couch Sleeping
Couch Sleeping
Unsafe Bedding NISP Trends 1993-2102
Why Use Soft Bedding
Soft Bedding for Older Infants
To Swaddle or Not to Swaddle That is the Question
Swaddling
SwaddlingmdashIs it Safe
SwaddlingmdashMore Questionshellip
wwwhealthychildrenorg
Pacifiers
Pacifiers and Breastfeeding
Baby Friendly USA Pacifiers
Addressing Sleep Deprivation
Overcoming Barriers to Change What Parents are Sayinghellip
Factors Associated With Choice of Infant Sleep Position
Slide Number 65
What is Working
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Infant Sleep Safety
Safe Sleep Nurse Modeling
Physician Advocacy
Healthcare Provider Advice to New Mothers Safe Sleep
Mason Clinical Peds 713
Bundled Intervention = Behavior Change
Hospital Unsafe Sleep Persists
Washington DC
TodaysBaby QI Safe Sleep Teaching
TodaysBaby QI Safe Sleep Teaching
Social Media and Risk-Reduction Training Study (SMART)
The National Safe Sleep Hospital Certification Program
Coordinated Education Efforts Work
Coordinated Education Efforts Work
And Finallyhellip
Encouraging Parents to Take Action
Motivational Interviewing
Impact of Eliminating Sleep-Related Deaths
Thank You
Contact Information
Slide Number 89
IMR over time Finland vs US
Column1
correct advice
55
incorrect advice
25
no advice
20
correct advice
incorrect advice
no advice
SIDS Rate
Percent Back Sleeping
1988
14
1989
139
1990
13
1991
13
1992
12
13
1993
117
17
1994
103
269
1995
087
386
1996
074
353
1997
077
531
1998
072
557
1999
067
644
2000
062
666
2001
056
716
2002
057
711
2003
053
728
2004
056
701
2005
055
722
2006
055
757
2007
057
703
2008
055
721
2009
054
741
2010
051
728
2011
048
2012
042
2013
04
2014
039
httpwwwcdcgovNCHSdatanvsrnvsr58nvsr58_19pdf
Xu JQ Kochanek KD Murphy SL Tejada-Vera B Deaths Final data for
2007
National vital statistics reports vol 58 no 19 Hyattsville MD
National Center for Health Statistics 2010
1988
1988
1989
1989
1990
1990
1991
1991
1992
1992
1993
1993
1994
1994
1995
1995
1996
1996
1997
1997
1998
1998
1999
1999
2000
2000
2001
2001
2002
2002
2003
2003
2004
2004
2005
2005
2006
2006
2007
2007
2008
2008
2009
2009
2010
2010
2011
2012
2013
2014
Incidence per 100000 live births
Maternal Complications
1
Malignant Neoplasm
2
MVA
2
Short gestation
2
CNS infections
6
Intentional Injury
6
GI Infections
6
SepsisInfection
7
Respiratory Diseases
13
Congenital Malformations
36
SUID
78
Maternal Complications
Malignant Neoplasm
MVA
Short gestation
CNS infections
Intentional Injury
GI Infections
SepsisInfection
Respiratory Diseases
Congenital Malformations
SUID
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Infant Mortality Rates for the Five Leading Causes of Infant Death in the United States 2005 and 2011
24000 deaths per year
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
US Post-Neonatal Mortality 2015
United States Department of Health and Human Services (US DHHS) Centers for Disease Control and Prevention (CDC) National Center for Health Statistics (NCHS) Division of Vital Statistics (DVS) Linked Birth Infant Death Records 2007-2015 as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program on CDC WONDER On-line Database Accessed at httpwondercdcgovlbd-currenthtml on Dec 27 2017
Chart1
Incidence per 100000 live births
1
2
2
2
6
6
6
7
13
36
78
Sheet1
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
FACT 3700 babies in the US die suddenly and unexpectedly each year
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
What is SUID or SUDI
Sudden Unexpected Infant Death o Occurs in a previously healthy infanto Can be explained or unexplained
o Most unobserved during sleepenvironment Sleep-related deaths SIDS represents a subcategory of SUID
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Some Causes of Deaths that Occur Suddenly and Unexpectedly during Infancy
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
What is SIDS ICD-10 definition The sudden death of an infant
under one year of age which remains unexplained after the performance of a complete post-mortem investigation including o Performance of a complete autopsyo Examination of the death sceneo Review of the case history
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
SIDS FACTS The leading cause of death in
infants from 1 month to 1 year of age (post-neonatal infant mortality)
A diagnosis of exclusion The cause of death is assigned only after ruling out other causes
Peak time of occurrence1-4 months
Higher incidence in males No longer see a higher
frequency in colder months
Percent distribution of SIDS by age at death United States 2004-2006
AAP Task Force on SIDS SIDS and other sleep-related infant deaths expansion of recommendations for a safe infant sleeping environment Pediatrics 2011128(5)e1341-e1367
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
SIDS FACTS
Higher incidence in preterm and low birth weight infants
Associated witho Young maternal ageo Maternal smoking with pregnancyo Late or no prenatal care
2-3 times more common in African-American American Indian and Alaska Native children
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Triple Risk Model to Explain SIDS
Critical Developmental
Period
Vulnerable Infant Exogenous
Stressors(eg brainstem dysfunction)
First 6 months
bull Proneside sleep position
bull Soft beddingbull Overbundling
overheatingbull Bed sharing
Intrinsic risk factors
bull Smokingbull Prematuritybull Alcohol and
illicit drugsbull Hypoxiabull Growth
restriction
SIDS
Extrinsic risk factors
Adapted from Filiano and Kinney 1994
bull Bed sharing + smoking
andor alcohol
Modifiable Risk Factors
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Paterson DS Krous HF Kinney HC et al JAMA 2006
Serotonin receptor binding density lower in SIDS cases compared to controls
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Adapted from Kinney and Thach 2009
An Example of SIDS Pathogenesis
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
2016 AAP Recommendations Infant Sleep Safety Recommendations are to reduce
the risk of SIDS and sleep-related suffocation asphyxia and entrapment
Recommendations should be used consistently until 1 year of ageo Most epidemiological studies upon
which these recommendations are based include infants up to 1 year of age
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Strength of Recommendation
Scale based on the Strength of Recommendation Taxonomy (SORT)
A There is good quality patient-oriented evidence B There is inconsistent or limited quality patient-
oriented evidence C The recommendation is based on consensus
disease-oriented evidence usual practice expertopinion or case series for studies ofdiagnosis treatment prevention orscreening
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Recommendations Change as the Evidence Evolves Statistics and risk factors may change
o New risks emerge (eg side positioning)o Different levels of risk
Policies and procedures may changeo Better death scene investigationso Diagnostic shift
Unintended consequenceso Plagiocephaly development o New tummy time recommendations
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
2016 SIDS Task Force Policy Statement Level A Recommendations Back to sleep for every sleep Use a firm sleep surface Keep soft objects and loose bedding out of the crib Room-sharingmdashInfant on separate sleep surface Breastfeeding is recommended Consider offering a pacifier at nap time and bedtime Avoid smoke exposure during pregnancy and after birth Avoid alcohol and illicit drug use during pregnancy and
after birth
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
2016 SIDS Task Force Policy Statement Level A Recommendations Avoid overheating Pregnant women should receive regular prenatal care Do not use home cardiorespiratory monitors as a strategy
for reducing the risk of SIDS Health care professionals staff in newborn nurseries and
NICUs and child care providers should endorse the SIDS risk-reduction recommendations from birth
Media and manufacturers should follow safe-sleep guidelines in their messaging and advertising
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
2016 SIDS Task Force Policy Statement Level B Recommendations Avoid commercial devices that are inconsistent with
safe sleep recommendations Supervised awake tummy time is recommended to
facilitate development and to minimize development of positional plagiocephaly (flattening of skull)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
2016 SIDS Task Force Policy Statement Level C Recommendations Continue research and surveillance on the risk factors
causes and pathophysiological mechanisms of SIDS and other sleep-related infant deaths with the ultimate goal of eliminating these deaths entirely
There is no evidence to recommend swaddling as a strategy to reduce the risk of SIDS
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Correct Safe Sleep Environment
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
We Need to Move Beyond Back to Sleep
Shersquos on her back to sleep
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Sleep Position for Healthy Newborns
Skin-to-skin care is recommended for all mothers and newborns regardless of feeding or delivery method immediately following birtho Mom should be medically stable
awake and able to respond to baby When mother needs to sleep or take
care of other needs infant should be placed supine in a bassinet
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Sleep Position in Newborn Nursery Infants in the newborn nursery
and infants who are rooming in with their parents should be placed in the supine position as soon as they are ready to be placed in the bassinet o No evidence that placing infants
on the side during the first few hours of life promotes clearance of amniotic fluid and decreases the risk of aspiration
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Sleep Position and Reflux Infants with gastroesophageal (GE) reflux
should be kept supineo Unless the risk of death from complications
of GE reflux is greater than the risk of SIDS
Supine position does not increase the risk of choking and aspiration in infants with GE reflux o Protective airway mechanisms
Do NOT elevate the head of the infantrsquos cribo Ineffective in reducing GE refluxo Infant may slide to the foot of the cribmdashmay
compromise respiration
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
The Truth About Supine Sleep and Aspiration Ending the Fallacy Orientation of the Trachea to the Esophagus
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Title
Text
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Infant Sleep Location
Infants should sleep in parentsrsquo room close to parentsrsquo bed but on a separate surface designed for infants
Ideally for the first year of life but at least for the first 6 months
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Room-Share How Long Yoursquore Kidding Right
2011 ldquoall sleep recommendations are to be followed until 1 year of agerdquo
2016 ldquoroom-sharing without bed-sharinghellipideally until 1 year of age but at least for the first 6 monthsrdquo
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Supporting Data
3 case-control studies comparing sleeping in a separate room vs room-sharingo Tappin (Scotland) AOR 326 (95 CI 103-1035)
bull Protection is significant for smoker motherso Blair (England) AOR 1049 (95 CI 426-2581)
bull Protection is significant for both smoker and nonsmoker mothers
o New Zealand Cot Death study AOR 285(95 CI 204-385)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
More Recent Data
New Zealand SUDI studyo 64 protection with room-sharing AOR 036
(95 CI 019-071)
Estimate of 50 reduction is very conservative
None of the case-control studies stratify by age (months)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Why is Room-Sharing Protective
SIDSmdashfailure to arouse More small awakenings during the night
o Stirrings movement not fully awake Postulation protective effect from small awakenings Room-sharing facilitates breastfeeding
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Room-Sharing and Sleep Quality
Volkovich room-sharing vs solitary sleepo Room-sharing mothers with more sleep disturbanceso Infants with similar sleep quality
Mao Mindell room-sharing infantsmdashmore awakenings
Montgomery-Downs Doan sleep quality in breastfeeding mothers gt to formula feeding motherso Exclusive breastfeeding = 30 min more sleep
More study needed
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Insight Study (Paul 2017)
Sleep questionnaire at 4 9 12 and 30 monthso Sleep duration overnight behaviorso Compared early vs late independent infants
At 4 monthso Equal sleep durationo Early group had better sleep consolidationo Longest stretch 46 minutes
Paul IM Hohman EE Loken E et al Mother-infant room-sharing and sleep outcomes in the INSIGHT study Pediatrics 2017140(1)e20170122
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Insight Study (Paul 2017)
At 9 monthso Longer sleep duration (40 minnight) o Better consolidation (100 min)
At 30 monthso Longer sleep duration (45 minnight)
Room-sharing 4 times more likely to transition to bed sharing overnight
Paul IM Hohman EE Loken E et al Mother-infant room-sharing and sleep outcomes in the INSIGHT study Pediatrics 2017140(1)e20170122
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Insight Commentary (Hauck Moon)
Late room-sharing mean 7 hours longest sleep Is early consolidation desirable Differences related to bedtime routines
o Early bedtimeo Number of night feedso Feeding back to sleep
Focus on the routine not early separation
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Feeding the Baby at Night Acknowledgment that parents may fall
asleep while feeding babyo Safer to feed on bed than on sofa
couch or armchair if you might fall asleep
o No pillows sheets blankets or other items that could obstruct infant breathing or cause overheating should be in bed
o Return infant back to separate sleep surface as soon as parent awakens
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Say NO to Couches Sofas and Cushioned Armchairs Never place a baby for sleep on these surfaces Never sleep with a baby on these surfaces One of the MOST dangerous places for an infant
(OR 51-669)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
High-Risk Bed Sharing Situations Age lt4 months Preterm or low birth weight Smoked during pregnancy Bed sharer is current smoker (even if not
smoking in bed) Bed sharer has usedis using meds or
substances that could impair alertness or arousal
Bed sharer is not parent (including other children)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bedsharing in Low-Risk Breastfed Infants
Blair et al AOR 16 (95 CI 096-27) o Age lt14 weekso Parents No cigarettes or alcoholo Independent of feeding method
Carpenter et al AOR 51 (95 CI 23-114) o Age lt3 months o Parents did not smokeo Mother No alcohol or drugso Breastfed infants
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Independent Review (Dr Robert Platt)
Very small numbers of low-risk babieso 24 in Blairrsquos studyo 12 in Carpenterrsquos study
Does not believe that data support definitive differences in 2 studies
Some evidence of increased risk in this group but cannot say how large the increased risk is
Cannot conclude that bed sharing in this group is safe
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing
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Bed Sharing
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Bed Sharing with Overlay
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Bed Sharing with Overlay
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Bed Sharing with Overlay
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Couch Sleeping
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Couch Sleeping
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Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Unsafe Bedding NISP Trends 1993-2102
Shapiro-Mendoza CK Colson ER Willinger M Rybin DV Camperlengo L Corwin MJ Trends in infant bedding use National Infant Sleep Position study 1993ndash2010 Pediatrics 2015135(1)10-17
Decrease from 86 to 55 Rate of decline decreases
2001-10 835 for teen mothers Predictors of adjusted OR
gt15
o Young motherso Non-white race
ethnicityo Less than college
education
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Why Use Soft Bedding
ComfortWarmtho Extrapolation of own feelingso Misinterpret firm with taut
bull Soft + taut ne firm
Safetyo Blankets pillows rolls to prevent falls
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Soft Bedding for Older Infants
Many parents recognize soft bedding is a risk Increased complacency as baby gets older Soft bedding is THE most important risk factor for
infants 4-12 months old (Colvin 2015) Infants roll into bedding and cannot extract
themselves
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
To Swaddle or Not to Swaddle That is the Question Pros
o Calms the infant promotes sleep decreases number of awakenings
o Encourages use of the supine position
Conso Increased respiratory rate and
reduced functional residual lung capacity
o Exacerbates hip dysplasia if the hips are kept in extension and adduction
o ldquoLooserdquo swaddling becomes loose bedding
o Overheating especially if the head is covered or the infant has infection
o Effects on arousability to an external stimulus remain unclear (conflicting data) There may be minimal effects of routine swaddling on arousal
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Swaddling
There is insufficient evidence to recommend routine swaddling as a strategy to reduce the incidence of SIDS
Swaddling must be correctly applied to avoid the possible hazards
Swaddling does not reduce the necessity to follow recommended safe sleep practices Ambrogio Lorenzettis Madonna and Child (1319)
Wikipedia
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McDonnell E Moon RY Infant deaths and injuries associated with wearable blankets swaddle wraps and swaddling J Pediatr 20141641152-1156
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
SwaddlingmdashMore Questionshellip
Pease 2016 Pediatrics Pooled OR = 138
o Prone = 1299 o Side = 316o Supine = 193
Increased risk with age Limitations
o Heterogeneity definitions other risk factorsPease AS Fleming PJ Hauck FR et al Swaddling and the risk of sudden infant death syndrome a meta-analysis Pediatrics 2016137(6)e20153
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
wwwhealthychildrenorg
Swaddling (wrapping a light blanket snuggly around a baby) may help calm a crying baby If you swaddle your baby be sure to place him on his back to sleep Stop swaddling your baby when he starts to roll
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers
AAP recommendation Consider offering a pacifier at nap time and bedtime
Studies consistently demonstrate a protective effect of pacifiers on SIDS
Mechanism unknowno Dislodge within 15 to 60 minuteso Decreased arousal threshold
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers and Breastfeeding Well-designed trials
o 2 found no association among term infants
o 1 found no association among preterm infants
o 1 found slightly decreased breastfeeding duration at one month if pacifier introduced in first week of life but NO difference if pacifier introduced after one month
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Baby Friendly USA Pacifiers
Breastfeeding babies should not be given pacifiers by the staff of the facility with the exception of o Limited use to decrease pain during procedures when
the baby cannot safely be held or breastfed (pacifiers used should be discarded after these procedures)
o Babies who are being tube-fed in NICUo Other rare specific medical reasons
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Addressing Sleep Deprivation
Give parents tools to cope with fussy babies
Sleep-deprived parents may make poor judgments
Make use of tools o Swaddling side carrying
shushing swinging and sucking
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Overcoming Barriers to Change What Parents are Sayinghellip
Prone positioning fear of choking Baby sleeps ldquobetterrdquo on stomach Soft things are safer for the baby SIDS is ldquoGodrsquos willrdquo Why bother Recommendations keep changing
anyway Vigilance sleep with baby for protection
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Factors Associated With Choice of Infant Sleep Position 3300 mothers from 32 hospitals 77 usually use supine position 49 exclusive use supine position Most likely to use prone
o African-American motherso Mothers with lt high school educationo Lack of perceived controlo Personal attitudesocietal norms
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
A continuum starting in childhoodo Secondary school baby sitting classes
Pre-pregnancy Pregnancyprenatal education
o Prior to baby showerhellipldquowrong giftsrdquo In-hospital education and modeling
o Include family friends baby sitters Re-enforcement in the doctorrsquos office
o Especially between 1 to 4 months Grandparents They hold great power The general public (day cares religious leaders)
A Lifetime of Infant Sleep Safety
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Chart1
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
14
139
13
13
12
13
117
17
103
269
087
386
074
353
077
531
072
557
067
644
062
666
056
716
057
711
053
728
056
701
055
722
055
757
057
703
055
721
054
741
051
728
048
042
04
039
Sheet1
Sheet1
ampA
Page ampP
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
Sheet2
Pre-AAP recommendation Post-AAP RecommendationBack to SleepSafe to Sleep Campaign
Sheet3
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Infant Sleep Safety
Requires a consistent and repetitive message in the community to prevent accidental deaths
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Safe Sleep Nurse Modeling
People trust nurses Whatever the nurse does must
be correct and it will be imitated in the home
Fact supine positioning in the nursery can almost DOUBLE its use in the home
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Physician Advocacy
Srivatsa 1997 HCP education to new familieshellip34 reduction in prone sleeping
Eron 2009 Study of Central NY state physicianshellip30 identified incorrect safest sleep positionhellip30 do not discuss with families
Colson 2009 Only 13 mothers advised by MD to use supine positionhellip3 times more likely to position the baby properly
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Healthcare Provider Advice to New Mothers Safe Sleep
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Chart1
Column1
[]
[]
[]
55
25
20
Sheet1
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Mason Clinical Peds 713
Bundled interventiono Nursing education policy model behavior safe sleep
video posters in rooms declaration of safe sleep practice
Safe sleep environment uarr from 25 to 58 Intention in home 95 supine none ldquoco-sleepingrdquo
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bundled Intervention = Behavior Change
QUESTION GROUP p-value
ISS Study NISP
Behavior Questions n = 490 n = 1046
Baby routinely placed to sleep on back 925 73 lt 0001
Baby routinely sleeps in bassinetcrib 995 71 lt 00001
Baby sleeps under a thin sheet 992 86 lt 0001
Baby given a pacifier for sleep 741 84 lt 0001Goodstein MH Bell T Krugman SD Improving infant sleep safety through a comprehensive hospital-based program Clinical Pediatrics 201554(3)212-221
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
o Baseline Safe sleep 49 of 264 infants o Post 312 of 234 infants (P lt 001) o Extra blankets most common o Baseline 77 vs 44 post-intervention o Mean number of unsafe items reduced by 50 (P lt 001)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Washington DC
2 urban DC nurseries 26 did not believe or unsure that infant positioning
was associated with SIDS Top 3 factors influencing sleep position
o 56 PERSONAL PREFERENCE Why non-supine Clinical experience (25)
o Increase risk aspirationo Decrease sleep and comfort
Bartow KL Nursesrsquo knowledge and adherence to sudden infant death syndrome prevention guidelines Pediatr Nurs 201642(1)7-13
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Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
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TodaysBaby QI Safe Sleep Teaching
QI intervention median = 160 days Mothers reported receiving information 72 to 95
(increase of 24-57) 94 babies observed supine (plus 24) 88 infants in safe sleep environment
o Increase of 33 Gains maintained up to 12 months
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Social Media and Risk-Reduction Training Study (SMART) Cluster randomization 4 groups Safe sleep or breast feeding education Nursing QI and social media (mobile health) N = 1600 1263 responses (79) Safe sleep NQI and MHealth
o Supine sleep 925 o Room-sharing 859o No soft bedding 819o Pacifier use 762
Moon RY Hauck FR Colson ER et al The effect of nursing quality improvement and mobile health interventions on infant sleep practices a randomized clinical trial JAMA 2017318(4)351-359
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Hospital Initiative ComponentswwwcribsforkidsorgHospitalInitiativeToolkit INTRODUCTORY LETTER HOSPITAL INITIATIVE TOOL KIT
INSTRUCTIONS ORGANIZATIONAL CHART HOSPITAL POLICY ACKNOWLEDGMENT FORM (Engl amp
Span) SAFE SLEEP EDUCATIONAL FLIP CHART
NONCOMPLIANCE WAIVER (Engl amp Span)
NURSING EDUCATION MODULE
SAFE SLEEP POSTERS DOOR HANGERS (Engl amp Span) GRADUATION CERTIFICATE SAMPLE LETTER TO HOSPITALS SAMPLE LETTER TO PROVIDERS INFANT SAFE SLEEP BROCHURES
(Engl amp Span) PRESS KIT
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
All materials available on-lineo No major costs to the hospital
Easy on-line access for documentation
NO FEE FOR PARTICIPATION
wwwCribsforKidsorgHospitalInitiative
Tiffany Price (tpricecribsforkidsorg)
The National Safe Sleep Hospital Certification Program
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
TNmdash25 reduction in infant sleep-related deaths in 2 years
SDmdashOver 7915 Pack lsquon Plays distributed since 2012 Infant mortality rate decreased from 86 (2012) to 48 (2016)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
2009 to 2015 38 decrease in infant mortality Decreased from 135 to 84 per 1000 SUID decreased gt50 Decrease in racial disparityhttphealthybabiesbaltimorecomhome
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
And Finallyhellip
Health care providers should have open frank nonjudgmental conversations with families about their sleep practices
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Encouraging Parents to Take Action
According to the Social Learning Theory parents are more likely to recall and comply with instructions when
the health care provider
Uses a positive tone Provides adequate information Allows the parent to ask most of the questions
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Motivational Interviewing
ldquoa collaborative goal-oriented style of communication with particular attention to the language of changerdquo
o Strengthen personal motivation and commitment to a specific goal
o Explore onersquos reasons for change (barriers)o Patient generates own solutions
bull More likely to feel realisticbull Planting seeds of change
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Impact of Eliminating Sleep-Related Deaths
Every week we lose 70 children which is equivalent to 4 kindergarten classrooms
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Thank You
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Contact Information
mgoodsteinwellspanorg
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Visit Pediatric Care Online today for additional information on this and other topics
httppediatriccaresolutionsaaporgPediatric Care Online is a convenient electronic resource for immediate expert help with
virtually every pediatric clinical information need with must-have resources that are included in a comprehensive reference library and time-saving clinical tools
Donrsquot have a subscription to PCOThen take advantage of a free trial today
Call Mead Johnson Nutrition at 888363-2362 orfor more information go to
httppediatriccaresolutionsaaporgSSFree_Trialaspx
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
IMR over time Finland vs US
Slide Number 1
Disclaimer
Objectives for Todayrsquos Talk
Infant Mortality Rates for the Five Leading Causes of Infant Death in the United States 2005 and 2011
US Post-Neonatal Mortality 2015
FACT
What is SUID or SUDI
Some Causes of Deaths that Occur Suddenly and Unexpectedly during Infancy
What is SIDS
SIDS FACTS
SIDS FACTS
Triple Risk Model to Explain SIDS
Paterson DS Krous HF Kinney HC et al JAMA 2006
An Example of SIDS Pathogenesis
2016 AAP Recommendations Infant Sleep Safety
Strength of Recommendation
Recommendations Change as the Evidence Evolves
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
Correct Safe Sleep Environment
We Need to Move Beyond Back to Sleep
Sleep Position for Healthy Newborns
Sleep Position in Newborn Nursery
Sleep Position and Reflux
The Truth About Supine Sleep and Aspiration Ending the Fallacy
Title
Infant Sleep Location
Room-Share How Long Yoursquore Kidding Right
Supporting Data
More Recent Data
Why is Room-Sharing Protective
Room-Sharing and Sleep Quality
Insight Study (Paul 2017)
Insight Study (Paul 2017)
Insight Commentary (Hauck Moon)
Feeding the Baby at Night
Say NO to Couches Sofas and Cushioned Armchairs
High-Risk Bed Sharing Situations
Bedsharing in Low-Risk Breastfed Infants
Independent Review (Dr Robert Platt)
Bed Sharing
Bed Sharing
Bed Sharing with Overlay
Bed Sharing with Overlay
Bed Sharing with Overlay
Couch Sleeping
Couch Sleeping
Couch Sleeping
Unsafe Bedding NISP Trends 1993-2102
Why Use Soft Bedding
Soft Bedding for Older Infants
To Swaddle or Not to Swaddle That is the Question
Swaddling
SwaddlingmdashIs it Safe
SwaddlingmdashMore Questionshellip
wwwhealthychildrenorg
Pacifiers
Pacifiers and Breastfeeding
Baby Friendly USA Pacifiers
Addressing Sleep Deprivation
Overcoming Barriers to Change What Parents are Sayinghellip
Factors Associated With Choice of Infant Sleep Position
Slide Number 65
What is Working
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Infant Sleep Safety
Safe Sleep Nurse Modeling
Physician Advocacy
Healthcare Provider Advice to New Mothers Safe Sleep
Mason Clinical Peds 713
Bundled Intervention = Behavior Change
Hospital Unsafe Sleep Persists
Washington DC
TodaysBaby QI Safe Sleep Teaching
TodaysBaby QI Safe Sleep Teaching
Social Media and Risk-Reduction Training Study (SMART)
The National Safe Sleep Hospital Certification Program
Coordinated Education Efforts Work
Coordinated Education Efforts Work
And Finallyhellip
Encouraging Parents to Take Action
Motivational Interviewing
Impact of Eliminating Sleep-Related Deaths
Thank You
Contact Information
Slide Number 89
IMR over time Finland vs US
Column1
correct advice
55
incorrect advice
25
no advice
20
correct advice
incorrect advice
no advice
SIDS Rate
Percent Back Sleeping
1988
14
1989
139
1990
13
1991
13
1992
12
13
1993
117
17
1994
103
269
1995
087
386
1996
074
353
1997
077
531
1998
072
557
1999
067
644
2000
062
666
2001
056
716
2002
057
711
2003
053
728
2004
056
701
2005
055
722
2006
055
757
2007
057
703
2008
055
721
2009
054
741
2010
051
728
2011
048
2012
042
2013
04
2014
039
httpwwwcdcgovNCHSdatanvsrnvsr58nvsr58_19pdf
Xu JQ Kochanek KD Murphy SL Tejada-Vera B Deaths Final data for
2007
National vital statistics reports vol 58 no 19 Hyattsville MD
National Center for Health Statistics 2010
1988
1988
1989
1989
1990
1990
1991
1991
1992
1992
1993
1993
1994
1994
1995
1995
1996
1996
1997
1997
1998
1998
1999
1999
2000
2000
2001
2001
2002
2002
2003
2003
2004
2004
2005
2005
2006
2006
2007
2007
2008
2008
2009
2009
2010
2010
2011
2012
2013
2014
Incidence per 100000 live births
Maternal Complications
1
Malignant Neoplasm
2
MVA
2
Short gestation
2
CNS infections
6
Intentional Injury
6
GI Infections
6
SepsisInfection
7
Respiratory Diseases
13
Congenital Malformations
36
SUID
78
Maternal Complications
Malignant Neoplasm
MVA
Short gestation
CNS infections
Intentional Injury
GI Infections
SepsisInfection
Respiratory Diseases
Congenital Malformations
SUID
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
US Post-Neonatal Mortality 2015
United States Department of Health and Human Services (US DHHS) Centers for Disease Control and Prevention (CDC) National Center for Health Statistics (NCHS) Division of Vital Statistics (DVS) Linked Birth Infant Death Records 2007-2015 as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program on CDC WONDER On-line Database Accessed at httpwondercdcgovlbd-currenthtml on Dec 27 2017
Chart1
Incidence per 100000 live births
1
2
2
2
6
6
6
7
13
36
78
Sheet1
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
FACT 3700 babies in the US die suddenly and unexpectedly each year
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
What is SUID or SUDI
Sudden Unexpected Infant Death o Occurs in a previously healthy infanto Can be explained or unexplained
o Most unobserved during sleepenvironment Sleep-related deaths SIDS represents a subcategory of SUID
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Some Causes of Deaths that Occur Suddenly and Unexpectedly during Infancy
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
What is SIDS ICD-10 definition The sudden death of an infant
under one year of age which remains unexplained after the performance of a complete post-mortem investigation including o Performance of a complete autopsyo Examination of the death sceneo Review of the case history
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
SIDS FACTS The leading cause of death in
infants from 1 month to 1 year of age (post-neonatal infant mortality)
A diagnosis of exclusion The cause of death is assigned only after ruling out other causes
Peak time of occurrence1-4 months
Higher incidence in males No longer see a higher
frequency in colder months
Percent distribution of SIDS by age at death United States 2004-2006
AAP Task Force on SIDS SIDS and other sleep-related infant deaths expansion of recommendations for a safe infant sleeping environment Pediatrics 2011128(5)e1341-e1367
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
SIDS FACTS
Higher incidence in preterm and low birth weight infants
Associated witho Young maternal ageo Maternal smoking with pregnancyo Late or no prenatal care
2-3 times more common in African-American American Indian and Alaska Native children
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Triple Risk Model to Explain SIDS
Critical Developmental
Period
Vulnerable Infant Exogenous
Stressors(eg brainstem dysfunction)
First 6 months
bull Proneside sleep position
bull Soft beddingbull Overbundling
overheatingbull Bed sharing
Intrinsic risk factors
bull Smokingbull Prematuritybull Alcohol and
illicit drugsbull Hypoxiabull Growth
restriction
SIDS
Extrinsic risk factors
Adapted from Filiano and Kinney 1994
bull Bed sharing + smoking
andor alcohol
Modifiable Risk Factors
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Paterson DS Krous HF Kinney HC et al JAMA 2006
Serotonin receptor binding density lower in SIDS cases compared to controls
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Adapted from Kinney and Thach 2009
An Example of SIDS Pathogenesis
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
2016 AAP Recommendations Infant Sleep Safety Recommendations are to reduce
the risk of SIDS and sleep-related suffocation asphyxia and entrapment
Recommendations should be used consistently until 1 year of ageo Most epidemiological studies upon
which these recommendations are based include infants up to 1 year of age
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Strength of Recommendation
Scale based on the Strength of Recommendation Taxonomy (SORT)
A There is good quality patient-oriented evidence B There is inconsistent or limited quality patient-
oriented evidence C The recommendation is based on consensus
disease-oriented evidence usual practice expertopinion or case series for studies ofdiagnosis treatment prevention orscreening
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Recommendations Change as the Evidence Evolves Statistics and risk factors may change
o New risks emerge (eg side positioning)o Different levels of risk
Policies and procedures may changeo Better death scene investigationso Diagnostic shift
Unintended consequenceso Plagiocephaly development o New tummy time recommendations
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
2016 SIDS Task Force Policy Statement Level A Recommendations Back to sleep for every sleep Use a firm sleep surface Keep soft objects and loose bedding out of the crib Room-sharingmdashInfant on separate sleep surface Breastfeeding is recommended Consider offering a pacifier at nap time and bedtime Avoid smoke exposure during pregnancy and after birth Avoid alcohol and illicit drug use during pregnancy and
after birth
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
2016 SIDS Task Force Policy Statement Level A Recommendations Avoid overheating Pregnant women should receive regular prenatal care Do not use home cardiorespiratory monitors as a strategy
for reducing the risk of SIDS Health care professionals staff in newborn nurseries and
NICUs and child care providers should endorse the SIDS risk-reduction recommendations from birth
Media and manufacturers should follow safe-sleep guidelines in their messaging and advertising
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
2016 SIDS Task Force Policy Statement Level B Recommendations Avoid commercial devices that are inconsistent with
safe sleep recommendations Supervised awake tummy time is recommended to
facilitate development and to minimize development of positional plagiocephaly (flattening of skull)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
2016 SIDS Task Force Policy Statement Level C Recommendations Continue research and surveillance on the risk factors
causes and pathophysiological mechanisms of SIDS and other sleep-related infant deaths with the ultimate goal of eliminating these deaths entirely
There is no evidence to recommend swaddling as a strategy to reduce the risk of SIDS
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Correct Safe Sleep Environment
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
We Need to Move Beyond Back to Sleep
Shersquos on her back to sleep
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Sleep Position for Healthy Newborns
Skin-to-skin care is recommended for all mothers and newborns regardless of feeding or delivery method immediately following birtho Mom should be medically stable
awake and able to respond to baby When mother needs to sleep or take
care of other needs infant should be placed supine in a bassinet
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Sleep Position in Newborn Nursery Infants in the newborn nursery
and infants who are rooming in with their parents should be placed in the supine position as soon as they are ready to be placed in the bassinet o No evidence that placing infants
on the side during the first few hours of life promotes clearance of amniotic fluid and decreases the risk of aspiration
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Sleep Position and Reflux Infants with gastroesophageal (GE) reflux
should be kept supineo Unless the risk of death from complications
of GE reflux is greater than the risk of SIDS
Supine position does not increase the risk of choking and aspiration in infants with GE reflux o Protective airway mechanisms
Do NOT elevate the head of the infantrsquos cribo Ineffective in reducing GE refluxo Infant may slide to the foot of the cribmdashmay
compromise respiration
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
The Truth About Supine Sleep and Aspiration Ending the Fallacy Orientation of the Trachea to the Esophagus
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Title
Text
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Infant Sleep Location
Infants should sleep in parentsrsquo room close to parentsrsquo bed but on a separate surface designed for infants
Ideally for the first year of life but at least for the first 6 months
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Room-Share How Long Yoursquore Kidding Right
2011 ldquoall sleep recommendations are to be followed until 1 year of agerdquo
2016 ldquoroom-sharing without bed-sharinghellipideally until 1 year of age but at least for the first 6 monthsrdquo
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Supporting Data
3 case-control studies comparing sleeping in a separate room vs room-sharingo Tappin (Scotland) AOR 326 (95 CI 103-1035)
bull Protection is significant for smoker motherso Blair (England) AOR 1049 (95 CI 426-2581)
bull Protection is significant for both smoker and nonsmoker mothers
o New Zealand Cot Death study AOR 285(95 CI 204-385)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
More Recent Data
New Zealand SUDI studyo 64 protection with room-sharing AOR 036
(95 CI 019-071)
Estimate of 50 reduction is very conservative
None of the case-control studies stratify by age (months)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Why is Room-Sharing Protective
SIDSmdashfailure to arouse More small awakenings during the night
o Stirrings movement not fully awake Postulation protective effect from small awakenings Room-sharing facilitates breastfeeding
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Room-Sharing and Sleep Quality
Volkovich room-sharing vs solitary sleepo Room-sharing mothers with more sleep disturbanceso Infants with similar sleep quality
Mao Mindell room-sharing infantsmdashmore awakenings
Montgomery-Downs Doan sleep quality in breastfeeding mothers gt to formula feeding motherso Exclusive breastfeeding = 30 min more sleep
More study needed
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Insight Study (Paul 2017)
Sleep questionnaire at 4 9 12 and 30 monthso Sleep duration overnight behaviorso Compared early vs late independent infants
At 4 monthso Equal sleep durationo Early group had better sleep consolidationo Longest stretch 46 minutes
Paul IM Hohman EE Loken E et al Mother-infant room-sharing and sleep outcomes in the INSIGHT study Pediatrics 2017140(1)e20170122
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Insight Study (Paul 2017)
At 9 monthso Longer sleep duration (40 minnight) o Better consolidation (100 min)
At 30 monthso Longer sleep duration (45 minnight)
Room-sharing 4 times more likely to transition to bed sharing overnight
Paul IM Hohman EE Loken E et al Mother-infant room-sharing and sleep outcomes in the INSIGHT study Pediatrics 2017140(1)e20170122
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Insight Commentary (Hauck Moon)
Late room-sharing mean 7 hours longest sleep Is early consolidation desirable Differences related to bedtime routines
o Early bedtimeo Number of night feedso Feeding back to sleep
Focus on the routine not early separation
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Feeding the Baby at Night Acknowledgment that parents may fall
asleep while feeding babyo Safer to feed on bed than on sofa
couch or armchair if you might fall asleep
o No pillows sheets blankets or other items that could obstruct infant breathing or cause overheating should be in bed
o Return infant back to separate sleep surface as soon as parent awakens
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Say NO to Couches Sofas and Cushioned Armchairs Never place a baby for sleep on these surfaces Never sleep with a baby on these surfaces One of the MOST dangerous places for an infant
(OR 51-669)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
High-Risk Bed Sharing Situations Age lt4 months Preterm or low birth weight Smoked during pregnancy Bed sharer is current smoker (even if not
smoking in bed) Bed sharer has usedis using meds or
substances that could impair alertness or arousal
Bed sharer is not parent (including other children)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bedsharing in Low-Risk Breastfed Infants
Blair et al AOR 16 (95 CI 096-27) o Age lt14 weekso Parents No cigarettes or alcoholo Independent of feeding method
Carpenter et al AOR 51 (95 CI 23-114) o Age lt3 months o Parents did not smokeo Mother No alcohol or drugso Breastfed infants
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Independent Review (Dr Robert Platt)
Very small numbers of low-risk babieso 24 in Blairrsquos studyo 12 in Carpenterrsquos study
Does not believe that data support definitive differences in 2 studies
Some evidence of increased risk in this group but cannot say how large the increased risk is
Cannot conclude that bed sharing in this group is safe
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Unsafe Bedding NISP Trends 1993-2102
Shapiro-Mendoza CK Colson ER Willinger M Rybin DV Camperlengo L Corwin MJ Trends in infant bedding use National Infant Sleep Position study 1993ndash2010 Pediatrics 2015135(1)10-17
Decrease from 86 to 55 Rate of decline decreases
2001-10 835 for teen mothers Predictors of adjusted OR
gt15
o Young motherso Non-white race
ethnicityo Less than college
education
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Why Use Soft Bedding
ComfortWarmtho Extrapolation of own feelingso Misinterpret firm with taut
bull Soft + taut ne firm
Safetyo Blankets pillows rolls to prevent falls
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Soft Bedding for Older Infants
Many parents recognize soft bedding is a risk Increased complacency as baby gets older Soft bedding is THE most important risk factor for
infants 4-12 months old (Colvin 2015) Infants roll into bedding and cannot extract
themselves
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
To Swaddle or Not to Swaddle That is the Question Pros
o Calms the infant promotes sleep decreases number of awakenings
o Encourages use of the supine position
Conso Increased respiratory rate and
reduced functional residual lung capacity
o Exacerbates hip dysplasia if the hips are kept in extension and adduction
o ldquoLooserdquo swaddling becomes loose bedding
o Overheating especially if the head is covered or the infant has infection
o Effects on arousability to an external stimulus remain unclear (conflicting data) There may be minimal effects of routine swaddling on arousal
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Swaddling
There is insufficient evidence to recommend routine swaddling as a strategy to reduce the incidence of SIDS
Swaddling must be correctly applied to avoid the possible hazards
Swaddling does not reduce the necessity to follow recommended safe sleep practices Ambrogio Lorenzettis Madonna and Child (1319)
Wikipedia
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
McDonnell E Moon RY Infant deaths and injuries associated with wearable blankets swaddle wraps and swaddling J Pediatr 20141641152-1156
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
SwaddlingmdashMore Questionshellip
Pease 2016 Pediatrics Pooled OR = 138
o Prone = 1299 o Side = 316o Supine = 193
Increased risk with age Limitations
o Heterogeneity definitions other risk factorsPease AS Fleming PJ Hauck FR et al Swaddling and the risk of sudden infant death syndrome a meta-analysis Pediatrics 2016137(6)e20153
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
wwwhealthychildrenorg
Swaddling (wrapping a light blanket snuggly around a baby) may help calm a crying baby If you swaddle your baby be sure to place him on his back to sleep Stop swaddling your baby when he starts to roll
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers
AAP recommendation Consider offering a pacifier at nap time and bedtime
Studies consistently demonstrate a protective effect of pacifiers on SIDS
Mechanism unknowno Dislodge within 15 to 60 minuteso Decreased arousal threshold
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers and Breastfeeding Well-designed trials
o 2 found no association among term infants
o 1 found no association among preterm infants
o 1 found slightly decreased breastfeeding duration at one month if pacifier introduced in first week of life but NO difference if pacifier introduced after one month
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Baby Friendly USA Pacifiers
Breastfeeding babies should not be given pacifiers by the staff of the facility with the exception of o Limited use to decrease pain during procedures when
the baby cannot safely be held or breastfed (pacifiers used should be discarded after these procedures)
o Babies who are being tube-fed in NICUo Other rare specific medical reasons
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Addressing Sleep Deprivation
Give parents tools to cope with fussy babies
Sleep-deprived parents may make poor judgments
Make use of tools o Swaddling side carrying
shushing swinging and sucking
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Overcoming Barriers to Change What Parents are Sayinghellip
Prone positioning fear of choking Baby sleeps ldquobetterrdquo on stomach Soft things are safer for the baby SIDS is ldquoGodrsquos willrdquo Why bother Recommendations keep changing
anyway Vigilance sleep with baby for protection
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Factors Associated With Choice of Infant Sleep Position 3300 mothers from 32 hospitals 77 usually use supine position 49 exclusive use supine position Most likely to use prone
o African-American motherso Mothers with lt high school educationo Lack of perceived controlo Personal attitudesocietal norms
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
A continuum starting in childhoodo Secondary school baby sitting classes
Pre-pregnancy Pregnancyprenatal education
o Prior to baby showerhellipldquowrong giftsrdquo In-hospital education and modeling
o Include family friends baby sitters Re-enforcement in the doctorrsquos office
o Especially between 1 to 4 months Grandparents They hold great power The general public (day cares religious leaders)
A Lifetime of Infant Sleep Safety
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Chart1
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
14
139
13
13
12
13
117
17
103
269
087
386
074
353
077
531
072
557
067
644
062
666
056
716
057
711
053
728
056
701
055
722
055
757
057
703
055
721
054
741
051
728
048
042
04
039
Sheet1
Sheet1
ampA
Page ampP
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
Sheet2
Pre-AAP recommendation Post-AAP RecommendationBack to SleepSafe to Sleep Campaign
Sheet3
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Infant Sleep Safety
Requires a consistent and repetitive message in the community to prevent accidental deaths
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Safe Sleep Nurse Modeling
People trust nurses Whatever the nurse does must
be correct and it will be imitated in the home
Fact supine positioning in the nursery can almost DOUBLE its use in the home
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Physician Advocacy
Srivatsa 1997 HCP education to new familieshellip34 reduction in prone sleeping
Eron 2009 Study of Central NY state physicianshellip30 identified incorrect safest sleep positionhellip30 do not discuss with families
Colson 2009 Only 13 mothers advised by MD to use supine positionhellip3 times more likely to position the baby properly
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Healthcare Provider Advice to New Mothers Safe Sleep
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Chart1
Column1
[]
[]
[]
55
25
20
Sheet1
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Mason Clinical Peds 713
Bundled interventiono Nursing education policy model behavior safe sleep
video posters in rooms declaration of safe sleep practice
Safe sleep environment uarr from 25 to 58 Intention in home 95 supine none ldquoco-sleepingrdquo
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bundled Intervention = Behavior Change
QUESTION GROUP p-value
ISS Study NISP
Behavior Questions n = 490 n = 1046
Baby routinely placed to sleep on back 925 73 lt 0001
Baby routinely sleeps in bassinetcrib 995 71 lt 00001
Baby sleeps under a thin sheet 992 86 lt 0001
Baby given a pacifier for sleep 741 84 lt 0001Goodstein MH Bell T Krugman SD Improving infant sleep safety through a comprehensive hospital-based program Clinical Pediatrics 201554(3)212-221
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
o Baseline Safe sleep 49 of 264 infants o Post 312 of 234 infants (P lt 001) o Extra blankets most common o Baseline 77 vs 44 post-intervention o Mean number of unsafe items reduced by 50 (P lt 001)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Washington DC
2 urban DC nurseries 26 did not believe or unsure that infant positioning
was associated with SIDS Top 3 factors influencing sleep position
o 56 PERSONAL PREFERENCE Why non-supine Clinical experience (25)
o Increase risk aspirationo Decrease sleep and comfort
Bartow KL Nursesrsquo knowledge and adherence to sudden infant death syndrome prevention guidelines Pediatr Nurs 201642(1)7-13
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
TodaysBaby QI Safe Sleep Teaching
QI intervention median = 160 days Mothers reported receiving information 72 to 95
(increase of 24-57) 94 babies observed supine (plus 24) 88 infants in safe sleep environment
o Increase of 33 Gains maintained up to 12 months
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Social Media and Risk-Reduction Training Study (SMART) Cluster randomization 4 groups Safe sleep or breast feeding education Nursing QI and social media (mobile health) N = 1600 1263 responses (79) Safe sleep NQI and MHealth
o Supine sleep 925 o Room-sharing 859o No soft bedding 819o Pacifier use 762
Moon RY Hauck FR Colson ER et al The effect of nursing quality improvement and mobile health interventions on infant sleep practices a randomized clinical trial JAMA 2017318(4)351-359
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Hospital Initiative ComponentswwwcribsforkidsorgHospitalInitiativeToolkit INTRODUCTORY LETTER HOSPITAL INITIATIVE TOOL KIT
INSTRUCTIONS ORGANIZATIONAL CHART HOSPITAL POLICY ACKNOWLEDGMENT FORM (Engl amp
Span) SAFE SLEEP EDUCATIONAL FLIP CHART
NONCOMPLIANCE WAIVER (Engl amp Span)
NURSING EDUCATION MODULE
SAFE SLEEP POSTERS DOOR HANGERS (Engl amp Span) GRADUATION CERTIFICATE SAMPLE LETTER TO HOSPITALS SAMPLE LETTER TO PROVIDERS INFANT SAFE SLEEP BROCHURES
(Engl amp Span) PRESS KIT
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
All materials available on-lineo No major costs to the hospital
Easy on-line access for documentation
NO FEE FOR PARTICIPATION
wwwCribsforKidsorgHospitalInitiative
Tiffany Price (tpricecribsforkidsorg)
The National Safe Sleep Hospital Certification Program
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
TNmdash25 reduction in infant sleep-related deaths in 2 years
SDmdashOver 7915 Pack lsquon Plays distributed since 2012 Infant mortality rate decreased from 86 (2012) to 48 (2016)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
2009 to 2015 38 decrease in infant mortality Decreased from 135 to 84 per 1000 SUID decreased gt50 Decrease in racial disparityhttphealthybabiesbaltimorecomhome
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
And Finallyhellip
Health care providers should have open frank nonjudgmental conversations with families about their sleep practices
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Encouraging Parents to Take Action
According to the Social Learning Theory parents are more likely to recall and comply with instructions when
the health care provider
Uses a positive tone Provides adequate information Allows the parent to ask most of the questions
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Motivational Interviewing
ldquoa collaborative goal-oriented style of communication with particular attention to the language of changerdquo
o Strengthen personal motivation and commitment to a specific goal
o Explore onersquos reasons for change (barriers)o Patient generates own solutions
bull More likely to feel realisticbull Planting seeds of change
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Impact of Eliminating Sleep-Related Deaths
Every week we lose 70 children which is equivalent to 4 kindergarten classrooms
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Thank You
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Contact Information
mgoodsteinwellspanorg
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Visit Pediatric Care Online today for additional information on this and other topics
httppediatriccaresolutionsaaporgPediatric Care Online is a convenient electronic resource for immediate expert help with
virtually every pediatric clinical information need with must-have resources that are included in a comprehensive reference library and time-saving clinical tools
Donrsquot have a subscription to PCOThen take advantage of a free trial today
Call Mead Johnson Nutrition at 888363-2362 orfor more information go to
httppediatriccaresolutionsaaporgSSFree_Trialaspx
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
IMR over time Finland vs US
Slide Number 1
Disclaimer
Objectives for Todayrsquos Talk
Infant Mortality Rates for the Five Leading Causes of Infant Death in the United States 2005 and 2011
US Post-Neonatal Mortality 2015
FACT
What is SUID or SUDI
Some Causes of Deaths that Occur Suddenly and Unexpectedly during Infancy
What is SIDS
SIDS FACTS
SIDS FACTS
Triple Risk Model to Explain SIDS
Paterson DS Krous HF Kinney HC et al JAMA 2006
An Example of SIDS Pathogenesis
2016 AAP Recommendations Infant Sleep Safety
Strength of Recommendation
Recommendations Change as the Evidence Evolves
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
Correct Safe Sleep Environment
We Need to Move Beyond Back to Sleep
Sleep Position for Healthy Newborns
Sleep Position in Newborn Nursery
Sleep Position and Reflux
The Truth About Supine Sleep and Aspiration Ending the Fallacy
Title
Infant Sleep Location
Room-Share How Long Yoursquore Kidding Right
Supporting Data
More Recent Data
Why is Room-Sharing Protective
Room-Sharing and Sleep Quality
Insight Study (Paul 2017)
Insight Study (Paul 2017)
Insight Commentary (Hauck Moon)
Feeding the Baby at Night
Say NO to Couches Sofas and Cushioned Armchairs
High-Risk Bed Sharing Situations
Bedsharing in Low-Risk Breastfed Infants
Independent Review (Dr Robert Platt)
Bed Sharing
Bed Sharing
Bed Sharing with Overlay
Bed Sharing with Overlay
Bed Sharing with Overlay
Couch Sleeping
Couch Sleeping
Couch Sleeping
Unsafe Bedding NISP Trends 1993-2102
Why Use Soft Bedding
Soft Bedding for Older Infants
To Swaddle or Not to Swaddle That is the Question
Swaddling
SwaddlingmdashIs it Safe
SwaddlingmdashMore Questionshellip
wwwhealthychildrenorg
Pacifiers
Pacifiers and Breastfeeding
Baby Friendly USA Pacifiers
Addressing Sleep Deprivation
Overcoming Barriers to Change What Parents are Sayinghellip
Factors Associated With Choice of Infant Sleep Position
Slide Number 65
What is Working
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Infant Sleep Safety
Safe Sleep Nurse Modeling
Physician Advocacy
Healthcare Provider Advice to New Mothers Safe Sleep
Mason Clinical Peds 713
Bundled Intervention = Behavior Change
Hospital Unsafe Sleep Persists
Washington DC
TodaysBaby QI Safe Sleep Teaching
TodaysBaby QI Safe Sleep Teaching
Social Media and Risk-Reduction Training Study (SMART)
The National Safe Sleep Hospital Certification Program
Coordinated Education Efforts Work
Coordinated Education Efforts Work
And Finallyhellip
Encouraging Parents to Take Action
Motivational Interviewing
Impact of Eliminating Sleep-Related Deaths
Thank You
Contact Information
Slide Number 89
IMR over time Finland vs US
Column1
correct advice
55
incorrect advice
25
no advice
20
correct advice
incorrect advice
no advice
SIDS Rate
Percent Back Sleeping
1988
14
1989
139
1990
13
1991
13
1992
12
13
1993
117
17
1994
103
269
1995
087
386
1996
074
353
1997
077
531
1998
072
557
1999
067
644
2000
062
666
2001
056
716
2002
057
711
2003
053
728
2004
056
701
2005
055
722
2006
055
757
2007
057
703
2008
055
721
2009
054
741
2010
051
728
2011
048
2012
042
2013
04
2014
039
httpwwwcdcgovNCHSdatanvsrnvsr58nvsr58_19pdf
Xu JQ Kochanek KD Murphy SL Tejada-Vera B Deaths Final data for
2007
National vital statistics reports vol 58 no 19 Hyattsville MD
National Center for Health Statistics 2010
1988
1988
1989
1989
1990
1990
1991
1991
1992
1992
1993
1993
1994
1994
1995
1995
1996
1996
1997
1997
1998
1998
1999
1999
2000
2000
2001
2001
2002
2002
2003
2003
2004
2004
2005
2005
2006
2006
2007
2007
2008
2008
2009
2009
2010
2010
2011
2012
2013
2014
Incidence per 100000 live births
Maternal Complications
1
Malignant Neoplasm
2
MVA
2
Short gestation
2
CNS infections
6
Intentional Injury
6
GI Infections
6
SepsisInfection
7
Respiratory Diseases
13
Congenital Malformations
36
SUID
78
Maternal Complications
Malignant Neoplasm
MVA
Short gestation
CNS infections
Intentional Injury
GI Infections
SepsisInfection
Respiratory Diseases
Congenital Malformations
SUID
Chart1
Incidence per 100000 live births
1
2
2
2
6
6
6
7
13
36
78
Sheet1
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
FACT 3700 babies in the US die suddenly and unexpectedly each year
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
What is SUID or SUDI
Sudden Unexpected Infant Death o Occurs in a previously healthy infanto Can be explained or unexplained
o Most unobserved during sleepenvironment Sleep-related deaths SIDS represents a subcategory of SUID
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Some Causes of Deaths that Occur Suddenly and Unexpectedly during Infancy
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
What is SIDS ICD-10 definition The sudden death of an infant
under one year of age which remains unexplained after the performance of a complete post-mortem investigation including o Performance of a complete autopsyo Examination of the death sceneo Review of the case history
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
SIDS FACTS The leading cause of death in
infants from 1 month to 1 year of age (post-neonatal infant mortality)
A diagnosis of exclusion The cause of death is assigned only after ruling out other causes
Peak time of occurrence1-4 months
Higher incidence in males No longer see a higher
frequency in colder months
Percent distribution of SIDS by age at death United States 2004-2006
AAP Task Force on SIDS SIDS and other sleep-related infant deaths expansion of recommendations for a safe infant sleeping environment Pediatrics 2011128(5)e1341-e1367
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
SIDS FACTS
Higher incidence in preterm and low birth weight infants
Associated witho Young maternal ageo Maternal smoking with pregnancyo Late or no prenatal care
2-3 times more common in African-American American Indian and Alaska Native children
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Triple Risk Model to Explain SIDS
Critical Developmental
Period
Vulnerable Infant Exogenous
Stressors(eg brainstem dysfunction)
First 6 months
bull Proneside sleep position
bull Soft beddingbull Overbundling
overheatingbull Bed sharing
Intrinsic risk factors
bull Smokingbull Prematuritybull Alcohol and
illicit drugsbull Hypoxiabull Growth
restriction
SIDS
Extrinsic risk factors
Adapted from Filiano and Kinney 1994
bull Bed sharing + smoking
andor alcohol
Modifiable Risk Factors
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Paterson DS Krous HF Kinney HC et al JAMA 2006
Serotonin receptor binding density lower in SIDS cases compared to controls
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Adapted from Kinney and Thach 2009
An Example of SIDS Pathogenesis
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2016 AAP Recommendations Infant Sleep Safety Recommendations are to reduce
the risk of SIDS and sleep-related suffocation asphyxia and entrapment
Recommendations should be used consistently until 1 year of ageo Most epidemiological studies upon
which these recommendations are based include infants up to 1 year of age
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Strength of Recommendation
Scale based on the Strength of Recommendation Taxonomy (SORT)
A There is good quality patient-oriented evidence B There is inconsistent or limited quality patient-
oriented evidence C The recommendation is based on consensus
disease-oriented evidence usual practice expertopinion or case series for studies ofdiagnosis treatment prevention orscreening
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Recommendations Change as the Evidence Evolves Statistics and risk factors may change
o New risks emerge (eg side positioning)o Different levels of risk
Policies and procedures may changeo Better death scene investigationso Diagnostic shift
Unintended consequenceso Plagiocephaly development o New tummy time recommendations
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2016 SIDS Task Force Policy Statement Level A Recommendations Back to sleep for every sleep Use a firm sleep surface Keep soft objects and loose bedding out of the crib Room-sharingmdashInfant on separate sleep surface Breastfeeding is recommended Consider offering a pacifier at nap time and bedtime Avoid smoke exposure during pregnancy and after birth Avoid alcohol and illicit drug use during pregnancy and
after birth
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
2016 SIDS Task Force Policy Statement Level A Recommendations Avoid overheating Pregnant women should receive regular prenatal care Do not use home cardiorespiratory monitors as a strategy
for reducing the risk of SIDS Health care professionals staff in newborn nurseries and
NICUs and child care providers should endorse the SIDS risk-reduction recommendations from birth
Media and manufacturers should follow safe-sleep guidelines in their messaging and advertising
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2016 SIDS Task Force Policy Statement Level B Recommendations Avoid commercial devices that are inconsistent with
safe sleep recommendations Supervised awake tummy time is recommended to
facilitate development and to minimize development of positional plagiocephaly (flattening of skull)
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2016 SIDS Task Force Policy Statement Level C Recommendations Continue research and surveillance on the risk factors
causes and pathophysiological mechanisms of SIDS and other sleep-related infant deaths with the ultimate goal of eliminating these deaths entirely
There is no evidence to recommend swaddling as a strategy to reduce the risk of SIDS
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Correct Safe Sleep Environment
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We Need to Move Beyond Back to Sleep
Shersquos on her back to sleep
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Sleep Position for Healthy Newborns
Skin-to-skin care is recommended for all mothers and newborns regardless of feeding or delivery method immediately following birtho Mom should be medically stable
awake and able to respond to baby When mother needs to sleep or take
care of other needs infant should be placed supine in a bassinet
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Sleep Position in Newborn Nursery Infants in the newborn nursery
and infants who are rooming in with their parents should be placed in the supine position as soon as they are ready to be placed in the bassinet o No evidence that placing infants
on the side during the first few hours of life promotes clearance of amniotic fluid and decreases the risk of aspiration
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Sleep Position and Reflux Infants with gastroesophageal (GE) reflux
should be kept supineo Unless the risk of death from complications
of GE reflux is greater than the risk of SIDS
Supine position does not increase the risk of choking and aspiration in infants with GE reflux o Protective airway mechanisms
Do NOT elevate the head of the infantrsquos cribo Ineffective in reducing GE refluxo Infant may slide to the foot of the cribmdashmay
compromise respiration
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
The Truth About Supine Sleep and Aspiration Ending the Fallacy Orientation of the Trachea to the Esophagus
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Title
Text
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Infant Sleep Location
Infants should sleep in parentsrsquo room close to parentsrsquo bed but on a separate surface designed for infants
Ideally for the first year of life but at least for the first 6 months
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Room-Share How Long Yoursquore Kidding Right
2011 ldquoall sleep recommendations are to be followed until 1 year of agerdquo
2016 ldquoroom-sharing without bed-sharinghellipideally until 1 year of age but at least for the first 6 monthsrdquo
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Supporting Data
3 case-control studies comparing sleeping in a separate room vs room-sharingo Tappin (Scotland) AOR 326 (95 CI 103-1035)
bull Protection is significant for smoker motherso Blair (England) AOR 1049 (95 CI 426-2581)
bull Protection is significant for both smoker and nonsmoker mothers
o New Zealand Cot Death study AOR 285(95 CI 204-385)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
More Recent Data
New Zealand SUDI studyo 64 protection with room-sharing AOR 036
(95 CI 019-071)
Estimate of 50 reduction is very conservative
None of the case-control studies stratify by age (months)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Why is Room-Sharing Protective
SIDSmdashfailure to arouse More small awakenings during the night
o Stirrings movement not fully awake Postulation protective effect from small awakenings Room-sharing facilitates breastfeeding
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Room-Sharing and Sleep Quality
Volkovich room-sharing vs solitary sleepo Room-sharing mothers with more sleep disturbanceso Infants with similar sleep quality
Mao Mindell room-sharing infantsmdashmore awakenings
Montgomery-Downs Doan sleep quality in breastfeeding mothers gt to formula feeding motherso Exclusive breastfeeding = 30 min more sleep
More study needed
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Insight Study (Paul 2017)
Sleep questionnaire at 4 9 12 and 30 monthso Sleep duration overnight behaviorso Compared early vs late independent infants
At 4 monthso Equal sleep durationo Early group had better sleep consolidationo Longest stretch 46 minutes
Paul IM Hohman EE Loken E et al Mother-infant room-sharing and sleep outcomes in the INSIGHT study Pediatrics 2017140(1)e20170122
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Insight Study (Paul 2017)
At 9 monthso Longer sleep duration (40 minnight) o Better consolidation (100 min)
At 30 monthso Longer sleep duration (45 minnight)
Room-sharing 4 times more likely to transition to bed sharing overnight
Paul IM Hohman EE Loken E et al Mother-infant room-sharing and sleep outcomes in the INSIGHT study Pediatrics 2017140(1)e20170122
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Insight Commentary (Hauck Moon)
Late room-sharing mean 7 hours longest sleep Is early consolidation desirable Differences related to bedtime routines
o Early bedtimeo Number of night feedso Feeding back to sleep
Focus on the routine not early separation
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Feeding the Baby at Night Acknowledgment that parents may fall
asleep while feeding babyo Safer to feed on bed than on sofa
couch or armchair if you might fall asleep
o No pillows sheets blankets or other items that could obstruct infant breathing or cause overheating should be in bed
o Return infant back to separate sleep surface as soon as parent awakens
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Say NO to Couches Sofas and Cushioned Armchairs Never place a baby for sleep on these surfaces Never sleep with a baby on these surfaces One of the MOST dangerous places for an infant
(OR 51-669)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
High-Risk Bed Sharing Situations Age lt4 months Preterm or low birth weight Smoked during pregnancy Bed sharer is current smoker (even if not
smoking in bed) Bed sharer has usedis using meds or
substances that could impair alertness or arousal
Bed sharer is not parent (including other children)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bedsharing in Low-Risk Breastfed Infants
Blair et al AOR 16 (95 CI 096-27) o Age lt14 weekso Parents No cigarettes or alcoholo Independent of feeding method
Carpenter et al AOR 51 (95 CI 23-114) o Age lt3 months o Parents did not smokeo Mother No alcohol or drugso Breastfed infants
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Independent Review (Dr Robert Platt)
Very small numbers of low-risk babieso 24 in Blairrsquos studyo 12 in Carpenterrsquos study
Does not believe that data support definitive differences in 2 studies
Some evidence of increased risk in this group but cannot say how large the increased risk is
Cannot conclude that bed sharing in this group is safe
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing
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Bed Sharing with Overlay
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Bed Sharing with Overlay
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Bed Sharing with Overlay
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Couch Sleeping
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Couch Sleeping
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Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Unsafe Bedding NISP Trends 1993-2102
Shapiro-Mendoza CK Colson ER Willinger M Rybin DV Camperlengo L Corwin MJ Trends in infant bedding use National Infant Sleep Position study 1993ndash2010 Pediatrics 2015135(1)10-17
Decrease from 86 to 55 Rate of decline decreases
2001-10 835 for teen mothers Predictors of adjusted OR
gt15
o Young motherso Non-white race
ethnicityo Less than college
education
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Why Use Soft Bedding
ComfortWarmtho Extrapolation of own feelingso Misinterpret firm with taut
bull Soft + taut ne firm
Safetyo Blankets pillows rolls to prevent falls
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Soft Bedding for Older Infants
Many parents recognize soft bedding is a risk Increased complacency as baby gets older Soft bedding is THE most important risk factor for
infants 4-12 months old (Colvin 2015) Infants roll into bedding and cannot extract
themselves
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
To Swaddle or Not to Swaddle That is the Question Pros
o Calms the infant promotes sleep decreases number of awakenings
o Encourages use of the supine position
Conso Increased respiratory rate and
reduced functional residual lung capacity
o Exacerbates hip dysplasia if the hips are kept in extension and adduction
o ldquoLooserdquo swaddling becomes loose bedding
o Overheating especially if the head is covered or the infant has infection
o Effects on arousability to an external stimulus remain unclear (conflicting data) There may be minimal effects of routine swaddling on arousal
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Swaddling
There is insufficient evidence to recommend routine swaddling as a strategy to reduce the incidence of SIDS
Swaddling must be correctly applied to avoid the possible hazards
Swaddling does not reduce the necessity to follow recommended safe sleep practices Ambrogio Lorenzettis Madonna and Child (1319)
Wikipedia
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McDonnell E Moon RY Infant deaths and injuries associated with wearable blankets swaddle wraps and swaddling J Pediatr 20141641152-1156
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
SwaddlingmdashMore Questionshellip
Pease 2016 Pediatrics Pooled OR = 138
o Prone = 1299 o Side = 316o Supine = 193
Increased risk with age Limitations
o Heterogeneity definitions other risk factorsPease AS Fleming PJ Hauck FR et al Swaddling and the risk of sudden infant death syndrome a meta-analysis Pediatrics 2016137(6)e20153
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
wwwhealthychildrenorg
Swaddling (wrapping a light blanket snuggly around a baby) may help calm a crying baby If you swaddle your baby be sure to place him on his back to sleep Stop swaddling your baby when he starts to roll
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers
AAP recommendation Consider offering a pacifier at nap time and bedtime
Studies consistently demonstrate a protective effect of pacifiers on SIDS
Mechanism unknowno Dislodge within 15 to 60 minuteso Decreased arousal threshold
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers and Breastfeeding Well-designed trials
o 2 found no association among term infants
o 1 found no association among preterm infants
o 1 found slightly decreased breastfeeding duration at one month if pacifier introduced in first week of life but NO difference if pacifier introduced after one month
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Baby Friendly USA Pacifiers
Breastfeeding babies should not be given pacifiers by the staff of the facility with the exception of o Limited use to decrease pain during procedures when
the baby cannot safely be held or breastfed (pacifiers used should be discarded after these procedures)
o Babies who are being tube-fed in NICUo Other rare specific medical reasons
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Addressing Sleep Deprivation
Give parents tools to cope with fussy babies
Sleep-deprived parents may make poor judgments
Make use of tools o Swaddling side carrying
shushing swinging and sucking
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Overcoming Barriers to Change What Parents are Sayinghellip
Prone positioning fear of choking Baby sleeps ldquobetterrdquo on stomach Soft things are safer for the baby SIDS is ldquoGodrsquos willrdquo Why bother Recommendations keep changing
anyway Vigilance sleep with baby for protection
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Factors Associated With Choice of Infant Sleep Position 3300 mothers from 32 hospitals 77 usually use supine position 49 exclusive use supine position Most likely to use prone
o African-American motherso Mothers with lt high school educationo Lack of perceived controlo Personal attitudesocietal norms
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
A continuum starting in childhoodo Secondary school baby sitting classes
Pre-pregnancy Pregnancyprenatal education
o Prior to baby showerhellipldquowrong giftsrdquo In-hospital education and modeling
o Include family friends baby sitters Re-enforcement in the doctorrsquos office
o Especially between 1 to 4 months Grandparents They hold great power The general public (day cares religious leaders)
A Lifetime of Infant Sleep Safety
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Chart1
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
14
139
13
13
12
13
117
17
103
269
087
386
074
353
077
531
072
557
067
644
062
666
056
716
057
711
053
728
056
701
055
722
055
757
057
703
055
721
054
741
051
728
048
042
04
039
Sheet1
Sheet1
ampA
Page ampP
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
Sheet2
Pre-AAP recommendation Post-AAP RecommendationBack to SleepSafe to Sleep Campaign
Sheet3
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Infant Sleep Safety
Requires a consistent and repetitive message in the community to prevent accidental deaths
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Safe Sleep Nurse Modeling
People trust nurses Whatever the nurse does must
be correct and it will be imitated in the home
Fact supine positioning in the nursery can almost DOUBLE its use in the home
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Physician Advocacy
Srivatsa 1997 HCP education to new familieshellip34 reduction in prone sleeping
Eron 2009 Study of Central NY state physicianshellip30 identified incorrect safest sleep positionhellip30 do not discuss with families
Colson 2009 Only 13 mothers advised by MD to use supine positionhellip3 times more likely to position the baby properly
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Healthcare Provider Advice to New Mothers Safe Sleep
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Chart1
Column1
[]
[]
[]
55
25
20
Sheet1
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Mason Clinical Peds 713
Bundled interventiono Nursing education policy model behavior safe sleep
video posters in rooms declaration of safe sleep practice
Safe sleep environment uarr from 25 to 58 Intention in home 95 supine none ldquoco-sleepingrdquo
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bundled Intervention = Behavior Change
QUESTION GROUP p-value
ISS Study NISP
Behavior Questions n = 490 n = 1046
Baby routinely placed to sleep on back 925 73 lt 0001
Baby routinely sleeps in bassinetcrib 995 71 lt 00001
Baby sleeps under a thin sheet 992 86 lt 0001
Baby given a pacifier for sleep 741 84 lt 0001Goodstein MH Bell T Krugman SD Improving infant sleep safety through a comprehensive hospital-based program Clinical Pediatrics 201554(3)212-221
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o Baseline Safe sleep 49 of 264 infants o Post 312 of 234 infants (P lt 001) o Extra blankets most common o Baseline 77 vs 44 post-intervention o Mean number of unsafe items reduced by 50 (P lt 001)
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Washington DC
2 urban DC nurseries 26 did not believe or unsure that infant positioning
was associated with SIDS Top 3 factors influencing sleep position
o 56 PERSONAL PREFERENCE Why non-supine Clinical experience (25)
o Increase risk aspirationo Decrease sleep and comfort
Bartow KL Nursesrsquo knowledge and adherence to sudden infant death syndrome prevention guidelines Pediatr Nurs 201642(1)7-13
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Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
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TodaysBaby QI Safe Sleep Teaching
QI intervention median = 160 days Mothers reported receiving information 72 to 95
(increase of 24-57) 94 babies observed supine (plus 24) 88 infants in safe sleep environment
o Increase of 33 Gains maintained up to 12 months
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Social Media and Risk-Reduction Training Study (SMART) Cluster randomization 4 groups Safe sleep or breast feeding education Nursing QI and social media (mobile health) N = 1600 1263 responses (79) Safe sleep NQI and MHealth
o Supine sleep 925 o Room-sharing 859o No soft bedding 819o Pacifier use 762
Moon RY Hauck FR Colson ER et al The effect of nursing quality improvement and mobile health interventions on infant sleep practices a randomized clinical trial JAMA 2017318(4)351-359
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Hospital Initiative ComponentswwwcribsforkidsorgHospitalInitiativeToolkit INTRODUCTORY LETTER HOSPITAL INITIATIVE TOOL KIT
INSTRUCTIONS ORGANIZATIONAL CHART HOSPITAL POLICY ACKNOWLEDGMENT FORM (Engl amp
Span) SAFE SLEEP EDUCATIONAL FLIP CHART
NONCOMPLIANCE WAIVER (Engl amp Span)
NURSING EDUCATION MODULE
SAFE SLEEP POSTERS DOOR HANGERS (Engl amp Span) GRADUATION CERTIFICATE SAMPLE LETTER TO HOSPITALS SAMPLE LETTER TO PROVIDERS INFANT SAFE SLEEP BROCHURES
(Engl amp Span) PRESS KIT
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
All materials available on-lineo No major costs to the hospital
Easy on-line access for documentation
NO FEE FOR PARTICIPATION
wwwCribsforKidsorgHospitalInitiative
Tiffany Price (tpricecribsforkidsorg)
The National Safe Sleep Hospital Certification Program
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
TNmdash25 reduction in infant sleep-related deaths in 2 years
SDmdashOver 7915 Pack lsquon Plays distributed since 2012 Infant mortality rate decreased from 86 (2012) to 48 (2016)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
2009 to 2015 38 decrease in infant mortality Decreased from 135 to 84 per 1000 SUID decreased gt50 Decrease in racial disparityhttphealthybabiesbaltimorecomhome
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
And Finallyhellip
Health care providers should have open frank nonjudgmental conversations with families about their sleep practices
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Encouraging Parents to Take Action
According to the Social Learning Theory parents are more likely to recall and comply with instructions when
the health care provider
Uses a positive tone Provides adequate information Allows the parent to ask most of the questions
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Motivational Interviewing
ldquoa collaborative goal-oriented style of communication with particular attention to the language of changerdquo
o Strengthen personal motivation and commitment to a specific goal
o Explore onersquos reasons for change (barriers)o Patient generates own solutions
bull More likely to feel realisticbull Planting seeds of change
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Impact of Eliminating Sleep-Related Deaths
Every week we lose 70 children which is equivalent to 4 kindergarten classrooms
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Thank You
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Contact Information
mgoodsteinwellspanorg
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Visit Pediatric Care Online today for additional information on this and other topics
httppediatriccaresolutionsaaporgPediatric Care Online is a convenient electronic resource for immediate expert help with
virtually every pediatric clinical information need with must-have resources that are included in a comprehensive reference library and time-saving clinical tools
Donrsquot have a subscription to PCOThen take advantage of a free trial today
Call Mead Johnson Nutrition at 888363-2362 orfor more information go to
httppediatriccaresolutionsaaporgSSFree_Trialaspx
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
IMR over time Finland vs US
Slide Number 1
Disclaimer
Objectives for Todayrsquos Talk
Infant Mortality Rates for the Five Leading Causes of Infant Death in the United States 2005 and 2011
US Post-Neonatal Mortality 2015
FACT
What is SUID or SUDI
Some Causes of Deaths that Occur Suddenly and Unexpectedly during Infancy
What is SIDS
SIDS FACTS
SIDS FACTS
Triple Risk Model to Explain SIDS
Paterson DS Krous HF Kinney HC et al JAMA 2006
An Example of SIDS Pathogenesis
2016 AAP Recommendations Infant Sleep Safety
Strength of Recommendation
Recommendations Change as the Evidence Evolves
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
Correct Safe Sleep Environment
We Need to Move Beyond Back to Sleep
Sleep Position for Healthy Newborns
Sleep Position in Newborn Nursery
Sleep Position and Reflux
The Truth About Supine Sleep and Aspiration Ending the Fallacy
Title
Infant Sleep Location
Room-Share How Long Yoursquore Kidding Right
Supporting Data
More Recent Data
Why is Room-Sharing Protective
Room-Sharing and Sleep Quality
Insight Study (Paul 2017)
Insight Study (Paul 2017)
Insight Commentary (Hauck Moon)
Feeding the Baby at Night
Say NO to Couches Sofas and Cushioned Armchairs
High-Risk Bed Sharing Situations
Bedsharing in Low-Risk Breastfed Infants
Independent Review (Dr Robert Platt)
Bed Sharing
Bed Sharing
Bed Sharing with Overlay
Bed Sharing with Overlay
Bed Sharing with Overlay
Couch Sleeping
Couch Sleeping
Couch Sleeping
Unsafe Bedding NISP Trends 1993-2102
Why Use Soft Bedding
Soft Bedding for Older Infants
To Swaddle or Not to Swaddle That is the Question
Swaddling
SwaddlingmdashIs it Safe
SwaddlingmdashMore Questionshellip
wwwhealthychildrenorg
Pacifiers
Pacifiers and Breastfeeding
Baby Friendly USA Pacifiers
Addressing Sleep Deprivation
Overcoming Barriers to Change What Parents are Sayinghellip
Factors Associated With Choice of Infant Sleep Position
Slide Number 65
What is Working
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Infant Sleep Safety
Safe Sleep Nurse Modeling
Physician Advocacy
Healthcare Provider Advice to New Mothers Safe Sleep
Mason Clinical Peds 713
Bundled Intervention = Behavior Change
Hospital Unsafe Sleep Persists
Washington DC
TodaysBaby QI Safe Sleep Teaching
TodaysBaby QI Safe Sleep Teaching
Social Media and Risk-Reduction Training Study (SMART)
The National Safe Sleep Hospital Certification Program
Coordinated Education Efforts Work
Coordinated Education Efforts Work
And Finallyhellip
Encouraging Parents to Take Action
Motivational Interviewing
Impact of Eliminating Sleep-Related Deaths
Thank You
Contact Information
Slide Number 89
IMR over time Finland vs US
Column1
correct advice
55
incorrect advice
25
no advice
20
correct advice
incorrect advice
no advice
SIDS Rate
Percent Back Sleeping
1988
14
1989
139
1990
13
1991
13
1992
12
13
1993
117
17
1994
103
269
1995
087
386
1996
074
353
1997
077
531
1998
072
557
1999
067
644
2000
062
666
2001
056
716
2002
057
711
2003
053
728
2004
056
701
2005
055
722
2006
055
757
2007
057
703
2008
055
721
2009
054
741
2010
051
728
2011
048
2012
042
2013
04
2014
039
httpwwwcdcgovNCHSdatanvsrnvsr58nvsr58_19pdf
Xu JQ Kochanek KD Murphy SL Tejada-Vera B Deaths Final data for
2007
National vital statistics reports vol 58 no 19 Hyattsville MD
National Center for Health Statistics 2010
1988
1988
1989
1989
1990
1990
1991
1991
1992
1992
1993
1993
1994
1994
1995
1995
1996
1996
1997
1997
1998
1998
1999
1999
2000
2000
2001
2001
2002
2002
2003
2003
2004
2004
2005
2005
2006
2006
2007
2007
2008
2008
2009
2009
2010
2010
2011
2012
2013
2014
Incidence per 100000 live births
Maternal Complications
1
Malignant Neoplasm
2
MVA
2
Short gestation
2
CNS infections
6
Intentional Injury
6
GI Infections
6
SepsisInfection
7
Respiratory Diseases
13
Congenital Malformations
36
SUID
78
Maternal Complications
Malignant Neoplasm
MVA
Short gestation
CNS infections
Intentional Injury
GI Infections
SepsisInfection
Respiratory Diseases
Congenital Malformations
SUID
Sheet1
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FACT 3700 babies in the US die suddenly and unexpectedly each year
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What is SUID or SUDI
Sudden Unexpected Infant Death o Occurs in a previously healthy infanto Can be explained or unexplained
o Most unobserved during sleepenvironment Sleep-related deaths SIDS represents a subcategory of SUID
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Some Causes of Deaths that Occur Suddenly and Unexpectedly during Infancy
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What is SIDS ICD-10 definition The sudden death of an infant
under one year of age which remains unexplained after the performance of a complete post-mortem investigation including o Performance of a complete autopsyo Examination of the death sceneo Review of the case history
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SIDS FACTS The leading cause of death in
infants from 1 month to 1 year of age (post-neonatal infant mortality)
A diagnosis of exclusion The cause of death is assigned only after ruling out other causes
Peak time of occurrence1-4 months
Higher incidence in males No longer see a higher
frequency in colder months
Percent distribution of SIDS by age at death United States 2004-2006
AAP Task Force on SIDS SIDS and other sleep-related infant deaths expansion of recommendations for a safe infant sleeping environment Pediatrics 2011128(5)e1341-e1367
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SIDS FACTS
Higher incidence in preterm and low birth weight infants
Associated witho Young maternal ageo Maternal smoking with pregnancyo Late or no prenatal care
2-3 times more common in African-American American Indian and Alaska Native children
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Triple Risk Model to Explain SIDS
Critical Developmental
Period
Vulnerable Infant Exogenous
Stressors(eg brainstem dysfunction)
First 6 months
bull Proneside sleep position
bull Soft beddingbull Overbundling
overheatingbull Bed sharing
Intrinsic risk factors
bull Smokingbull Prematuritybull Alcohol and
illicit drugsbull Hypoxiabull Growth
restriction
SIDS
Extrinsic risk factors
Adapted from Filiano and Kinney 1994
bull Bed sharing + smoking
andor alcohol
Modifiable Risk Factors
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Paterson DS Krous HF Kinney HC et al JAMA 2006
Serotonin receptor binding density lower in SIDS cases compared to controls
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Adapted from Kinney and Thach 2009
An Example of SIDS Pathogenesis
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2016 AAP Recommendations Infant Sleep Safety Recommendations are to reduce
the risk of SIDS and sleep-related suffocation asphyxia and entrapment
Recommendations should be used consistently until 1 year of ageo Most epidemiological studies upon
which these recommendations are based include infants up to 1 year of age
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Strength of Recommendation
Scale based on the Strength of Recommendation Taxonomy (SORT)
A There is good quality patient-oriented evidence B There is inconsistent or limited quality patient-
oriented evidence C The recommendation is based on consensus
disease-oriented evidence usual practice expertopinion or case series for studies ofdiagnosis treatment prevention orscreening
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Recommendations Change as the Evidence Evolves Statistics and risk factors may change
o New risks emerge (eg side positioning)o Different levels of risk
Policies and procedures may changeo Better death scene investigationso Diagnostic shift
Unintended consequenceso Plagiocephaly development o New tummy time recommendations
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2016 SIDS Task Force Policy Statement Level A Recommendations Back to sleep for every sleep Use a firm sleep surface Keep soft objects and loose bedding out of the crib Room-sharingmdashInfant on separate sleep surface Breastfeeding is recommended Consider offering a pacifier at nap time and bedtime Avoid smoke exposure during pregnancy and after birth Avoid alcohol and illicit drug use during pregnancy and
after birth
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2016 SIDS Task Force Policy Statement Level A Recommendations Avoid overheating Pregnant women should receive regular prenatal care Do not use home cardiorespiratory monitors as a strategy
for reducing the risk of SIDS Health care professionals staff in newborn nurseries and
NICUs and child care providers should endorse the SIDS risk-reduction recommendations from birth
Media and manufacturers should follow safe-sleep guidelines in their messaging and advertising
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2016 SIDS Task Force Policy Statement Level B Recommendations Avoid commercial devices that are inconsistent with
safe sleep recommendations Supervised awake tummy time is recommended to
facilitate development and to minimize development of positional plagiocephaly (flattening of skull)
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2016 SIDS Task Force Policy Statement Level C Recommendations Continue research and surveillance on the risk factors
causes and pathophysiological mechanisms of SIDS and other sleep-related infant deaths with the ultimate goal of eliminating these deaths entirely
There is no evidence to recommend swaddling as a strategy to reduce the risk of SIDS
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Correct Safe Sleep Environment
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We Need to Move Beyond Back to Sleep
Shersquos on her back to sleep
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Sleep Position for Healthy Newborns
Skin-to-skin care is recommended for all mothers and newborns regardless of feeding or delivery method immediately following birtho Mom should be medically stable
awake and able to respond to baby When mother needs to sleep or take
care of other needs infant should be placed supine in a bassinet
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Sleep Position in Newborn Nursery Infants in the newborn nursery
and infants who are rooming in with their parents should be placed in the supine position as soon as they are ready to be placed in the bassinet o No evidence that placing infants
on the side during the first few hours of life promotes clearance of amniotic fluid and decreases the risk of aspiration
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Sleep Position and Reflux Infants with gastroesophageal (GE) reflux
should be kept supineo Unless the risk of death from complications
of GE reflux is greater than the risk of SIDS
Supine position does not increase the risk of choking and aspiration in infants with GE reflux o Protective airway mechanisms
Do NOT elevate the head of the infantrsquos cribo Ineffective in reducing GE refluxo Infant may slide to the foot of the cribmdashmay
compromise respiration
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The Truth About Supine Sleep and Aspiration Ending the Fallacy Orientation of the Trachea to the Esophagus
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Title
Text
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Infant Sleep Location
Infants should sleep in parentsrsquo room close to parentsrsquo bed but on a separate surface designed for infants
Ideally for the first year of life but at least for the first 6 months
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Room-Share How Long Yoursquore Kidding Right
2011 ldquoall sleep recommendations are to be followed until 1 year of agerdquo
2016 ldquoroom-sharing without bed-sharinghellipideally until 1 year of age but at least for the first 6 monthsrdquo
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Supporting Data
3 case-control studies comparing sleeping in a separate room vs room-sharingo Tappin (Scotland) AOR 326 (95 CI 103-1035)
bull Protection is significant for smoker motherso Blair (England) AOR 1049 (95 CI 426-2581)
bull Protection is significant for both smoker and nonsmoker mothers
o New Zealand Cot Death study AOR 285(95 CI 204-385)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
More Recent Data
New Zealand SUDI studyo 64 protection with room-sharing AOR 036
(95 CI 019-071)
Estimate of 50 reduction is very conservative
None of the case-control studies stratify by age (months)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Why is Room-Sharing Protective
SIDSmdashfailure to arouse More small awakenings during the night
o Stirrings movement not fully awake Postulation protective effect from small awakenings Room-sharing facilitates breastfeeding
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Room-Sharing and Sleep Quality
Volkovich room-sharing vs solitary sleepo Room-sharing mothers with more sleep disturbanceso Infants with similar sleep quality
Mao Mindell room-sharing infantsmdashmore awakenings
Montgomery-Downs Doan sleep quality in breastfeeding mothers gt to formula feeding motherso Exclusive breastfeeding = 30 min more sleep
More study needed
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Insight Study (Paul 2017)
Sleep questionnaire at 4 9 12 and 30 monthso Sleep duration overnight behaviorso Compared early vs late independent infants
At 4 monthso Equal sleep durationo Early group had better sleep consolidationo Longest stretch 46 minutes
Paul IM Hohman EE Loken E et al Mother-infant room-sharing and sleep outcomes in the INSIGHT study Pediatrics 2017140(1)e20170122
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Insight Study (Paul 2017)
At 9 monthso Longer sleep duration (40 minnight) o Better consolidation (100 min)
At 30 monthso Longer sleep duration (45 minnight)
Room-sharing 4 times more likely to transition to bed sharing overnight
Paul IM Hohman EE Loken E et al Mother-infant room-sharing and sleep outcomes in the INSIGHT study Pediatrics 2017140(1)e20170122
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Insight Commentary (Hauck Moon)
Late room-sharing mean 7 hours longest sleep Is early consolidation desirable Differences related to bedtime routines
o Early bedtimeo Number of night feedso Feeding back to sleep
Focus on the routine not early separation
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Feeding the Baby at Night Acknowledgment that parents may fall
asleep while feeding babyo Safer to feed on bed than on sofa
couch or armchair if you might fall asleep
o No pillows sheets blankets or other items that could obstruct infant breathing or cause overheating should be in bed
o Return infant back to separate sleep surface as soon as parent awakens
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Say NO to Couches Sofas and Cushioned Armchairs Never place a baby for sleep on these surfaces Never sleep with a baby on these surfaces One of the MOST dangerous places for an infant
(OR 51-669)
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High-Risk Bed Sharing Situations Age lt4 months Preterm or low birth weight Smoked during pregnancy Bed sharer is current smoker (even if not
smoking in bed) Bed sharer has usedis using meds or
substances that could impair alertness or arousal
Bed sharer is not parent (including other children)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bedsharing in Low-Risk Breastfed Infants
Blair et al AOR 16 (95 CI 096-27) o Age lt14 weekso Parents No cigarettes or alcoholo Independent of feeding method
Carpenter et al AOR 51 (95 CI 23-114) o Age lt3 months o Parents did not smokeo Mother No alcohol or drugso Breastfed infants
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Independent Review (Dr Robert Platt)
Very small numbers of low-risk babieso 24 in Blairrsquos studyo 12 in Carpenterrsquos study
Does not believe that data support definitive differences in 2 studies
Some evidence of increased risk in this group but cannot say how large the increased risk is
Cannot conclude that bed sharing in this group is safe
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Bed Sharing
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Bed Sharing
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Bed Sharing with Overlay
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Bed Sharing with Overlay
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Bed Sharing with Overlay
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Couch Sleeping
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Couch Sleeping
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Couch Sleeping
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Unsafe Bedding NISP Trends 1993-2102
Shapiro-Mendoza CK Colson ER Willinger M Rybin DV Camperlengo L Corwin MJ Trends in infant bedding use National Infant Sleep Position study 1993ndash2010 Pediatrics 2015135(1)10-17
Decrease from 86 to 55 Rate of decline decreases
2001-10 835 for teen mothers Predictors of adjusted OR
gt15
o Young motherso Non-white race
ethnicityo Less than college
education
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Why Use Soft Bedding
ComfortWarmtho Extrapolation of own feelingso Misinterpret firm with taut
bull Soft + taut ne firm
Safetyo Blankets pillows rolls to prevent falls
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Soft Bedding for Older Infants
Many parents recognize soft bedding is a risk Increased complacency as baby gets older Soft bedding is THE most important risk factor for
infants 4-12 months old (Colvin 2015) Infants roll into bedding and cannot extract
themselves
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
To Swaddle or Not to Swaddle That is the Question Pros
o Calms the infant promotes sleep decreases number of awakenings
o Encourages use of the supine position
Conso Increased respiratory rate and
reduced functional residual lung capacity
o Exacerbates hip dysplasia if the hips are kept in extension and adduction
o ldquoLooserdquo swaddling becomes loose bedding
o Overheating especially if the head is covered or the infant has infection
o Effects on arousability to an external stimulus remain unclear (conflicting data) There may be minimal effects of routine swaddling on arousal
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Swaddling
There is insufficient evidence to recommend routine swaddling as a strategy to reduce the incidence of SIDS
Swaddling must be correctly applied to avoid the possible hazards
Swaddling does not reduce the necessity to follow recommended safe sleep practices Ambrogio Lorenzettis Madonna and Child (1319)
Wikipedia
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McDonnell E Moon RY Infant deaths and injuries associated with wearable blankets swaddle wraps and swaddling J Pediatr 20141641152-1156
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SwaddlingmdashMore Questionshellip
Pease 2016 Pediatrics Pooled OR = 138
o Prone = 1299 o Side = 316o Supine = 193
Increased risk with age Limitations
o Heterogeneity definitions other risk factorsPease AS Fleming PJ Hauck FR et al Swaddling and the risk of sudden infant death syndrome a meta-analysis Pediatrics 2016137(6)e20153
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wwwhealthychildrenorg
Swaddling (wrapping a light blanket snuggly around a baby) may help calm a crying baby If you swaddle your baby be sure to place him on his back to sleep Stop swaddling your baby when he starts to roll
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers
AAP recommendation Consider offering a pacifier at nap time and bedtime
Studies consistently demonstrate a protective effect of pacifiers on SIDS
Mechanism unknowno Dislodge within 15 to 60 minuteso Decreased arousal threshold
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers and Breastfeeding Well-designed trials
o 2 found no association among term infants
o 1 found no association among preterm infants
o 1 found slightly decreased breastfeeding duration at one month if pacifier introduced in first week of life but NO difference if pacifier introduced after one month
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Baby Friendly USA Pacifiers
Breastfeeding babies should not be given pacifiers by the staff of the facility with the exception of o Limited use to decrease pain during procedures when
the baby cannot safely be held or breastfed (pacifiers used should be discarded after these procedures)
o Babies who are being tube-fed in NICUo Other rare specific medical reasons
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Addressing Sleep Deprivation
Give parents tools to cope with fussy babies
Sleep-deprived parents may make poor judgments
Make use of tools o Swaddling side carrying
shushing swinging and sucking
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Overcoming Barriers to Change What Parents are Sayinghellip
Prone positioning fear of choking Baby sleeps ldquobetterrdquo on stomach Soft things are safer for the baby SIDS is ldquoGodrsquos willrdquo Why bother Recommendations keep changing
anyway Vigilance sleep with baby for protection
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Factors Associated With Choice of Infant Sleep Position 3300 mothers from 32 hospitals 77 usually use supine position 49 exclusive use supine position Most likely to use prone
o African-American motherso Mothers with lt high school educationo Lack of perceived controlo Personal attitudesocietal norms
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
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A continuum starting in childhoodo Secondary school baby sitting classes
Pre-pregnancy Pregnancyprenatal education
o Prior to baby showerhellipldquowrong giftsrdquo In-hospital education and modeling
o Include family friends baby sitters Re-enforcement in the doctorrsquos office
o Especially between 1 to 4 months Grandparents They hold great power The general public (day cares religious leaders)
A Lifetime of Infant Sleep Safety
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The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Chart1
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
14
139
13
13
12
13
117
17
103
269
087
386
074
353
077
531
072
557
067
644
062
666
056
716
057
711
053
728
056
701
055
722
055
757
057
703
055
721
054
741
051
728
048
042
04
039
Sheet1
Sheet1
ampA
Page ampP
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
Sheet2
Pre-AAP recommendation Post-AAP RecommendationBack to SleepSafe to Sleep Campaign
Sheet3
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Infant Sleep Safety
Requires a consistent and repetitive message in the community to prevent accidental deaths
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Safe Sleep Nurse Modeling
People trust nurses Whatever the nurse does must
be correct and it will be imitated in the home
Fact supine positioning in the nursery can almost DOUBLE its use in the home
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Physician Advocacy
Srivatsa 1997 HCP education to new familieshellip34 reduction in prone sleeping
Eron 2009 Study of Central NY state physicianshellip30 identified incorrect safest sleep positionhellip30 do not discuss with families
Colson 2009 Only 13 mothers advised by MD to use supine positionhellip3 times more likely to position the baby properly
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Healthcare Provider Advice to New Mothers Safe Sleep
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Chart1
Column1
[]
[]
[]
55
25
20
Sheet1
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Mason Clinical Peds 713
Bundled interventiono Nursing education policy model behavior safe sleep
video posters in rooms declaration of safe sleep practice
Safe sleep environment uarr from 25 to 58 Intention in home 95 supine none ldquoco-sleepingrdquo
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Bundled Intervention = Behavior Change
QUESTION GROUP p-value
ISS Study NISP
Behavior Questions n = 490 n = 1046
Baby routinely placed to sleep on back 925 73 lt 0001
Baby routinely sleeps in bassinetcrib 995 71 lt 00001
Baby sleeps under a thin sheet 992 86 lt 0001
Baby given a pacifier for sleep 741 84 lt 0001Goodstein MH Bell T Krugman SD Improving infant sleep safety through a comprehensive hospital-based program Clinical Pediatrics 201554(3)212-221
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o Baseline Safe sleep 49 of 264 infants o Post 312 of 234 infants (P lt 001) o Extra blankets most common o Baseline 77 vs 44 post-intervention o Mean number of unsafe items reduced by 50 (P lt 001)
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Washington DC
2 urban DC nurseries 26 did not believe or unsure that infant positioning
was associated with SIDS Top 3 factors influencing sleep position
o 56 PERSONAL PREFERENCE Why non-supine Clinical experience (25)
o Increase risk aspirationo Decrease sleep and comfort
Bartow KL Nursesrsquo knowledge and adherence to sudden infant death syndrome prevention guidelines Pediatr Nurs 201642(1)7-13
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Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
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TodaysBaby QI Safe Sleep Teaching
QI intervention median = 160 days Mothers reported receiving information 72 to 95
(increase of 24-57) 94 babies observed supine (plus 24) 88 infants in safe sleep environment
o Increase of 33 Gains maintained up to 12 months
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
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Social Media and Risk-Reduction Training Study (SMART) Cluster randomization 4 groups Safe sleep or breast feeding education Nursing QI and social media (mobile health) N = 1600 1263 responses (79) Safe sleep NQI and MHealth
o Supine sleep 925 o Room-sharing 859o No soft bedding 819o Pacifier use 762
Moon RY Hauck FR Colson ER et al The effect of nursing quality improvement and mobile health interventions on infant sleep practices a randomized clinical trial JAMA 2017318(4)351-359
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Hospital Initiative ComponentswwwcribsforkidsorgHospitalInitiativeToolkit INTRODUCTORY LETTER HOSPITAL INITIATIVE TOOL KIT
INSTRUCTIONS ORGANIZATIONAL CHART HOSPITAL POLICY ACKNOWLEDGMENT FORM (Engl amp
Span) SAFE SLEEP EDUCATIONAL FLIP CHART
NONCOMPLIANCE WAIVER (Engl amp Span)
NURSING EDUCATION MODULE
SAFE SLEEP POSTERS DOOR HANGERS (Engl amp Span) GRADUATION CERTIFICATE SAMPLE LETTER TO HOSPITALS SAMPLE LETTER TO PROVIDERS INFANT SAFE SLEEP BROCHURES
(Engl amp Span) PRESS KIT
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
All materials available on-lineo No major costs to the hospital
Easy on-line access for documentation
NO FEE FOR PARTICIPATION
wwwCribsforKidsorgHospitalInitiative
Tiffany Price (tpricecribsforkidsorg)
The National Safe Sleep Hospital Certification Program
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
TNmdash25 reduction in infant sleep-related deaths in 2 years
SDmdashOver 7915 Pack lsquon Plays distributed since 2012 Infant mortality rate decreased from 86 (2012) to 48 (2016)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
2009 to 2015 38 decrease in infant mortality Decreased from 135 to 84 per 1000 SUID decreased gt50 Decrease in racial disparityhttphealthybabiesbaltimorecomhome
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And Finallyhellip
Health care providers should have open frank nonjudgmental conversations with families about their sleep practices
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Encouraging Parents to Take Action
According to the Social Learning Theory parents are more likely to recall and comply with instructions when
the health care provider
Uses a positive tone Provides adequate information Allows the parent to ask most of the questions
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Motivational Interviewing
ldquoa collaborative goal-oriented style of communication with particular attention to the language of changerdquo
o Strengthen personal motivation and commitment to a specific goal
o Explore onersquos reasons for change (barriers)o Patient generates own solutions
bull More likely to feel realisticbull Planting seeds of change
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Impact of Eliminating Sleep-Related Deaths
Every week we lose 70 children which is equivalent to 4 kindergarten classrooms
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Thank You
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Contact Information
mgoodsteinwellspanorg
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Visit Pediatric Care Online today for additional information on this and other topics
httppediatriccaresolutionsaaporgPediatric Care Online is a convenient electronic resource for immediate expert help with
virtually every pediatric clinical information need with must-have resources that are included in a comprehensive reference library and time-saving clinical tools
Donrsquot have a subscription to PCOThen take advantage of a free trial today
Call Mead Johnson Nutrition at 888363-2362 orfor more information go to
httppediatriccaresolutionsaaporgSSFree_Trialaspx
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
IMR over time Finland vs US
Slide Number 1
Disclaimer
Objectives for Todayrsquos Talk
Infant Mortality Rates for the Five Leading Causes of Infant Death in the United States 2005 and 2011
US Post-Neonatal Mortality 2015
FACT
What is SUID or SUDI
Some Causes of Deaths that Occur Suddenly and Unexpectedly during Infancy
What is SIDS
SIDS FACTS
SIDS FACTS
Triple Risk Model to Explain SIDS
Paterson DS Krous HF Kinney HC et al JAMA 2006
An Example of SIDS Pathogenesis
2016 AAP Recommendations Infant Sleep Safety
Strength of Recommendation
Recommendations Change as the Evidence Evolves
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
Correct Safe Sleep Environment
We Need to Move Beyond Back to Sleep
Sleep Position for Healthy Newborns
Sleep Position in Newborn Nursery
Sleep Position and Reflux
The Truth About Supine Sleep and Aspiration Ending the Fallacy
Title
Infant Sleep Location
Room-Share How Long Yoursquore Kidding Right
Supporting Data
More Recent Data
Why is Room-Sharing Protective
Room-Sharing and Sleep Quality
Insight Study (Paul 2017)
Insight Study (Paul 2017)
Insight Commentary (Hauck Moon)
Feeding the Baby at Night
Say NO to Couches Sofas and Cushioned Armchairs
High-Risk Bed Sharing Situations
Bedsharing in Low-Risk Breastfed Infants
Independent Review (Dr Robert Platt)
Bed Sharing
Bed Sharing
Bed Sharing with Overlay
Bed Sharing with Overlay
Bed Sharing with Overlay
Couch Sleeping
Couch Sleeping
Couch Sleeping
Unsafe Bedding NISP Trends 1993-2102
Why Use Soft Bedding
Soft Bedding for Older Infants
To Swaddle or Not to Swaddle That is the Question
Swaddling
SwaddlingmdashIs it Safe
SwaddlingmdashMore Questionshellip
wwwhealthychildrenorg
Pacifiers
Pacifiers and Breastfeeding
Baby Friendly USA Pacifiers
Addressing Sleep Deprivation
Overcoming Barriers to Change What Parents are Sayinghellip
Factors Associated With Choice of Infant Sleep Position
Slide Number 65
What is Working
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Infant Sleep Safety
Safe Sleep Nurse Modeling
Physician Advocacy
Healthcare Provider Advice to New Mothers Safe Sleep
Mason Clinical Peds 713
Bundled Intervention = Behavior Change
Hospital Unsafe Sleep Persists
Washington DC
TodaysBaby QI Safe Sleep Teaching
TodaysBaby QI Safe Sleep Teaching
Social Media and Risk-Reduction Training Study (SMART)
The National Safe Sleep Hospital Certification Program
Coordinated Education Efforts Work
Coordinated Education Efforts Work
And Finallyhellip
Encouraging Parents to Take Action
Motivational Interviewing
Impact of Eliminating Sleep-Related Deaths
Thank You
Contact Information
Slide Number 89
IMR over time Finland vs US
Column1
correct advice
55
incorrect advice
25
no advice
20
correct advice
incorrect advice
no advice
SIDS Rate
Percent Back Sleeping
1988
14
1989
139
1990
13
1991
13
1992
12
13
1993
117
17
1994
103
269
1995
087
386
1996
074
353
1997
077
531
1998
072
557
1999
067
644
2000
062
666
2001
056
716
2002
057
711
2003
053
728
2004
056
701
2005
055
722
2006
055
757
2007
057
703
2008
055
721
2009
054
741
2010
051
728
2011
048
2012
042
2013
04
2014
039
httpwwwcdcgovNCHSdatanvsrnvsr58nvsr58_19pdf
Xu JQ Kochanek KD Murphy SL Tejada-Vera B Deaths Final data for
2007
National vital statistics reports vol 58 no 19 Hyattsville MD
National Center for Health Statistics 2010
1988
1988
1989
1989
1990
1990
1991
1991
1992
1992
1993
1993
1994
1994
1995
1995
1996
1996
1997
1997
1998
1998
1999
1999
2000
2000
2001
2001
2002
2002
2003
2003
2004
2004
2005
2005
2006
2006
2007
2007
2008
2008
2009
2009
2010
2010
2011
2012
2013
2014
Incidence per 100000 live births
Maternal Complications
1
Malignant Neoplasm
2
MVA
2
Short gestation
2
CNS infections
6
Intentional Injury
6
GI Infections
6
SepsisInfection
7
Respiratory Diseases
13
Congenital Malformations
36
SUID
78
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
FACT 3700 babies in the US die suddenly and unexpectedly each year
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
What is SUID or SUDI
Sudden Unexpected Infant Death o Occurs in a previously healthy infanto Can be explained or unexplained
o Most unobserved during sleepenvironment Sleep-related deaths SIDS represents a subcategory of SUID
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Some Causes of Deaths that Occur Suddenly and Unexpectedly during Infancy
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
What is SIDS ICD-10 definition The sudden death of an infant
under one year of age which remains unexplained after the performance of a complete post-mortem investigation including o Performance of a complete autopsyo Examination of the death sceneo Review of the case history
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
SIDS FACTS The leading cause of death in
infants from 1 month to 1 year of age (post-neonatal infant mortality)
A diagnosis of exclusion The cause of death is assigned only after ruling out other causes
Peak time of occurrence1-4 months
Higher incidence in males No longer see a higher
frequency in colder months
Percent distribution of SIDS by age at death United States 2004-2006
AAP Task Force on SIDS SIDS and other sleep-related infant deaths expansion of recommendations for a safe infant sleeping environment Pediatrics 2011128(5)e1341-e1367
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
SIDS FACTS
Higher incidence in preterm and low birth weight infants
Associated witho Young maternal ageo Maternal smoking with pregnancyo Late or no prenatal care
2-3 times more common in African-American American Indian and Alaska Native children
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Triple Risk Model to Explain SIDS
Critical Developmental
Period
Vulnerable Infant Exogenous
Stressors(eg brainstem dysfunction)
First 6 months
bull Proneside sleep position
bull Soft beddingbull Overbundling
overheatingbull Bed sharing
Intrinsic risk factors
bull Smokingbull Prematuritybull Alcohol and
illicit drugsbull Hypoxiabull Growth
restriction
SIDS
Extrinsic risk factors
Adapted from Filiano and Kinney 1994
bull Bed sharing + smoking
andor alcohol
Modifiable Risk Factors
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Paterson DS Krous HF Kinney HC et al JAMA 2006
Serotonin receptor binding density lower in SIDS cases compared to controls
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Adapted from Kinney and Thach 2009
An Example of SIDS Pathogenesis
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
2016 AAP Recommendations Infant Sleep Safety Recommendations are to reduce
the risk of SIDS and sleep-related suffocation asphyxia and entrapment
Recommendations should be used consistently until 1 year of ageo Most epidemiological studies upon
which these recommendations are based include infants up to 1 year of age
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Strength of Recommendation
Scale based on the Strength of Recommendation Taxonomy (SORT)
A There is good quality patient-oriented evidence B There is inconsistent or limited quality patient-
oriented evidence C The recommendation is based on consensus
disease-oriented evidence usual practice expertopinion or case series for studies ofdiagnosis treatment prevention orscreening
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Recommendations Change as the Evidence Evolves Statistics and risk factors may change
o New risks emerge (eg side positioning)o Different levels of risk
Policies and procedures may changeo Better death scene investigationso Diagnostic shift
Unintended consequenceso Plagiocephaly development o New tummy time recommendations
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
2016 SIDS Task Force Policy Statement Level A Recommendations Back to sleep for every sleep Use a firm sleep surface Keep soft objects and loose bedding out of the crib Room-sharingmdashInfant on separate sleep surface Breastfeeding is recommended Consider offering a pacifier at nap time and bedtime Avoid smoke exposure during pregnancy and after birth Avoid alcohol and illicit drug use during pregnancy and
after birth
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
2016 SIDS Task Force Policy Statement Level A Recommendations Avoid overheating Pregnant women should receive regular prenatal care Do not use home cardiorespiratory monitors as a strategy
for reducing the risk of SIDS Health care professionals staff in newborn nurseries and
NICUs and child care providers should endorse the SIDS risk-reduction recommendations from birth
Media and manufacturers should follow safe-sleep guidelines in their messaging and advertising
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
2016 SIDS Task Force Policy Statement Level B Recommendations Avoid commercial devices that are inconsistent with
safe sleep recommendations Supervised awake tummy time is recommended to
facilitate development and to minimize development of positional plagiocephaly (flattening of skull)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
2016 SIDS Task Force Policy Statement Level C Recommendations Continue research and surveillance on the risk factors
causes and pathophysiological mechanisms of SIDS and other sleep-related infant deaths with the ultimate goal of eliminating these deaths entirely
There is no evidence to recommend swaddling as a strategy to reduce the risk of SIDS
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Correct Safe Sleep Environment
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
We Need to Move Beyond Back to Sleep
Shersquos on her back to sleep
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Sleep Position for Healthy Newborns
Skin-to-skin care is recommended for all mothers and newborns regardless of feeding or delivery method immediately following birtho Mom should be medically stable
awake and able to respond to baby When mother needs to sleep or take
care of other needs infant should be placed supine in a bassinet
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Sleep Position in Newborn Nursery Infants in the newborn nursery
and infants who are rooming in with their parents should be placed in the supine position as soon as they are ready to be placed in the bassinet o No evidence that placing infants
on the side during the first few hours of life promotes clearance of amniotic fluid and decreases the risk of aspiration
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Sleep Position and Reflux Infants with gastroesophageal (GE) reflux
should be kept supineo Unless the risk of death from complications
of GE reflux is greater than the risk of SIDS
Supine position does not increase the risk of choking and aspiration in infants with GE reflux o Protective airway mechanisms
Do NOT elevate the head of the infantrsquos cribo Ineffective in reducing GE refluxo Infant may slide to the foot of the cribmdashmay
compromise respiration
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
The Truth About Supine Sleep and Aspiration Ending the Fallacy Orientation of the Trachea to the Esophagus
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Title
Text
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Infant Sleep Location
Infants should sleep in parentsrsquo room close to parentsrsquo bed but on a separate surface designed for infants
Ideally for the first year of life but at least for the first 6 months
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Room-Share How Long Yoursquore Kidding Right
2011 ldquoall sleep recommendations are to be followed until 1 year of agerdquo
2016 ldquoroom-sharing without bed-sharinghellipideally until 1 year of age but at least for the first 6 monthsrdquo
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Supporting Data
3 case-control studies comparing sleeping in a separate room vs room-sharingo Tappin (Scotland) AOR 326 (95 CI 103-1035)
bull Protection is significant for smoker motherso Blair (England) AOR 1049 (95 CI 426-2581)
bull Protection is significant for both smoker and nonsmoker mothers
o New Zealand Cot Death study AOR 285(95 CI 204-385)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
More Recent Data
New Zealand SUDI studyo 64 protection with room-sharing AOR 036
(95 CI 019-071)
Estimate of 50 reduction is very conservative
None of the case-control studies stratify by age (months)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Why is Room-Sharing Protective
SIDSmdashfailure to arouse More small awakenings during the night
o Stirrings movement not fully awake Postulation protective effect from small awakenings Room-sharing facilitates breastfeeding
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Room-Sharing and Sleep Quality
Volkovich room-sharing vs solitary sleepo Room-sharing mothers with more sleep disturbanceso Infants with similar sleep quality
Mao Mindell room-sharing infantsmdashmore awakenings
Montgomery-Downs Doan sleep quality in breastfeeding mothers gt to formula feeding motherso Exclusive breastfeeding = 30 min more sleep
More study needed
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Insight Study (Paul 2017)
Sleep questionnaire at 4 9 12 and 30 monthso Sleep duration overnight behaviorso Compared early vs late independent infants
At 4 monthso Equal sleep durationo Early group had better sleep consolidationo Longest stretch 46 minutes
Paul IM Hohman EE Loken E et al Mother-infant room-sharing and sleep outcomes in the INSIGHT study Pediatrics 2017140(1)e20170122
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Insight Study (Paul 2017)
At 9 monthso Longer sleep duration (40 minnight) o Better consolidation (100 min)
At 30 monthso Longer sleep duration (45 minnight)
Room-sharing 4 times more likely to transition to bed sharing overnight
Paul IM Hohman EE Loken E et al Mother-infant room-sharing and sleep outcomes in the INSIGHT study Pediatrics 2017140(1)e20170122
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Insight Commentary (Hauck Moon)
Late room-sharing mean 7 hours longest sleep Is early consolidation desirable Differences related to bedtime routines
o Early bedtimeo Number of night feedso Feeding back to sleep
Focus on the routine not early separation
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Feeding the Baby at Night Acknowledgment that parents may fall
asleep while feeding babyo Safer to feed on bed than on sofa
couch or armchair if you might fall asleep
o No pillows sheets blankets or other items that could obstruct infant breathing or cause overheating should be in bed
o Return infant back to separate sleep surface as soon as parent awakens
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Say NO to Couches Sofas and Cushioned Armchairs Never place a baby for sleep on these surfaces Never sleep with a baby on these surfaces One of the MOST dangerous places for an infant
(OR 51-669)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
High-Risk Bed Sharing Situations Age lt4 months Preterm or low birth weight Smoked during pregnancy Bed sharer is current smoker (even if not
smoking in bed) Bed sharer has usedis using meds or
substances that could impair alertness or arousal
Bed sharer is not parent (including other children)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bedsharing in Low-Risk Breastfed Infants
Blair et al AOR 16 (95 CI 096-27) o Age lt14 weekso Parents No cigarettes or alcoholo Independent of feeding method
Carpenter et al AOR 51 (95 CI 23-114) o Age lt3 months o Parents did not smokeo Mother No alcohol or drugso Breastfed infants
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Independent Review (Dr Robert Platt)
Very small numbers of low-risk babieso 24 in Blairrsquos studyo 12 in Carpenterrsquos study
Does not believe that data support definitive differences in 2 studies
Some evidence of increased risk in this group but cannot say how large the increased risk is
Cannot conclude that bed sharing in this group is safe
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Unsafe Bedding NISP Trends 1993-2102
Shapiro-Mendoza CK Colson ER Willinger M Rybin DV Camperlengo L Corwin MJ Trends in infant bedding use National Infant Sleep Position study 1993ndash2010 Pediatrics 2015135(1)10-17
Decrease from 86 to 55 Rate of decline decreases
2001-10 835 for teen mothers Predictors of adjusted OR
gt15
o Young motherso Non-white race
ethnicityo Less than college
education
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Why Use Soft Bedding
ComfortWarmtho Extrapolation of own feelingso Misinterpret firm with taut
bull Soft + taut ne firm
Safetyo Blankets pillows rolls to prevent falls
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Soft Bedding for Older Infants
Many parents recognize soft bedding is a risk Increased complacency as baby gets older Soft bedding is THE most important risk factor for
infants 4-12 months old (Colvin 2015) Infants roll into bedding and cannot extract
themselves
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
To Swaddle or Not to Swaddle That is the Question Pros
o Calms the infant promotes sleep decreases number of awakenings
o Encourages use of the supine position
Conso Increased respiratory rate and
reduced functional residual lung capacity
o Exacerbates hip dysplasia if the hips are kept in extension and adduction
o ldquoLooserdquo swaddling becomes loose bedding
o Overheating especially if the head is covered or the infant has infection
o Effects on arousability to an external stimulus remain unclear (conflicting data) There may be minimal effects of routine swaddling on arousal
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Swaddling
There is insufficient evidence to recommend routine swaddling as a strategy to reduce the incidence of SIDS
Swaddling must be correctly applied to avoid the possible hazards
Swaddling does not reduce the necessity to follow recommended safe sleep practices Ambrogio Lorenzettis Madonna and Child (1319)
Wikipedia
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
McDonnell E Moon RY Infant deaths and injuries associated with wearable blankets swaddle wraps and swaddling J Pediatr 20141641152-1156
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
SwaddlingmdashMore Questionshellip
Pease 2016 Pediatrics Pooled OR = 138
o Prone = 1299 o Side = 316o Supine = 193
Increased risk with age Limitations
o Heterogeneity definitions other risk factorsPease AS Fleming PJ Hauck FR et al Swaddling and the risk of sudden infant death syndrome a meta-analysis Pediatrics 2016137(6)e20153
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
wwwhealthychildrenorg
Swaddling (wrapping a light blanket snuggly around a baby) may help calm a crying baby If you swaddle your baby be sure to place him on his back to sleep Stop swaddling your baby when he starts to roll
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers
AAP recommendation Consider offering a pacifier at nap time and bedtime
Studies consistently demonstrate a protective effect of pacifiers on SIDS
Mechanism unknowno Dislodge within 15 to 60 minuteso Decreased arousal threshold
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers and Breastfeeding Well-designed trials
o 2 found no association among term infants
o 1 found no association among preterm infants
o 1 found slightly decreased breastfeeding duration at one month if pacifier introduced in first week of life but NO difference if pacifier introduced after one month
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Baby Friendly USA Pacifiers
Breastfeeding babies should not be given pacifiers by the staff of the facility with the exception of o Limited use to decrease pain during procedures when
the baby cannot safely be held or breastfed (pacifiers used should be discarded after these procedures)
o Babies who are being tube-fed in NICUo Other rare specific medical reasons
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Addressing Sleep Deprivation
Give parents tools to cope with fussy babies
Sleep-deprived parents may make poor judgments
Make use of tools o Swaddling side carrying
shushing swinging and sucking
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Overcoming Barriers to Change What Parents are Sayinghellip
Prone positioning fear of choking Baby sleeps ldquobetterrdquo on stomach Soft things are safer for the baby SIDS is ldquoGodrsquos willrdquo Why bother Recommendations keep changing
anyway Vigilance sleep with baby for protection
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Factors Associated With Choice of Infant Sleep Position 3300 mothers from 32 hospitals 77 usually use supine position 49 exclusive use supine position Most likely to use prone
o African-American motherso Mothers with lt high school educationo Lack of perceived controlo Personal attitudesocietal norms
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
A continuum starting in childhoodo Secondary school baby sitting classes
Pre-pregnancy Pregnancyprenatal education
o Prior to baby showerhellipldquowrong giftsrdquo In-hospital education and modeling
o Include family friends baby sitters Re-enforcement in the doctorrsquos office
o Especially between 1 to 4 months Grandparents They hold great power The general public (day cares religious leaders)
A Lifetime of Infant Sleep Safety
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Chart1
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
14
139
13
13
12
13
117
17
103
269
087
386
074
353
077
531
072
557
067
644
062
666
056
716
057
711
053
728
056
701
055
722
055
757
057
703
055
721
054
741
051
728
048
042
04
039
Sheet1
Sheet1
ampA
Page ampP
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
Sheet2
Pre-AAP recommendation Post-AAP RecommendationBack to SleepSafe to Sleep Campaign
Sheet3
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Infant Sleep Safety
Requires a consistent and repetitive message in the community to prevent accidental deaths
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Safe Sleep Nurse Modeling
People trust nurses Whatever the nurse does must
be correct and it will be imitated in the home
Fact supine positioning in the nursery can almost DOUBLE its use in the home
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Physician Advocacy
Srivatsa 1997 HCP education to new familieshellip34 reduction in prone sleeping
Eron 2009 Study of Central NY state physicianshellip30 identified incorrect safest sleep positionhellip30 do not discuss with families
Colson 2009 Only 13 mothers advised by MD to use supine positionhellip3 times more likely to position the baby properly
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Healthcare Provider Advice to New Mothers Safe Sleep
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Chart1
Column1
[]
[]
[]
55
25
20
Sheet1
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Mason Clinical Peds 713
Bundled interventiono Nursing education policy model behavior safe sleep
video posters in rooms declaration of safe sleep practice
Safe sleep environment uarr from 25 to 58 Intention in home 95 supine none ldquoco-sleepingrdquo
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bundled Intervention = Behavior Change
QUESTION GROUP p-value
ISS Study NISP
Behavior Questions n = 490 n = 1046
Baby routinely placed to sleep on back 925 73 lt 0001
Baby routinely sleeps in bassinetcrib 995 71 lt 00001
Baby sleeps under a thin sheet 992 86 lt 0001
Baby given a pacifier for sleep 741 84 lt 0001Goodstein MH Bell T Krugman SD Improving infant sleep safety through a comprehensive hospital-based program Clinical Pediatrics 201554(3)212-221
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
o Baseline Safe sleep 49 of 264 infants o Post 312 of 234 infants (P lt 001) o Extra blankets most common o Baseline 77 vs 44 post-intervention o Mean number of unsafe items reduced by 50 (P lt 001)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Washington DC
2 urban DC nurseries 26 did not believe or unsure that infant positioning
was associated with SIDS Top 3 factors influencing sleep position
o 56 PERSONAL PREFERENCE Why non-supine Clinical experience (25)
o Increase risk aspirationo Decrease sleep and comfort
Bartow KL Nursesrsquo knowledge and adherence to sudden infant death syndrome prevention guidelines Pediatr Nurs 201642(1)7-13
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
TodaysBaby QI Safe Sleep Teaching
QI intervention median = 160 days Mothers reported receiving information 72 to 95
(increase of 24-57) 94 babies observed supine (plus 24) 88 infants in safe sleep environment
o Increase of 33 Gains maintained up to 12 months
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Social Media and Risk-Reduction Training Study (SMART) Cluster randomization 4 groups Safe sleep or breast feeding education Nursing QI and social media (mobile health) N = 1600 1263 responses (79) Safe sleep NQI and MHealth
o Supine sleep 925 o Room-sharing 859o No soft bedding 819o Pacifier use 762
Moon RY Hauck FR Colson ER et al The effect of nursing quality improvement and mobile health interventions on infant sleep practices a randomized clinical trial JAMA 2017318(4)351-359
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Hospital Initiative ComponentswwwcribsforkidsorgHospitalInitiativeToolkit INTRODUCTORY LETTER HOSPITAL INITIATIVE TOOL KIT
INSTRUCTIONS ORGANIZATIONAL CHART HOSPITAL POLICY ACKNOWLEDGMENT FORM (Engl amp
Span) SAFE SLEEP EDUCATIONAL FLIP CHART
NONCOMPLIANCE WAIVER (Engl amp Span)
NURSING EDUCATION MODULE
SAFE SLEEP POSTERS DOOR HANGERS (Engl amp Span) GRADUATION CERTIFICATE SAMPLE LETTER TO HOSPITALS SAMPLE LETTER TO PROVIDERS INFANT SAFE SLEEP BROCHURES
(Engl amp Span) PRESS KIT
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
All materials available on-lineo No major costs to the hospital
Easy on-line access for documentation
NO FEE FOR PARTICIPATION
wwwCribsforKidsorgHospitalInitiative
Tiffany Price (tpricecribsforkidsorg)
The National Safe Sleep Hospital Certification Program
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
TNmdash25 reduction in infant sleep-related deaths in 2 years
SDmdashOver 7915 Pack lsquon Plays distributed since 2012 Infant mortality rate decreased from 86 (2012) to 48 (2016)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
2009 to 2015 38 decrease in infant mortality Decreased from 135 to 84 per 1000 SUID decreased gt50 Decrease in racial disparityhttphealthybabiesbaltimorecomhome
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
And Finallyhellip
Health care providers should have open frank nonjudgmental conversations with families about their sleep practices
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Encouraging Parents to Take Action
According to the Social Learning Theory parents are more likely to recall and comply with instructions when
the health care provider
Uses a positive tone Provides adequate information Allows the parent to ask most of the questions
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Motivational Interviewing
ldquoa collaborative goal-oriented style of communication with particular attention to the language of changerdquo
o Strengthen personal motivation and commitment to a specific goal
o Explore onersquos reasons for change (barriers)o Patient generates own solutions
bull More likely to feel realisticbull Planting seeds of change
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Impact of Eliminating Sleep-Related Deaths
Every week we lose 70 children which is equivalent to 4 kindergarten classrooms
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Thank You
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Contact Information
mgoodsteinwellspanorg
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Visit Pediatric Care Online today for additional information on this and other topics
httppediatriccaresolutionsaaporgPediatric Care Online is a convenient electronic resource for immediate expert help with
virtually every pediatric clinical information need with must-have resources that are included in a comprehensive reference library and time-saving clinical tools
Donrsquot have a subscription to PCOThen take advantage of a free trial today
Call Mead Johnson Nutrition at 888363-2362 orfor more information go to
httppediatriccaresolutionsaaporgSSFree_Trialaspx
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
IMR over time Finland vs US
Slide Number 1
Disclaimer
Objectives for Todayrsquos Talk
Infant Mortality Rates for the Five Leading Causes of Infant Death in the United States 2005 and 2011
US Post-Neonatal Mortality 2015
FACT
What is SUID or SUDI
Some Causes of Deaths that Occur Suddenly and Unexpectedly during Infancy
What is SIDS
SIDS FACTS
SIDS FACTS
Triple Risk Model to Explain SIDS
Paterson DS Krous HF Kinney HC et al JAMA 2006
An Example of SIDS Pathogenesis
2016 AAP Recommendations Infant Sleep Safety
Strength of Recommendation
Recommendations Change as the Evidence Evolves
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
Correct Safe Sleep Environment
We Need to Move Beyond Back to Sleep
Sleep Position for Healthy Newborns
Sleep Position in Newborn Nursery
Sleep Position and Reflux
The Truth About Supine Sleep and Aspiration Ending the Fallacy
Title
Infant Sleep Location
Room-Share How Long Yoursquore Kidding Right
Supporting Data
More Recent Data
Why is Room-Sharing Protective
Room-Sharing and Sleep Quality
Insight Study (Paul 2017)
Insight Study (Paul 2017)
Insight Commentary (Hauck Moon)
Feeding the Baby at Night
Say NO to Couches Sofas and Cushioned Armchairs
High-Risk Bed Sharing Situations
Bedsharing in Low-Risk Breastfed Infants
Independent Review (Dr Robert Platt)
Bed Sharing
Bed Sharing
Bed Sharing with Overlay
Bed Sharing with Overlay
Bed Sharing with Overlay
Couch Sleeping
Couch Sleeping
Couch Sleeping
Unsafe Bedding NISP Trends 1993-2102
Why Use Soft Bedding
Soft Bedding for Older Infants
To Swaddle or Not to Swaddle That is the Question
Swaddling
SwaddlingmdashIs it Safe
SwaddlingmdashMore Questionshellip
wwwhealthychildrenorg
Pacifiers
Pacifiers and Breastfeeding
Baby Friendly USA Pacifiers
Addressing Sleep Deprivation
Overcoming Barriers to Change What Parents are Sayinghellip
Factors Associated With Choice of Infant Sleep Position
Slide Number 65
What is Working
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Infant Sleep Safety
Safe Sleep Nurse Modeling
Physician Advocacy
Healthcare Provider Advice to New Mothers Safe Sleep
Mason Clinical Peds 713
Bundled Intervention = Behavior Change
Hospital Unsafe Sleep Persists
Washington DC
TodaysBaby QI Safe Sleep Teaching
TodaysBaby QI Safe Sleep Teaching
Social Media and Risk-Reduction Training Study (SMART)
The National Safe Sleep Hospital Certification Program
Coordinated Education Efforts Work
Coordinated Education Efforts Work
And Finallyhellip
Encouraging Parents to Take Action
Motivational Interviewing
Impact of Eliminating Sleep-Related Deaths
Thank You
Contact Information
Slide Number 89
IMR over time Finland vs US
Column1
correct advice
55
incorrect advice
25
no advice
20
correct advice
incorrect advice
no advice
SIDS Rate
Percent Back Sleeping
1988
14
1989
139
1990
13
1991
13
1992
12
13
1993
117
17
1994
103
269
1995
087
386
1996
074
353
1997
077
531
1998
072
557
1999
067
644
2000
062
666
2001
056
716
2002
057
711
2003
053
728
2004
056
701
2005
055
722
2006
055
757
2007
057
703
2008
055
721
2009
054
741
2010
051
728
2011
048
2012
042
2013
04
2014
039
httpwwwcdcgovNCHSdatanvsrnvsr58nvsr58_19pdf
Xu JQ Kochanek KD Murphy SL Tejada-Vera B Deaths Final data for
2007
National vital statistics reports vol 58 no 19 Hyattsville MD
National Center for Health Statistics 2010
1988
1988
1989
1989
1990
1990
1991
1991
1992
1992
1993
1993
1994
1994
1995
1995
1996
1996
1997
1997
1998
1998
1999
1999
2000
2000
2001
2001
2002
2002
2003
2003
2004
2004
2005
2005
2006
2006
2007
2007
2008
2008
2009
2009
2010
2010
2011
2012
2013
2014
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
What is SUID or SUDI
Sudden Unexpected Infant Death o Occurs in a previously healthy infanto Can be explained or unexplained
o Most unobserved during sleepenvironment Sleep-related deaths SIDS represents a subcategory of SUID
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Some Causes of Deaths that Occur Suddenly and Unexpectedly during Infancy
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
What is SIDS ICD-10 definition The sudden death of an infant
under one year of age which remains unexplained after the performance of a complete post-mortem investigation including o Performance of a complete autopsyo Examination of the death sceneo Review of the case history
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
SIDS FACTS The leading cause of death in
infants from 1 month to 1 year of age (post-neonatal infant mortality)
A diagnosis of exclusion The cause of death is assigned only after ruling out other causes
Peak time of occurrence1-4 months
Higher incidence in males No longer see a higher
frequency in colder months
Percent distribution of SIDS by age at death United States 2004-2006
AAP Task Force on SIDS SIDS and other sleep-related infant deaths expansion of recommendations for a safe infant sleeping environment Pediatrics 2011128(5)e1341-e1367
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
SIDS FACTS
Higher incidence in preterm and low birth weight infants
Associated witho Young maternal ageo Maternal smoking with pregnancyo Late or no prenatal care
2-3 times more common in African-American American Indian and Alaska Native children
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Triple Risk Model to Explain SIDS
Critical Developmental
Period
Vulnerable Infant Exogenous
Stressors(eg brainstem dysfunction)
First 6 months
bull Proneside sleep position
bull Soft beddingbull Overbundling
overheatingbull Bed sharing
Intrinsic risk factors
bull Smokingbull Prematuritybull Alcohol and
illicit drugsbull Hypoxiabull Growth
restriction
SIDS
Extrinsic risk factors
Adapted from Filiano and Kinney 1994
bull Bed sharing + smoking
andor alcohol
Modifiable Risk Factors
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Paterson DS Krous HF Kinney HC et al JAMA 2006
Serotonin receptor binding density lower in SIDS cases compared to controls
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Adapted from Kinney and Thach 2009
An Example of SIDS Pathogenesis
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
2016 AAP Recommendations Infant Sleep Safety Recommendations are to reduce
the risk of SIDS and sleep-related suffocation asphyxia and entrapment
Recommendations should be used consistently until 1 year of ageo Most epidemiological studies upon
which these recommendations are based include infants up to 1 year of age
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Strength of Recommendation
Scale based on the Strength of Recommendation Taxonomy (SORT)
A There is good quality patient-oriented evidence B There is inconsistent or limited quality patient-
oriented evidence C The recommendation is based on consensus
disease-oriented evidence usual practice expertopinion or case series for studies ofdiagnosis treatment prevention orscreening
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Recommendations Change as the Evidence Evolves Statistics and risk factors may change
o New risks emerge (eg side positioning)o Different levels of risk
Policies and procedures may changeo Better death scene investigationso Diagnostic shift
Unintended consequenceso Plagiocephaly development o New tummy time recommendations
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
2016 SIDS Task Force Policy Statement Level A Recommendations Back to sleep for every sleep Use a firm sleep surface Keep soft objects and loose bedding out of the crib Room-sharingmdashInfant on separate sleep surface Breastfeeding is recommended Consider offering a pacifier at nap time and bedtime Avoid smoke exposure during pregnancy and after birth Avoid alcohol and illicit drug use during pregnancy and
after birth
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
2016 SIDS Task Force Policy Statement Level A Recommendations Avoid overheating Pregnant women should receive regular prenatal care Do not use home cardiorespiratory monitors as a strategy
for reducing the risk of SIDS Health care professionals staff in newborn nurseries and
NICUs and child care providers should endorse the SIDS risk-reduction recommendations from birth
Media and manufacturers should follow safe-sleep guidelines in their messaging and advertising
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
2016 SIDS Task Force Policy Statement Level B Recommendations Avoid commercial devices that are inconsistent with
safe sleep recommendations Supervised awake tummy time is recommended to
facilitate development and to minimize development of positional plagiocephaly (flattening of skull)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
2016 SIDS Task Force Policy Statement Level C Recommendations Continue research and surveillance on the risk factors
causes and pathophysiological mechanisms of SIDS and other sleep-related infant deaths with the ultimate goal of eliminating these deaths entirely
There is no evidence to recommend swaddling as a strategy to reduce the risk of SIDS
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Correct Safe Sleep Environment
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
We Need to Move Beyond Back to Sleep
Shersquos on her back to sleep
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Sleep Position for Healthy Newborns
Skin-to-skin care is recommended for all mothers and newborns regardless of feeding or delivery method immediately following birtho Mom should be medically stable
awake and able to respond to baby When mother needs to sleep or take
care of other needs infant should be placed supine in a bassinet
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Sleep Position in Newborn Nursery Infants in the newborn nursery
and infants who are rooming in with their parents should be placed in the supine position as soon as they are ready to be placed in the bassinet o No evidence that placing infants
on the side during the first few hours of life promotes clearance of amniotic fluid and decreases the risk of aspiration
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Sleep Position and Reflux Infants with gastroesophageal (GE) reflux
should be kept supineo Unless the risk of death from complications
of GE reflux is greater than the risk of SIDS
Supine position does not increase the risk of choking and aspiration in infants with GE reflux o Protective airway mechanisms
Do NOT elevate the head of the infantrsquos cribo Ineffective in reducing GE refluxo Infant may slide to the foot of the cribmdashmay
compromise respiration
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
The Truth About Supine Sleep and Aspiration Ending the Fallacy Orientation of the Trachea to the Esophagus
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Title
Text
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Infant Sleep Location
Infants should sleep in parentsrsquo room close to parentsrsquo bed but on a separate surface designed for infants
Ideally for the first year of life but at least for the first 6 months
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Room-Share How Long Yoursquore Kidding Right
2011 ldquoall sleep recommendations are to be followed until 1 year of agerdquo
2016 ldquoroom-sharing without bed-sharinghellipideally until 1 year of age but at least for the first 6 monthsrdquo
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Supporting Data
3 case-control studies comparing sleeping in a separate room vs room-sharingo Tappin (Scotland) AOR 326 (95 CI 103-1035)
bull Protection is significant for smoker motherso Blair (England) AOR 1049 (95 CI 426-2581)
bull Protection is significant for both smoker and nonsmoker mothers
o New Zealand Cot Death study AOR 285(95 CI 204-385)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
More Recent Data
New Zealand SUDI studyo 64 protection with room-sharing AOR 036
(95 CI 019-071)
Estimate of 50 reduction is very conservative
None of the case-control studies stratify by age (months)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Why is Room-Sharing Protective
SIDSmdashfailure to arouse More small awakenings during the night
o Stirrings movement not fully awake Postulation protective effect from small awakenings Room-sharing facilitates breastfeeding
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Room-Sharing and Sleep Quality
Volkovich room-sharing vs solitary sleepo Room-sharing mothers with more sleep disturbanceso Infants with similar sleep quality
Mao Mindell room-sharing infantsmdashmore awakenings
Montgomery-Downs Doan sleep quality in breastfeeding mothers gt to formula feeding motherso Exclusive breastfeeding = 30 min more sleep
More study needed
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Insight Study (Paul 2017)
Sleep questionnaire at 4 9 12 and 30 monthso Sleep duration overnight behaviorso Compared early vs late independent infants
At 4 monthso Equal sleep durationo Early group had better sleep consolidationo Longest stretch 46 minutes
Paul IM Hohman EE Loken E et al Mother-infant room-sharing and sleep outcomes in the INSIGHT study Pediatrics 2017140(1)e20170122
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Insight Study (Paul 2017)
At 9 monthso Longer sleep duration (40 minnight) o Better consolidation (100 min)
At 30 monthso Longer sleep duration (45 minnight)
Room-sharing 4 times more likely to transition to bed sharing overnight
Paul IM Hohman EE Loken E et al Mother-infant room-sharing and sleep outcomes in the INSIGHT study Pediatrics 2017140(1)e20170122
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Insight Commentary (Hauck Moon)
Late room-sharing mean 7 hours longest sleep Is early consolidation desirable Differences related to bedtime routines
o Early bedtimeo Number of night feedso Feeding back to sleep
Focus on the routine not early separation
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Feeding the Baby at Night Acknowledgment that parents may fall
asleep while feeding babyo Safer to feed on bed than on sofa
couch or armchair if you might fall asleep
o No pillows sheets blankets or other items that could obstruct infant breathing or cause overheating should be in bed
o Return infant back to separate sleep surface as soon as parent awakens
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Say NO to Couches Sofas and Cushioned Armchairs Never place a baby for sleep on these surfaces Never sleep with a baby on these surfaces One of the MOST dangerous places for an infant
(OR 51-669)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
High-Risk Bed Sharing Situations Age lt4 months Preterm or low birth weight Smoked during pregnancy Bed sharer is current smoker (even if not
smoking in bed) Bed sharer has usedis using meds or
substances that could impair alertness or arousal
Bed sharer is not parent (including other children)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bedsharing in Low-Risk Breastfed Infants
Blair et al AOR 16 (95 CI 096-27) o Age lt14 weekso Parents No cigarettes or alcoholo Independent of feeding method
Carpenter et al AOR 51 (95 CI 23-114) o Age lt3 months o Parents did not smokeo Mother No alcohol or drugso Breastfed infants
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Independent Review (Dr Robert Platt)
Very small numbers of low-risk babieso 24 in Blairrsquos studyo 12 in Carpenterrsquos study
Does not believe that data support definitive differences in 2 studies
Some evidence of increased risk in this group but cannot say how large the increased risk is
Cannot conclude that bed sharing in this group is safe
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Unsafe Bedding NISP Trends 1993-2102
Shapiro-Mendoza CK Colson ER Willinger M Rybin DV Camperlengo L Corwin MJ Trends in infant bedding use National Infant Sleep Position study 1993ndash2010 Pediatrics 2015135(1)10-17
Decrease from 86 to 55 Rate of decline decreases
2001-10 835 for teen mothers Predictors of adjusted OR
gt15
o Young motherso Non-white race
ethnicityo Less than college
education
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Why Use Soft Bedding
ComfortWarmtho Extrapolation of own feelingso Misinterpret firm with taut
bull Soft + taut ne firm
Safetyo Blankets pillows rolls to prevent falls
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Soft Bedding for Older Infants
Many parents recognize soft bedding is a risk Increased complacency as baby gets older Soft bedding is THE most important risk factor for
infants 4-12 months old (Colvin 2015) Infants roll into bedding and cannot extract
themselves
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
To Swaddle or Not to Swaddle That is the Question Pros
o Calms the infant promotes sleep decreases number of awakenings
o Encourages use of the supine position
Conso Increased respiratory rate and
reduced functional residual lung capacity
o Exacerbates hip dysplasia if the hips are kept in extension and adduction
o ldquoLooserdquo swaddling becomes loose bedding
o Overheating especially if the head is covered or the infant has infection
o Effects on arousability to an external stimulus remain unclear (conflicting data) There may be minimal effects of routine swaddling on arousal
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Swaddling
There is insufficient evidence to recommend routine swaddling as a strategy to reduce the incidence of SIDS
Swaddling must be correctly applied to avoid the possible hazards
Swaddling does not reduce the necessity to follow recommended safe sleep practices Ambrogio Lorenzettis Madonna and Child (1319)
Wikipedia
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
McDonnell E Moon RY Infant deaths and injuries associated with wearable blankets swaddle wraps and swaddling J Pediatr 20141641152-1156
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
SwaddlingmdashMore Questionshellip
Pease 2016 Pediatrics Pooled OR = 138
o Prone = 1299 o Side = 316o Supine = 193
Increased risk with age Limitations
o Heterogeneity definitions other risk factorsPease AS Fleming PJ Hauck FR et al Swaddling and the risk of sudden infant death syndrome a meta-analysis Pediatrics 2016137(6)e20153
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
wwwhealthychildrenorg
Swaddling (wrapping a light blanket snuggly around a baby) may help calm a crying baby If you swaddle your baby be sure to place him on his back to sleep Stop swaddling your baby when he starts to roll
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers
AAP recommendation Consider offering a pacifier at nap time and bedtime
Studies consistently demonstrate a protective effect of pacifiers on SIDS
Mechanism unknowno Dislodge within 15 to 60 minuteso Decreased arousal threshold
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers and Breastfeeding Well-designed trials
o 2 found no association among term infants
o 1 found no association among preterm infants
o 1 found slightly decreased breastfeeding duration at one month if pacifier introduced in first week of life but NO difference if pacifier introduced after one month
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Baby Friendly USA Pacifiers
Breastfeeding babies should not be given pacifiers by the staff of the facility with the exception of o Limited use to decrease pain during procedures when
the baby cannot safely be held or breastfed (pacifiers used should be discarded after these procedures)
o Babies who are being tube-fed in NICUo Other rare specific medical reasons
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Addressing Sleep Deprivation
Give parents tools to cope with fussy babies
Sleep-deprived parents may make poor judgments
Make use of tools o Swaddling side carrying
shushing swinging and sucking
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Overcoming Barriers to Change What Parents are Sayinghellip
Prone positioning fear of choking Baby sleeps ldquobetterrdquo on stomach Soft things are safer for the baby SIDS is ldquoGodrsquos willrdquo Why bother Recommendations keep changing
anyway Vigilance sleep with baby for protection
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Factors Associated With Choice of Infant Sleep Position 3300 mothers from 32 hospitals 77 usually use supine position 49 exclusive use supine position Most likely to use prone
o African-American motherso Mothers with lt high school educationo Lack of perceived controlo Personal attitudesocietal norms
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
A continuum starting in childhoodo Secondary school baby sitting classes
Pre-pregnancy Pregnancyprenatal education
o Prior to baby showerhellipldquowrong giftsrdquo In-hospital education and modeling
o Include family friends baby sitters Re-enforcement in the doctorrsquos office
o Especially between 1 to 4 months Grandparents They hold great power The general public (day cares religious leaders)
A Lifetime of Infant Sleep Safety
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Chart1
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
14
139
13
13
12
13
117
17
103
269
087
386
074
353
077
531
072
557
067
644
062
666
056
716
057
711
053
728
056
701
055
722
055
757
057
703
055
721
054
741
051
728
048
042
04
039
Sheet1
Sheet1
ampA
Page ampP
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
Sheet2
Pre-AAP recommendation Post-AAP RecommendationBack to SleepSafe to Sleep Campaign
Sheet3
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Infant Sleep Safety
Requires a consistent and repetitive message in the community to prevent accidental deaths
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Safe Sleep Nurse Modeling
People trust nurses Whatever the nurse does must
be correct and it will be imitated in the home
Fact supine positioning in the nursery can almost DOUBLE its use in the home
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Physician Advocacy
Srivatsa 1997 HCP education to new familieshellip34 reduction in prone sleeping
Eron 2009 Study of Central NY state physicianshellip30 identified incorrect safest sleep positionhellip30 do not discuss with families
Colson 2009 Only 13 mothers advised by MD to use supine positionhellip3 times more likely to position the baby properly
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Healthcare Provider Advice to New Mothers Safe Sleep
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Chart1
Column1
[]
[]
[]
55
25
20
Sheet1
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Mason Clinical Peds 713
Bundled interventiono Nursing education policy model behavior safe sleep
video posters in rooms declaration of safe sleep practice
Safe sleep environment uarr from 25 to 58 Intention in home 95 supine none ldquoco-sleepingrdquo
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bundled Intervention = Behavior Change
QUESTION GROUP p-value
ISS Study NISP
Behavior Questions n = 490 n = 1046
Baby routinely placed to sleep on back 925 73 lt 0001
Baby routinely sleeps in bassinetcrib 995 71 lt 00001
Baby sleeps under a thin sheet 992 86 lt 0001
Baby given a pacifier for sleep 741 84 lt 0001Goodstein MH Bell T Krugman SD Improving infant sleep safety through a comprehensive hospital-based program Clinical Pediatrics 201554(3)212-221
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
o Baseline Safe sleep 49 of 264 infants o Post 312 of 234 infants (P lt 001) o Extra blankets most common o Baseline 77 vs 44 post-intervention o Mean number of unsafe items reduced by 50 (P lt 001)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Washington DC
2 urban DC nurseries 26 did not believe or unsure that infant positioning
was associated with SIDS Top 3 factors influencing sleep position
o 56 PERSONAL PREFERENCE Why non-supine Clinical experience (25)
o Increase risk aspirationo Decrease sleep and comfort
Bartow KL Nursesrsquo knowledge and adherence to sudden infant death syndrome prevention guidelines Pediatr Nurs 201642(1)7-13
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
TodaysBaby QI Safe Sleep Teaching
QI intervention median = 160 days Mothers reported receiving information 72 to 95
(increase of 24-57) 94 babies observed supine (plus 24) 88 infants in safe sleep environment
o Increase of 33 Gains maintained up to 12 months
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Social Media and Risk-Reduction Training Study (SMART) Cluster randomization 4 groups Safe sleep or breast feeding education Nursing QI and social media (mobile health) N = 1600 1263 responses (79) Safe sleep NQI and MHealth
o Supine sleep 925 o Room-sharing 859o No soft bedding 819o Pacifier use 762
Moon RY Hauck FR Colson ER et al The effect of nursing quality improvement and mobile health interventions on infant sleep practices a randomized clinical trial JAMA 2017318(4)351-359
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Hospital Initiative ComponentswwwcribsforkidsorgHospitalInitiativeToolkit INTRODUCTORY LETTER HOSPITAL INITIATIVE TOOL KIT
INSTRUCTIONS ORGANIZATIONAL CHART HOSPITAL POLICY ACKNOWLEDGMENT FORM (Engl amp
Span) SAFE SLEEP EDUCATIONAL FLIP CHART
NONCOMPLIANCE WAIVER (Engl amp Span)
NURSING EDUCATION MODULE
SAFE SLEEP POSTERS DOOR HANGERS (Engl amp Span) GRADUATION CERTIFICATE SAMPLE LETTER TO HOSPITALS SAMPLE LETTER TO PROVIDERS INFANT SAFE SLEEP BROCHURES
(Engl amp Span) PRESS KIT
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
All materials available on-lineo No major costs to the hospital
Easy on-line access for documentation
NO FEE FOR PARTICIPATION
wwwCribsforKidsorgHospitalInitiative
Tiffany Price (tpricecribsforkidsorg)
The National Safe Sleep Hospital Certification Program
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
TNmdash25 reduction in infant sleep-related deaths in 2 years
SDmdashOver 7915 Pack lsquon Plays distributed since 2012 Infant mortality rate decreased from 86 (2012) to 48 (2016)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
2009 to 2015 38 decrease in infant mortality Decreased from 135 to 84 per 1000 SUID decreased gt50 Decrease in racial disparityhttphealthybabiesbaltimorecomhome
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
And Finallyhellip
Health care providers should have open frank nonjudgmental conversations with families about their sleep practices
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Encouraging Parents to Take Action
According to the Social Learning Theory parents are more likely to recall and comply with instructions when
the health care provider
Uses a positive tone Provides adequate information Allows the parent to ask most of the questions
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Motivational Interviewing
ldquoa collaborative goal-oriented style of communication with particular attention to the language of changerdquo
o Strengthen personal motivation and commitment to a specific goal
o Explore onersquos reasons for change (barriers)o Patient generates own solutions
bull More likely to feel realisticbull Planting seeds of change
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Impact of Eliminating Sleep-Related Deaths
Every week we lose 70 children which is equivalent to 4 kindergarten classrooms
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Thank You
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Contact Information
mgoodsteinwellspanorg
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Visit Pediatric Care Online today for additional information on this and other topics
httppediatriccaresolutionsaaporgPediatric Care Online is a convenient electronic resource for immediate expert help with
virtually every pediatric clinical information need with must-have resources that are included in a comprehensive reference library and time-saving clinical tools
Donrsquot have a subscription to PCOThen take advantage of a free trial today
Call Mead Johnson Nutrition at 888363-2362 orfor more information go to
httppediatriccaresolutionsaaporgSSFree_Trialaspx
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
IMR over time Finland vs US
Slide Number 1
Disclaimer
Objectives for Todayrsquos Talk
Infant Mortality Rates for the Five Leading Causes of Infant Death in the United States 2005 and 2011
US Post-Neonatal Mortality 2015
FACT
What is SUID or SUDI
Some Causes of Deaths that Occur Suddenly and Unexpectedly during Infancy
What is SIDS
SIDS FACTS
SIDS FACTS
Triple Risk Model to Explain SIDS
Paterson DS Krous HF Kinney HC et al JAMA 2006
An Example of SIDS Pathogenesis
2016 AAP Recommendations Infant Sleep Safety
Strength of Recommendation
Recommendations Change as the Evidence Evolves
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
Correct Safe Sleep Environment
We Need to Move Beyond Back to Sleep
Sleep Position for Healthy Newborns
Sleep Position in Newborn Nursery
Sleep Position and Reflux
The Truth About Supine Sleep and Aspiration Ending the Fallacy
Title
Infant Sleep Location
Room-Share How Long Yoursquore Kidding Right
Supporting Data
More Recent Data
Why is Room-Sharing Protective
Room-Sharing and Sleep Quality
Insight Study (Paul 2017)
Insight Study (Paul 2017)
Insight Commentary (Hauck Moon)
Feeding the Baby at Night
Say NO to Couches Sofas and Cushioned Armchairs
High-Risk Bed Sharing Situations
Bedsharing in Low-Risk Breastfed Infants
Independent Review (Dr Robert Platt)
Bed Sharing
Bed Sharing
Bed Sharing with Overlay
Bed Sharing with Overlay
Bed Sharing with Overlay
Couch Sleeping
Couch Sleeping
Couch Sleeping
Unsafe Bedding NISP Trends 1993-2102
Why Use Soft Bedding
Soft Bedding for Older Infants
To Swaddle or Not to Swaddle That is the Question
Swaddling
SwaddlingmdashIs it Safe
SwaddlingmdashMore Questionshellip
wwwhealthychildrenorg
Pacifiers
Pacifiers and Breastfeeding
Baby Friendly USA Pacifiers
Addressing Sleep Deprivation
Overcoming Barriers to Change What Parents are Sayinghellip
Factors Associated With Choice of Infant Sleep Position
Slide Number 65
What is Working
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Infant Sleep Safety
Safe Sleep Nurse Modeling
Physician Advocacy
Healthcare Provider Advice to New Mothers Safe Sleep
Mason Clinical Peds 713
Bundled Intervention = Behavior Change
Hospital Unsafe Sleep Persists
Washington DC
TodaysBaby QI Safe Sleep Teaching
TodaysBaby QI Safe Sleep Teaching
Social Media and Risk-Reduction Training Study (SMART)
The National Safe Sleep Hospital Certification Program
Coordinated Education Efforts Work
Coordinated Education Efforts Work
And Finallyhellip
Encouraging Parents to Take Action
Motivational Interviewing
Impact of Eliminating Sleep-Related Deaths
Thank You
Contact Information
Slide Number 89
IMR over time Finland vs US
Column1
correct advice
55
incorrect advice
25
no advice
20
correct advice
incorrect advice
no advice
SIDS Rate
Percent Back Sleeping
1988
14
1989
139
1990
13
1991
13
1992
12
13
1993
117
17
1994
103
269
1995
087
386
1996
074
353
1997
077
531
1998
072
557
1999
067
644
2000
062
666
2001
056
716
2002
057
711
2003
053
728
2004
056
701
2005
055
722
2006
055
757
2007
057
703
2008
055
721
2009
054
741
2010
051
728
2011
048
2012
042
2013
04
2014
039
httpwwwcdcgovNCHSdatanvsrnvsr58nvsr58_19pdf
Xu JQ Kochanek KD Murphy SL Tejada-Vera B Deaths Final data for
2007
National vital statistics reports vol 58 no 19 Hyattsville MD
National Center for Health Statistics 2010
1988
1988
1989
1989
1990
1990
1991
1991
1992
1992
1993
1993
1994
1994
1995
1995
1996
1996
1997
1997
1998
1998
1999
1999
2000
2000
2001
2001
2002
2002
2003
2003
2004
2004
2005
2005
2006
2006
2007
2007
2008
2008
2009
2009
2010
2010
2011
2012
2013
2014
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Some Causes of Deaths that Occur Suddenly and Unexpectedly during Infancy
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
What is SIDS ICD-10 definition The sudden death of an infant
under one year of age which remains unexplained after the performance of a complete post-mortem investigation including o Performance of a complete autopsyo Examination of the death sceneo Review of the case history
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
SIDS FACTS The leading cause of death in
infants from 1 month to 1 year of age (post-neonatal infant mortality)
A diagnosis of exclusion The cause of death is assigned only after ruling out other causes
Peak time of occurrence1-4 months
Higher incidence in males No longer see a higher
frequency in colder months
Percent distribution of SIDS by age at death United States 2004-2006
AAP Task Force on SIDS SIDS and other sleep-related infant deaths expansion of recommendations for a safe infant sleeping environment Pediatrics 2011128(5)e1341-e1367
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
SIDS FACTS
Higher incidence in preterm and low birth weight infants
Associated witho Young maternal ageo Maternal smoking with pregnancyo Late or no prenatal care
2-3 times more common in African-American American Indian and Alaska Native children
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Triple Risk Model to Explain SIDS
Critical Developmental
Period
Vulnerable Infant Exogenous
Stressors(eg brainstem dysfunction)
First 6 months
bull Proneside sleep position
bull Soft beddingbull Overbundling
overheatingbull Bed sharing
Intrinsic risk factors
bull Smokingbull Prematuritybull Alcohol and
illicit drugsbull Hypoxiabull Growth
restriction
SIDS
Extrinsic risk factors
Adapted from Filiano and Kinney 1994
bull Bed sharing + smoking
andor alcohol
Modifiable Risk Factors
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Paterson DS Krous HF Kinney HC et al JAMA 2006
Serotonin receptor binding density lower in SIDS cases compared to controls
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Adapted from Kinney and Thach 2009
An Example of SIDS Pathogenesis
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
2016 AAP Recommendations Infant Sleep Safety Recommendations are to reduce
the risk of SIDS and sleep-related suffocation asphyxia and entrapment
Recommendations should be used consistently until 1 year of ageo Most epidemiological studies upon
which these recommendations are based include infants up to 1 year of age
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Strength of Recommendation
Scale based on the Strength of Recommendation Taxonomy (SORT)
A There is good quality patient-oriented evidence B There is inconsistent or limited quality patient-
oriented evidence C The recommendation is based on consensus
disease-oriented evidence usual practice expertopinion or case series for studies ofdiagnosis treatment prevention orscreening
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Recommendations Change as the Evidence Evolves Statistics and risk factors may change
o New risks emerge (eg side positioning)o Different levels of risk
Policies and procedures may changeo Better death scene investigationso Diagnostic shift
Unintended consequenceso Plagiocephaly development o New tummy time recommendations
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
2016 SIDS Task Force Policy Statement Level A Recommendations Back to sleep for every sleep Use a firm sleep surface Keep soft objects and loose bedding out of the crib Room-sharingmdashInfant on separate sleep surface Breastfeeding is recommended Consider offering a pacifier at nap time and bedtime Avoid smoke exposure during pregnancy and after birth Avoid alcohol and illicit drug use during pregnancy and
after birth
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
2016 SIDS Task Force Policy Statement Level A Recommendations Avoid overheating Pregnant women should receive regular prenatal care Do not use home cardiorespiratory monitors as a strategy
for reducing the risk of SIDS Health care professionals staff in newborn nurseries and
NICUs and child care providers should endorse the SIDS risk-reduction recommendations from birth
Media and manufacturers should follow safe-sleep guidelines in their messaging and advertising
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
2016 SIDS Task Force Policy Statement Level B Recommendations Avoid commercial devices that are inconsistent with
safe sleep recommendations Supervised awake tummy time is recommended to
facilitate development and to minimize development of positional plagiocephaly (flattening of skull)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
2016 SIDS Task Force Policy Statement Level C Recommendations Continue research and surveillance on the risk factors
causes and pathophysiological mechanisms of SIDS and other sleep-related infant deaths with the ultimate goal of eliminating these deaths entirely
There is no evidence to recommend swaddling as a strategy to reduce the risk of SIDS
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Correct Safe Sleep Environment
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
We Need to Move Beyond Back to Sleep
Shersquos on her back to sleep
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Sleep Position for Healthy Newborns
Skin-to-skin care is recommended for all mothers and newborns regardless of feeding or delivery method immediately following birtho Mom should be medically stable
awake and able to respond to baby When mother needs to sleep or take
care of other needs infant should be placed supine in a bassinet
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Sleep Position in Newborn Nursery Infants in the newborn nursery
and infants who are rooming in with their parents should be placed in the supine position as soon as they are ready to be placed in the bassinet o No evidence that placing infants
on the side during the first few hours of life promotes clearance of amniotic fluid and decreases the risk of aspiration
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Sleep Position and Reflux Infants with gastroesophageal (GE) reflux
should be kept supineo Unless the risk of death from complications
of GE reflux is greater than the risk of SIDS
Supine position does not increase the risk of choking and aspiration in infants with GE reflux o Protective airway mechanisms
Do NOT elevate the head of the infantrsquos cribo Ineffective in reducing GE refluxo Infant may slide to the foot of the cribmdashmay
compromise respiration
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
The Truth About Supine Sleep and Aspiration Ending the Fallacy Orientation of the Trachea to the Esophagus
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Title
Text
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Infant Sleep Location
Infants should sleep in parentsrsquo room close to parentsrsquo bed but on a separate surface designed for infants
Ideally for the first year of life but at least for the first 6 months
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Room-Share How Long Yoursquore Kidding Right
2011 ldquoall sleep recommendations are to be followed until 1 year of agerdquo
2016 ldquoroom-sharing without bed-sharinghellipideally until 1 year of age but at least for the first 6 monthsrdquo
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Supporting Data
3 case-control studies comparing sleeping in a separate room vs room-sharingo Tappin (Scotland) AOR 326 (95 CI 103-1035)
bull Protection is significant for smoker motherso Blair (England) AOR 1049 (95 CI 426-2581)
bull Protection is significant for both smoker and nonsmoker mothers
o New Zealand Cot Death study AOR 285(95 CI 204-385)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
More Recent Data
New Zealand SUDI studyo 64 protection with room-sharing AOR 036
(95 CI 019-071)
Estimate of 50 reduction is very conservative
None of the case-control studies stratify by age (months)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Why is Room-Sharing Protective
SIDSmdashfailure to arouse More small awakenings during the night
o Stirrings movement not fully awake Postulation protective effect from small awakenings Room-sharing facilitates breastfeeding
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Room-Sharing and Sleep Quality
Volkovich room-sharing vs solitary sleepo Room-sharing mothers with more sleep disturbanceso Infants with similar sleep quality
Mao Mindell room-sharing infantsmdashmore awakenings
Montgomery-Downs Doan sleep quality in breastfeeding mothers gt to formula feeding motherso Exclusive breastfeeding = 30 min more sleep
More study needed
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Insight Study (Paul 2017)
Sleep questionnaire at 4 9 12 and 30 monthso Sleep duration overnight behaviorso Compared early vs late independent infants
At 4 monthso Equal sleep durationo Early group had better sleep consolidationo Longest stretch 46 minutes
Paul IM Hohman EE Loken E et al Mother-infant room-sharing and sleep outcomes in the INSIGHT study Pediatrics 2017140(1)e20170122
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Insight Study (Paul 2017)
At 9 monthso Longer sleep duration (40 minnight) o Better consolidation (100 min)
At 30 monthso Longer sleep duration (45 minnight)
Room-sharing 4 times more likely to transition to bed sharing overnight
Paul IM Hohman EE Loken E et al Mother-infant room-sharing and sleep outcomes in the INSIGHT study Pediatrics 2017140(1)e20170122
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Insight Commentary (Hauck Moon)
Late room-sharing mean 7 hours longest sleep Is early consolidation desirable Differences related to bedtime routines
o Early bedtimeo Number of night feedso Feeding back to sleep
Focus on the routine not early separation
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Feeding the Baby at Night Acknowledgment that parents may fall
asleep while feeding babyo Safer to feed on bed than on sofa
couch or armchair if you might fall asleep
o No pillows sheets blankets or other items that could obstruct infant breathing or cause overheating should be in bed
o Return infant back to separate sleep surface as soon as parent awakens
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Say NO to Couches Sofas and Cushioned Armchairs Never place a baby for sleep on these surfaces Never sleep with a baby on these surfaces One of the MOST dangerous places for an infant
(OR 51-669)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
High-Risk Bed Sharing Situations Age lt4 months Preterm or low birth weight Smoked during pregnancy Bed sharer is current smoker (even if not
smoking in bed) Bed sharer has usedis using meds or
substances that could impair alertness or arousal
Bed sharer is not parent (including other children)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bedsharing in Low-Risk Breastfed Infants
Blair et al AOR 16 (95 CI 096-27) o Age lt14 weekso Parents No cigarettes or alcoholo Independent of feeding method
Carpenter et al AOR 51 (95 CI 23-114) o Age lt3 months o Parents did not smokeo Mother No alcohol or drugso Breastfed infants
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Independent Review (Dr Robert Platt)
Very small numbers of low-risk babieso 24 in Blairrsquos studyo 12 in Carpenterrsquos study
Does not believe that data support definitive differences in 2 studies
Some evidence of increased risk in this group but cannot say how large the increased risk is
Cannot conclude that bed sharing in this group is safe
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Unsafe Bedding NISP Trends 1993-2102
Shapiro-Mendoza CK Colson ER Willinger M Rybin DV Camperlengo L Corwin MJ Trends in infant bedding use National Infant Sleep Position study 1993ndash2010 Pediatrics 2015135(1)10-17
Decrease from 86 to 55 Rate of decline decreases
2001-10 835 for teen mothers Predictors of adjusted OR
gt15
o Young motherso Non-white race
ethnicityo Less than college
education
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Why Use Soft Bedding
ComfortWarmtho Extrapolation of own feelingso Misinterpret firm with taut
bull Soft + taut ne firm
Safetyo Blankets pillows rolls to prevent falls
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Soft Bedding for Older Infants
Many parents recognize soft bedding is a risk Increased complacency as baby gets older Soft bedding is THE most important risk factor for
infants 4-12 months old (Colvin 2015) Infants roll into bedding and cannot extract
themselves
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
To Swaddle or Not to Swaddle That is the Question Pros
o Calms the infant promotes sleep decreases number of awakenings
o Encourages use of the supine position
Conso Increased respiratory rate and
reduced functional residual lung capacity
o Exacerbates hip dysplasia if the hips are kept in extension and adduction
o ldquoLooserdquo swaddling becomes loose bedding
o Overheating especially if the head is covered or the infant has infection
o Effects on arousability to an external stimulus remain unclear (conflicting data) There may be minimal effects of routine swaddling on arousal
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Swaddling
There is insufficient evidence to recommend routine swaddling as a strategy to reduce the incidence of SIDS
Swaddling must be correctly applied to avoid the possible hazards
Swaddling does not reduce the necessity to follow recommended safe sleep practices Ambrogio Lorenzettis Madonna and Child (1319)
Wikipedia
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
McDonnell E Moon RY Infant deaths and injuries associated with wearable blankets swaddle wraps and swaddling J Pediatr 20141641152-1156
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
SwaddlingmdashMore Questionshellip
Pease 2016 Pediatrics Pooled OR = 138
o Prone = 1299 o Side = 316o Supine = 193
Increased risk with age Limitations
o Heterogeneity definitions other risk factorsPease AS Fleming PJ Hauck FR et al Swaddling and the risk of sudden infant death syndrome a meta-analysis Pediatrics 2016137(6)e20153
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
wwwhealthychildrenorg
Swaddling (wrapping a light blanket snuggly around a baby) may help calm a crying baby If you swaddle your baby be sure to place him on his back to sleep Stop swaddling your baby when he starts to roll
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers
AAP recommendation Consider offering a pacifier at nap time and bedtime
Studies consistently demonstrate a protective effect of pacifiers on SIDS
Mechanism unknowno Dislodge within 15 to 60 minuteso Decreased arousal threshold
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers and Breastfeeding Well-designed trials
o 2 found no association among term infants
o 1 found no association among preterm infants
o 1 found slightly decreased breastfeeding duration at one month if pacifier introduced in first week of life but NO difference if pacifier introduced after one month
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Baby Friendly USA Pacifiers
Breastfeeding babies should not be given pacifiers by the staff of the facility with the exception of o Limited use to decrease pain during procedures when
the baby cannot safely be held or breastfed (pacifiers used should be discarded after these procedures)
o Babies who are being tube-fed in NICUo Other rare specific medical reasons
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Addressing Sleep Deprivation
Give parents tools to cope with fussy babies
Sleep-deprived parents may make poor judgments
Make use of tools o Swaddling side carrying
shushing swinging and sucking
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Overcoming Barriers to Change What Parents are Sayinghellip
Prone positioning fear of choking Baby sleeps ldquobetterrdquo on stomach Soft things are safer for the baby SIDS is ldquoGodrsquos willrdquo Why bother Recommendations keep changing
anyway Vigilance sleep with baby for protection
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Factors Associated With Choice of Infant Sleep Position 3300 mothers from 32 hospitals 77 usually use supine position 49 exclusive use supine position Most likely to use prone
o African-American motherso Mothers with lt high school educationo Lack of perceived controlo Personal attitudesocietal norms
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
A continuum starting in childhoodo Secondary school baby sitting classes
Pre-pregnancy Pregnancyprenatal education
o Prior to baby showerhellipldquowrong giftsrdquo In-hospital education and modeling
o Include family friends baby sitters Re-enforcement in the doctorrsquos office
o Especially between 1 to 4 months Grandparents They hold great power The general public (day cares religious leaders)
A Lifetime of Infant Sleep Safety
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Chart1
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
14
139
13
13
12
13
117
17
103
269
087
386
074
353
077
531
072
557
067
644
062
666
056
716
057
711
053
728
056
701
055
722
055
757
057
703
055
721
054
741
051
728
048
042
04
039
Sheet1
Sheet1
ampA
Page ampP
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
Sheet2
Pre-AAP recommendation Post-AAP RecommendationBack to SleepSafe to Sleep Campaign
Sheet3
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Infant Sleep Safety
Requires a consistent and repetitive message in the community to prevent accidental deaths
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Safe Sleep Nurse Modeling
People trust nurses Whatever the nurse does must
be correct and it will be imitated in the home
Fact supine positioning in the nursery can almost DOUBLE its use in the home
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Physician Advocacy
Srivatsa 1997 HCP education to new familieshellip34 reduction in prone sleeping
Eron 2009 Study of Central NY state physicianshellip30 identified incorrect safest sleep positionhellip30 do not discuss with families
Colson 2009 Only 13 mothers advised by MD to use supine positionhellip3 times more likely to position the baby properly
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Healthcare Provider Advice to New Mothers Safe Sleep
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Chart1
Column1
[]
[]
[]
55
25
20
Sheet1
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Mason Clinical Peds 713
Bundled interventiono Nursing education policy model behavior safe sleep
video posters in rooms declaration of safe sleep practice
Safe sleep environment uarr from 25 to 58 Intention in home 95 supine none ldquoco-sleepingrdquo
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bundled Intervention = Behavior Change
QUESTION GROUP p-value
ISS Study NISP
Behavior Questions n = 490 n = 1046
Baby routinely placed to sleep on back 925 73 lt 0001
Baby routinely sleeps in bassinetcrib 995 71 lt 00001
Baby sleeps under a thin sheet 992 86 lt 0001
Baby given a pacifier for sleep 741 84 lt 0001Goodstein MH Bell T Krugman SD Improving infant sleep safety through a comprehensive hospital-based program Clinical Pediatrics 201554(3)212-221
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
o Baseline Safe sleep 49 of 264 infants o Post 312 of 234 infants (P lt 001) o Extra blankets most common o Baseline 77 vs 44 post-intervention o Mean number of unsafe items reduced by 50 (P lt 001)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Washington DC
2 urban DC nurseries 26 did not believe or unsure that infant positioning
was associated with SIDS Top 3 factors influencing sleep position
o 56 PERSONAL PREFERENCE Why non-supine Clinical experience (25)
o Increase risk aspirationo Decrease sleep and comfort
Bartow KL Nursesrsquo knowledge and adherence to sudden infant death syndrome prevention guidelines Pediatr Nurs 201642(1)7-13
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
TodaysBaby QI Safe Sleep Teaching
QI intervention median = 160 days Mothers reported receiving information 72 to 95
(increase of 24-57) 94 babies observed supine (plus 24) 88 infants in safe sleep environment
o Increase of 33 Gains maintained up to 12 months
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Social Media and Risk-Reduction Training Study (SMART) Cluster randomization 4 groups Safe sleep or breast feeding education Nursing QI and social media (mobile health) N = 1600 1263 responses (79) Safe sleep NQI and MHealth
o Supine sleep 925 o Room-sharing 859o No soft bedding 819o Pacifier use 762
Moon RY Hauck FR Colson ER et al The effect of nursing quality improvement and mobile health interventions on infant sleep practices a randomized clinical trial JAMA 2017318(4)351-359
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Hospital Initiative ComponentswwwcribsforkidsorgHospitalInitiativeToolkit INTRODUCTORY LETTER HOSPITAL INITIATIVE TOOL KIT
INSTRUCTIONS ORGANIZATIONAL CHART HOSPITAL POLICY ACKNOWLEDGMENT FORM (Engl amp
Span) SAFE SLEEP EDUCATIONAL FLIP CHART
NONCOMPLIANCE WAIVER (Engl amp Span)
NURSING EDUCATION MODULE
SAFE SLEEP POSTERS DOOR HANGERS (Engl amp Span) GRADUATION CERTIFICATE SAMPLE LETTER TO HOSPITALS SAMPLE LETTER TO PROVIDERS INFANT SAFE SLEEP BROCHURES
(Engl amp Span) PRESS KIT
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
All materials available on-lineo No major costs to the hospital
Easy on-line access for documentation
NO FEE FOR PARTICIPATION
wwwCribsforKidsorgHospitalInitiative
Tiffany Price (tpricecribsforkidsorg)
The National Safe Sleep Hospital Certification Program
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
TNmdash25 reduction in infant sleep-related deaths in 2 years
SDmdashOver 7915 Pack lsquon Plays distributed since 2012 Infant mortality rate decreased from 86 (2012) to 48 (2016)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
2009 to 2015 38 decrease in infant mortality Decreased from 135 to 84 per 1000 SUID decreased gt50 Decrease in racial disparityhttphealthybabiesbaltimorecomhome
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
And Finallyhellip
Health care providers should have open frank nonjudgmental conversations with families about their sleep practices
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Encouraging Parents to Take Action
According to the Social Learning Theory parents are more likely to recall and comply with instructions when
the health care provider
Uses a positive tone Provides adequate information Allows the parent to ask most of the questions
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Motivational Interviewing
ldquoa collaborative goal-oriented style of communication with particular attention to the language of changerdquo
o Strengthen personal motivation and commitment to a specific goal
o Explore onersquos reasons for change (barriers)o Patient generates own solutions
bull More likely to feel realisticbull Planting seeds of change
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Impact of Eliminating Sleep-Related Deaths
Every week we lose 70 children which is equivalent to 4 kindergarten classrooms
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Thank You
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Contact Information
mgoodsteinwellspanorg
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Visit Pediatric Care Online today for additional information on this and other topics
httppediatriccaresolutionsaaporgPediatric Care Online is a convenient electronic resource for immediate expert help with
virtually every pediatric clinical information need with must-have resources that are included in a comprehensive reference library and time-saving clinical tools
Donrsquot have a subscription to PCOThen take advantage of a free trial today
Call Mead Johnson Nutrition at 888363-2362 orfor more information go to
httppediatriccaresolutionsaaporgSSFree_Trialaspx
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
IMR over time Finland vs US
Slide Number 1
Disclaimer
Objectives for Todayrsquos Talk
Infant Mortality Rates for the Five Leading Causes of Infant Death in the United States 2005 and 2011
US Post-Neonatal Mortality 2015
FACT
What is SUID or SUDI
Some Causes of Deaths that Occur Suddenly and Unexpectedly during Infancy
What is SIDS
SIDS FACTS
SIDS FACTS
Triple Risk Model to Explain SIDS
Paterson DS Krous HF Kinney HC et al JAMA 2006
An Example of SIDS Pathogenesis
2016 AAP Recommendations Infant Sleep Safety
Strength of Recommendation
Recommendations Change as the Evidence Evolves
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
Correct Safe Sleep Environment
We Need to Move Beyond Back to Sleep
Sleep Position for Healthy Newborns
Sleep Position in Newborn Nursery
Sleep Position and Reflux
The Truth About Supine Sleep and Aspiration Ending the Fallacy
Title
Infant Sleep Location
Room-Share How Long Yoursquore Kidding Right
Supporting Data
More Recent Data
Why is Room-Sharing Protective
Room-Sharing and Sleep Quality
Insight Study (Paul 2017)
Insight Study (Paul 2017)
Insight Commentary (Hauck Moon)
Feeding the Baby at Night
Say NO to Couches Sofas and Cushioned Armchairs
High-Risk Bed Sharing Situations
Bedsharing in Low-Risk Breastfed Infants
Independent Review (Dr Robert Platt)
Bed Sharing
Bed Sharing
Bed Sharing with Overlay
Bed Sharing with Overlay
Bed Sharing with Overlay
Couch Sleeping
Couch Sleeping
Couch Sleeping
Unsafe Bedding NISP Trends 1993-2102
Why Use Soft Bedding
Soft Bedding for Older Infants
To Swaddle or Not to Swaddle That is the Question
Swaddling
SwaddlingmdashIs it Safe
SwaddlingmdashMore Questionshellip
wwwhealthychildrenorg
Pacifiers
Pacifiers and Breastfeeding
Baby Friendly USA Pacifiers
Addressing Sleep Deprivation
Overcoming Barriers to Change What Parents are Sayinghellip
Factors Associated With Choice of Infant Sleep Position
Slide Number 65
What is Working
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Infant Sleep Safety
Safe Sleep Nurse Modeling
Physician Advocacy
Healthcare Provider Advice to New Mothers Safe Sleep
Mason Clinical Peds 713
Bundled Intervention = Behavior Change
Hospital Unsafe Sleep Persists
Washington DC
TodaysBaby QI Safe Sleep Teaching
TodaysBaby QI Safe Sleep Teaching
Social Media and Risk-Reduction Training Study (SMART)
The National Safe Sleep Hospital Certification Program
Coordinated Education Efforts Work
Coordinated Education Efforts Work
And Finallyhellip
Encouraging Parents to Take Action
Motivational Interviewing
Impact of Eliminating Sleep-Related Deaths
Thank You
Contact Information
Slide Number 89
IMR over time Finland vs US
Column1
correct advice
55
incorrect advice
25
no advice
20
correct advice
incorrect advice
no advice
SIDS Rate
Percent Back Sleeping
1988
14
1989
139
1990
13
1991
13
1992
12
13
1993
117
17
1994
103
269
1995
087
386
1996
074
353
1997
077
531
1998
072
557
1999
067
644
2000
062
666
2001
056
716
2002
057
711
2003
053
728
2004
056
701
2005
055
722
2006
055
757
2007
057
703
2008
055
721
2009
054
741
2010
051
728
2011
048
2012
042
2013
04
2014
039
httpwwwcdcgovNCHSdatanvsrnvsr58nvsr58_19pdf
Xu JQ Kochanek KD Murphy SL Tejada-Vera B Deaths Final data for
2007
National vital statistics reports vol 58 no 19 Hyattsville MD
National Center for Health Statistics 2010
1988
1988
1989
1989
1990
1990
1991
1991
1992
1992
1993
1993
1994
1994
1995
1995
1996
1996
1997
1997
1998
1998
1999
1999
2000
2000
2001
2001
2002
2002
2003
2003
2004
2004
2005
2005
2006
2006
2007
2007
2008
2008
2009
2009
2010
2010
2011
2012
2013
2014
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
What is SIDS ICD-10 definition The sudden death of an infant
under one year of age which remains unexplained after the performance of a complete post-mortem investigation including o Performance of a complete autopsyo Examination of the death sceneo Review of the case history
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
SIDS FACTS The leading cause of death in
infants from 1 month to 1 year of age (post-neonatal infant mortality)
A diagnosis of exclusion The cause of death is assigned only after ruling out other causes
Peak time of occurrence1-4 months
Higher incidence in males No longer see a higher
frequency in colder months
Percent distribution of SIDS by age at death United States 2004-2006
AAP Task Force on SIDS SIDS and other sleep-related infant deaths expansion of recommendations for a safe infant sleeping environment Pediatrics 2011128(5)e1341-e1367
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
SIDS FACTS
Higher incidence in preterm and low birth weight infants
Associated witho Young maternal ageo Maternal smoking with pregnancyo Late or no prenatal care
2-3 times more common in African-American American Indian and Alaska Native children
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Triple Risk Model to Explain SIDS
Critical Developmental
Period
Vulnerable Infant Exogenous
Stressors(eg brainstem dysfunction)
First 6 months
bull Proneside sleep position
bull Soft beddingbull Overbundling
overheatingbull Bed sharing
Intrinsic risk factors
bull Smokingbull Prematuritybull Alcohol and
illicit drugsbull Hypoxiabull Growth
restriction
SIDS
Extrinsic risk factors
Adapted from Filiano and Kinney 1994
bull Bed sharing + smoking
andor alcohol
Modifiable Risk Factors
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Paterson DS Krous HF Kinney HC et al JAMA 2006
Serotonin receptor binding density lower in SIDS cases compared to controls
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Adapted from Kinney and Thach 2009
An Example of SIDS Pathogenesis
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
2016 AAP Recommendations Infant Sleep Safety Recommendations are to reduce
the risk of SIDS and sleep-related suffocation asphyxia and entrapment
Recommendations should be used consistently until 1 year of ageo Most epidemiological studies upon
which these recommendations are based include infants up to 1 year of age
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Strength of Recommendation
Scale based on the Strength of Recommendation Taxonomy (SORT)
A There is good quality patient-oriented evidence B There is inconsistent or limited quality patient-
oriented evidence C The recommendation is based on consensus
disease-oriented evidence usual practice expertopinion or case series for studies ofdiagnosis treatment prevention orscreening
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Recommendations Change as the Evidence Evolves Statistics and risk factors may change
o New risks emerge (eg side positioning)o Different levels of risk
Policies and procedures may changeo Better death scene investigationso Diagnostic shift
Unintended consequenceso Plagiocephaly development o New tummy time recommendations
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
2016 SIDS Task Force Policy Statement Level A Recommendations Back to sleep for every sleep Use a firm sleep surface Keep soft objects and loose bedding out of the crib Room-sharingmdashInfant on separate sleep surface Breastfeeding is recommended Consider offering a pacifier at nap time and bedtime Avoid smoke exposure during pregnancy and after birth Avoid alcohol and illicit drug use during pregnancy and
after birth
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
2016 SIDS Task Force Policy Statement Level A Recommendations Avoid overheating Pregnant women should receive regular prenatal care Do not use home cardiorespiratory monitors as a strategy
for reducing the risk of SIDS Health care professionals staff in newborn nurseries and
NICUs and child care providers should endorse the SIDS risk-reduction recommendations from birth
Media and manufacturers should follow safe-sleep guidelines in their messaging and advertising
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
2016 SIDS Task Force Policy Statement Level B Recommendations Avoid commercial devices that are inconsistent with
safe sleep recommendations Supervised awake tummy time is recommended to
facilitate development and to minimize development of positional plagiocephaly (flattening of skull)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
2016 SIDS Task Force Policy Statement Level C Recommendations Continue research and surveillance on the risk factors
causes and pathophysiological mechanisms of SIDS and other sleep-related infant deaths with the ultimate goal of eliminating these deaths entirely
There is no evidence to recommend swaddling as a strategy to reduce the risk of SIDS
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Correct Safe Sleep Environment
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
We Need to Move Beyond Back to Sleep
Shersquos on her back to sleep
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Sleep Position for Healthy Newborns
Skin-to-skin care is recommended for all mothers and newborns regardless of feeding or delivery method immediately following birtho Mom should be medically stable
awake and able to respond to baby When mother needs to sleep or take
care of other needs infant should be placed supine in a bassinet
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Sleep Position in Newborn Nursery Infants in the newborn nursery
and infants who are rooming in with their parents should be placed in the supine position as soon as they are ready to be placed in the bassinet o No evidence that placing infants
on the side during the first few hours of life promotes clearance of amniotic fluid and decreases the risk of aspiration
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Sleep Position and Reflux Infants with gastroesophageal (GE) reflux
should be kept supineo Unless the risk of death from complications
of GE reflux is greater than the risk of SIDS
Supine position does not increase the risk of choking and aspiration in infants with GE reflux o Protective airway mechanisms
Do NOT elevate the head of the infantrsquos cribo Ineffective in reducing GE refluxo Infant may slide to the foot of the cribmdashmay
compromise respiration
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
The Truth About Supine Sleep and Aspiration Ending the Fallacy Orientation of the Trachea to the Esophagus
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Title
Text
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Infant Sleep Location
Infants should sleep in parentsrsquo room close to parentsrsquo bed but on a separate surface designed for infants
Ideally for the first year of life but at least for the first 6 months
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Room-Share How Long Yoursquore Kidding Right
2011 ldquoall sleep recommendations are to be followed until 1 year of agerdquo
2016 ldquoroom-sharing without bed-sharinghellipideally until 1 year of age but at least for the first 6 monthsrdquo
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Supporting Data
3 case-control studies comparing sleeping in a separate room vs room-sharingo Tappin (Scotland) AOR 326 (95 CI 103-1035)
bull Protection is significant for smoker motherso Blair (England) AOR 1049 (95 CI 426-2581)
bull Protection is significant for both smoker and nonsmoker mothers
o New Zealand Cot Death study AOR 285(95 CI 204-385)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
More Recent Data
New Zealand SUDI studyo 64 protection with room-sharing AOR 036
(95 CI 019-071)
Estimate of 50 reduction is very conservative
None of the case-control studies stratify by age (months)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Why is Room-Sharing Protective
SIDSmdashfailure to arouse More small awakenings during the night
o Stirrings movement not fully awake Postulation protective effect from small awakenings Room-sharing facilitates breastfeeding
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Room-Sharing and Sleep Quality
Volkovich room-sharing vs solitary sleepo Room-sharing mothers with more sleep disturbanceso Infants with similar sleep quality
Mao Mindell room-sharing infantsmdashmore awakenings
Montgomery-Downs Doan sleep quality in breastfeeding mothers gt to formula feeding motherso Exclusive breastfeeding = 30 min more sleep
More study needed
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Insight Study (Paul 2017)
Sleep questionnaire at 4 9 12 and 30 monthso Sleep duration overnight behaviorso Compared early vs late independent infants
At 4 monthso Equal sleep durationo Early group had better sleep consolidationo Longest stretch 46 minutes
Paul IM Hohman EE Loken E et al Mother-infant room-sharing and sleep outcomes in the INSIGHT study Pediatrics 2017140(1)e20170122
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Insight Study (Paul 2017)
At 9 monthso Longer sleep duration (40 minnight) o Better consolidation (100 min)
At 30 monthso Longer sleep duration (45 minnight)
Room-sharing 4 times more likely to transition to bed sharing overnight
Paul IM Hohman EE Loken E et al Mother-infant room-sharing and sleep outcomes in the INSIGHT study Pediatrics 2017140(1)e20170122
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Insight Commentary (Hauck Moon)
Late room-sharing mean 7 hours longest sleep Is early consolidation desirable Differences related to bedtime routines
o Early bedtimeo Number of night feedso Feeding back to sleep
Focus on the routine not early separation
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Feeding the Baby at Night Acknowledgment that parents may fall
asleep while feeding babyo Safer to feed on bed than on sofa
couch or armchair if you might fall asleep
o No pillows sheets blankets or other items that could obstruct infant breathing or cause overheating should be in bed
o Return infant back to separate sleep surface as soon as parent awakens
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Say NO to Couches Sofas and Cushioned Armchairs Never place a baby for sleep on these surfaces Never sleep with a baby on these surfaces One of the MOST dangerous places for an infant
(OR 51-669)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
High-Risk Bed Sharing Situations Age lt4 months Preterm or low birth weight Smoked during pregnancy Bed sharer is current smoker (even if not
smoking in bed) Bed sharer has usedis using meds or
substances that could impair alertness or arousal
Bed sharer is not parent (including other children)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bedsharing in Low-Risk Breastfed Infants
Blair et al AOR 16 (95 CI 096-27) o Age lt14 weekso Parents No cigarettes or alcoholo Independent of feeding method
Carpenter et al AOR 51 (95 CI 23-114) o Age lt3 months o Parents did not smokeo Mother No alcohol or drugso Breastfed infants
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Independent Review (Dr Robert Platt)
Very small numbers of low-risk babieso 24 in Blairrsquos studyo 12 in Carpenterrsquos study
Does not believe that data support definitive differences in 2 studies
Some evidence of increased risk in this group but cannot say how large the increased risk is
Cannot conclude that bed sharing in this group is safe
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
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Bed Sharing with Overlay
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Couch Sleeping
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Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Unsafe Bedding NISP Trends 1993-2102
Shapiro-Mendoza CK Colson ER Willinger M Rybin DV Camperlengo L Corwin MJ Trends in infant bedding use National Infant Sleep Position study 1993ndash2010 Pediatrics 2015135(1)10-17
Decrease from 86 to 55 Rate of decline decreases
2001-10 835 for teen mothers Predictors of adjusted OR
gt15
o Young motherso Non-white race
ethnicityo Less than college
education
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Why Use Soft Bedding
ComfortWarmtho Extrapolation of own feelingso Misinterpret firm with taut
bull Soft + taut ne firm
Safetyo Blankets pillows rolls to prevent falls
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Soft Bedding for Older Infants
Many parents recognize soft bedding is a risk Increased complacency as baby gets older Soft bedding is THE most important risk factor for
infants 4-12 months old (Colvin 2015) Infants roll into bedding and cannot extract
themselves
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
To Swaddle or Not to Swaddle That is the Question Pros
o Calms the infant promotes sleep decreases number of awakenings
o Encourages use of the supine position
Conso Increased respiratory rate and
reduced functional residual lung capacity
o Exacerbates hip dysplasia if the hips are kept in extension and adduction
o ldquoLooserdquo swaddling becomes loose bedding
o Overheating especially if the head is covered or the infant has infection
o Effects on arousability to an external stimulus remain unclear (conflicting data) There may be minimal effects of routine swaddling on arousal
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Swaddling
There is insufficient evidence to recommend routine swaddling as a strategy to reduce the incidence of SIDS
Swaddling must be correctly applied to avoid the possible hazards
Swaddling does not reduce the necessity to follow recommended safe sleep practices Ambrogio Lorenzettis Madonna and Child (1319)
Wikipedia
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McDonnell E Moon RY Infant deaths and injuries associated with wearable blankets swaddle wraps and swaddling J Pediatr 20141641152-1156
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
SwaddlingmdashMore Questionshellip
Pease 2016 Pediatrics Pooled OR = 138
o Prone = 1299 o Side = 316o Supine = 193
Increased risk with age Limitations
o Heterogeneity definitions other risk factorsPease AS Fleming PJ Hauck FR et al Swaddling and the risk of sudden infant death syndrome a meta-analysis Pediatrics 2016137(6)e20153
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
wwwhealthychildrenorg
Swaddling (wrapping a light blanket snuggly around a baby) may help calm a crying baby If you swaddle your baby be sure to place him on his back to sleep Stop swaddling your baby when he starts to roll
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers
AAP recommendation Consider offering a pacifier at nap time and bedtime
Studies consistently demonstrate a protective effect of pacifiers on SIDS
Mechanism unknowno Dislodge within 15 to 60 minuteso Decreased arousal threshold
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers and Breastfeeding Well-designed trials
o 2 found no association among term infants
o 1 found no association among preterm infants
o 1 found slightly decreased breastfeeding duration at one month if pacifier introduced in first week of life but NO difference if pacifier introduced after one month
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Baby Friendly USA Pacifiers
Breastfeeding babies should not be given pacifiers by the staff of the facility with the exception of o Limited use to decrease pain during procedures when
the baby cannot safely be held or breastfed (pacifiers used should be discarded after these procedures)
o Babies who are being tube-fed in NICUo Other rare specific medical reasons
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Addressing Sleep Deprivation
Give parents tools to cope with fussy babies
Sleep-deprived parents may make poor judgments
Make use of tools o Swaddling side carrying
shushing swinging and sucking
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Overcoming Barriers to Change What Parents are Sayinghellip
Prone positioning fear of choking Baby sleeps ldquobetterrdquo on stomach Soft things are safer for the baby SIDS is ldquoGodrsquos willrdquo Why bother Recommendations keep changing
anyway Vigilance sleep with baby for protection
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Factors Associated With Choice of Infant Sleep Position 3300 mothers from 32 hospitals 77 usually use supine position 49 exclusive use supine position Most likely to use prone
o African-American motherso Mothers with lt high school educationo Lack of perceived controlo Personal attitudesocietal norms
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
A continuum starting in childhoodo Secondary school baby sitting classes
Pre-pregnancy Pregnancyprenatal education
o Prior to baby showerhellipldquowrong giftsrdquo In-hospital education and modeling
o Include family friends baby sitters Re-enforcement in the doctorrsquos office
o Especially between 1 to 4 months Grandparents They hold great power The general public (day cares religious leaders)
A Lifetime of Infant Sleep Safety
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Chart1
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
14
139
13
13
12
13
117
17
103
269
087
386
074
353
077
531
072
557
067
644
062
666
056
716
057
711
053
728
056
701
055
722
055
757
057
703
055
721
054
741
051
728
048
042
04
039
Sheet1
Sheet1
ampA
Page ampP
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
Sheet2
Pre-AAP recommendation Post-AAP RecommendationBack to SleepSafe to Sleep Campaign
Sheet3
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Infant Sleep Safety
Requires a consistent and repetitive message in the community to prevent accidental deaths
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Safe Sleep Nurse Modeling
People trust nurses Whatever the nurse does must
be correct and it will be imitated in the home
Fact supine positioning in the nursery can almost DOUBLE its use in the home
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Physician Advocacy
Srivatsa 1997 HCP education to new familieshellip34 reduction in prone sleeping
Eron 2009 Study of Central NY state physicianshellip30 identified incorrect safest sleep positionhellip30 do not discuss with families
Colson 2009 Only 13 mothers advised by MD to use supine positionhellip3 times more likely to position the baby properly
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Healthcare Provider Advice to New Mothers Safe Sleep
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Chart1
Column1
[]
[]
[]
55
25
20
Sheet1
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Mason Clinical Peds 713
Bundled interventiono Nursing education policy model behavior safe sleep
video posters in rooms declaration of safe sleep practice
Safe sleep environment uarr from 25 to 58 Intention in home 95 supine none ldquoco-sleepingrdquo
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bundled Intervention = Behavior Change
QUESTION GROUP p-value
ISS Study NISP
Behavior Questions n = 490 n = 1046
Baby routinely placed to sleep on back 925 73 lt 0001
Baby routinely sleeps in bassinetcrib 995 71 lt 00001
Baby sleeps under a thin sheet 992 86 lt 0001
Baby given a pacifier for sleep 741 84 lt 0001Goodstein MH Bell T Krugman SD Improving infant sleep safety through a comprehensive hospital-based program Clinical Pediatrics 201554(3)212-221
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
o Baseline Safe sleep 49 of 264 infants o Post 312 of 234 infants (P lt 001) o Extra blankets most common o Baseline 77 vs 44 post-intervention o Mean number of unsafe items reduced by 50 (P lt 001)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Washington DC
2 urban DC nurseries 26 did not believe or unsure that infant positioning
was associated with SIDS Top 3 factors influencing sleep position
o 56 PERSONAL PREFERENCE Why non-supine Clinical experience (25)
o Increase risk aspirationo Decrease sleep and comfort
Bartow KL Nursesrsquo knowledge and adherence to sudden infant death syndrome prevention guidelines Pediatr Nurs 201642(1)7-13
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
TodaysBaby QI Safe Sleep Teaching
QI intervention median = 160 days Mothers reported receiving information 72 to 95
(increase of 24-57) 94 babies observed supine (plus 24) 88 infants in safe sleep environment
o Increase of 33 Gains maintained up to 12 months
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Social Media and Risk-Reduction Training Study (SMART) Cluster randomization 4 groups Safe sleep or breast feeding education Nursing QI and social media (mobile health) N = 1600 1263 responses (79) Safe sleep NQI and MHealth
o Supine sleep 925 o Room-sharing 859o No soft bedding 819o Pacifier use 762
Moon RY Hauck FR Colson ER et al The effect of nursing quality improvement and mobile health interventions on infant sleep practices a randomized clinical trial JAMA 2017318(4)351-359
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Hospital Initiative ComponentswwwcribsforkidsorgHospitalInitiativeToolkit INTRODUCTORY LETTER HOSPITAL INITIATIVE TOOL KIT
INSTRUCTIONS ORGANIZATIONAL CHART HOSPITAL POLICY ACKNOWLEDGMENT FORM (Engl amp
Span) SAFE SLEEP EDUCATIONAL FLIP CHART
NONCOMPLIANCE WAIVER (Engl amp Span)
NURSING EDUCATION MODULE
SAFE SLEEP POSTERS DOOR HANGERS (Engl amp Span) GRADUATION CERTIFICATE SAMPLE LETTER TO HOSPITALS SAMPLE LETTER TO PROVIDERS INFANT SAFE SLEEP BROCHURES
(Engl amp Span) PRESS KIT
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
All materials available on-lineo No major costs to the hospital
Easy on-line access for documentation
NO FEE FOR PARTICIPATION
wwwCribsforKidsorgHospitalInitiative
Tiffany Price (tpricecribsforkidsorg)
The National Safe Sleep Hospital Certification Program
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
TNmdash25 reduction in infant sleep-related deaths in 2 years
SDmdashOver 7915 Pack lsquon Plays distributed since 2012 Infant mortality rate decreased from 86 (2012) to 48 (2016)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
2009 to 2015 38 decrease in infant mortality Decreased from 135 to 84 per 1000 SUID decreased gt50 Decrease in racial disparityhttphealthybabiesbaltimorecomhome
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
And Finallyhellip
Health care providers should have open frank nonjudgmental conversations with families about their sleep practices
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Encouraging Parents to Take Action
According to the Social Learning Theory parents are more likely to recall and comply with instructions when
the health care provider
Uses a positive tone Provides adequate information Allows the parent to ask most of the questions
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Motivational Interviewing
ldquoa collaborative goal-oriented style of communication with particular attention to the language of changerdquo
o Strengthen personal motivation and commitment to a specific goal
o Explore onersquos reasons for change (barriers)o Patient generates own solutions
bull More likely to feel realisticbull Planting seeds of change
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Impact of Eliminating Sleep-Related Deaths
Every week we lose 70 children which is equivalent to 4 kindergarten classrooms
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Thank You
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Contact Information
mgoodsteinwellspanorg
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Visit Pediatric Care Online today for additional information on this and other topics
httppediatriccaresolutionsaaporgPediatric Care Online is a convenient electronic resource for immediate expert help with
virtually every pediatric clinical information need with must-have resources that are included in a comprehensive reference library and time-saving clinical tools
Donrsquot have a subscription to PCOThen take advantage of a free trial today
Call Mead Johnson Nutrition at 888363-2362 orfor more information go to
httppediatriccaresolutionsaaporgSSFree_Trialaspx
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
IMR over time Finland vs US
Slide Number 1
Disclaimer
Objectives for Todayrsquos Talk
Infant Mortality Rates for the Five Leading Causes of Infant Death in the United States 2005 and 2011
US Post-Neonatal Mortality 2015
FACT
What is SUID or SUDI
Some Causes of Deaths that Occur Suddenly and Unexpectedly during Infancy
What is SIDS
SIDS FACTS
SIDS FACTS
Triple Risk Model to Explain SIDS
Paterson DS Krous HF Kinney HC et al JAMA 2006
An Example of SIDS Pathogenesis
2016 AAP Recommendations Infant Sleep Safety
Strength of Recommendation
Recommendations Change as the Evidence Evolves
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
Correct Safe Sleep Environment
We Need to Move Beyond Back to Sleep
Sleep Position for Healthy Newborns
Sleep Position in Newborn Nursery
Sleep Position and Reflux
The Truth About Supine Sleep and Aspiration Ending the Fallacy
Title
Infant Sleep Location
Room-Share How Long Yoursquore Kidding Right
Supporting Data
More Recent Data
Why is Room-Sharing Protective
Room-Sharing and Sleep Quality
Insight Study (Paul 2017)
Insight Study (Paul 2017)
Insight Commentary (Hauck Moon)
Feeding the Baby at Night
Say NO to Couches Sofas and Cushioned Armchairs
High-Risk Bed Sharing Situations
Bedsharing in Low-Risk Breastfed Infants
Independent Review (Dr Robert Platt)
Bed Sharing
Bed Sharing
Bed Sharing with Overlay
Bed Sharing with Overlay
Bed Sharing with Overlay
Couch Sleeping
Couch Sleeping
Couch Sleeping
Unsafe Bedding NISP Trends 1993-2102
Why Use Soft Bedding
Soft Bedding for Older Infants
To Swaddle or Not to Swaddle That is the Question
Swaddling
SwaddlingmdashIs it Safe
SwaddlingmdashMore Questionshellip
wwwhealthychildrenorg
Pacifiers
Pacifiers and Breastfeeding
Baby Friendly USA Pacifiers
Addressing Sleep Deprivation
Overcoming Barriers to Change What Parents are Sayinghellip
Factors Associated With Choice of Infant Sleep Position
Slide Number 65
What is Working
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Infant Sleep Safety
Safe Sleep Nurse Modeling
Physician Advocacy
Healthcare Provider Advice to New Mothers Safe Sleep
Mason Clinical Peds 713
Bundled Intervention = Behavior Change
Hospital Unsafe Sleep Persists
Washington DC
TodaysBaby QI Safe Sleep Teaching
TodaysBaby QI Safe Sleep Teaching
Social Media and Risk-Reduction Training Study (SMART)
The National Safe Sleep Hospital Certification Program
Coordinated Education Efforts Work
Coordinated Education Efforts Work
And Finallyhellip
Encouraging Parents to Take Action
Motivational Interviewing
Impact of Eliminating Sleep-Related Deaths
Thank You
Contact Information
Slide Number 89
IMR over time Finland vs US
Column1
correct advice
55
incorrect advice
25
no advice
20
correct advice
incorrect advice
no advice
SIDS Rate
Percent Back Sleeping
1988
14
1989
139
1990
13
1991
13
1992
12
13
1993
117
17
1994
103
269
1995
087
386
1996
074
353
1997
077
531
1998
072
557
1999
067
644
2000
062
666
2001
056
716
2002
057
711
2003
053
728
2004
056
701
2005
055
722
2006
055
757
2007
057
703
2008
055
721
2009
054
741
2010
051
728
2011
048
2012
042
2013
04
2014
039
httpwwwcdcgovNCHSdatanvsrnvsr58nvsr58_19pdf
Xu JQ Kochanek KD Murphy SL Tejada-Vera B Deaths Final data for
2007
National vital statistics reports vol 58 no 19 Hyattsville MD
National Center for Health Statistics 2010
1988
1988
1989
1989
1990
1990
1991
1991
1992
1992
1993
1993
1994
1994
1995
1995
1996
1996
1997
1997
1998
1998
1999
1999
2000
2000
2001
2001
2002
2002
2003
2003
2004
2004
2005
2005
2006
2006
2007
2007
2008
2008
2009
2009
2010
2010
2011
2012
2013
2014
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
SIDS FACTS The leading cause of death in
infants from 1 month to 1 year of age (post-neonatal infant mortality)
A diagnosis of exclusion The cause of death is assigned only after ruling out other causes
Peak time of occurrence1-4 months
Higher incidence in males No longer see a higher
frequency in colder months
Percent distribution of SIDS by age at death United States 2004-2006
AAP Task Force on SIDS SIDS and other sleep-related infant deaths expansion of recommendations for a safe infant sleeping environment Pediatrics 2011128(5)e1341-e1367
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
SIDS FACTS
Higher incidence in preterm and low birth weight infants
Associated witho Young maternal ageo Maternal smoking with pregnancyo Late or no prenatal care
2-3 times more common in African-American American Indian and Alaska Native children
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Triple Risk Model to Explain SIDS
Critical Developmental
Period
Vulnerable Infant Exogenous
Stressors(eg brainstem dysfunction)
First 6 months
bull Proneside sleep position
bull Soft beddingbull Overbundling
overheatingbull Bed sharing
Intrinsic risk factors
bull Smokingbull Prematuritybull Alcohol and
illicit drugsbull Hypoxiabull Growth
restriction
SIDS
Extrinsic risk factors
Adapted from Filiano and Kinney 1994
bull Bed sharing + smoking
andor alcohol
Modifiable Risk Factors
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Paterson DS Krous HF Kinney HC et al JAMA 2006
Serotonin receptor binding density lower in SIDS cases compared to controls
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Adapted from Kinney and Thach 2009
An Example of SIDS Pathogenesis
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
2016 AAP Recommendations Infant Sleep Safety Recommendations are to reduce
the risk of SIDS and sleep-related suffocation asphyxia and entrapment
Recommendations should be used consistently until 1 year of ageo Most epidemiological studies upon
which these recommendations are based include infants up to 1 year of age
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Strength of Recommendation
Scale based on the Strength of Recommendation Taxonomy (SORT)
A There is good quality patient-oriented evidence B There is inconsistent or limited quality patient-
oriented evidence C The recommendation is based on consensus
disease-oriented evidence usual practice expertopinion or case series for studies ofdiagnosis treatment prevention orscreening
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Recommendations Change as the Evidence Evolves Statistics and risk factors may change
o New risks emerge (eg side positioning)o Different levels of risk
Policies and procedures may changeo Better death scene investigationso Diagnostic shift
Unintended consequenceso Plagiocephaly development o New tummy time recommendations
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
2016 SIDS Task Force Policy Statement Level A Recommendations Back to sleep for every sleep Use a firm sleep surface Keep soft objects and loose bedding out of the crib Room-sharingmdashInfant on separate sleep surface Breastfeeding is recommended Consider offering a pacifier at nap time and bedtime Avoid smoke exposure during pregnancy and after birth Avoid alcohol and illicit drug use during pregnancy and
after birth
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
2016 SIDS Task Force Policy Statement Level A Recommendations Avoid overheating Pregnant women should receive regular prenatal care Do not use home cardiorespiratory monitors as a strategy
for reducing the risk of SIDS Health care professionals staff in newborn nurseries and
NICUs and child care providers should endorse the SIDS risk-reduction recommendations from birth
Media and manufacturers should follow safe-sleep guidelines in their messaging and advertising
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
2016 SIDS Task Force Policy Statement Level B Recommendations Avoid commercial devices that are inconsistent with
safe sleep recommendations Supervised awake tummy time is recommended to
facilitate development and to minimize development of positional plagiocephaly (flattening of skull)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
2016 SIDS Task Force Policy Statement Level C Recommendations Continue research and surveillance on the risk factors
causes and pathophysiological mechanisms of SIDS and other sleep-related infant deaths with the ultimate goal of eliminating these deaths entirely
There is no evidence to recommend swaddling as a strategy to reduce the risk of SIDS
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Correct Safe Sleep Environment
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
We Need to Move Beyond Back to Sleep
Shersquos on her back to sleep
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Sleep Position for Healthy Newborns
Skin-to-skin care is recommended for all mothers and newborns regardless of feeding or delivery method immediately following birtho Mom should be medically stable
awake and able to respond to baby When mother needs to sleep or take
care of other needs infant should be placed supine in a bassinet
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Sleep Position in Newborn Nursery Infants in the newborn nursery
and infants who are rooming in with their parents should be placed in the supine position as soon as they are ready to be placed in the bassinet o No evidence that placing infants
on the side during the first few hours of life promotes clearance of amniotic fluid and decreases the risk of aspiration
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Sleep Position and Reflux Infants with gastroesophageal (GE) reflux
should be kept supineo Unless the risk of death from complications
of GE reflux is greater than the risk of SIDS
Supine position does not increase the risk of choking and aspiration in infants with GE reflux o Protective airway mechanisms
Do NOT elevate the head of the infantrsquos cribo Ineffective in reducing GE refluxo Infant may slide to the foot of the cribmdashmay
compromise respiration
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
The Truth About Supine Sleep and Aspiration Ending the Fallacy Orientation of the Trachea to the Esophagus
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Title
Text
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Infant Sleep Location
Infants should sleep in parentsrsquo room close to parentsrsquo bed but on a separate surface designed for infants
Ideally for the first year of life but at least for the first 6 months
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Room-Share How Long Yoursquore Kidding Right
2011 ldquoall sleep recommendations are to be followed until 1 year of agerdquo
2016 ldquoroom-sharing without bed-sharinghellipideally until 1 year of age but at least for the first 6 monthsrdquo
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Supporting Data
3 case-control studies comparing sleeping in a separate room vs room-sharingo Tappin (Scotland) AOR 326 (95 CI 103-1035)
bull Protection is significant for smoker motherso Blair (England) AOR 1049 (95 CI 426-2581)
bull Protection is significant for both smoker and nonsmoker mothers
o New Zealand Cot Death study AOR 285(95 CI 204-385)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
More Recent Data
New Zealand SUDI studyo 64 protection with room-sharing AOR 036
(95 CI 019-071)
Estimate of 50 reduction is very conservative
None of the case-control studies stratify by age (months)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Why is Room-Sharing Protective
SIDSmdashfailure to arouse More small awakenings during the night
o Stirrings movement not fully awake Postulation protective effect from small awakenings Room-sharing facilitates breastfeeding
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Room-Sharing and Sleep Quality
Volkovich room-sharing vs solitary sleepo Room-sharing mothers with more sleep disturbanceso Infants with similar sleep quality
Mao Mindell room-sharing infantsmdashmore awakenings
Montgomery-Downs Doan sleep quality in breastfeeding mothers gt to formula feeding motherso Exclusive breastfeeding = 30 min more sleep
More study needed
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Insight Study (Paul 2017)
Sleep questionnaire at 4 9 12 and 30 monthso Sleep duration overnight behaviorso Compared early vs late independent infants
At 4 monthso Equal sleep durationo Early group had better sleep consolidationo Longest stretch 46 minutes
Paul IM Hohman EE Loken E et al Mother-infant room-sharing and sleep outcomes in the INSIGHT study Pediatrics 2017140(1)e20170122
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Insight Study (Paul 2017)
At 9 monthso Longer sleep duration (40 minnight) o Better consolidation (100 min)
At 30 monthso Longer sleep duration (45 minnight)
Room-sharing 4 times more likely to transition to bed sharing overnight
Paul IM Hohman EE Loken E et al Mother-infant room-sharing and sleep outcomes in the INSIGHT study Pediatrics 2017140(1)e20170122
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Insight Commentary (Hauck Moon)
Late room-sharing mean 7 hours longest sleep Is early consolidation desirable Differences related to bedtime routines
o Early bedtimeo Number of night feedso Feeding back to sleep
Focus on the routine not early separation
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Feeding the Baby at Night Acknowledgment that parents may fall
asleep while feeding babyo Safer to feed on bed than on sofa
couch or armchair if you might fall asleep
o No pillows sheets blankets or other items that could obstruct infant breathing or cause overheating should be in bed
o Return infant back to separate sleep surface as soon as parent awakens
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Say NO to Couches Sofas and Cushioned Armchairs Never place a baby for sleep on these surfaces Never sleep with a baby on these surfaces One of the MOST dangerous places for an infant
(OR 51-669)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
High-Risk Bed Sharing Situations Age lt4 months Preterm or low birth weight Smoked during pregnancy Bed sharer is current smoker (even if not
smoking in bed) Bed sharer has usedis using meds or
substances that could impair alertness or arousal
Bed sharer is not parent (including other children)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bedsharing in Low-Risk Breastfed Infants
Blair et al AOR 16 (95 CI 096-27) o Age lt14 weekso Parents No cigarettes or alcoholo Independent of feeding method
Carpenter et al AOR 51 (95 CI 23-114) o Age lt3 months o Parents did not smokeo Mother No alcohol or drugso Breastfed infants
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Independent Review (Dr Robert Platt)
Very small numbers of low-risk babieso 24 in Blairrsquos studyo 12 in Carpenterrsquos study
Does not believe that data support definitive differences in 2 studies
Some evidence of increased risk in this group but cannot say how large the increased risk is
Cannot conclude that bed sharing in this group is safe
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
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Bed Sharing with Overlay
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Bed Sharing with Overlay
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Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Unsafe Bedding NISP Trends 1993-2102
Shapiro-Mendoza CK Colson ER Willinger M Rybin DV Camperlengo L Corwin MJ Trends in infant bedding use National Infant Sleep Position study 1993ndash2010 Pediatrics 2015135(1)10-17
Decrease from 86 to 55 Rate of decline decreases
2001-10 835 for teen mothers Predictors of adjusted OR
gt15
o Young motherso Non-white race
ethnicityo Less than college
education
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Why Use Soft Bedding
ComfortWarmtho Extrapolation of own feelingso Misinterpret firm with taut
bull Soft + taut ne firm
Safetyo Blankets pillows rolls to prevent falls
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Soft Bedding for Older Infants
Many parents recognize soft bedding is a risk Increased complacency as baby gets older Soft bedding is THE most important risk factor for
infants 4-12 months old (Colvin 2015) Infants roll into bedding and cannot extract
themselves
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
To Swaddle or Not to Swaddle That is the Question Pros
o Calms the infant promotes sleep decreases number of awakenings
o Encourages use of the supine position
Conso Increased respiratory rate and
reduced functional residual lung capacity
o Exacerbates hip dysplasia if the hips are kept in extension and adduction
o ldquoLooserdquo swaddling becomes loose bedding
o Overheating especially if the head is covered or the infant has infection
o Effects on arousability to an external stimulus remain unclear (conflicting data) There may be minimal effects of routine swaddling on arousal
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Swaddling
There is insufficient evidence to recommend routine swaddling as a strategy to reduce the incidence of SIDS
Swaddling must be correctly applied to avoid the possible hazards
Swaddling does not reduce the necessity to follow recommended safe sleep practices Ambrogio Lorenzettis Madonna and Child (1319)
Wikipedia
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
McDonnell E Moon RY Infant deaths and injuries associated with wearable blankets swaddle wraps and swaddling J Pediatr 20141641152-1156
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
SwaddlingmdashMore Questionshellip
Pease 2016 Pediatrics Pooled OR = 138
o Prone = 1299 o Side = 316o Supine = 193
Increased risk with age Limitations
o Heterogeneity definitions other risk factorsPease AS Fleming PJ Hauck FR et al Swaddling and the risk of sudden infant death syndrome a meta-analysis Pediatrics 2016137(6)e20153
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
wwwhealthychildrenorg
Swaddling (wrapping a light blanket snuggly around a baby) may help calm a crying baby If you swaddle your baby be sure to place him on his back to sleep Stop swaddling your baby when he starts to roll
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers
AAP recommendation Consider offering a pacifier at nap time and bedtime
Studies consistently demonstrate a protective effect of pacifiers on SIDS
Mechanism unknowno Dislodge within 15 to 60 minuteso Decreased arousal threshold
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers and Breastfeeding Well-designed trials
o 2 found no association among term infants
o 1 found no association among preterm infants
o 1 found slightly decreased breastfeeding duration at one month if pacifier introduced in first week of life but NO difference if pacifier introduced after one month
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Baby Friendly USA Pacifiers
Breastfeeding babies should not be given pacifiers by the staff of the facility with the exception of o Limited use to decrease pain during procedures when
the baby cannot safely be held or breastfed (pacifiers used should be discarded after these procedures)
o Babies who are being tube-fed in NICUo Other rare specific medical reasons
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Addressing Sleep Deprivation
Give parents tools to cope with fussy babies
Sleep-deprived parents may make poor judgments
Make use of tools o Swaddling side carrying
shushing swinging and sucking
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Overcoming Barriers to Change What Parents are Sayinghellip
Prone positioning fear of choking Baby sleeps ldquobetterrdquo on stomach Soft things are safer for the baby SIDS is ldquoGodrsquos willrdquo Why bother Recommendations keep changing
anyway Vigilance sleep with baby for protection
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Factors Associated With Choice of Infant Sleep Position 3300 mothers from 32 hospitals 77 usually use supine position 49 exclusive use supine position Most likely to use prone
o African-American motherso Mothers with lt high school educationo Lack of perceived controlo Personal attitudesocietal norms
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
A continuum starting in childhoodo Secondary school baby sitting classes
Pre-pregnancy Pregnancyprenatal education
o Prior to baby showerhellipldquowrong giftsrdquo In-hospital education and modeling
o Include family friends baby sitters Re-enforcement in the doctorrsquos office
o Especially between 1 to 4 months Grandparents They hold great power The general public (day cares religious leaders)
A Lifetime of Infant Sleep Safety
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Chart1
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
14
139
13
13
12
13
117
17
103
269
087
386
074
353
077
531
072
557
067
644
062
666
056
716
057
711
053
728
056
701
055
722
055
757
057
703
055
721
054
741
051
728
048
042
04
039
Sheet1
Sheet1
ampA
Page ampP
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
Sheet2
Pre-AAP recommendation Post-AAP RecommendationBack to SleepSafe to Sleep Campaign
Sheet3
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Infant Sleep Safety
Requires a consistent and repetitive message in the community to prevent accidental deaths
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Safe Sleep Nurse Modeling
People trust nurses Whatever the nurse does must
be correct and it will be imitated in the home
Fact supine positioning in the nursery can almost DOUBLE its use in the home
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Physician Advocacy
Srivatsa 1997 HCP education to new familieshellip34 reduction in prone sleeping
Eron 2009 Study of Central NY state physicianshellip30 identified incorrect safest sleep positionhellip30 do not discuss with families
Colson 2009 Only 13 mothers advised by MD to use supine positionhellip3 times more likely to position the baby properly
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Healthcare Provider Advice to New Mothers Safe Sleep
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Chart1
Column1
[]
[]
[]
55
25
20
Sheet1
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Mason Clinical Peds 713
Bundled interventiono Nursing education policy model behavior safe sleep
video posters in rooms declaration of safe sleep practice
Safe sleep environment uarr from 25 to 58 Intention in home 95 supine none ldquoco-sleepingrdquo
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bundled Intervention = Behavior Change
QUESTION GROUP p-value
ISS Study NISP
Behavior Questions n = 490 n = 1046
Baby routinely placed to sleep on back 925 73 lt 0001
Baby routinely sleeps in bassinetcrib 995 71 lt 00001
Baby sleeps under a thin sheet 992 86 lt 0001
Baby given a pacifier for sleep 741 84 lt 0001Goodstein MH Bell T Krugman SD Improving infant sleep safety through a comprehensive hospital-based program Clinical Pediatrics 201554(3)212-221
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
o Baseline Safe sleep 49 of 264 infants o Post 312 of 234 infants (P lt 001) o Extra blankets most common o Baseline 77 vs 44 post-intervention o Mean number of unsafe items reduced by 50 (P lt 001)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Washington DC
2 urban DC nurseries 26 did not believe or unsure that infant positioning
was associated with SIDS Top 3 factors influencing sleep position
o 56 PERSONAL PREFERENCE Why non-supine Clinical experience (25)
o Increase risk aspirationo Decrease sleep and comfort
Bartow KL Nursesrsquo knowledge and adherence to sudden infant death syndrome prevention guidelines Pediatr Nurs 201642(1)7-13
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
TodaysBaby QI Safe Sleep Teaching
QI intervention median = 160 days Mothers reported receiving information 72 to 95
(increase of 24-57) 94 babies observed supine (plus 24) 88 infants in safe sleep environment
o Increase of 33 Gains maintained up to 12 months
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Social Media and Risk-Reduction Training Study (SMART) Cluster randomization 4 groups Safe sleep or breast feeding education Nursing QI and social media (mobile health) N = 1600 1263 responses (79) Safe sleep NQI and MHealth
o Supine sleep 925 o Room-sharing 859o No soft bedding 819o Pacifier use 762
Moon RY Hauck FR Colson ER et al The effect of nursing quality improvement and mobile health interventions on infant sleep practices a randomized clinical trial JAMA 2017318(4)351-359
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Hospital Initiative ComponentswwwcribsforkidsorgHospitalInitiativeToolkit INTRODUCTORY LETTER HOSPITAL INITIATIVE TOOL KIT
INSTRUCTIONS ORGANIZATIONAL CHART HOSPITAL POLICY ACKNOWLEDGMENT FORM (Engl amp
Span) SAFE SLEEP EDUCATIONAL FLIP CHART
NONCOMPLIANCE WAIVER (Engl amp Span)
NURSING EDUCATION MODULE
SAFE SLEEP POSTERS DOOR HANGERS (Engl amp Span) GRADUATION CERTIFICATE SAMPLE LETTER TO HOSPITALS SAMPLE LETTER TO PROVIDERS INFANT SAFE SLEEP BROCHURES
(Engl amp Span) PRESS KIT
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
All materials available on-lineo No major costs to the hospital
Easy on-line access for documentation
NO FEE FOR PARTICIPATION
wwwCribsforKidsorgHospitalInitiative
Tiffany Price (tpricecribsforkidsorg)
The National Safe Sleep Hospital Certification Program
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
TNmdash25 reduction in infant sleep-related deaths in 2 years
SDmdashOver 7915 Pack lsquon Plays distributed since 2012 Infant mortality rate decreased from 86 (2012) to 48 (2016)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
2009 to 2015 38 decrease in infant mortality Decreased from 135 to 84 per 1000 SUID decreased gt50 Decrease in racial disparityhttphealthybabiesbaltimorecomhome
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
And Finallyhellip
Health care providers should have open frank nonjudgmental conversations with families about their sleep practices
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Encouraging Parents to Take Action
According to the Social Learning Theory parents are more likely to recall and comply with instructions when
the health care provider
Uses a positive tone Provides adequate information Allows the parent to ask most of the questions
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Motivational Interviewing
ldquoa collaborative goal-oriented style of communication with particular attention to the language of changerdquo
o Strengthen personal motivation and commitment to a specific goal
o Explore onersquos reasons for change (barriers)o Patient generates own solutions
bull More likely to feel realisticbull Planting seeds of change
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Impact of Eliminating Sleep-Related Deaths
Every week we lose 70 children which is equivalent to 4 kindergarten classrooms
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Thank You
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Contact Information
mgoodsteinwellspanorg
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Visit Pediatric Care Online today for additional information on this and other topics
httppediatriccaresolutionsaaporgPediatric Care Online is a convenient electronic resource for immediate expert help with
virtually every pediatric clinical information need with must-have resources that are included in a comprehensive reference library and time-saving clinical tools
Donrsquot have a subscription to PCOThen take advantage of a free trial today
Call Mead Johnson Nutrition at 888363-2362 orfor more information go to
httppediatriccaresolutionsaaporgSSFree_Trialaspx
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
IMR over time Finland vs US
Slide Number 1
Disclaimer
Objectives for Todayrsquos Talk
Infant Mortality Rates for the Five Leading Causes of Infant Death in the United States 2005 and 2011
US Post-Neonatal Mortality 2015
FACT
What is SUID or SUDI
Some Causes of Deaths that Occur Suddenly and Unexpectedly during Infancy
What is SIDS
SIDS FACTS
SIDS FACTS
Triple Risk Model to Explain SIDS
Paterson DS Krous HF Kinney HC et al JAMA 2006
An Example of SIDS Pathogenesis
2016 AAP Recommendations Infant Sleep Safety
Strength of Recommendation
Recommendations Change as the Evidence Evolves
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
Correct Safe Sleep Environment
We Need to Move Beyond Back to Sleep
Sleep Position for Healthy Newborns
Sleep Position in Newborn Nursery
Sleep Position and Reflux
The Truth About Supine Sleep and Aspiration Ending the Fallacy
Title
Infant Sleep Location
Room-Share How Long Yoursquore Kidding Right
Supporting Data
More Recent Data
Why is Room-Sharing Protective
Room-Sharing and Sleep Quality
Insight Study (Paul 2017)
Insight Study (Paul 2017)
Insight Commentary (Hauck Moon)
Feeding the Baby at Night
Say NO to Couches Sofas and Cushioned Armchairs
High-Risk Bed Sharing Situations
Bedsharing in Low-Risk Breastfed Infants
Independent Review (Dr Robert Platt)
Bed Sharing
Bed Sharing
Bed Sharing with Overlay
Bed Sharing with Overlay
Bed Sharing with Overlay
Couch Sleeping
Couch Sleeping
Couch Sleeping
Unsafe Bedding NISP Trends 1993-2102
Why Use Soft Bedding
Soft Bedding for Older Infants
To Swaddle or Not to Swaddle That is the Question
Swaddling
SwaddlingmdashIs it Safe
SwaddlingmdashMore Questionshellip
wwwhealthychildrenorg
Pacifiers
Pacifiers and Breastfeeding
Baby Friendly USA Pacifiers
Addressing Sleep Deprivation
Overcoming Barriers to Change What Parents are Sayinghellip
Factors Associated With Choice of Infant Sleep Position
Slide Number 65
What is Working
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Infant Sleep Safety
Safe Sleep Nurse Modeling
Physician Advocacy
Healthcare Provider Advice to New Mothers Safe Sleep
Mason Clinical Peds 713
Bundled Intervention = Behavior Change
Hospital Unsafe Sleep Persists
Washington DC
TodaysBaby QI Safe Sleep Teaching
TodaysBaby QI Safe Sleep Teaching
Social Media and Risk-Reduction Training Study (SMART)
The National Safe Sleep Hospital Certification Program
Coordinated Education Efforts Work
Coordinated Education Efforts Work
And Finallyhellip
Encouraging Parents to Take Action
Motivational Interviewing
Impact of Eliminating Sleep-Related Deaths
Thank You
Contact Information
Slide Number 89
IMR over time Finland vs US
Column1
correct advice
55
incorrect advice
25
no advice
20
correct advice
incorrect advice
no advice
SIDS Rate
Percent Back Sleeping
1988
14
1989
139
1990
13
1991
13
1992
12
13
1993
117
17
1994
103
269
1995
087
386
1996
074
353
1997
077
531
1998
072
557
1999
067
644
2000
062
666
2001
056
716
2002
057
711
2003
053
728
2004
056
701
2005
055
722
2006
055
757
2007
057
703
2008
055
721
2009
054
741
2010
051
728
2011
048
2012
042
2013
04
2014
039
httpwwwcdcgovNCHSdatanvsrnvsr58nvsr58_19pdf
Xu JQ Kochanek KD Murphy SL Tejada-Vera B Deaths Final data for
2007
National vital statistics reports vol 58 no 19 Hyattsville MD
National Center for Health Statistics 2010
1988
1988
1989
1989
1990
1990
1991
1991
1992
1992
1993
1993
1994
1994
1995
1995
1996
1996
1997
1997
1998
1998
1999
1999
2000
2000
2001
2001
2002
2002
2003
2003
2004
2004
2005
2005
2006
2006
2007
2007
2008
2008
2009
2009
2010
2010
2011
2012
2013
2014
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
SIDS FACTS
Higher incidence in preterm and low birth weight infants
Associated witho Young maternal ageo Maternal smoking with pregnancyo Late or no prenatal care
2-3 times more common in African-American American Indian and Alaska Native children
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Triple Risk Model to Explain SIDS
Critical Developmental
Period
Vulnerable Infant Exogenous
Stressors(eg brainstem dysfunction)
First 6 months
bull Proneside sleep position
bull Soft beddingbull Overbundling
overheatingbull Bed sharing
Intrinsic risk factors
bull Smokingbull Prematuritybull Alcohol and
illicit drugsbull Hypoxiabull Growth
restriction
SIDS
Extrinsic risk factors
Adapted from Filiano and Kinney 1994
bull Bed sharing + smoking
andor alcohol
Modifiable Risk Factors
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Paterson DS Krous HF Kinney HC et al JAMA 2006
Serotonin receptor binding density lower in SIDS cases compared to controls
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Adapted from Kinney and Thach 2009
An Example of SIDS Pathogenesis
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
2016 AAP Recommendations Infant Sleep Safety Recommendations are to reduce
the risk of SIDS and sleep-related suffocation asphyxia and entrapment
Recommendations should be used consistently until 1 year of ageo Most epidemiological studies upon
which these recommendations are based include infants up to 1 year of age
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Strength of Recommendation
Scale based on the Strength of Recommendation Taxonomy (SORT)
A There is good quality patient-oriented evidence B There is inconsistent or limited quality patient-
oriented evidence C The recommendation is based on consensus
disease-oriented evidence usual practice expertopinion or case series for studies ofdiagnosis treatment prevention orscreening
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Recommendations Change as the Evidence Evolves Statistics and risk factors may change
o New risks emerge (eg side positioning)o Different levels of risk
Policies and procedures may changeo Better death scene investigationso Diagnostic shift
Unintended consequenceso Plagiocephaly development o New tummy time recommendations
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
2016 SIDS Task Force Policy Statement Level A Recommendations Back to sleep for every sleep Use a firm sleep surface Keep soft objects and loose bedding out of the crib Room-sharingmdashInfant on separate sleep surface Breastfeeding is recommended Consider offering a pacifier at nap time and bedtime Avoid smoke exposure during pregnancy and after birth Avoid alcohol and illicit drug use during pregnancy and
after birth
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
2016 SIDS Task Force Policy Statement Level A Recommendations Avoid overheating Pregnant women should receive regular prenatal care Do not use home cardiorespiratory monitors as a strategy
for reducing the risk of SIDS Health care professionals staff in newborn nurseries and
NICUs and child care providers should endorse the SIDS risk-reduction recommendations from birth
Media and manufacturers should follow safe-sleep guidelines in their messaging and advertising
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
2016 SIDS Task Force Policy Statement Level B Recommendations Avoid commercial devices that are inconsistent with
safe sleep recommendations Supervised awake tummy time is recommended to
facilitate development and to minimize development of positional plagiocephaly (flattening of skull)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
2016 SIDS Task Force Policy Statement Level C Recommendations Continue research and surveillance on the risk factors
causes and pathophysiological mechanisms of SIDS and other sleep-related infant deaths with the ultimate goal of eliminating these deaths entirely
There is no evidence to recommend swaddling as a strategy to reduce the risk of SIDS
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Correct Safe Sleep Environment
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
We Need to Move Beyond Back to Sleep
Shersquos on her back to sleep
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Sleep Position for Healthy Newborns
Skin-to-skin care is recommended for all mothers and newborns regardless of feeding or delivery method immediately following birtho Mom should be medically stable
awake and able to respond to baby When mother needs to sleep or take
care of other needs infant should be placed supine in a bassinet
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Sleep Position in Newborn Nursery Infants in the newborn nursery
and infants who are rooming in with their parents should be placed in the supine position as soon as they are ready to be placed in the bassinet o No evidence that placing infants
on the side during the first few hours of life promotes clearance of amniotic fluid and decreases the risk of aspiration
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Sleep Position and Reflux Infants with gastroesophageal (GE) reflux
should be kept supineo Unless the risk of death from complications
of GE reflux is greater than the risk of SIDS
Supine position does not increase the risk of choking and aspiration in infants with GE reflux o Protective airway mechanisms
Do NOT elevate the head of the infantrsquos cribo Ineffective in reducing GE refluxo Infant may slide to the foot of the cribmdashmay
compromise respiration
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
The Truth About Supine Sleep and Aspiration Ending the Fallacy Orientation of the Trachea to the Esophagus
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Title
Text
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Infant Sleep Location
Infants should sleep in parentsrsquo room close to parentsrsquo bed but on a separate surface designed for infants
Ideally for the first year of life but at least for the first 6 months
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Room-Share How Long Yoursquore Kidding Right
2011 ldquoall sleep recommendations are to be followed until 1 year of agerdquo
2016 ldquoroom-sharing without bed-sharinghellipideally until 1 year of age but at least for the first 6 monthsrdquo
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Supporting Data
3 case-control studies comparing sleeping in a separate room vs room-sharingo Tappin (Scotland) AOR 326 (95 CI 103-1035)
bull Protection is significant for smoker motherso Blair (England) AOR 1049 (95 CI 426-2581)
bull Protection is significant for both smoker and nonsmoker mothers
o New Zealand Cot Death study AOR 285(95 CI 204-385)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
More Recent Data
New Zealand SUDI studyo 64 protection with room-sharing AOR 036
(95 CI 019-071)
Estimate of 50 reduction is very conservative
None of the case-control studies stratify by age (months)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Why is Room-Sharing Protective
SIDSmdashfailure to arouse More small awakenings during the night
o Stirrings movement not fully awake Postulation protective effect from small awakenings Room-sharing facilitates breastfeeding
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Room-Sharing and Sleep Quality
Volkovich room-sharing vs solitary sleepo Room-sharing mothers with more sleep disturbanceso Infants with similar sleep quality
Mao Mindell room-sharing infantsmdashmore awakenings
Montgomery-Downs Doan sleep quality in breastfeeding mothers gt to formula feeding motherso Exclusive breastfeeding = 30 min more sleep
More study needed
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Insight Study (Paul 2017)
Sleep questionnaire at 4 9 12 and 30 monthso Sleep duration overnight behaviorso Compared early vs late independent infants
At 4 monthso Equal sleep durationo Early group had better sleep consolidationo Longest stretch 46 minutes
Paul IM Hohman EE Loken E et al Mother-infant room-sharing and sleep outcomes in the INSIGHT study Pediatrics 2017140(1)e20170122
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Insight Study (Paul 2017)
At 9 monthso Longer sleep duration (40 minnight) o Better consolidation (100 min)
At 30 monthso Longer sleep duration (45 minnight)
Room-sharing 4 times more likely to transition to bed sharing overnight
Paul IM Hohman EE Loken E et al Mother-infant room-sharing and sleep outcomes in the INSIGHT study Pediatrics 2017140(1)e20170122
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Insight Commentary (Hauck Moon)
Late room-sharing mean 7 hours longest sleep Is early consolidation desirable Differences related to bedtime routines
o Early bedtimeo Number of night feedso Feeding back to sleep
Focus on the routine not early separation
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Feeding the Baby at Night Acknowledgment that parents may fall
asleep while feeding babyo Safer to feed on bed than on sofa
couch or armchair if you might fall asleep
o No pillows sheets blankets or other items that could obstruct infant breathing or cause overheating should be in bed
o Return infant back to separate sleep surface as soon as parent awakens
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Say NO to Couches Sofas and Cushioned Armchairs Never place a baby for sleep on these surfaces Never sleep with a baby on these surfaces One of the MOST dangerous places for an infant
(OR 51-669)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
High-Risk Bed Sharing Situations Age lt4 months Preterm or low birth weight Smoked during pregnancy Bed sharer is current smoker (even if not
smoking in bed) Bed sharer has usedis using meds or
substances that could impair alertness or arousal
Bed sharer is not parent (including other children)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bedsharing in Low-Risk Breastfed Infants
Blair et al AOR 16 (95 CI 096-27) o Age lt14 weekso Parents No cigarettes or alcoholo Independent of feeding method
Carpenter et al AOR 51 (95 CI 23-114) o Age lt3 months o Parents did not smokeo Mother No alcohol or drugso Breastfed infants
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Independent Review (Dr Robert Platt)
Very small numbers of low-risk babieso 24 in Blairrsquos studyo 12 in Carpenterrsquos study
Does not believe that data support definitive differences in 2 studies
Some evidence of increased risk in this group but cannot say how large the increased risk is
Cannot conclude that bed sharing in this group is safe
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
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Bed Sharing with Overlay
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Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Unsafe Bedding NISP Trends 1993-2102
Shapiro-Mendoza CK Colson ER Willinger M Rybin DV Camperlengo L Corwin MJ Trends in infant bedding use National Infant Sleep Position study 1993ndash2010 Pediatrics 2015135(1)10-17
Decrease from 86 to 55 Rate of decline decreases
2001-10 835 for teen mothers Predictors of adjusted OR
gt15
o Young motherso Non-white race
ethnicityo Less than college
education
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Why Use Soft Bedding
ComfortWarmtho Extrapolation of own feelingso Misinterpret firm with taut
bull Soft + taut ne firm
Safetyo Blankets pillows rolls to prevent falls
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Soft Bedding for Older Infants
Many parents recognize soft bedding is a risk Increased complacency as baby gets older Soft bedding is THE most important risk factor for
infants 4-12 months old (Colvin 2015) Infants roll into bedding and cannot extract
themselves
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
To Swaddle or Not to Swaddle That is the Question Pros
o Calms the infant promotes sleep decreases number of awakenings
o Encourages use of the supine position
Conso Increased respiratory rate and
reduced functional residual lung capacity
o Exacerbates hip dysplasia if the hips are kept in extension and adduction
o ldquoLooserdquo swaddling becomes loose bedding
o Overheating especially if the head is covered or the infant has infection
o Effects on arousability to an external stimulus remain unclear (conflicting data) There may be minimal effects of routine swaddling on arousal
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Swaddling
There is insufficient evidence to recommend routine swaddling as a strategy to reduce the incidence of SIDS
Swaddling must be correctly applied to avoid the possible hazards
Swaddling does not reduce the necessity to follow recommended safe sleep practices Ambrogio Lorenzettis Madonna and Child (1319)
Wikipedia
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
McDonnell E Moon RY Infant deaths and injuries associated with wearable blankets swaddle wraps and swaddling J Pediatr 20141641152-1156
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
SwaddlingmdashMore Questionshellip
Pease 2016 Pediatrics Pooled OR = 138
o Prone = 1299 o Side = 316o Supine = 193
Increased risk with age Limitations
o Heterogeneity definitions other risk factorsPease AS Fleming PJ Hauck FR et al Swaddling and the risk of sudden infant death syndrome a meta-analysis Pediatrics 2016137(6)e20153
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
wwwhealthychildrenorg
Swaddling (wrapping a light blanket snuggly around a baby) may help calm a crying baby If you swaddle your baby be sure to place him on his back to sleep Stop swaddling your baby when he starts to roll
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers
AAP recommendation Consider offering a pacifier at nap time and bedtime
Studies consistently demonstrate a protective effect of pacifiers on SIDS
Mechanism unknowno Dislodge within 15 to 60 minuteso Decreased arousal threshold
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers and Breastfeeding Well-designed trials
o 2 found no association among term infants
o 1 found no association among preterm infants
o 1 found slightly decreased breastfeeding duration at one month if pacifier introduced in first week of life but NO difference if pacifier introduced after one month
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Baby Friendly USA Pacifiers
Breastfeeding babies should not be given pacifiers by the staff of the facility with the exception of o Limited use to decrease pain during procedures when
the baby cannot safely be held or breastfed (pacifiers used should be discarded after these procedures)
o Babies who are being tube-fed in NICUo Other rare specific medical reasons
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Addressing Sleep Deprivation
Give parents tools to cope with fussy babies
Sleep-deprived parents may make poor judgments
Make use of tools o Swaddling side carrying
shushing swinging and sucking
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Overcoming Barriers to Change What Parents are Sayinghellip
Prone positioning fear of choking Baby sleeps ldquobetterrdquo on stomach Soft things are safer for the baby SIDS is ldquoGodrsquos willrdquo Why bother Recommendations keep changing
anyway Vigilance sleep with baby for protection
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Factors Associated With Choice of Infant Sleep Position 3300 mothers from 32 hospitals 77 usually use supine position 49 exclusive use supine position Most likely to use prone
o African-American motherso Mothers with lt high school educationo Lack of perceived controlo Personal attitudesocietal norms
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
A continuum starting in childhoodo Secondary school baby sitting classes
Pre-pregnancy Pregnancyprenatal education
o Prior to baby showerhellipldquowrong giftsrdquo In-hospital education and modeling
o Include family friends baby sitters Re-enforcement in the doctorrsquos office
o Especially between 1 to 4 months Grandparents They hold great power The general public (day cares religious leaders)
A Lifetime of Infant Sleep Safety
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Chart1
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
14
139
13
13
12
13
117
17
103
269
087
386
074
353
077
531
072
557
067
644
062
666
056
716
057
711
053
728
056
701
055
722
055
757
057
703
055
721
054
741
051
728
048
042
04
039
Sheet1
Sheet1
ampA
Page ampP
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
Sheet2
Pre-AAP recommendation Post-AAP RecommendationBack to SleepSafe to Sleep Campaign
Sheet3
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Infant Sleep Safety
Requires a consistent and repetitive message in the community to prevent accidental deaths
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Safe Sleep Nurse Modeling
People trust nurses Whatever the nurse does must
be correct and it will be imitated in the home
Fact supine positioning in the nursery can almost DOUBLE its use in the home
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Physician Advocacy
Srivatsa 1997 HCP education to new familieshellip34 reduction in prone sleeping
Eron 2009 Study of Central NY state physicianshellip30 identified incorrect safest sleep positionhellip30 do not discuss with families
Colson 2009 Only 13 mothers advised by MD to use supine positionhellip3 times more likely to position the baby properly
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Healthcare Provider Advice to New Mothers Safe Sleep
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Chart1
Column1
[]
[]
[]
55
25
20
Sheet1
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Mason Clinical Peds 713
Bundled interventiono Nursing education policy model behavior safe sleep
video posters in rooms declaration of safe sleep practice
Safe sleep environment uarr from 25 to 58 Intention in home 95 supine none ldquoco-sleepingrdquo
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bundled Intervention = Behavior Change
QUESTION GROUP p-value
ISS Study NISP
Behavior Questions n = 490 n = 1046
Baby routinely placed to sleep on back 925 73 lt 0001
Baby routinely sleeps in bassinetcrib 995 71 lt 00001
Baby sleeps under a thin sheet 992 86 lt 0001
Baby given a pacifier for sleep 741 84 lt 0001Goodstein MH Bell T Krugman SD Improving infant sleep safety through a comprehensive hospital-based program Clinical Pediatrics 201554(3)212-221
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
o Baseline Safe sleep 49 of 264 infants o Post 312 of 234 infants (P lt 001) o Extra blankets most common o Baseline 77 vs 44 post-intervention o Mean number of unsafe items reduced by 50 (P lt 001)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Washington DC
2 urban DC nurseries 26 did not believe or unsure that infant positioning
was associated with SIDS Top 3 factors influencing sleep position
o 56 PERSONAL PREFERENCE Why non-supine Clinical experience (25)
o Increase risk aspirationo Decrease sleep and comfort
Bartow KL Nursesrsquo knowledge and adherence to sudden infant death syndrome prevention guidelines Pediatr Nurs 201642(1)7-13
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
TodaysBaby QI Safe Sleep Teaching
QI intervention median = 160 days Mothers reported receiving information 72 to 95
(increase of 24-57) 94 babies observed supine (plus 24) 88 infants in safe sleep environment
o Increase of 33 Gains maintained up to 12 months
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Social Media and Risk-Reduction Training Study (SMART) Cluster randomization 4 groups Safe sleep or breast feeding education Nursing QI and social media (mobile health) N = 1600 1263 responses (79) Safe sleep NQI and MHealth
o Supine sleep 925 o Room-sharing 859o No soft bedding 819o Pacifier use 762
Moon RY Hauck FR Colson ER et al The effect of nursing quality improvement and mobile health interventions on infant sleep practices a randomized clinical trial JAMA 2017318(4)351-359
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Hospital Initiative ComponentswwwcribsforkidsorgHospitalInitiativeToolkit INTRODUCTORY LETTER HOSPITAL INITIATIVE TOOL KIT
INSTRUCTIONS ORGANIZATIONAL CHART HOSPITAL POLICY ACKNOWLEDGMENT FORM (Engl amp
Span) SAFE SLEEP EDUCATIONAL FLIP CHART
NONCOMPLIANCE WAIVER (Engl amp Span)
NURSING EDUCATION MODULE
SAFE SLEEP POSTERS DOOR HANGERS (Engl amp Span) GRADUATION CERTIFICATE SAMPLE LETTER TO HOSPITALS SAMPLE LETTER TO PROVIDERS INFANT SAFE SLEEP BROCHURES
(Engl amp Span) PRESS KIT
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
All materials available on-lineo No major costs to the hospital
Easy on-line access for documentation
NO FEE FOR PARTICIPATION
wwwCribsforKidsorgHospitalInitiative
Tiffany Price (tpricecribsforkidsorg)
The National Safe Sleep Hospital Certification Program
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
TNmdash25 reduction in infant sleep-related deaths in 2 years
SDmdashOver 7915 Pack lsquon Plays distributed since 2012 Infant mortality rate decreased from 86 (2012) to 48 (2016)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
2009 to 2015 38 decrease in infant mortality Decreased from 135 to 84 per 1000 SUID decreased gt50 Decrease in racial disparityhttphealthybabiesbaltimorecomhome
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
And Finallyhellip
Health care providers should have open frank nonjudgmental conversations with families about their sleep practices
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Encouraging Parents to Take Action
According to the Social Learning Theory parents are more likely to recall and comply with instructions when
the health care provider
Uses a positive tone Provides adequate information Allows the parent to ask most of the questions
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Motivational Interviewing
ldquoa collaborative goal-oriented style of communication with particular attention to the language of changerdquo
o Strengthen personal motivation and commitment to a specific goal
o Explore onersquos reasons for change (barriers)o Patient generates own solutions
bull More likely to feel realisticbull Planting seeds of change
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Impact of Eliminating Sleep-Related Deaths
Every week we lose 70 children which is equivalent to 4 kindergarten classrooms
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Thank You
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Contact Information
mgoodsteinwellspanorg
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Visit Pediatric Care Online today for additional information on this and other topics
httppediatriccaresolutionsaaporgPediatric Care Online is a convenient electronic resource for immediate expert help with
virtually every pediatric clinical information need with must-have resources that are included in a comprehensive reference library and time-saving clinical tools
Donrsquot have a subscription to PCOThen take advantage of a free trial today
Call Mead Johnson Nutrition at 888363-2362 orfor more information go to
httppediatriccaresolutionsaaporgSSFree_Trialaspx
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
IMR over time Finland vs US
Slide Number 1
Disclaimer
Objectives for Todayrsquos Talk
Infant Mortality Rates for the Five Leading Causes of Infant Death in the United States 2005 and 2011
US Post-Neonatal Mortality 2015
FACT
What is SUID or SUDI
Some Causes of Deaths that Occur Suddenly and Unexpectedly during Infancy
What is SIDS
SIDS FACTS
SIDS FACTS
Triple Risk Model to Explain SIDS
Paterson DS Krous HF Kinney HC et al JAMA 2006
An Example of SIDS Pathogenesis
2016 AAP Recommendations Infant Sleep Safety
Strength of Recommendation
Recommendations Change as the Evidence Evolves
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
Correct Safe Sleep Environment
We Need to Move Beyond Back to Sleep
Sleep Position for Healthy Newborns
Sleep Position in Newborn Nursery
Sleep Position and Reflux
The Truth About Supine Sleep and Aspiration Ending the Fallacy
Title
Infant Sleep Location
Room-Share How Long Yoursquore Kidding Right
Supporting Data
More Recent Data
Why is Room-Sharing Protective
Room-Sharing and Sleep Quality
Insight Study (Paul 2017)
Insight Study (Paul 2017)
Insight Commentary (Hauck Moon)
Feeding the Baby at Night
Say NO to Couches Sofas and Cushioned Armchairs
High-Risk Bed Sharing Situations
Bedsharing in Low-Risk Breastfed Infants
Independent Review (Dr Robert Platt)
Bed Sharing
Bed Sharing
Bed Sharing with Overlay
Bed Sharing with Overlay
Bed Sharing with Overlay
Couch Sleeping
Couch Sleeping
Couch Sleeping
Unsafe Bedding NISP Trends 1993-2102
Why Use Soft Bedding
Soft Bedding for Older Infants
To Swaddle or Not to Swaddle That is the Question
Swaddling
SwaddlingmdashIs it Safe
SwaddlingmdashMore Questionshellip
wwwhealthychildrenorg
Pacifiers
Pacifiers and Breastfeeding
Baby Friendly USA Pacifiers
Addressing Sleep Deprivation
Overcoming Barriers to Change What Parents are Sayinghellip
Factors Associated With Choice of Infant Sleep Position
Slide Number 65
What is Working
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Infant Sleep Safety
Safe Sleep Nurse Modeling
Physician Advocacy
Healthcare Provider Advice to New Mothers Safe Sleep
Mason Clinical Peds 713
Bundled Intervention = Behavior Change
Hospital Unsafe Sleep Persists
Washington DC
TodaysBaby QI Safe Sleep Teaching
TodaysBaby QI Safe Sleep Teaching
Social Media and Risk-Reduction Training Study (SMART)
The National Safe Sleep Hospital Certification Program
Coordinated Education Efforts Work
Coordinated Education Efforts Work
And Finallyhellip
Encouraging Parents to Take Action
Motivational Interviewing
Impact of Eliminating Sleep-Related Deaths
Thank You
Contact Information
Slide Number 89
IMR over time Finland vs US
Column1
correct advice
55
incorrect advice
25
no advice
20
correct advice
incorrect advice
no advice
SIDS Rate
Percent Back Sleeping
1988
14
1989
139
1990
13
1991
13
1992
12
13
1993
117
17
1994
103
269
1995
087
386
1996
074
353
1997
077
531
1998
072
557
1999
067
644
2000
062
666
2001
056
716
2002
057
711
2003
053
728
2004
056
701
2005
055
722
2006
055
757
2007
057
703
2008
055
721
2009
054
741
2010
051
728
2011
048
2012
042
2013
04
2014
039
httpwwwcdcgovNCHSdatanvsrnvsr58nvsr58_19pdf
Xu JQ Kochanek KD Murphy SL Tejada-Vera B Deaths Final data for
2007
National vital statistics reports vol 58 no 19 Hyattsville MD
National Center for Health Statistics 2010
1988
1988
1989
1989
1990
1990
1991
1991
1992
1992
1993
1993
1994
1994
1995
1995
1996
1996
1997
1997
1998
1998
1999
1999
2000
2000
2001
2001
2002
2002
2003
2003
2004
2004
2005
2005
2006
2006
2007
2007
2008
2008
2009
2009
2010
2010
2011
2012
2013
2014
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Triple Risk Model to Explain SIDS
Critical Developmental
Period
Vulnerable Infant Exogenous
Stressors(eg brainstem dysfunction)
First 6 months
bull Proneside sleep position
bull Soft beddingbull Overbundling
overheatingbull Bed sharing
Intrinsic risk factors
bull Smokingbull Prematuritybull Alcohol and
illicit drugsbull Hypoxiabull Growth
restriction
SIDS
Extrinsic risk factors
Adapted from Filiano and Kinney 1994
bull Bed sharing + smoking
andor alcohol
Modifiable Risk Factors
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Paterson DS Krous HF Kinney HC et al JAMA 2006
Serotonin receptor binding density lower in SIDS cases compared to controls
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Adapted from Kinney and Thach 2009
An Example of SIDS Pathogenesis
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
2016 AAP Recommendations Infant Sleep Safety Recommendations are to reduce
the risk of SIDS and sleep-related suffocation asphyxia and entrapment
Recommendations should be used consistently until 1 year of ageo Most epidemiological studies upon
which these recommendations are based include infants up to 1 year of age
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Strength of Recommendation
Scale based on the Strength of Recommendation Taxonomy (SORT)
A There is good quality patient-oriented evidence B There is inconsistent or limited quality patient-
oriented evidence C The recommendation is based on consensus
disease-oriented evidence usual practice expertopinion or case series for studies ofdiagnosis treatment prevention orscreening
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Recommendations Change as the Evidence Evolves Statistics and risk factors may change
o New risks emerge (eg side positioning)o Different levels of risk
Policies and procedures may changeo Better death scene investigationso Diagnostic shift
Unintended consequenceso Plagiocephaly development o New tummy time recommendations
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
2016 SIDS Task Force Policy Statement Level A Recommendations Back to sleep for every sleep Use a firm sleep surface Keep soft objects and loose bedding out of the crib Room-sharingmdashInfant on separate sleep surface Breastfeeding is recommended Consider offering a pacifier at nap time and bedtime Avoid smoke exposure during pregnancy and after birth Avoid alcohol and illicit drug use during pregnancy and
after birth
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
2016 SIDS Task Force Policy Statement Level A Recommendations Avoid overheating Pregnant women should receive regular prenatal care Do not use home cardiorespiratory monitors as a strategy
for reducing the risk of SIDS Health care professionals staff in newborn nurseries and
NICUs and child care providers should endorse the SIDS risk-reduction recommendations from birth
Media and manufacturers should follow safe-sleep guidelines in their messaging and advertising
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
2016 SIDS Task Force Policy Statement Level B Recommendations Avoid commercial devices that are inconsistent with
safe sleep recommendations Supervised awake tummy time is recommended to
facilitate development and to minimize development of positional plagiocephaly (flattening of skull)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
2016 SIDS Task Force Policy Statement Level C Recommendations Continue research and surveillance on the risk factors
causes and pathophysiological mechanisms of SIDS and other sleep-related infant deaths with the ultimate goal of eliminating these deaths entirely
There is no evidence to recommend swaddling as a strategy to reduce the risk of SIDS
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Correct Safe Sleep Environment
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
We Need to Move Beyond Back to Sleep
Shersquos on her back to sleep
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Sleep Position for Healthy Newborns
Skin-to-skin care is recommended for all mothers and newborns regardless of feeding or delivery method immediately following birtho Mom should be medically stable
awake and able to respond to baby When mother needs to sleep or take
care of other needs infant should be placed supine in a bassinet
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Sleep Position in Newborn Nursery Infants in the newborn nursery
and infants who are rooming in with their parents should be placed in the supine position as soon as they are ready to be placed in the bassinet o No evidence that placing infants
on the side during the first few hours of life promotes clearance of amniotic fluid and decreases the risk of aspiration
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Sleep Position and Reflux Infants with gastroesophageal (GE) reflux
should be kept supineo Unless the risk of death from complications
of GE reflux is greater than the risk of SIDS
Supine position does not increase the risk of choking and aspiration in infants with GE reflux o Protective airway mechanisms
Do NOT elevate the head of the infantrsquos cribo Ineffective in reducing GE refluxo Infant may slide to the foot of the cribmdashmay
compromise respiration
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
The Truth About Supine Sleep and Aspiration Ending the Fallacy Orientation of the Trachea to the Esophagus
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Title
Text
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Infant Sleep Location
Infants should sleep in parentsrsquo room close to parentsrsquo bed but on a separate surface designed for infants
Ideally for the first year of life but at least for the first 6 months
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Room-Share How Long Yoursquore Kidding Right
2011 ldquoall sleep recommendations are to be followed until 1 year of agerdquo
2016 ldquoroom-sharing without bed-sharinghellipideally until 1 year of age but at least for the first 6 monthsrdquo
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Supporting Data
3 case-control studies comparing sleeping in a separate room vs room-sharingo Tappin (Scotland) AOR 326 (95 CI 103-1035)
bull Protection is significant for smoker motherso Blair (England) AOR 1049 (95 CI 426-2581)
bull Protection is significant for both smoker and nonsmoker mothers
o New Zealand Cot Death study AOR 285(95 CI 204-385)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
More Recent Data
New Zealand SUDI studyo 64 protection with room-sharing AOR 036
(95 CI 019-071)
Estimate of 50 reduction is very conservative
None of the case-control studies stratify by age (months)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Why is Room-Sharing Protective
SIDSmdashfailure to arouse More small awakenings during the night
o Stirrings movement not fully awake Postulation protective effect from small awakenings Room-sharing facilitates breastfeeding
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Room-Sharing and Sleep Quality
Volkovich room-sharing vs solitary sleepo Room-sharing mothers with more sleep disturbanceso Infants with similar sleep quality
Mao Mindell room-sharing infantsmdashmore awakenings
Montgomery-Downs Doan sleep quality in breastfeeding mothers gt to formula feeding motherso Exclusive breastfeeding = 30 min more sleep
More study needed
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Insight Study (Paul 2017)
Sleep questionnaire at 4 9 12 and 30 monthso Sleep duration overnight behaviorso Compared early vs late independent infants
At 4 monthso Equal sleep durationo Early group had better sleep consolidationo Longest stretch 46 minutes
Paul IM Hohman EE Loken E et al Mother-infant room-sharing and sleep outcomes in the INSIGHT study Pediatrics 2017140(1)e20170122
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Insight Study (Paul 2017)
At 9 monthso Longer sleep duration (40 minnight) o Better consolidation (100 min)
At 30 monthso Longer sleep duration (45 minnight)
Room-sharing 4 times more likely to transition to bed sharing overnight
Paul IM Hohman EE Loken E et al Mother-infant room-sharing and sleep outcomes in the INSIGHT study Pediatrics 2017140(1)e20170122
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Insight Commentary (Hauck Moon)
Late room-sharing mean 7 hours longest sleep Is early consolidation desirable Differences related to bedtime routines
o Early bedtimeo Number of night feedso Feeding back to sleep
Focus on the routine not early separation
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Feeding the Baby at Night Acknowledgment that parents may fall
asleep while feeding babyo Safer to feed on bed than on sofa
couch or armchair if you might fall asleep
o No pillows sheets blankets or other items that could obstruct infant breathing or cause overheating should be in bed
o Return infant back to separate sleep surface as soon as parent awakens
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Say NO to Couches Sofas and Cushioned Armchairs Never place a baby for sleep on these surfaces Never sleep with a baby on these surfaces One of the MOST dangerous places for an infant
(OR 51-669)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
High-Risk Bed Sharing Situations Age lt4 months Preterm or low birth weight Smoked during pregnancy Bed sharer is current smoker (even if not
smoking in bed) Bed sharer has usedis using meds or
substances that could impair alertness or arousal
Bed sharer is not parent (including other children)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bedsharing in Low-Risk Breastfed Infants
Blair et al AOR 16 (95 CI 096-27) o Age lt14 weekso Parents No cigarettes or alcoholo Independent of feeding method
Carpenter et al AOR 51 (95 CI 23-114) o Age lt3 months o Parents did not smokeo Mother No alcohol or drugso Breastfed infants
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Independent Review (Dr Robert Platt)
Very small numbers of low-risk babieso 24 in Blairrsquos studyo 12 in Carpenterrsquos study
Does not believe that data support definitive differences in 2 studies
Some evidence of increased risk in this group but cannot say how large the increased risk is
Cannot conclude that bed sharing in this group is safe
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Unsafe Bedding NISP Trends 1993-2102
Shapiro-Mendoza CK Colson ER Willinger M Rybin DV Camperlengo L Corwin MJ Trends in infant bedding use National Infant Sleep Position study 1993ndash2010 Pediatrics 2015135(1)10-17
Decrease from 86 to 55 Rate of decline decreases
2001-10 835 for teen mothers Predictors of adjusted OR
gt15
o Young motherso Non-white race
ethnicityo Less than college
education
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Why Use Soft Bedding
ComfortWarmtho Extrapolation of own feelingso Misinterpret firm with taut
bull Soft + taut ne firm
Safetyo Blankets pillows rolls to prevent falls
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Soft Bedding for Older Infants
Many parents recognize soft bedding is a risk Increased complacency as baby gets older Soft bedding is THE most important risk factor for
infants 4-12 months old (Colvin 2015) Infants roll into bedding and cannot extract
themselves
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
To Swaddle or Not to Swaddle That is the Question Pros
o Calms the infant promotes sleep decreases number of awakenings
o Encourages use of the supine position
Conso Increased respiratory rate and
reduced functional residual lung capacity
o Exacerbates hip dysplasia if the hips are kept in extension and adduction
o ldquoLooserdquo swaddling becomes loose bedding
o Overheating especially if the head is covered or the infant has infection
o Effects on arousability to an external stimulus remain unclear (conflicting data) There may be minimal effects of routine swaddling on arousal
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Swaddling
There is insufficient evidence to recommend routine swaddling as a strategy to reduce the incidence of SIDS
Swaddling must be correctly applied to avoid the possible hazards
Swaddling does not reduce the necessity to follow recommended safe sleep practices Ambrogio Lorenzettis Madonna and Child (1319)
Wikipedia
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
McDonnell E Moon RY Infant deaths and injuries associated with wearable blankets swaddle wraps and swaddling J Pediatr 20141641152-1156
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
SwaddlingmdashMore Questionshellip
Pease 2016 Pediatrics Pooled OR = 138
o Prone = 1299 o Side = 316o Supine = 193
Increased risk with age Limitations
o Heterogeneity definitions other risk factorsPease AS Fleming PJ Hauck FR et al Swaddling and the risk of sudden infant death syndrome a meta-analysis Pediatrics 2016137(6)e20153
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
wwwhealthychildrenorg
Swaddling (wrapping a light blanket snuggly around a baby) may help calm a crying baby If you swaddle your baby be sure to place him on his back to sleep Stop swaddling your baby when he starts to roll
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers
AAP recommendation Consider offering a pacifier at nap time and bedtime
Studies consistently demonstrate a protective effect of pacifiers on SIDS
Mechanism unknowno Dislodge within 15 to 60 minuteso Decreased arousal threshold
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers and Breastfeeding Well-designed trials
o 2 found no association among term infants
o 1 found no association among preterm infants
o 1 found slightly decreased breastfeeding duration at one month if pacifier introduced in first week of life but NO difference if pacifier introduced after one month
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Baby Friendly USA Pacifiers
Breastfeeding babies should not be given pacifiers by the staff of the facility with the exception of o Limited use to decrease pain during procedures when
the baby cannot safely be held or breastfed (pacifiers used should be discarded after these procedures)
o Babies who are being tube-fed in NICUo Other rare specific medical reasons
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Addressing Sleep Deprivation
Give parents tools to cope with fussy babies
Sleep-deprived parents may make poor judgments
Make use of tools o Swaddling side carrying
shushing swinging and sucking
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Overcoming Barriers to Change What Parents are Sayinghellip
Prone positioning fear of choking Baby sleeps ldquobetterrdquo on stomach Soft things are safer for the baby SIDS is ldquoGodrsquos willrdquo Why bother Recommendations keep changing
anyway Vigilance sleep with baby for protection
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Factors Associated With Choice of Infant Sleep Position 3300 mothers from 32 hospitals 77 usually use supine position 49 exclusive use supine position Most likely to use prone
o African-American motherso Mothers with lt high school educationo Lack of perceived controlo Personal attitudesocietal norms
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
A continuum starting in childhoodo Secondary school baby sitting classes
Pre-pregnancy Pregnancyprenatal education
o Prior to baby showerhellipldquowrong giftsrdquo In-hospital education and modeling
o Include family friends baby sitters Re-enforcement in the doctorrsquos office
o Especially between 1 to 4 months Grandparents They hold great power The general public (day cares religious leaders)
A Lifetime of Infant Sleep Safety
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Chart1
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
14
139
13
13
12
13
117
17
103
269
087
386
074
353
077
531
072
557
067
644
062
666
056
716
057
711
053
728
056
701
055
722
055
757
057
703
055
721
054
741
051
728
048
042
04
039
Sheet1
Sheet1
ampA
Page ampP
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
Sheet2
Pre-AAP recommendation Post-AAP RecommendationBack to SleepSafe to Sleep Campaign
Sheet3
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Infant Sleep Safety
Requires a consistent and repetitive message in the community to prevent accidental deaths
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Safe Sleep Nurse Modeling
People trust nurses Whatever the nurse does must
be correct and it will be imitated in the home
Fact supine positioning in the nursery can almost DOUBLE its use in the home
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Physician Advocacy
Srivatsa 1997 HCP education to new familieshellip34 reduction in prone sleeping
Eron 2009 Study of Central NY state physicianshellip30 identified incorrect safest sleep positionhellip30 do not discuss with families
Colson 2009 Only 13 mothers advised by MD to use supine positionhellip3 times more likely to position the baby properly
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Healthcare Provider Advice to New Mothers Safe Sleep
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Chart1
Column1
[]
[]
[]
55
25
20
Sheet1
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Mason Clinical Peds 713
Bundled interventiono Nursing education policy model behavior safe sleep
video posters in rooms declaration of safe sleep practice
Safe sleep environment uarr from 25 to 58 Intention in home 95 supine none ldquoco-sleepingrdquo
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bundled Intervention = Behavior Change
QUESTION GROUP p-value
ISS Study NISP
Behavior Questions n = 490 n = 1046
Baby routinely placed to sleep on back 925 73 lt 0001
Baby routinely sleeps in bassinetcrib 995 71 lt 00001
Baby sleeps under a thin sheet 992 86 lt 0001
Baby given a pacifier for sleep 741 84 lt 0001Goodstein MH Bell T Krugman SD Improving infant sleep safety through a comprehensive hospital-based program Clinical Pediatrics 201554(3)212-221
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
o Baseline Safe sleep 49 of 264 infants o Post 312 of 234 infants (P lt 001) o Extra blankets most common o Baseline 77 vs 44 post-intervention o Mean number of unsafe items reduced by 50 (P lt 001)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Washington DC
2 urban DC nurseries 26 did not believe or unsure that infant positioning
was associated with SIDS Top 3 factors influencing sleep position
o 56 PERSONAL PREFERENCE Why non-supine Clinical experience (25)
o Increase risk aspirationo Decrease sleep and comfort
Bartow KL Nursesrsquo knowledge and adherence to sudden infant death syndrome prevention guidelines Pediatr Nurs 201642(1)7-13
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
TodaysBaby QI Safe Sleep Teaching
QI intervention median = 160 days Mothers reported receiving information 72 to 95
(increase of 24-57) 94 babies observed supine (plus 24) 88 infants in safe sleep environment
o Increase of 33 Gains maintained up to 12 months
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Social Media and Risk-Reduction Training Study (SMART) Cluster randomization 4 groups Safe sleep or breast feeding education Nursing QI and social media (mobile health) N = 1600 1263 responses (79) Safe sleep NQI and MHealth
o Supine sleep 925 o Room-sharing 859o No soft bedding 819o Pacifier use 762
Moon RY Hauck FR Colson ER et al The effect of nursing quality improvement and mobile health interventions on infant sleep practices a randomized clinical trial JAMA 2017318(4)351-359
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Hospital Initiative ComponentswwwcribsforkidsorgHospitalInitiativeToolkit INTRODUCTORY LETTER HOSPITAL INITIATIVE TOOL KIT
INSTRUCTIONS ORGANIZATIONAL CHART HOSPITAL POLICY ACKNOWLEDGMENT FORM (Engl amp
Span) SAFE SLEEP EDUCATIONAL FLIP CHART
NONCOMPLIANCE WAIVER (Engl amp Span)
NURSING EDUCATION MODULE
SAFE SLEEP POSTERS DOOR HANGERS (Engl amp Span) GRADUATION CERTIFICATE SAMPLE LETTER TO HOSPITALS SAMPLE LETTER TO PROVIDERS INFANT SAFE SLEEP BROCHURES
(Engl amp Span) PRESS KIT
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
All materials available on-lineo No major costs to the hospital
Easy on-line access for documentation
NO FEE FOR PARTICIPATION
wwwCribsforKidsorgHospitalInitiative
Tiffany Price (tpricecribsforkidsorg)
The National Safe Sleep Hospital Certification Program
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
TNmdash25 reduction in infant sleep-related deaths in 2 years
SDmdashOver 7915 Pack lsquon Plays distributed since 2012 Infant mortality rate decreased from 86 (2012) to 48 (2016)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
2009 to 2015 38 decrease in infant mortality Decreased from 135 to 84 per 1000 SUID decreased gt50 Decrease in racial disparityhttphealthybabiesbaltimorecomhome
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
And Finallyhellip
Health care providers should have open frank nonjudgmental conversations with families about their sleep practices
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Encouraging Parents to Take Action
According to the Social Learning Theory parents are more likely to recall and comply with instructions when
the health care provider
Uses a positive tone Provides adequate information Allows the parent to ask most of the questions
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Motivational Interviewing
ldquoa collaborative goal-oriented style of communication with particular attention to the language of changerdquo
o Strengthen personal motivation and commitment to a specific goal
o Explore onersquos reasons for change (barriers)o Patient generates own solutions
bull More likely to feel realisticbull Planting seeds of change
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Impact of Eliminating Sleep-Related Deaths
Every week we lose 70 children which is equivalent to 4 kindergarten classrooms
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Thank You
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Contact Information
mgoodsteinwellspanorg
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Visit Pediatric Care Online today for additional information on this and other topics
httppediatriccaresolutionsaaporgPediatric Care Online is a convenient electronic resource for immediate expert help with
virtually every pediatric clinical information need with must-have resources that are included in a comprehensive reference library and time-saving clinical tools
Donrsquot have a subscription to PCOThen take advantage of a free trial today
Call Mead Johnson Nutrition at 888363-2362 orfor more information go to
httppediatriccaresolutionsaaporgSSFree_Trialaspx
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
IMR over time Finland vs US
Slide Number 1
Disclaimer
Objectives for Todayrsquos Talk
Infant Mortality Rates for the Five Leading Causes of Infant Death in the United States 2005 and 2011
US Post-Neonatal Mortality 2015
FACT
What is SUID or SUDI
Some Causes of Deaths that Occur Suddenly and Unexpectedly during Infancy
What is SIDS
SIDS FACTS
SIDS FACTS
Triple Risk Model to Explain SIDS
Paterson DS Krous HF Kinney HC et al JAMA 2006
An Example of SIDS Pathogenesis
2016 AAP Recommendations Infant Sleep Safety
Strength of Recommendation
Recommendations Change as the Evidence Evolves
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
Correct Safe Sleep Environment
We Need to Move Beyond Back to Sleep
Sleep Position for Healthy Newborns
Sleep Position in Newborn Nursery
Sleep Position and Reflux
The Truth About Supine Sleep and Aspiration Ending the Fallacy
Title
Infant Sleep Location
Room-Share How Long Yoursquore Kidding Right
Supporting Data
More Recent Data
Why is Room-Sharing Protective
Room-Sharing and Sleep Quality
Insight Study (Paul 2017)
Insight Study (Paul 2017)
Insight Commentary (Hauck Moon)
Feeding the Baby at Night
Say NO to Couches Sofas and Cushioned Armchairs
High-Risk Bed Sharing Situations
Bedsharing in Low-Risk Breastfed Infants
Independent Review (Dr Robert Platt)
Bed Sharing
Bed Sharing
Bed Sharing with Overlay
Bed Sharing with Overlay
Bed Sharing with Overlay
Couch Sleeping
Couch Sleeping
Couch Sleeping
Unsafe Bedding NISP Trends 1993-2102
Why Use Soft Bedding
Soft Bedding for Older Infants
To Swaddle or Not to Swaddle That is the Question
Swaddling
SwaddlingmdashIs it Safe
SwaddlingmdashMore Questionshellip
wwwhealthychildrenorg
Pacifiers
Pacifiers and Breastfeeding
Baby Friendly USA Pacifiers
Addressing Sleep Deprivation
Overcoming Barriers to Change What Parents are Sayinghellip
Factors Associated With Choice of Infant Sleep Position
Slide Number 65
What is Working
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Infant Sleep Safety
Safe Sleep Nurse Modeling
Physician Advocacy
Healthcare Provider Advice to New Mothers Safe Sleep
Mason Clinical Peds 713
Bundled Intervention = Behavior Change
Hospital Unsafe Sleep Persists
Washington DC
TodaysBaby QI Safe Sleep Teaching
TodaysBaby QI Safe Sleep Teaching
Social Media and Risk-Reduction Training Study (SMART)
The National Safe Sleep Hospital Certification Program
Coordinated Education Efforts Work
Coordinated Education Efforts Work
And Finallyhellip
Encouraging Parents to Take Action
Motivational Interviewing
Impact of Eliminating Sleep-Related Deaths
Thank You
Contact Information
Slide Number 89
IMR over time Finland vs US
Column1
correct advice
55
incorrect advice
25
no advice
20
correct advice
incorrect advice
no advice
SIDS Rate
Percent Back Sleeping
1988
14
1989
139
1990
13
1991
13
1992
12
13
1993
117
17
1994
103
269
1995
087
386
1996
074
353
1997
077
531
1998
072
557
1999
067
644
2000
062
666
2001
056
716
2002
057
711
2003
053
728
2004
056
701
2005
055
722
2006
055
757
2007
057
703
2008
055
721
2009
054
741
2010
051
728
2011
048
2012
042
2013
04
2014
039
httpwwwcdcgovNCHSdatanvsrnvsr58nvsr58_19pdf
Xu JQ Kochanek KD Murphy SL Tejada-Vera B Deaths Final data for
2007
National vital statistics reports vol 58 no 19 Hyattsville MD
National Center for Health Statistics 2010
1988
1988
1989
1989
1990
1990
1991
1991
1992
1992
1993
1993
1994
1994
1995
1995
1996
1996
1997
1997
1998
1998
1999
1999
2000
2000
2001
2001
2002
2002
2003
2003
2004
2004
2005
2005
2006
2006
2007
2007
2008
2008
2009
2009
2010
2010
2011
2012
2013
2014
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Paterson DS Krous HF Kinney HC et al JAMA 2006
Serotonin receptor binding density lower in SIDS cases compared to controls
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Adapted from Kinney and Thach 2009
An Example of SIDS Pathogenesis
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
2016 AAP Recommendations Infant Sleep Safety Recommendations are to reduce
the risk of SIDS and sleep-related suffocation asphyxia and entrapment
Recommendations should be used consistently until 1 year of ageo Most epidemiological studies upon
which these recommendations are based include infants up to 1 year of age
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Strength of Recommendation
Scale based on the Strength of Recommendation Taxonomy (SORT)
A There is good quality patient-oriented evidence B There is inconsistent or limited quality patient-
oriented evidence C The recommendation is based on consensus
disease-oriented evidence usual practice expertopinion or case series for studies ofdiagnosis treatment prevention orscreening
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Recommendations Change as the Evidence Evolves Statistics and risk factors may change
o New risks emerge (eg side positioning)o Different levels of risk
Policies and procedures may changeo Better death scene investigationso Diagnostic shift
Unintended consequenceso Plagiocephaly development o New tummy time recommendations
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
2016 SIDS Task Force Policy Statement Level A Recommendations Back to sleep for every sleep Use a firm sleep surface Keep soft objects and loose bedding out of the crib Room-sharingmdashInfant on separate sleep surface Breastfeeding is recommended Consider offering a pacifier at nap time and bedtime Avoid smoke exposure during pregnancy and after birth Avoid alcohol and illicit drug use during pregnancy and
after birth
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
2016 SIDS Task Force Policy Statement Level A Recommendations Avoid overheating Pregnant women should receive regular prenatal care Do not use home cardiorespiratory monitors as a strategy
for reducing the risk of SIDS Health care professionals staff in newborn nurseries and
NICUs and child care providers should endorse the SIDS risk-reduction recommendations from birth
Media and manufacturers should follow safe-sleep guidelines in their messaging and advertising
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
2016 SIDS Task Force Policy Statement Level B Recommendations Avoid commercial devices that are inconsistent with
safe sleep recommendations Supervised awake tummy time is recommended to
facilitate development and to minimize development of positional plagiocephaly (flattening of skull)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
2016 SIDS Task Force Policy Statement Level C Recommendations Continue research and surveillance on the risk factors
causes and pathophysiological mechanisms of SIDS and other sleep-related infant deaths with the ultimate goal of eliminating these deaths entirely
There is no evidence to recommend swaddling as a strategy to reduce the risk of SIDS
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Correct Safe Sleep Environment
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
We Need to Move Beyond Back to Sleep
Shersquos on her back to sleep
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Sleep Position for Healthy Newborns
Skin-to-skin care is recommended for all mothers and newborns regardless of feeding or delivery method immediately following birtho Mom should be medically stable
awake and able to respond to baby When mother needs to sleep or take
care of other needs infant should be placed supine in a bassinet
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Sleep Position in Newborn Nursery Infants in the newborn nursery
and infants who are rooming in with their parents should be placed in the supine position as soon as they are ready to be placed in the bassinet o No evidence that placing infants
on the side during the first few hours of life promotes clearance of amniotic fluid and decreases the risk of aspiration
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Sleep Position and Reflux Infants with gastroesophageal (GE) reflux
should be kept supineo Unless the risk of death from complications
of GE reflux is greater than the risk of SIDS
Supine position does not increase the risk of choking and aspiration in infants with GE reflux o Protective airway mechanisms
Do NOT elevate the head of the infantrsquos cribo Ineffective in reducing GE refluxo Infant may slide to the foot of the cribmdashmay
compromise respiration
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
The Truth About Supine Sleep and Aspiration Ending the Fallacy Orientation of the Trachea to the Esophagus
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Title
Text
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Infant Sleep Location
Infants should sleep in parentsrsquo room close to parentsrsquo bed but on a separate surface designed for infants
Ideally for the first year of life but at least for the first 6 months
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Room-Share How Long Yoursquore Kidding Right
2011 ldquoall sleep recommendations are to be followed until 1 year of agerdquo
2016 ldquoroom-sharing without bed-sharinghellipideally until 1 year of age but at least for the first 6 monthsrdquo
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Supporting Data
3 case-control studies comparing sleeping in a separate room vs room-sharingo Tappin (Scotland) AOR 326 (95 CI 103-1035)
bull Protection is significant for smoker motherso Blair (England) AOR 1049 (95 CI 426-2581)
bull Protection is significant for both smoker and nonsmoker mothers
o New Zealand Cot Death study AOR 285(95 CI 204-385)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
More Recent Data
New Zealand SUDI studyo 64 protection with room-sharing AOR 036
(95 CI 019-071)
Estimate of 50 reduction is very conservative
None of the case-control studies stratify by age (months)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Why is Room-Sharing Protective
SIDSmdashfailure to arouse More small awakenings during the night
o Stirrings movement not fully awake Postulation protective effect from small awakenings Room-sharing facilitates breastfeeding
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Room-Sharing and Sleep Quality
Volkovich room-sharing vs solitary sleepo Room-sharing mothers with more sleep disturbanceso Infants with similar sleep quality
Mao Mindell room-sharing infantsmdashmore awakenings
Montgomery-Downs Doan sleep quality in breastfeeding mothers gt to formula feeding motherso Exclusive breastfeeding = 30 min more sleep
More study needed
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Insight Study (Paul 2017)
Sleep questionnaire at 4 9 12 and 30 monthso Sleep duration overnight behaviorso Compared early vs late independent infants
At 4 monthso Equal sleep durationo Early group had better sleep consolidationo Longest stretch 46 minutes
Paul IM Hohman EE Loken E et al Mother-infant room-sharing and sleep outcomes in the INSIGHT study Pediatrics 2017140(1)e20170122
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Insight Study (Paul 2017)
At 9 monthso Longer sleep duration (40 minnight) o Better consolidation (100 min)
At 30 monthso Longer sleep duration (45 minnight)
Room-sharing 4 times more likely to transition to bed sharing overnight
Paul IM Hohman EE Loken E et al Mother-infant room-sharing and sleep outcomes in the INSIGHT study Pediatrics 2017140(1)e20170122
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Insight Commentary (Hauck Moon)
Late room-sharing mean 7 hours longest sleep Is early consolidation desirable Differences related to bedtime routines
o Early bedtimeo Number of night feedso Feeding back to sleep
Focus on the routine not early separation
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Feeding the Baby at Night Acknowledgment that parents may fall
asleep while feeding babyo Safer to feed on bed than on sofa
couch or armchair if you might fall asleep
o No pillows sheets blankets or other items that could obstruct infant breathing or cause overheating should be in bed
o Return infant back to separate sleep surface as soon as parent awakens
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Say NO to Couches Sofas and Cushioned Armchairs Never place a baby for sleep on these surfaces Never sleep with a baby on these surfaces One of the MOST dangerous places for an infant
(OR 51-669)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
High-Risk Bed Sharing Situations Age lt4 months Preterm or low birth weight Smoked during pregnancy Bed sharer is current smoker (even if not
smoking in bed) Bed sharer has usedis using meds or
substances that could impair alertness or arousal
Bed sharer is not parent (including other children)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bedsharing in Low-Risk Breastfed Infants
Blair et al AOR 16 (95 CI 096-27) o Age lt14 weekso Parents No cigarettes or alcoholo Independent of feeding method
Carpenter et al AOR 51 (95 CI 23-114) o Age lt3 months o Parents did not smokeo Mother No alcohol or drugso Breastfed infants
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Independent Review (Dr Robert Platt)
Very small numbers of low-risk babieso 24 in Blairrsquos studyo 12 in Carpenterrsquos study
Does not believe that data support definitive differences in 2 studies
Some evidence of increased risk in this group but cannot say how large the increased risk is
Cannot conclude that bed sharing in this group is safe
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Unsafe Bedding NISP Trends 1993-2102
Shapiro-Mendoza CK Colson ER Willinger M Rybin DV Camperlengo L Corwin MJ Trends in infant bedding use National Infant Sleep Position study 1993ndash2010 Pediatrics 2015135(1)10-17
Decrease from 86 to 55 Rate of decline decreases
2001-10 835 for teen mothers Predictors of adjusted OR
gt15
o Young motherso Non-white race
ethnicityo Less than college
education
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Why Use Soft Bedding
ComfortWarmtho Extrapolation of own feelingso Misinterpret firm with taut
bull Soft + taut ne firm
Safetyo Blankets pillows rolls to prevent falls
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Soft Bedding for Older Infants
Many parents recognize soft bedding is a risk Increased complacency as baby gets older Soft bedding is THE most important risk factor for
infants 4-12 months old (Colvin 2015) Infants roll into bedding and cannot extract
themselves
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
To Swaddle or Not to Swaddle That is the Question Pros
o Calms the infant promotes sleep decreases number of awakenings
o Encourages use of the supine position
Conso Increased respiratory rate and
reduced functional residual lung capacity
o Exacerbates hip dysplasia if the hips are kept in extension and adduction
o ldquoLooserdquo swaddling becomes loose bedding
o Overheating especially if the head is covered or the infant has infection
o Effects on arousability to an external stimulus remain unclear (conflicting data) There may be minimal effects of routine swaddling on arousal
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Swaddling
There is insufficient evidence to recommend routine swaddling as a strategy to reduce the incidence of SIDS
Swaddling must be correctly applied to avoid the possible hazards
Swaddling does not reduce the necessity to follow recommended safe sleep practices Ambrogio Lorenzettis Madonna and Child (1319)
Wikipedia
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
McDonnell E Moon RY Infant deaths and injuries associated with wearable blankets swaddle wraps and swaddling J Pediatr 20141641152-1156
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
SwaddlingmdashMore Questionshellip
Pease 2016 Pediatrics Pooled OR = 138
o Prone = 1299 o Side = 316o Supine = 193
Increased risk with age Limitations
o Heterogeneity definitions other risk factorsPease AS Fleming PJ Hauck FR et al Swaddling and the risk of sudden infant death syndrome a meta-analysis Pediatrics 2016137(6)e20153
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
wwwhealthychildrenorg
Swaddling (wrapping a light blanket snuggly around a baby) may help calm a crying baby If you swaddle your baby be sure to place him on his back to sleep Stop swaddling your baby when he starts to roll
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers
AAP recommendation Consider offering a pacifier at nap time and bedtime
Studies consistently demonstrate a protective effect of pacifiers on SIDS
Mechanism unknowno Dislodge within 15 to 60 minuteso Decreased arousal threshold
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers and Breastfeeding Well-designed trials
o 2 found no association among term infants
o 1 found no association among preterm infants
o 1 found slightly decreased breastfeeding duration at one month if pacifier introduced in first week of life but NO difference if pacifier introduced after one month
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Baby Friendly USA Pacifiers
Breastfeeding babies should not be given pacifiers by the staff of the facility with the exception of o Limited use to decrease pain during procedures when
the baby cannot safely be held or breastfed (pacifiers used should be discarded after these procedures)
o Babies who are being tube-fed in NICUo Other rare specific medical reasons
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Addressing Sleep Deprivation
Give parents tools to cope with fussy babies
Sleep-deprived parents may make poor judgments
Make use of tools o Swaddling side carrying
shushing swinging and sucking
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Overcoming Barriers to Change What Parents are Sayinghellip
Prone positioning fear of choking Baby sleeps ldquobetterrdquo on stomach Soft things are safer for the baby SIDS is ldquoGodrsquos willrdquo Why bother Recommendations keep changing
anyway Vigilance sleep with baby for protection
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Factors Associated With Choice of Infant Sleep Position 3300 mothers from 32 hospitals 77 usually use supine position 49 exclusive use supine position Most likely to use prone
o African-American motherso Mothers with lt high school educationo Lack of perceived controlo Personal attitudesocietal norms
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
A continuum starting in childhoodo Secondary school baby sitting classes
Pre-pregnancy Pregnancyprenatal education
o Prior to baby showerhellipldquowrong giftsrdquo In-hospital education and modeling
o Include family friends baby sitters Re-enforcement in the doctorrsquos office
o Especially between 1 to 4 months Grandparents They hold great power The general public (day cares religious leaders)
A Lifetime of Infant Sleep Safety
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Chart1
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
14
139
13
13
12
13
117
17
103
269
087
386
074
353
077
531
072
557
067
644
062
666
056
716
057
711
053
728
056
701
055
722
055
757
057
703
055
721
054
741
051
728
048
042
04
039
Sheet1
Sheet1
ampA
Page ampP
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
Sheet2
Pre-AAP recommendation Post-AAP RecommendationBack to SleepSafe to Sleep Campaign
Sheet3
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Infant Sleep Safety
Requires a consistent and repetitive message in the community to prevent accidental deaths
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Safe Sleep Nurse Modeling
People trust nurses Whatever the nurse does must
be correct and it will be imitated in the home
Fact supine positioning in the nursery can almost DOUBLE its use in the home
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Physician Advocacy
Srivatsa 1997 HCP education to new familieshellip34 reduction in prone sleeping
Eron 2009 Study of Central NY state physicianshellip30 identified incorrect safest sleep positionhellip30 do not discuss with families
Colson 2009 Only 13 mothers advised by MD to use supine positionhellip3 times more likely to position the baby properly
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Healthcare Provider Advice to New Mothers Safe Sleep
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Chart1
Column1
[]
[]
[]
55
25
20
Sheet1
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Mason Clinical Peds 713
Bundled interventiono Nursing education policy model behavior safe sleep
video posters in rooms declaration of safe sleep practice
Safe sleep environment uarr from 25 to 58 Intention in home 95 supine none ldquoco-sleepingrdquo
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bundled Intervention = Behavior Change
QUESTION GROUP p-value
ISS Study NISP
Behavior Questions n = 490 n = 1046
Baby routinely placed to sleep on back 925 73 lt 0001
Baby routinely sleeps in bassinetcrib 995 71 lt 00001
Baby sleeps under a thin sheet 992 86 lt 0001
Baby given a pacifier for sleep 741 84 lt 0001Goodstein MH Bell T Krugman SD Improving infant sleep safety through a comprehensive hospital-based program Clinical Pediatrics 201554(3)212-221
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
o Baseline Safe sleep 49 of 264 infants o Post 312 of 234 infants (P lt 001) o Extra blankets most common o Baseline 77 vs 44 post-intervention o Mean number of unsafe items reduced by 50 (P lt 001)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Washington DC
2 urban DC nurseries 26 did not believe or unsure that infant positioning
was associated with SIDS Top 3 factors influencing sleep position
o 56 PERSONAL PREFERENCE Why non-supine Clinical experience (25)
o Increase risk aspirationo Decrease sleep and comfort
Bartow KL Nursesrsquo knowledge and adherence to sudden infant death syndrome prevention guidelines Pediatr Nurs 201642(1)7-13
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
TodaysBaby QI Safe Sleep Teaching
QI intervention median = 160 days Mothers reported receiving information 72 to 95
(increase of 24-57) 94 babies observed supine (plus 24) 88 infants in safe sleep environment
o Increase of 33 Gains maintained up to 12 months
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Social Media and Risk-Reduction Training Study (SMART) Cluster randomization 4 groups Safe sleep or breast feeding education Nursing QI and social media (mobile health) N = 1600 1263 responses (79) Safe sleep NQI and MHealth
o Supine sleep 925 o Room-sharing 859o No soft bedding 819o Pacifier use 762
Moon RY Hauck FR Colson ER et al The effect of nursing quality improvement and mobile health interventions on infant sleep practices a randomized clinical trial JAMA 2017318(4)351-359
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Hospital Initiative ComponentswwwcribsforkidsorgHospitalInitiativeToolkit INTRODUCTORY LETTER HOSPITAL INITIATIVE TOOL KIT
INSTRUCTIONS ORGANIZATIONAL CHART HOSPITAL POLICY ACKNOWLEDGMENT FORM (Engl amp
Span) SAFE SLEEP EDUCATIONAL FLIP CHART
NONCOMPLIANCE WAIVER (Engl amp Span)
NURSING EDUCATION MODULE
SAFE SLEEP POSTERS DOOR HANGERS (Engl amp Span) GRADUATION CERTIFICATE SAMPLE LETTER TO HOSPITALS SAMPLE LETTER TO PROVIDERS INFANT SAFE SLEEP BROCHURES
(Engl amp Span) PRESS KIT
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
All materials available on-lineo No major costs to the hospital
Easy on-line access for documentation
NO FEE FOR PARTICIPATION
wwwCribsforKidsorgHospitalInitiative
Tiffany Price (tpricecribsforkidsorg)
The National Safe Sleep Hospital Certification Program
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
TNmdash25 reduction in infant sleep-related deaths in 2 years
SDmdashOver 7915 Pack lsquon Plays distributed since 2012 Infant mortality rate decreased from 86 (2012) to 48 (2016)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
2009 to 2015 38 decrease in infant mortality Decreased from 135 to 84 per 1000 SUID decreased gt50 Decrease in racial disparityhttphealthybabiesbaltimorecomhome
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
And Finallyhellip
Health care providers should have open frank nonjudgmental conversations with families about their sleep practices
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Encouraging Parents to Take Action
According to the Social Learning Theory parents are more likely to recall and comply with instructions when
the health care provider
Uses a positive tone Provides adequate information Allows the parent to ask most of the questions
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Motivational Interviewing
ldquoa collaborative goal-oriented style of communication with particular attention to the language of changerdquo
o Strengthen personal motivation and commitment to a specific goal
o Explore onersquos reasons for change (barriers)o Patient generates own solutions
bull More likely to feel realisticbull Planting seeds of change
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Impact of Eliminating Sleep-Related Deaths
Every week we lose 70 children which is equivalent to 4 kindergarten classrooms
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Thank You
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Contact Information
mgoodsteinwellspanorg
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Visit Pediatric Care Online today for additional information on this and other topics
httppediatriccaresolutionsaaporgPediatric Care Online is a convenient electronic resource for immediate expert help with
virtually every pediatric clinical information need with must-have resources that are included in a comprehensive reference library and time-saving clinical tools
Donrsquot have a subscription to PCOThen take advantage of a free trial today
Call Mead Johnson Nutrition at 888363-2362 orfor more information go to
httppediatriccaresolutionsaaporgSSFree_Trialaspx
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
IMR over time Finland vs US
Slide Number 1
Disclaimer
Objectives for Todayrsquos Talk
Infant Mortality Rates for the Five Leading Causes of Infant Death in the United States 2005 and 2011
US Post-Neonatal Mortality 2015
FACT
What is SUID or SUDI
Some Causes of Deaths that Occur Suddenly and Unexpectedly during Infancy
What is SIDS
SIDS FACTS
SIDS FACTS
Triple Risk Model to Explain SIDS
Paterson DS Krous HF Kinney HC et al JAMA 2006
An Example of SIDS Pathogenesis
2016 AAP Recommendations Infant Sleep Safety
Strength of Recommendation
Recommendations Change as the Evidence Evolves
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
Correct Safe Sleep Environment
We Need to Move Beyond Back to Sleep
Sleep Position for Healthy Newborns
Sleep Position in Newborn Nursery
Sleep Position and Reflux
The Truth About Supine Sleep and Aspiration Ending the Fallacy
Title
Infant Sleep Location
Room-Share How Long Yoursquore Kidding Right
Supporting Data
More Recent Data
Why is Room-Sharing Protective
Room-Sharing and Sleep Quality
Insight Study (Paul 2017)
Insight Study (Paul 2017)
Insight Commentary (Hauck Moon)
Feeding the Baby at Night
Say NO to Couches Sofas and Cushioned Armchairs
High-Risk Bed Sharing Situations
Bedsharing in Low-Risk Breastfed Infants
Independent Review (Dr Robert Platt)
Bed Sharing
Bed Sharing
Bed Sharing with Overlay
Bed Sharing with Overlay
Bed Sharing with Overlay
Couch Sleeping
Couch Sleeping
Couch Sleeping
Unsafe Bedding NISP Trends 1993-2102
Why Use Soft Bedding
Soft Bedding for Older Infants
To Swaddle or Not to Swaddle That is the Question
Swaddling
SwaddlingmdashIs it Safe
SwaddlingmdashMore Questionshellip
wwwhealthychildrenorg
Pacifiers
Pacifiers and Breastfeeding
Baby Friendly USA Pacifiers
Addressing Sleep Deprivation
Overcoming Barriers to Change What Parents are Sayinghellip
Factors Associated With Choice of Infant Sleep Position
Slide Number 65
What is Working
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Infant Sleep Safety
Safe Sleep Nurse Modeling
Physician Advocacy
Healthcare Provider Advice to New Mothers Safe Sleep
Mason Clinical Peds 713
Bundled Intervention = Behavior Change
Hospital Unsafe Sleep Persists
Washington DC
TodaysBaby QI Safe Sleep Teaching
TodaysBaby QI Safe Sleep Teaching
Social Media and Risk-Reduction Training Study (SMART)
The National Safe Sleep Hospital Certification Program
Coordinated Education Efforts Work
Coordinated Education Efforts Work
And Finallyhellip
Encouraging Parents to Take Action
Motivational Interviewing
Impact of Eliminating Sleep-Related Deaths
Thank You
Contact Information
Slide Number 89
IMR over time Finland vs US
Column1
correct advice
55
incorrect advice
25
no advice
20
correct advice
incorrect advice
no advice
SIDS Rate
Percent Back Sleeping
1988
14
1989
139
1990
13
1991
13
1992
12
13
1993
117
17
1994
103
269
1995
087
386
1996
074
353
1997
077
531
1998
072
557
1999
067
644
2000
062
666
2001
056
716
2002
057
711
2003
053
728
2004
056
701
2005
055
722
2006
055
757
2007
057
703
2008
055
721
2009
054
741
2010
051
728
2011
048
2012
042
2013
04
2014
039
httpwwwcdcgovNCHSdatanvsrnvsr58nvsr58_19pdf
Xu JQ Kochanek KD Murphy SL Tejada-Vera B Deaths Final data for
2007
National vital statistics reports vol 58 no 19 Hyattsville MD
National Center for Health Statistics 2010
1988
1988
1989
1989
1990
1990
1991
1991
1992
1992
1993
1993
1994
1994
1995
1995
1996
1996
1997
1997
1998
1998
1999
1999
2000
2000
2001
2001
2002
2002
2003
2003
2004
2004
2005
2005
2006
2006
2007
2007
2008
2008
2009
2009
2010
2010
2011
2012
2013
2014
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Adapted from Kinney and Thach 2009
An Example of SIDS Pathogenesis
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
2016 AAP Recommendations Infant Sleep Safety Recommendations are to reduce
the risk of SIDS and sleep-related suffocation asphyxia and entrapment
Recommendations should be used consistently until 1 year of ageo Most epidemiological studies upon
which these recommendations are based include infants up to 1 year of age
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Strength of Recommendation
Scale based on the Strength of Recommendation Taxonomy (SORT)
A There is good quality patient-oriented evidence B There is inconsistent or limited quality patient-
oriented evidence C The recommendation is based on consensus
disease-oriented evidence usual practice expertopinion or case series for studies ofdiagnosis treatment prevention orscreening
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Recommendations Change as the Evidence Evolves Statistics and risk factors may change
o New risks emerge (eg side positioning)o Different levels of risk
Policies and procedures may changeo Better death scene investigationso Diagnostic shift
Unintended consequenceso Plagiocephaly development o New tummy time recommendations
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
2016 SIDS Task Force Policy Statement Level A Recommendations Back to sleep for every sleep Use a firm sleep surface Keep soft objects and loose bedding out of the crib Room-sharingmdashInfant on separate sleep surface Breastfeeding is recommended Consider offering a pacifier at nap time and bedtime Avoid smoke exposure during pregnancy and after birth Avoid alcohol and illicit drug use during pregnancy and
after birth
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
2016 SIDS Task Force Policy Statement Level A Recommendations Avoid overheating Pregnant women should receive regular prenatal care Do not use home cardiorespiratory monitors as a strategy
for reducing the risk of SIDS Health care professionals staff in newborn nurseries and
NICUs and child care providers should endorse the SIDS risk-reduction recommendations from birth
Media and manufacturers should follow safe-sleep guidelines in their messaging and advertising
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
2016 SIDS Task Force Policy Statement Level B Recommendations Avoid commercial devices that are inconsistent with
safe sleep recommendations Supervised awake tummy time is recommended to
facilitate development and to minimize development of positional plagiocephaly (flattening of skull)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
2016 SIDS Task Force Policy Statement Level C Recommendations Continue research and surveillance on the risk factors
causes and pathophysiological mechanisms of SIDS and other sleep-related infant deaths with the ultimate goal of eliminating these deaths entirely
There is no evidence to recommend swaddling as a strategy to reduce the risk of SIDS
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Correct Safe Sleep Environment
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
We Need to Move Beyond Back to Sleep
Shersquos on her back to sleep
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Sleep Position for Healthy Newborns
Skin-to-skin care is recommended for all mothers and newborns regardless of feeding or delivery method immediately following birtho Mom should be medically stable
awake and able to respond to baby When mother needs to sleep or take
care of other needs infant should be placed supine in a bassinet
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Sleep Position in Newborn Nursery Infants in the newborn nursery
and infants who are rooming in with their parents should be placed in the supine position as soon as they are ready to be placed in the bassinet o No evidence that placing infants
on the side during the first few hours of life promotes clearance of amniotic fluid and decreases the risk of aspiration
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Sleep Position and Reflux Infants with gastroesophageal (GE) reflux
should be kept supineo Unless the risk of death from complications
of GE reflux is greater than the risk of SIDS
Supine position does not increase the risk of choking and aspiration in infants with GE reflux o Protective airway mechanisms
Do NOT elevate the head of the infantrsquos cribo Ineffective in reducing GE refluxo Infant may slide to the foot of the cribmdashmay
compromise respiration
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
The Truth About Supine Sleep and Aspiration Ending the Fallacy Orientation of the Trachea to the Esophagus
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Title
Text
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Infant Sleep Location
Infants should sleep in parentsrsquo room close to parentsrsquo bed but on a separate surface designed for infants
Ideally for the first year of life but at least for the first 6 months
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Room-Share How Long Yoursquore Kidding Right
2011 ldquoall sleep recommendations are to be followed until 1 year of agerdquo
2016 ldquoroom-sharing without bed-sharinghellipideally until 1 year of age but at least for the first 6 monthsrdquo
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Supporting Data
3 case-control studies comparing sleeping in a separate room vs room-sharingo Tappin (Scotland) AOR 326 (95 CI 103-1035)
bull Protection is significant for smoker motherso Blair (England) AOR 1049 (95 CI 426-2581)
bull Protection is significant for both smoker and nonsmoker mothers
o New Zealand Cot Death study AOR 285(95 CI 204-385)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
More Recent Data
New Zealand SUDI studyo 64 protection with room-sharing AOR 036
(95 CI 019-071)
Estimate of 50 reduction is very conservative
None of the case-control studies stratify by age (months)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Why is Room-Sharing Protective
SIDSmdashfailure to arouse More small awakenings during the night
o Stirrings movement not fully awake Postulation protective effect from small awakenings Room-sharing facilitates breastfeeding
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Room-Sharing and Sleep Quality
Volkovich room-sharing vs solitary sleepo Room-sharing mothers with more sleep disturbanceso Infants with similar sleep quality
Mao Mindell room-sharing infantsmdashmore awakenings
Montgomery-Downs Doan sleep quality in breastfeeding mothers gt to formula feeding motherso Exclusive breastfeeding = 30 min more sleep
More study needed
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Insight Study (Paul 2017)
Sleep questionnaire at 4 9 12 and 30 monthso Sleep duration overnight behaviorso Compared early vs late independent infants
At 4 monthso Equal sleep durationo Early group had better sleep consolidationo Longest stretch 46 minutes
Paul IM Hohman EE Loken E et al Mother-infant room-sharing and sleep outcomes in the INSIGHT study Pediatrics 2017140(1)e20170122
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Insight Study (Paul 2017)
At 9 monthso Longer sleep duration (40 minnight) o Better consolidation (100 min)
At 30 monthso Longer sleep duration (45 minnight)
Room-sharing 4 times more likely to transition to bed sharing overnight
Paul IM Hohman EE Loken E et al Mother-infant room-sharing and sleep outcomes in the INSIGHT study Pediatrics 2017140(1)e20170122
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Insight Commentary (Hauck Moon)
Late room-sharing mean 7 hours longest sleep Is early consolidation desirable Differences related to bedtime routines
o Early bedtimeo Number of night feedso Feeding back to sleep
Focus on the routine not early separation
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Feeding the Baby at Night Acknowledgment that parents may fall
asleep while feeding babyo Safer to feed on bed than on sofa
couch or armchair if you might fall asleep
o No pillows sheets blankets or other items that could obstruct infant breathing or cause overheating should be in bed
o Return infant back to separate sleep surface as soon as parent awakens
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Say NO to Couches Sofas and Cushioned Armchairs Never place a baby for sleep on these surfaces Never sleep with a baby on these surfaces One of the MOST dangerous places for an infant
(OR 51-669)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
High-Risk Bed Sharing Situations Age lt4 months Preterm or low birth weight Smoked during pregnancy Bed sharer is current smoker (even if not
smoking in bed) Bed sharer has usedis using meds or
substances that could impair alertness or arousal
Bed sharer is not parent (including other children)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bedsharing in Low-Risk Breastfed Infants
Blair et al AOR 16 (95 CI 096-27) o Age lt14 weekso Parents No cigarettes or alcoholo Independent of feeding method
Carpenter et al AOR 51 (95 CI 23-114) o Age lt3 months o Parents did not smokeo Mother No alcohol or drugso Breastfed infants
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Independent Review (Dr Robert Platt)
Very small numbers of low-risk babieso 24 in Blairrsquos studyo 12 in Carpenterrsquos study
Does not believe that data support definitive differences in 2 studies
Some evidence of increased risk in this group but cannot say how large the increased risk is
Cannot conclude that bed sharing in this group is safe
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Unsafe Bedding NISP Trends 1993-2102
Shapiro-Mendoza CK Colson ER Willinger M Rybin DV Camperlengo L Corwin MJ Trends in infant bedding use National Infant Sleep Position study 1993ndash2010 Pediatrics 2015135(1)10-17
Decrease from 86 to 55 Rate of decline decreases
2001-10 835 for teen mothers Predictors of adjusted OR
gt15
o Young motherso Non-white race
ethnicityo Less than college
education
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Why Use Soft Bedding
ComfortWarmtho Extrapolation of own feelingso Misinterpret firm with taut
bull Soft + taut ne firm
Safetyo Blankets pillows rolls to prevent falls
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Soft Bedding for Older Infants
Many parents recognize soft bedding is a risk Increased complacency as baby gets older Soft bedding is THE most important risk factor for
infants 4-12 months old (Colvin 2015) Infants roll into bedding and cannot extract
themselves
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
To Swaddle or Not to Swaddle That is the Question Pros
o Calms the infant promotes sleep decreases number of awakenings
o Encourages use of the supine position
Conso Increased respiratory rate and
reduced functional residual lung capacity
o Exacerbates hip dysplasia if the hips are kept in extension and adduction
o ldquoLooserdquo swaddling becomes loose bedding
o Overheating especially if the head is covered or the infant has infection
o Effects on arousability to an external stimulus remain unclear (conflicting data) There may be minimal effects of routine swaddling on arousal
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Swaddling
There is insufficient evidence to recommend routine swaddling as a strategy to reduce the incidence of SIDS
Swaddling must be correctly applied to avoid the possible hazards
Swaddling does not reduce the necessity to follow recommended safe sleep practices Ambrogio Lorenzettis Madonna and Child (1319)
Wikipedia
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
McDonnell E Moon RY Infant deaths and injuries associated with wearable blankets swaddle wraps and swaddling J Pediatr 20141641152-1156
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
SwaddlingmdashMore Questionshellip
Pease 2016 Pediatrics Pooled OR = 138
o Prone = 1299 o Side = 316o Supine = 193
Increased risk with age Limitations
o Heterogeneity definitions other risk factorsPease AS Fleming PJ Hauck FR et al Swaddling and the risk of sudden infant death syndrome a meta-analysis Pediatrics 2016137(6)e20153
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
wwwhealthychildrenorg
Swaddling (wrapping a light blanket snuggly around a baby) may help calm a crying baby If you swaddle your baby be sure to place him on his back to sleep Stop swaddling your baby when he starts to roll
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers
AAP recommendation Consider offering a pacifier at nap time and bedtime
Studies consistently demonstrate a protective effect of pacifiers on SIDS
Mechanism unknowno Dislodge within 15 to 60 minuteso Decreased arousal threshold
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers and Breastfeeding Well-designed trials
o 2 found no association among term infants
o 1 found no association among preterm infants
o 1 found slightly decreased breastfeeding duration at one month if pacifier introduced in first week of life but NO difference if pacifier introduced after one month
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Baby Friendly USA Pacifiers
Breastfeeding babies should not be given pacifiers by the staff of the facility with the exception of o Limited use to decrease pain during procedures when
the baby cannot safely be held or breastfed (pacifiers used should be discarded after these procedures)
o Babies who are being tube-fed in NICUo Other rare specific medical reasons
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Addressing Sleep Deprivation
Give parents tools to cope with fussy babies
Sleep-deprived parents may make poor judgments
Make use of tools o Swaddling side carrying
shushing swinging and sucking
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Overcoming Barriers to Change What Parents are Sayinghellip
Prone positioning fear of choking Baby sleeps ldquobetterrdquo on stomach Soft things are safer for the baby SIDS is ldquoGodrsquos willrdquo Why bother Recommendations keep changing
anyway Vigilance sleep with baby for protection
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Factors Associated With Choice of Infant Sleep Position 3300 mothers from 32 hospitals 77 usually use supine position 49 exclusive use supine position Most likely to use prone
o African-American motherso Mothers with lt high school educationo Lack of perceived controlo Personal attitudesocietal norms
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
A continuum starting in childhoodo Secondary school baby sitting classes
Pre-pregnancy Pregnancyprenatal education
o Prior to baby showerhellipldquowrong giftsrdquo In-hospital education and modeling
o Include family friends baby sitters Re-enforcement in the doctorrsquos office
o Especially between 1 to 4 months Grandparents They hold great power The general public (day cares religious leaders)
A Lifetime of Infant Sleep Safety
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Chart1
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
14
139
13
13
12
13
117
17
103
269
087
386
074
353
077
531
072
557
067
644
062
666
056
716
057
711
053
728
056
701
055
722
055
757
057
703
055
721
054
741
051
728
048
042
04
039
Sheet1
Sheet1
ampA
Page ampP
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
Sheet2
Pre-AAP recommendation Post-AAP RecommendationBack to SleepSafe to Sleep Campaign
Sheet3
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Infant Sleep Safety
Requires a consistent and repetitive message in the community to prevent accidental deaths
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Safe Sleep Nurse Modeling
People trust nurses Whatever the nurse does must
be correct and it will be imitated in the home
Fact supine positioning in the nursery can almost DOUBLE its use in the home
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Physician Advocacy
Srivatsa 1997 HCP education to new familieshellip34 reduction in prone sleeping
Eron 2009 Study of Central NY state physicianshellip30 identified incorrect safest sleep positionhellip30 do not discuss with families
Colson 2009 Only 13 mothers advised by MD to use supine positionhellip3 times more likely to position the baby properly
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Healthcare Provider Advice to New Mothers Safe Sleep
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Chart1
Column1
[]
[]
[]
55
25
20
Sheet1
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Mason Clinical Peds 713
Bundled interventiono Nursing education policy model behavior safe sleep
video posters in rooms declaration of safe sleep practice
Safe sleep environment uarr from 25 to 58 Intention in home 95 supine none ldquoco-sleepingrdquo
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bundled Intervention = Behavior Change
QUESTION GROUP p-value
ISS Study NISP
Behavior Questions n = 490 n = 1046
Baby routinely placed to sleep on back 925 73 lt 0001
Baby routinely sleeps in bassinetcrib 995 71 lt 00001
Baby sleeps under a thin sheet 992 86 lt 0001
Baby given a pacifier for sleep 741 84 lt 0001Goodstein MH Bell T Krugman SD Improving infant sleep safety through a comprehensive hospital-based program Clinical Pediatrics 201554(3)212-221
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
o Baseline Safe sleep 49 of 264 infants o Post 312 of 234 infants (P lt 001) o Extra blankets most common o Baseline 77 vs 44 post-intervention o Mean number of unsafe items reduced by 50 (P lt 001)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Washington DC
2 urban DC nurseries 26 did not believe or unsure that infant positioning
was associated with SIDS Top 3 factors influencing sleep position
o 56 PERSONAL PREFERENCE Why non-supine Clinical experience (25)
o Increase risk aspirationo Decrease sleep and comfort
Bartow KL Nursesrsquo knowledge and adherence to sudden infant death syndrome prevention guidelines Pediatr Nurs 201642(1)7-13
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
TodaysBaby QI Safe Sleep Teaching
QI intervention median = 160 days Mothers reported receiving information 72 to 95
(increase of 24-57) 94 babies observed supine (plus 24) 88 infants in safe sleep environment
o Increase of 33 Gains maintained up to 12 months
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Social Media and Risk-Reduction Training Study (SMART) Cluster randomization 4 groups Safe sleep or breast feeding education Nursing QI and social media (mobile health) N = 1600 1263 responses (79) Safe sleep NQI and MHealth
o Supine sleep 925 o Room-sharing 859o No soft bedding 819o Pacifier use 762
Moon RY Hauck FR Colson ER et al The effect of nursing quality improvement and mobile health interventions on infant sleep practices a randomized clinical trial JAMA 2017318(4)351-359
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Hospital Initiative ComponentswwwcribsforkidsorgHospitalInitiativeToolkit INTRODUCTORY LETTER HOSPITAL INITIATIVE TOOL KIT
INSTRUCTIONS ORGANIZATIONAL CHART HOSPITAL POLICY ACKNOWLEDGMENT FORM (Engl amp
Span) SAFE SLEEP EDUCATIONAL FLIP CHART
NONCOMPLIANCE WAIVER (Engl amp Span)
NURSING EDUCATION MODULE
SAFE SLEEP POSTERS DOOR HANGERS (Engl amp Span) GRADUATION CERTIFICATE SAMPLE LETTER TO HOSPITALS SAMPLE LETTER TO PROVIDERS INFANT SAFE SLEEP BROCHURES
(Engl amp Span) PRESS KIT
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
All materials available on-lineo No major costs to the hospital
Easy on-line access for documentation
NO FEE FOR PARTICIPATION
wwwCribsforKidsorgHospitalInitiative
Tiffany Price (tpricecribsforkidsorg)
The National Safe Sleep Hospital Certification Program
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
TNmdash25 reduction in infant sleep-related deaths in 2 years
SDmdashOver 7915 Pack lsquon Plays distributed since 2012 Infant mortality rate decreased from 86 (2012) to 48 (2016)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
2009 to 2015 38 decrease in infant mortality Decreased from 135 to 84 per 1000 SUID decreased gt50 Decrease in racial disparityhttphealthybabiesbaltimorecomhome
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
And Finallyhellip
Health care providers should have open frank nonjudgmental conversations with families about their sleep practices
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Encouraging Parents to Take Action
According to the Social Learning Theory parents are more likely to recall and comply with instructions when
the health care provider
Uses a positive tone Provides adequate information Allows the parent to ask most of the questions
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Motivational Interviewing
ldquoa collaborative goal-oriented style of communication with particular attention to the language of changerdquo
o Strengthen personal motivation and commitment to a specific goal
o Explore onersquos reasons for change (barriers)o Patient generates own solutions
bull More likely to feel realisticbull Planting seeds of change
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Impact of Eliminating Sleep-Related Deaths
Every week we lose 70 children which is equivalent to 4 kindergarten classrooms
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Thank You
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Contact Information
mgoodsteinwellspanorg
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Visit Pediatric Care Online today for additional information on this and other topics
httppediatriccaresolutionsaaporgPediatric Care Online is a convenient electronic resource for immediate expert help with
virtually every pediatric clinical information need with must-have resources that are included in a comprehensive reference library and time-saving clinical tools
Donrsquot have a subscription to PCOThen take advantage of a free trial today
Call Mead Johnson Nutrition at 888363-2362 orfor more information go to
httppediatriccaresolutionsaaporgSSFree_Trialaspx
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
IMR over time Finland vs US
Slide Number 1
Disclaimer
Objectives for Todayrsquos Talk
Infant Mortality Rates for the Five Leading Causes of Infant Death in the United States 2005 and 2011
US Post-Neonatal Mortality 2015
FACT
What is SUID or SUDI
Some Causes of Deaths that Occur Suddenly and Unexpectedly during Infancy
What is SIDS
SIDS FACTS
SIDS FACTS
Triple Risk Model to Explain SIDS
Paterson DS Krous HF Kinney HC et al JAMA 2006
An Example of SIDS Pathogenesis
2016 AAP Recommendations Infant Sleep Safety
Strength of Recommendation
Recommendations Change as the Evidence Evolves
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
Correct Safe Sleep Environment
We Need to Move Beyond Back to Sleep
Sleep Position for Healthy Newborns
Sleep Position in Newborn Nursery
Sleep Position and Reflux
The Truth About Supine Sleep and Aspiration Ending the Fallacy
Title
Infant Sleep Location
Room-Share How Long Yoursquore Kidding Right
Supporting Data
More Recent Data
Why is Room-Sharing Protective
Room-Sharing and Sleep Quality
Insight Study (Paul 2017)
Insight Study (Paul 2017)
Insight Commentary (Hauck Moon)
Feeding the Baby at Night
Say NO to Couches Sofas and Cushioned Armchairs
High-Risk Bed Sharing Situations
Bedsharing in Low-Risk Breastfed Infants
Independent Review (Dr Robert Platt)
Bed Sharing
Bed Sharing
Bed Sharing with Overlay
Bed Sharing with Overlay
Bed Sharing with Overlay
Couch Sleeping
Couch Sleeping
Couch Sleeping
Unsafe Bedding NISP Trends 1993-2102
Why Use Soft Bedding
Soft Bedding for Older Infants
To Swaddle or Not to Swaddle That is the Question
Swaddling
SwaddlingmdashIs it Safe
SwaddlingmdashMore Questionshellip
wwwhealthychildrenorg
Pacifiers
Pacifiers and Breastfeeding
Baby Friendly USA Pacifiers
Addressing Sleep Deprivation
Overcoming Barriers to Change What Parents are Sayinghellip
Factors Associated With Choice of Infant Sleep Position
Slide Number 65
What is Working
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Infant Sleep Safety
Safe Sleep Nurse Modeling
Physician Advocacy
Healthcare Provider Advice to New Mothers Safe Sleep
Mason Clinical Peds 713
Bundled Intervention = Behavior Change
Hospital Unsafe Sleep Persists
Washington DC
TodaysBaby QI Safe Sleep Teaching
TodaysBaby QI Safe Sleep Teaching
Social Media and Risk-Reduction Training Study (SMART)
The National Safe Sleep Hospital Certification Program
Coordinated Education Efforts Work
Coordinated Education Efforts Work
And Finallyhellip
Encouraging Parents to Take Action
Motivational Interviewing
Impact of Eliminating Sleep-Related Deaths
Thank You
Contact Information
Slide Number 89
IMR over time Finland vs US
Column1
correct advice
55
incorrect advice
25
no advice
20
correct advice
incorrect advice
no advice
SIDS Rate
Percent Back Sleeping
1988
14
1989
139
1990
13
1991
13
1992
12
13
1993
117
17
1994
103
269
1995
087
386
1996
074
353
1997
077
531
1998
072
557
1999
067
644
2000
062
666
2001
056
716
2002
057
711
2003
053
728
2004
056
701
2005
055
722
2006
055
757
2007
057
703
2008
055
721
2009
054
741
2010
051
728
2011
048
2012
042
2013
04
2014
039
httpwwwcdcgovNCHSdatanvsrnvsr58nvsr58_19pdf
Xu JQ Kochanek KD Murphy SL Tejada-Vera B Deaths Final data for
2007
National vital statistics reports vol 58 no 19 Hyattsville MD
National Center for Health Statistics 2010
1988
1988
1989
1989
1990
1990
1991
1991
1992
1992
1993
1993
1994
1994
1995
1995
1996
1996
1997
1997
1998
1998
1999
1999
2000
2000
2001
2001
2002
2002
2003
2003
2004
2004
2005
2005
2006
2006
2007
2007
2008
2008
2009
2009
2010
2010
2011
2012
2013
2014
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
2016 AAP Recommendations Infant Sleep Safety Recommendations are to reduce
the risk of SIDS and sleep-related suffocation asphyxia and entrapment
Recommendations should be used consistently until 1 year of ageo Most epidemiological studies upon
which these recommendations are based include infants up to 1 year of age
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Strength of Recommendation
Scale based on the Strength of Recommendation Taxonomy (SORT)
A There is good quality patient-oriented evidence B There is inconsistent or limited quality patient-
oriented evidence C The recommendation is based on consensus
disease-oriented evidence usual practice expertopinion or case series for studies ofdiagnosis treatment prevention orscreening
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Recommendations Change as the Evidence Evolves Statistics and risk factors may change
o New risks emerge (eg side positioning)o Different levels of risk
Policies and procedures may changeo Better death scene investigationso Diagnostic shift
Unintended consequenceso Plagiocephaly development o New tummy time recommendations
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
2016 SIDS Task Force Policy Statement Level A Recommendations Back to sleep for every sleep Use a firm sleep surface Keep soft objects and loose bedding out of the crib Room-sharingmdashInfant on separate sleep surface Breastfeeding is recommended Consider offering a pacifier at nap time and bedtime Avoid smoke exposure during pregnancy and after birth Avoid alcohol and illicit drug use during pregnancy and
after birth
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
2016 SIDS Task Force Policy Statement Level A Recommendations Avoid overheating Pregnant women should receive regular prenatal care Do not use home cardiorespiratory monitors as a strategy
for reducing the risk of SIDS Health care professionals staff in newborn nurseries and
NICUs and child care providers should endorse the SIDS risk-reduction recommendations from birth
Media and manufacturers should follow safe-sleep guidelines in their messaging and advertising
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
2016 SIDS Task Force Policy Statement Level B Recommendations Avoid commercial devices that are inconsistent with
safe sleep recommendations Supervised awake tummy time is recommended to
facilitate development and to minimize development of positional plagiocephaly (flattening of skull)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
2016 SIDS Task Force Policy Statement Level C Recommendations Continue research and surveillance on the risk factors
causes and pathophysiological mechanisms of SIDS and other sleep-related infant deaths with the ultimate goal of eliminating these deaths entirely
There is no evidence to recommend swaddling as a strategy to reduce the risk of SIDS
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Correct Safe Sleep Environment
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
We Need to Move Beyond Back to Sleep
Shersquos on her back to sleep
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Sleep Position for Healthy Newborns
Skin-to-skin care is recommended for all mothers and newborns regardless of feeding or delivery method immediately following birtho Mom should be medically stable
awake and able to respond to baby When mother needs to sleep or take
care of other needs infant should be placed supine in a bassinet
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Sleep Position in Newborn Nursery Infants in the newborn nursery
and infants who are rooming in with their parents should be placed in the supine position as soon as they are ready to be placed in the bassinet o No evidence that placing infants
on the side during the first few hours of life promotes clearance of amniotic fluid and decreases the risk of aspiration
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Sleep Position and Reflux Infants with gastroesophageal (GE) reflux
should be kept supineo Unless the risk of death from complications
of GE reflux is greater than the risk of SIDS
Supine position does not increase the risk of choking and aspiration in infants with GE reflux o Protective airway mechanisms
Do NOT elevate the head of the infantrsquos cribo Ineffective in reducing GE refluxo Infant may slide to the foot of the cribmdashmay
compromise respiration
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
The Truth About Supine Sleep and Aspiration Ending the Fallacy Orientation of the Trachea to the Esophagus
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Title
Text
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Infant Sleep Location
Infants should sleep in parentsrsquo room close to parentsrsquo bed but on a separate surface designed for infants
Ideally for the first year of life but at least for the first 6 months
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Room-Share How Long Yoursquore Kidding Right
2011 ldquoall sleep recommendations are to be followed until 1 year of agerdquo
2016 ldquoroom-sharing without bed-sharinghellipideally until 1 year of age but at least for the first 6 monthsrdquo
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Supporting Data
3 case-control studies comparing sleeping in a separate room vs room-sharingo Tappin (Scotland) AOR 326 (95 CI 103-1035)
bull Protection is significant for smoker motherso Blair (England) AOR 1049 (95 CI 426-2581)
bull Protection is significant for both smoker and nonsmoker mothers
o New Zealand Cot Death study AOR 285(95 CI 204-385)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
More Recent Data
New Zealand SUDI studyo 64 protection with room-sharing AOR 036
(95 CI 019-071)
Estimate of 50 reduction is very conservative
None of the case-control studies stratify by age (months)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Why is Room-Sharing Protective
SIDSmdashfailure to arouse More small awakenings during the night
o Stirrings movement not fully awake Postulation protective effect from small awakenings Room-sharing facilitates breastfeeding
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Room-Sharing and Sleep Quality
Volkovich room-sharing vs solitary sleepo Room-sharing mothers with more sleep disturbanceso Infants with similar sleep quality
Mao Mindell room-sharing infantsmdashmore awakenings
Montgomery-Downs Doan sleep quality in breastfeeding mothers gt to formula feeding motherso Exclusive breastfeeding = 30 min more sleep
More study needed
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Insight Study (Paul 2017)
Sleep questionnaire at 4 9 12 and 30 monthso Sleep duration overnight behaviorso Compared early vs late independent infants
At 4 monthso Equal sleep durationo Early group had better sleep consolidationo Longest stretch 46 minutes
Paul IM Hohman EE Loken E et al Mother-infant room-sharing and sleep outcomes in the INSIGHT study Pediatrics 2017140(1)e20170122
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Insight Study (Paul 2017)
At 9 monthso Longer sleep duration (40 minnight) o Better consolidation (100 min)
At 30 monthso Longer sleep duration (45 minnight)
Room-sharing 4 times more likely to transition to bed sharing overnight
Paul IM Hohman EE Loken E et al Mother-infant room-sharing and sleep outcomes in the INSIGHT study Pediatrics 2017140(1)e20170122
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Insight Commentary (Hauck Moon)
Late room-sharing mean 7 hours longest sleep Is early consolidation desirable Differences related to bedtime routines
o Early bedtimeo Number of night feedso Feeding back to sleep
Focus on the routine not early separation
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Feeding the Baby at Night Acknowledgment that parents may fall
asleep while feeding babyo Safer to feed on bed than on sofa
couch or armchair if you might fall asleep
o No pillows sheets blankets or other items that could obstruct infant breathing or cause overheating should be in bed
o Return infant back to separate sleep surface as soon as parent awakens
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Say NO to Couches Sofas and Cushioned Armchairs Never place a baby for sleep on these surfaces Never sleep with a baby on these surfaces One of the MOST dangerous places for an infant
(OR 51-669)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
High-Risk Bed Sharing Situations Age lt4 months Preterm or low birth weight Smoked during pregnancy Bed sharer is current smoker (even if not
smoking in bed) Bed sharer has usedis using meds or
substances that could impair alertness or arousal
Bed sharer is not parent (including other children)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bedsharing in Low-Risk Breastfed Infants
Blair et al AOR 16 (95 CI 096-27) o Age lt14 weekso Parents No cigarettes or alcoholo Independent of feeding method
Carpenter et al AOR 51 (95 CI 23-114) o Age lt3 months o Parents did not smokeo Mother No alcohol or drugso Breastfed infants
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Independent Review (Dr Robert Platt)
Very small numbers of low-risk babieso 24 in Blairrsquos studyo 12 in Carpenterrsquos study
Does not believe that data support definitive differences in 2 studies
Some evidence of increased risk in this group but cannot say how large the increased risk is
Cannot conclude that bed sharing in this group is safe
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Unsafe Bedding NISP Trends 1993-2102
Shapiro-Mendoza CK Colson ER Willinger M Rybin DV Camperlengo L Corwin MJ Trends in infant bedding use National Infant Sleep Position study 1993ndash2010 Pediatrics 2015135(1)10-17
Decrease from 86 to 55 Rate of decline decreases
2001-10 835 for teen mothers Predictors of adjusted OR
gt15
o Young motherso Non-white race
ethnicityo Less than college
education
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Why Use Soft Bedding
ComfortWarmtho Extrapolation of own feelingso Misinterpret firm with taut
bull Soft + taut ne firm
Safetyo Blankets pillows rolls to prevent falls
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Soft Bedding for Older Infants
Many parents recognize soft bedding is a risk Increased complacency as baby gets older Soft bedding is THE most important risk factor for
infants 4-12 months old (Colvin 2015) Infants roll into bedding and cannot extract
themselves
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
To Swaddle or Not to Swaddle That is the Question Pros
o Calms the infant promotes sleep decreases number of awakenings
o Encourages use of the supine position
Conso Increased respiratory rate and
reduced functional residual lung capacity
o Exacerbates hip dysplasia if the hips are kept in extension and adduction
o ldquoLooserdquo swaddling becomes loose bedding
o Overheating especially if the head is covered or the infant has infection
o Effects on arousability to an external stimulus remain unclear (conflicting data) There may be minimal effects of routine swaddling on arousal
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Swaddling
There is insufficient evidence to recommend routine swaddling as a strategy to reduce the incidence of SIDS
Swaddling must be correctly applied to avoid the possible hazards
Swaddling does not reduce the necessity to follow recommended safe sleep practices Ambrogio Lorenzettis Madonna and Child (1319)
Wikipedia
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
McDonnell E Moon RY Infant deaths and injuries associated with wearable blankets swaddle wraps and swaddling J Pediatr 20141641152-1156
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
SwaddlingmdashMore Questionshellip
Pease 2016 Pediatrics Pooled OR = 138
o Prone = 1299 o Side = 316o Supine = 193
Increased risk with age Limitations
o Heterogeneity definitions other risk factorsPease AS Fleming PJ Hauck FR et al Swaddling and the risk of sudden infant death syndrome a meta-analysis Pediatrics 2016137(6)e20153
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
wwwhealthychildrenorg
Swaddling (wrapping a light blanket snuggly around a baby) may help calm a crying baby If you swaddle your baby be sure to place him on his back to sleep Stop swaddling your baby when he starts to roll
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers
AAP recommendation Consider offering a pacifier at nap time and bedtime
Studies consistently demonstrate a protective effect of pacifiers on SIDS
Mechanism unknowno Dislodge within 15 to 60 minuteso Decreased arousal threshold
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers and Breastfeeding Well-designed trials
o 2 found no association among term infants
o 1 found no association among preterm infants
o 1 found slightly decreased breastfeeding duration at one month if pacifier introduced in first week of life but NO difference if pacifier introduced after one month
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Baby Friendly USA Pacifiers
Breastfeeding babies should not be given pacifiers by the staff of the facility with the exception of o Limited use to decrease pain during procedures when
the baby cannot safely be held or breastfed (pacifiers used should be discarded after these procedures)
o Babies who are being tube-fed in NICUo Other rare specific medical reasons
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Addressing Sleep Deprivation
Give parents tools to cope with fussy babies
Sleep-deprived parents may make poor judgments
Make use of tools o Swaddling side carrying
shushing swinging and sucking
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Overcoming Barriers to Change What Parents are Sayinghellip
Prone positioning fear of choking Baby sleeps ldquobetterrdquo on stomach Soft things are safer for the baby SIDS is ldquoGodrsquos willrdquo Why bother Recommendations keep changing
anyway Vigilance sleep with baby for protection
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Factors Associated With Choice of Infant Sleep Position 3300 mothers from 32 hospitals 77 usually use supine position 49 exclusive use supine position Most likely to use prone
o African-American motherso Mothers with lt high school educationo Lack of perceived controlo Personal attitudesocietal norms
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
A continuum starting in childhoodo Secondary school baby sitting classes
Pre-pregnancy Pregnancyprenatal education
o Prior to baby showerhellipldquowrong giftsrdquo In-hospital education and modeling
o Include family friends baby sitters Re-enforcement in the doctorrsquos office
o Especially between 1 to 4 months Grandparents They hold great power The general public (day cares religious leaders)
A Lifetime of Infant Sleep Safety
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Chart1
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
14
139
13
13
12
13
117
17
103
269
087
386
074
353
077
531
072
557
067
644
062
666
056
716
057
711
053
728
056
701
055
722
055
757
057
703
055
721
054
741
051
728
048
042
04
039
Sheet1
Sheet1
ampA
Page ampP
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
Sheet2
Pre-AAP recommendation Post-AAP RecommendationBack to SleepSafe to Sleep Campaign
Sheet3
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Infant Sleep Safety
Requires a consistent and repetitive message in the community to prevent accidental deaths
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Safe Sleep Nurse Modeling
People trust nurses Whatever the nurse does must
be correct and it will be imitated in the home
Fact supine positioning in the nursery can almost DOUBLE its use in the home
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Physician Advocacy
Srivatsa 1997 HCP education to new familieshellip34 reduction in prone sleeping
Eron 2009 Study of Central NY state physicianshellip30 identified incorrect safest sleep positionhellip30 do not discuss with families
Colson 2009 Only 13 mothers advised by MD to use supine positionhellip3 times more likely to position the baby properly
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Healthcare Provider Advice to New Mothers Safe Sleep
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Chart1
Column1
[]
[]
[]
55
25
20
Sheet1
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Mason Clinical Peds 713
Bundled interventiono Nursing education policy model behavior safe sleep
video posters in rooms declaration of safe sleep practice
Safe sleep environment uarr from 25 to 58 Intention in home 95 supine none ldquoco-sleepingrdquo
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bundled Intervention = Behavior Change
QUESTION GROUP p-value
ISS Study NISP
Behavior Questions n = 490 n = 1046
Baby routinely placed to sleep on back 925 73 lt 0001
Baby routinely sleeps in bassinetcrib 995 71 lt 00001
Baby sleeps under a thin sheet 992 86 lt 0001
Baby given a pacifier for sleep 741 84 lt 0001Goodstein MH Bell T Krugman SD Improving infant sleep safety through a comprehensive hospital-based program Clinical Pediatrics 201554(3)212-221
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
o Baseline Safe sleep 49 of 264 infants o Post 312 of 234 infants (P lt 001) o Extra blankets most common o Baseline 77 vs 44 post-intervention o Mean number of unsafe items reduced by 50 (P lt 001)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Washington DC
2 urban DC nurseries 26 did not believe or unsure that infant positioning
was associated with SIDS Top 3 factors influencing sleep position
o 56 PERSONAL PREFERENCE Why non-supine Clinical experience (25)
o Increase risk aspirationo Decrease sleep and comfort
Bartow KL Nursesrsquo knowledge and adherence to sudden infant death syndrome prevention guidelines Pediatr Nurs 201642(1)7-13
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
TodaysBaby QI Safe Sleep Teaching
QI intervention median = 160 days Mothers reported receiving information 72 to 95
(increase of 24-57) 94 babies observed supine (plus 24) 88 infants in safe sleep environment
o Increase of 33 Gains maintained up to 12 months
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Social Media and Risk-Reduction Training Study (SMART) Cluster randomization 4 groups Safe sleep or breast feeding education Nursing QI and social media (mobile health) N = 1600 1263 responses (79) Safe sleep NQI and MHealth
o Supine sleep 925 o Room-sharing 859o No soft bedding 819o Pacifier use 762
Moon RY Hauck FR Colson ER et al The effect of nursing quality improvement and mobile health interventions on infant sleep practices a randomized clinical trial JAMA 2017318(4)351-359
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Hospital Initiative ComponentswwwcribsforkidsorgHospitalInitiativeToolkit INTRODUCTORY LETTER HOSPITAL INITIATIVE TOOL KIT
INSTRUCTIONS ORGANIZATIONAL CHART HOSPITAL POLICY ACKNOWLEDGMENT FORM (Engl amp
Span) SAFE SLEEP EDUCATIONAL FLIP CHART
NONCOMPLIANCE WAIVER (Engl amp Span)
NURSING EDUCATION MODULE
SAFE SLEEP POSTERS DOOR HANGERS (Engl amp Span) GRADUATION CERTIFICATE SAMPLE LETTER TO HOSPITALS SAMPLE LETTER TO PROVIDERS INFANT SAFE SLEEP BROCHURES
(Engl amp Span) PRESS KIT
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
All materials available on-lineo No major costs to the hospital
Easy on-line access for documentation
NO FEE FOR PARTICIPATION
wwwCribsforKidsorgHospitalInitiative
Tiffany Price (tpricecribsforkidsorg)
The National Safe Sleep Hospital Certification Program
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
TNmdash25 reduction in infant sleep-related deaths in 2 years
SDmdashOver 7915 Pack lsquon Plays distributed since 2012 Infant mortality rate decreased from 86 (2012) to 48 (2016)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
2009 to 2015 38 decrease in infant mortality Decreased from 135 to 84 per 1000 SUID decreased gt50 Decrease in racial disparityhttphealthybabiesbaltimorecomhome
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
And Finallyhellip
Health care providers should have open frank nonjudgmental conversations with families about their sleep practices
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Encouraging Parents to Take Action
According to the Social Learning Theory parents are more likely to recall and comply with instructions when
the health care provider
Uses a positive tone Provides adequate information Allows the parent to ask most of the questions
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Motivational Interviewing
ldquoa collaborative goal-oriented style of communication with particular attention to the language of changerdquo
o Strengthen personal motivation and commitment to a specific goal
o Explore onersquos reasons for change (barriers)o Patient generates own solutions
bull More likely to feel realisticbull Planting seeds of change
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Impact of Eliminating Sleep-Related Deaths
Every week we lose 70 children which is equivalent to 4 kindergarten classrooms
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Thank You
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Contact Information
mgoodsteinwellspanorg
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Visit Pediatric Care Online today for additional information on this and other topics
httppediatriccaresolutionsaaporgPediatric Care Online is a convenient electronic resource for immediate expert help with
virtually every pediatric clinical information need with must-have resources that are included in a comprehensive reference library and time-saving clinical tools
Donrsquot have a subscription to PCOThen take advantage of a free trial today
Call Mead Johnson Nutrition at 888363-2362 orfor more information go to
httppediatriccaresolutionsaaporgSSFree_Trialaspx
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
IMR over time Finland vs US
Slide Number 1
Disclaimer
Objectives for Todayrsquos Talk
Infant Mortality Rates for the Five Leading Causes of Infant Death in the United States 2005 and 2011
US Post-Neonatal Mortality 2015
FACT
What is SUID or SUDI
Some Causes of Deaths that Occur Suddenly and Unexpectedly during Infancy
What is SIDS
SIDS FACTS
SIDS FACTS
Triple Risk Model to Explain SIDS
Paterson DS Krous HF Kinney HC et al JAMA 2006
An Example of SIDS Pathogenesis
2016 AAP Recommendations Infant Sleep Safety
Strength of Recommendation
Recommendations Change as the Evidence Evolves
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
Correct Safe Sleep Environment
We Need to Move Beyond Back to Sleep
Sleep Position for Healthy Newborns
Sleep Position in Newborn Nursery
Sleep Position and Reflux
The Truth About Supine Sleep and Aspiration Ending the Fallacy
Title
Infant Sleep Location
Room-Share How Long Yoursquore Kidding Right
Supporting Data
More Recent Data
Why is Room-Sharing Protective
Room-Sharing and Sleep Quality
Insight Study (Paul 2017)
Insight Study (Paul 2017)
Insight Commentary (Hauck Moon)
Feeding the Baby at Night
Say NO to Couches Sofas and Cushioned Armchairs
High-Risk Bed Sharing Situations
Bedsharing in Low-Risk Breastfed Infants
Independent Review (Dr Robert Platt)
Bed Sharing
Bed Sharing
Bed Sharing with Overlay
Bed Sharing with Overlay
Bed Sharing with Overlay
Couch Sleeping
Couch Sleeping
Couch Sleeping
Unsafe Bedding NISP Trends 1993-2102
Why Use Soft Bedding
Soft Bedding for Older Infants
To Swaddle or Not to Swaddle That is the Question
Swaddling
SwaddlingmdashIs it Safe
SwaddlingmdashMore Questionshellip
wwwhealthychildrenorg
Pacifiers
Pacifiers and Breastfeeding
Baby Friendly USA Pacifiers
Addressing Sleep Deprivation
Overcoming Barriers to Change What Parents are Sayinghellip
Factors Associated With Choice of Infant Sleep Position
Slide Number 65
What is Working
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Infant Sleep Safety
Safe Sleep Nurse Modeling
Physician Advocacy
Healthcare Provider Advice to New Mothers Safe Sleep
Mason Clinical Peds 713
Bundled Intervention = Behavior Change
Hospital Unsafe Sleep Persists
Washington DC
TodaysBaby QI Safe Sleep Teaching
TodaysBaby QI Safe Sleep Teaching
Social Media and Risk-Reduction Training Study (SMART)
The National Safe Sleep Hospital Certification Program
Coordinated Education Efforts Work
Coordinated Education Efforts Work
And Finallyhellip
Encouraging Parents to Take Action
Motivational Interviewing
Impact of Eliminating Sleep-Related Deaths
Thank You
Contact Information
Slide Number 89
IMR over time Finland vs US
Column1
correct advice
55
incorrect advice
25
no advice
20
correct advice
incorrect advice
no advice
SIDS Rate
Percent Back Sleeping
1988
14
1989
139
1990
13
1991
13
1992
12
13
1993
117
17
1994
103
269
1995
087
386
1996
074
353
1997
077
531
1998
072
557
1999
067
644
2000
062
666
2001
056
716
2002
057
711
2003
053
728
2004
056
701
2005
055
722
2006
055
757
2007
057
703
2008
055
721
2009
054
741
2010
051
728
2011
048
2012
042
2013
04
2014
039
httpwwwcdcgovNCHSdatanvsrnvsr58nvsr58_19pdf
Xu JQ Kochanek KD Murphy SL Tejada-Vera B Deaths Final data for
2007
National vital statistics reports vol 58 no 19 Hyattsville MD
National Center for Health Statistics 2010
1988
1988
1989
1989
1990
1990
1991
1991
1992
1992
1993
1993
1994
1994
1995
1995
1996
1996
1997
1997
1998
1998
1999
1999
2000
2000
2001
2001
2002
2002
2003
2003
2004
2004
2005
2005
2006
2006
2007
2007
2008
2008
2009
2009
2010
2010
2011
2012
2013
2014
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Strength of Recommendation
Scale based on the Strength of Recommendation Taxonomy (SORT)
A There is good quality patient-oriented evidence B There is inconsistent or limited quality patient-
oriented evidence C The recommendation is based on consensus
disease-oriented evidence usual practice expertopinion or case series for studies ofdiagnosis treatment prevention orscreening
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Recommendations Change as the Evidence Evolves Statistics and risk factors may change
o New risks emerge (eg side positioning)o Different levels of risk
Policies and procedures may changeo Better death scene investigationso Diagnostic shift
Unintended consequenceso Plagiocephaly development o New tummy time recommendations
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
2016 SIDS Task Force Policy Statement Level A Recommendations Back to sleep for every sleep Use a firm sleep surface Keep soft objects and loose bedding out of the crib Room-sharingmdashInfant on separate sleep surface Breastfeeding is recommended Consider offering a pacifier at nap time and bedtime Avoid smoke exposure during pregnancy and after birth Avoid alcohol and illicit drug use during pregnancy and
after birth
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
2016 SIDS Task Force Policy Statement Level A Recommendations Avoid overheating Pregnant women should receive regular prenatal care Do not use home cardiorespiratory monitors as a strategy
for reducing the risk of SIDS Health care professionals staff in newborn nurseries and
NICUs and child care providers should endorse the SIDS risk-reduction recommendations from birth
Media and manufacturers should follow safe-sleep guidelines in their messaging and advertising
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
2016 SIDS Task Force Policy Statement Level B Recommendations Avoid commercial devices that are inconsistent with
safe sleep recommendations Supervised awake tummy time is recommended to
facilitate development and to minimize development of positional plagiocephaly (flattening of skull)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
2016 SIDS Task Force Policy Statement Level C Recommendations Continue research and surveillance on the risk factors
causes and pathophysiological mechanisms of SIDS and other sleep-related infant deaths with the ultimate goal of eliminating these deaths entirely
There is no evidence to recommend swaddling as a strategy to reduce the risk of SIDS
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Correct Safe Sleep Environment
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
We Need to Move Beyond Back to Sleep
Shersquos on her back to sleep
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Sleep Position for Healthy Newborns
Skin-to-skin care is recommended for all mothers and newborns regardless of feeding or delivery method immediately following birtho Mom should be medically stable
awake and able to respond to baby When mother needs to sleep or take
care of other needs infant should be placed supine in a bassinet
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Sleep Position in Newborn Nursery Infants in the newborn nursery
and infants who are rooming in with their parents should be placed in the supine position as soon as they are ready to be placed in the bassinet o No evidence that placing infants
on the side during the first few hours of life promotes clearance of amniotic fluid and decreases the risk of aspiration
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Sleep Position and Reflux Infants with gastroesophageal (GE) reflux
should be kept supineo Unless the risk of death from complications
of GE reflux is greater than the risk of SIDS
Supine position does not increase the risk of choking and aspiration in infants with GE reflux o Protective airway mechanisms
Do NOT elevate the head of the infantrsquos cribo Ineffective in reducing GE refluxo Infant may slide to the foot of the cribmdashmay
compromise respiration
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
The Truth About Supine Sleep and Aspiration Ending the Fallacy Orientation of the Trachea to the Esophagus
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Title
Text
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Infant Sleep Location
Infants should sleep in parentsrsquo room close to parentsrsquo bed but on a separate surface designed for infants
Ideally for the first year of life but at least for the first 6 months
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Room-Share How Long Yoursquore Kidding Right
2011 ldquoall sleep recommendations are to be followed until 1 year of agerdquo
2016 ldquoroom-sharing without bed-sharinghellipideally until 1 year of age but at least for the first 6 monthsrdquo
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Supporting Data
3 case-control studies comparing sleeping in a separate room vs room-sharingo Tappin (Scotland) AOR 326 (95 CI 103-1035)
bull Protection is significant for smoker motherso Blair (England) AOR 1049 (95 CI 426-2581)
bull Protection is significant for both smoker and nonsmoker mothers
o New Zealand Cot Death study AOR 285(95 CI 204-385)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
More Recent Data
New Zealand SUDI studyo 64 protection with room-sharing AOR 036
(95 CI 019-071)
Estimate of 50 reduction is very conservative
None of the case-control studies stratify by age (months)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Why is Room-Sharing Protective
SIDSmdashfailure to arouse More small awakenings during the night
o Stirrings movement not fully awake Postulation protective effect from small awakenings Room-sharing facilitates breastfeeding
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Room-Sharing and Sleep Quality
Volkovich room-sharing vs solitary sleepo Room-sharing mothers with more sleep disturbanceso Infants with similar sleep quality
Mao Mindell room-sharing infantsmdashmore awakenings
Montgomery-Downs Doan sleep quality in breastfeeding mothers gt to formula feeding motherso Exclusive breastfeeding = 30 min more sleep
More study needed
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Insight Study (Paul 2017)
Sleep questionnaire at 4 9 12 and 30 monthso Sleep duration overnight behaviorso Compared early vs late independent infants
At 4 monthso Equal sleep durationo Early group had better sleep consolidationo Longest stretch 46 minutes
Paul IM Hohman EE Loken E et al Mother-infant room-sharing and sleep outcomes in the INSIGHT study Pediatrics 2017140(1)e20170122
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Insight Study (Paul 2017)
At 9 monthso Longer sleep duration (40 minnight) o Better consolidation (100 min)
At 30 monthso Longer sleep duration (45 minnight)
Room-sharing 4 times more likely to transition to bed sharing overnight
Paul IM Hohman EE Loken E et al Mother-infant room-sharing and sleep outcomes in the INSIGHT study Pediatrics 2017140(1)e20170122
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Insight Commentary (Hauck Moon)
Late room-sharing mean 7 hours longest sleep Is early consolidation desirable Differences related to bedtime routines
o Early bedtimeo Number of night feedso Feeding back to sleep
Focus on the routine not early separation
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Feeding the Baby at Night Acknowledgment that parents may fall
asleep while feeding babyo Safer to feed on bed than on sofa
couch or armchair if you might fall asleep
o No pillows sheets blankets or other items that could obstruct infant breathing or cause overheating should be in bed
o Return infant back to separate sleep surface as soon as parent awakens
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Say NO to Couches Sofas and Cushioned Armchairs Never place a baby for sleep on these surfaces Never sleep with a baby on these surfaces One of the MOST dangerous places for an infant
(OR 51-669)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
High-Risk Bed Sharing Situations Age lt4 months Preterm or low birth weight Smoked during pregnancy Bed sharer is current smoker (even if not
smoking in bed) Bed sharer has usedis using meds or
substances that could impair alertness or arousal
Bed sharer is not parent (including other children)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bedsharing in Low-Risk Breastfed Infants
Blair et al AOR 16 (95 CI 096-27) o Age lt14 weekso Parents No cigarettes or alcoholo Independent of feeding method
Carpenter et al AOR 51 (95 CI 23-114) o Age lt3 months o Parents did not smokeo Mother No alcohol or drugso Breastfed infants
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Independent Review (Dr Robert Platt)
Very small numbers of low-risk babieso 24 in Blairrsquos studyo 12 in Carpenterrsquos study
Does not believe that data support definitive differences in 2 studies
Some evidence of increased risk in this group but cannot say how large the increased risk is
Cannot conclude that bed sharing in this group is safe
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Unsafe Bedding NISP Trends 1993-2102
Shapiro-Mendoza CK Colson ER Willinger M Rybin DV Camperlengo L Corwin MJ Trends in infant bedding use National Infant Sleep Position study 1993ndash2010 Pediatrics 2015135(1)10-17
Decrease from 86 to 55 Rate of decline decreases
2001-10 835 for teen mothers Predictors of adjusted OR
gt15
o Young motherso Non-white race
ethnicityo Less than college
education
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Why Use Soft Bedding
ComfortWarmtho Extrapolation of own feelingso Misinterpret firm with taut
bull Soft + taut ne firm
Safetyo Blankets pillows rolls to prevent falls
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Soft Bedding for Older Infants
Many parents recognize soft bedding is a risk Increased complacency as baby gets older Soft bedding is THE most important risk factor for
infants 4-12 months old (Colvin 2015) Infants roll into bedding and cannot extract
themselves
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
To Swaddle or Not to Swaddle That is the Question Pros
o Calms the infant promotes sleep decreases number of awakenings
o Encourages use of the supine position
Conso Increased respiratory rate and
reduced functional residual lung capacity
o Exacerbates hip dysplasia if the hips are kept in extension and adduction
o ldquoLooserdquo swaddling becomes loose bedding
o Overheating especially if the head is covered or the infant has infection
o Effects on arousability to an external stimulus remain unclear (conflicting data) There may be minimal effects of routine swaddling on arousal
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Swaddling
There is insufficient evidence to recommend routine swaddling as a strategy to reduce the incidence of SIDS
Swaddling must be correctly applied to avoid the possible hazards
Swaddling does not reduce the necessity to follow recommended safe sleep practices Ambrogio Lorenzettis Madonna and Child (1319)
Wikipedia
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
McDonnell E Moon RY Infant deaths and injuries associated with wearable blankets swaddle wraps and swaddling J Pediatr 20141641152-1156
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
SwaddlingmdashMore Questionshellip
Pease 2016 Pediatrics Pooled OR = 138
o Prone = 1299 o Side = 316o Supine = 193
Increased risk with age Limitations
o Heterogeneity definitions other risk factorsPease AS Fleming PJ Hauck FR et al Swaddling and the risk of sudden infant death syndrome a meta-analysis Pediatrics 2016137(6)e20153
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
wwwhealthychildrenorg
Swaddling (wrapping a light blanket snuggly around a baby) may help calm a crying baby If you swaddle your baby be sure to place him on his back to sleep Stop swaddling your baby when he starts to roll
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers
AAP recommendation Consider offering a pacifier at nap time and bedtime
Studies consistently demonstrate a protective effect of pacifiers on SIDS
Mechanism unknowno Dislodge within 15 to 60 minuteso Decreased arousal threshold
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers and Breastfeeding Well-designed trials
o 2 found no association among term infants
o 1 found no association among preterm infants
o 1 found slightly decreased breastfeeding duration at one month if pacifier introduced in first week of life but NO difference if pacifier introduced after one month
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Baby Friendly USA Pacifiers
Breastfeeding babies should not be given pacifiers by the staff of the facility with the exception of o Limited use to decrease pain during procedures when
the baby cannot safely be held or breastfed (pacifiers used should be discarded after these procedures)
o Babies who are being tube-fed in NICUo Other rare specific medical reasons
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Addressing Sleep Deprivation
Give parents tools to cope with fussy babies
Sleep-deprived parents may make poor judgments
Make use of tools o Swaddling side carrying
shushing swinging and sucking
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Overcoming Barriers to Change What Parents are Sayinghellip
Prone positioning fear of choking Baby sleeps ldquobetterrdquo on stomach Soft things are safer for the baby SIDS is ldquoGodrsquos willrdquo Why bother Recommendations keep changing
anyway Vigilance sleep with baby for protection
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Factors Associated With Choice of Infant Sleep Position 3300 mothers from 32 hospitals 77 usually use supine position 49 exclusive use supine position Most likely to use prone
o African-American motherso Mothers with lt high school educationo Lack of perceived controlo Personal attitudesocietal norms
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
A continuum starting in childhoodo Secondary school baby sitting classes
Pre-pregnancy Pregnancyprenatal education
o Prior to baby showerhellipldquowrong giftsrdquo In-hospital education and modeling
o Include family friends baby sitters Re-enforcement in the doctorrsquos office
o Especially between 1 to 4 months Grandparents They hold great power The general public (day cares religious leaders)
A Lifetime of Infant Sleep Safety
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Chart1
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
14
139
13
13
12
13
117
17
103
269
087
386
074
353
077
531
072
557
067
644
062
666
056
716
057
711
053
728
056
701
055
722
055
757
057
703
055
721
054
741
051
728
048
042
04
039
Sheet1
Sheet1
ampA
Page ampP
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
Sheet2
Pre-AAP recommendation Post-AAP RecommendationBack to SleepSafe to Sleep Campaign
Sheet3
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Infant Sleep Safety
Requires a consistent and repetitive message in the community to prevent accidental deaths
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Safe Sleep Nurse Modeling
People trust nurses Whatever the nurse does must
be correct and it will be imitated in the home
Fact supine positioning in the nursery can almost DOUBLE its use in the home
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Physician Advocacy
Srivatsa 1997 HCP education to new familieshellip34 reduction in prone sleeping
Eron 2009 Study of Central NY state physicianshellip30 identified incorrect safest sleep positionhellip30 do not discuss with families
Colson 2009 Only 13 mothers advised by MD to use supine positionhellip3 times more likely to position the baby properly
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Healthcare Provider Advice to New Mothers Safe Sleep
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Chart1
Column1
[]
[]
[]
55
25
20
Sheet1
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Mason Clinical Peds 713
Bundled interventiono Nursing education policy model behavior safe sleep
video posters in rooms declaration of safe sleep practice
Safe sleep environment uarr from 25 to 58 Intention in home 95 supine none ldquoco-sleepingrdquo
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bundled Intervention = Behavior Change
QUESTION GROUP p-value
ISS Study NISP
Behavior Questions n = 490 n = 1046
Baby routinely placed to sleep on back 925 73 lt 0001
Baby routinely sleeps in bassinetcrib 995 71 lt 00001
Baby sleeps under a thin sheet 992 86 lt 0001
Baby given a pacifier for sleep 741 84 lt 0001Goodstein MH Bell T Krugman SD Improving infant sleep safety through a comprehensive hospital-based program Clinical Pediatrics 201554(3)212-221
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
o Baseline Safe sleep 49 of 264 infants o Post 312 of 234 infants (P lt 001) o Extra blankets most common o Baseline 77 vs 44 post-intervention o Mean number of unsafe items reduced by 50 (P lt 001)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Washington DC
2 urban DC nurseries 26 did not believe or unsure that infant positioning
was associated with SIDS Top 3 factors influencing sleep position
o 56 PERSONAL PREFERENCE Why non-supine Clinical experience (25)
o Increase risk aspirationo Decrease sleep and comfort
Bartow KL Nursesrsquo knowledge and adherence to sudden infant death syndrome prevention guidelines Pediatr Nurs 201642(1)7-13
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
TodaysBaby QI Safe Sleep Teaching
QI intervention median = 160 days Mothers reported receiving information 72 to 95
(increase of 24-57) 94 babies observed supine (plus 24) 88 infants in safe sleep environment
o Increase of 33 Gains maintained up to 12 months
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Social Media and Risk-Reduction Training Study (SMART) Cluster randomization 4 groups Safe sleep or breast feeding education Nursing QI and social media (mobile health) N = 1600 1263 responses (79) Safe sleep NQI and MHealth
o Supine sleep 925 o Room-sharing 859o No soft bedding 819o Pacifier use 762
Moon RY Hauck FR Colson ER et al The effect of nursing quality improvement and mobile health interventions on infant sleep practices a randomized clinical trial JAMA 2017318(4)351-359
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Hospital Initiative ComponentswwwcribsforkidsorgHospitalInitiativeToolkit INTRODUCTORY LETTER HOSPITAL INITIATIVE TOOL KIT
INSTRUCTIONS ORGANIZATIONAL CHART HOSPITAL POLICY ACKNOWLEDGMENT FORM (Engl amp
Span) SAFE SLEEP EDUCATIONAL FLIP CHART
NONCOMPLIANCE WAIVER (Engl amp Span)
NURSING EDUCATION MODULE
SAFE SLEEP POSTERS DOOR HANGERS (Engl amp Span) GRADUATION CERTIFICATE SAMPLE LETTER TO HOSPITALS SAMPLE LETTER TO PROVIDERS INFANT SAFE SLEEP BROCHURES
(Engl amp Span) PRESS KIT
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
All materials available on-lineo No major costs to the hospital
Easy on-line access for documentation
NO FEE FOR PARTICIPATION
wwwCribsforKidsorgHospitalInitiative
Tiffany Price (tpricecribsforkidsorg)
The National Safe Sleep Hospital Certification Program
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
TNmdash25 reduction in infant sleep-related deaths in 2 years
SDmdashOver 7915 Pack lsquon Plays distributed since 2012 Infant mortality rate decreased from 86 (2012) to 48 (2016)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
2009 to 2015 38 decrease in infant mortality Decreased from 135 to 84 per 1000 SUID decreased gt50 Decrease in racial disparityhttphealthybabiesbaltimorecomhome
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
And Finallyhellip
Health care providers should have open frank nonjudgmental conversations with families about their sleep practices
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Encouraging Parents to Take Action
According to the Social Learning Theory parents are more likely to recall and comply with instructions when
the health care provider
Uses a positive tone Provides adequate information Allows the parent to ask most of the questions
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Motivational Interviewing
ldquoa collaborative goal-oriented style of communication with particular attention to the language of changerdquo
o Strengthen personal motivation and commitment to a specific goal
o Explore onersquos reasons for change (barriers)o Patient generates own solutions
bull More likely to feel realisticbull Planting seeds of change
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Impact of Eliminating Sleep-Related Deaths
Every week we lose 70 children which is equivalent to 4 kindergarten classrooms
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Thank You
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Contact Information
mgoodsteinwellspanorg
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Visit Pediatric Care Online today for additional information on this and other topics
httppediatriccaresolutionsaaporgPediatric Care Online is a convenient electronic resource for immediate expert help with
virtually every pediatric clinical information need with must-have resources that are included in a comprehensive reference library and time-saving clinical tools
Donrsquot have a subscription to PCOThen take advantage of a free trial today
Call Mead Johnson Nutrition at 888363-2362 orfor more information go to
httppediatriccaresolutionsaaporgSSFree_Trialaspx
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
IMR over time Finland vs US
Slide Number 1
Disclaimer
Objectives for Todayrsquos Talk
Infant Mortality Rates for the Five Leading Causes of Infant Death in the United States 2005 and 2011
US Post-Neonatal Mortality 2015
FACT
What is SUID or SUDI
Some Causes of Deaths that Occur Suddenly and Unexpectedly during Infancy
What is SIDS
SIDS FACTS
SIDS FACTS
Triple Risk Model to Explain SIDS
Paterson DS Krous HF Kinney HC et al JAMA 2006
An Example of SIDS Pathogenesis
2016 AAP Recommendations Infant Sleep Safety
Strength of Recommendation
Recommendations Change as the Evidence Evolves
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
Correct Safe Sleep Environment
We Need to Move Beyond Back to Sleep
Sleep Position for Healthy Newborns
Sleep Position in Newborn Nursery
Sleep Position and Reflux
The Truth About Supine Sleep and Aspiration Ending the Fallacy
Title
Infant Sleep Location
Room-Share How Long Yoursquore Kidding Right
Supporting Data
More Recent Data
Why is Room-Sharing Protective
Room-Sharing and Sleep Quality
Insight Study (Paul 2017)
Insight Study (Paul 2017)
Insight Commentary (Hauck Moon)
Feeding the Baby at Night
Say NO to Couches Sofas and Cushioned Armchairs
High-Risk Bed Sharing Situations
Bedsharing in Low-Risk Breastfed Infants
Independent Review (Dr Robert Platt)
Bed Sharing
Bed Sharing
Bed Sharing with Overlay
Bed Sharing with Overlay
Bed Sharing with Overlay
Couch Sleeping
Couch Sleeping
Couch Sleeping
Unsafe Bedding NISP Trends 1993-2102
Why Use Soft Bedding
Soft Bedding for Older Infants
To Swaddle or Not to Swaddle That is the Question
Swaddling
SwaddlingmdashIs it Safe
SwaddlingmdashMore Questionshellip
wwwhealthychildrenorg
Pacifiers
Pacifiers and Breastfeeding
Baby Friendly USA Pacifiers
Addressing Sleep Deprivation
Overcoming Barriers to Change What Parents are Sayinghellip
Factors Associated With Choice of Infant Sleep Position
Slide Number 65
What is Working
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Infant Sleep Safety
Safe Sleep Nurse Modeling
Physician Advocacy
Healthcare Provider Advice to New Mothers Safe Sleep
Mason Clinical Peds 713
Bundled Intervention = Behavior Change
Hospital Unsafe Sleep Persists
Washington DC
TodaysBaby QI Safe Sleep Teaching
TodaysBaby QI Safe Sleep Teaching
Social Media and Risk-Reduction Training Study (SMART)
The National Safe Sleep Hospital Certification Program
Coordinated Education Efforts Work
Coordinated Education Efforts Work
And Finallyhellip
Encouraging Parents to Take Action
Motivational Interviewing
Impact of Eliminating Sleep-Related Deaths
Thank You
Contact Information
Slide Number 89
IMR over time Finland vs US
Column1
correct advice
55
incorrect advice
25
no advice
20
correct advice
incorrect advice
no advice
SIDS Rate
Percent Back Sleeping
1988
14
1989
139
1990
13
1991
13
1992
12
13
1993
117
17
1994
103
269
1995
087
386
1996
074
353
1997
077
531
1998
072
557
1999
067
644
2000
062
666
2001
056
716
2002
057
711
2003
053
728
2004
056
701
2005
055
722
2006
055
757
2007
057
703
2008
055
721
2009
054
741
2010
051
728
2011
048
2012
042
2013
04
2014
039
httpwwwcdcgovNCHSdatanvsrnvsr58nvsr58_19pdf
Xu JQ Kochanek KD Murphy SL Tejada-Vera B Deaths Final data for
2007
National vital statistics reports vol 58 no 19 Hyattsville MD
National Center for Health Statistics 2010
1988
1988
1989
1989
1990
1990
1991
1991
1992
1992
1993
1993
1994
1994
1995
1995
1996
1996
1997
1997
1998
1998
1999
1999
2000
2000
2001
2001
2002
2002
2003
2003
2004
2004
2005
2005
2006
2006
2007
2007
2008
2008
2009
2009
2010
2010
2011
2012
2013
2014
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Recommendations Change as the Evidence Evolves Statistics and risk factors may change
o New risks emerge (eg side positioning)o Different levels of risk
Policies and procedures may changeo Better death scene investigationso Diagnostic shift
Unintended consequenceso Plagiocephaly development o New tummy time recommendations
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
2016 SIDS Task Force Policy Statement Level A Recommendations Back to sleep for every sleep Use a firm sleep surface Keep soft objects and loose bedding out of the crib Room-sharingmdashInfant on separate sleep surface Breastfeeding is recommended Consider offering a pacifier at nap time and bedtime Avoid smoke exposure during pregnancy and after birth Avoid alcohol and illicit drug use during pregnancy and
after birth
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
2016 SIDS Task Force Policy Statement Level A Recommendations Avoid overheating Pregnant women should receive regular prenatal care Do not use home cardiorespiratory monitors as a strategy
for reducing the risk of SIDS Health care professionals staff in newborn nurseries and
NICUs and child care providers should endorse the SIDS risk-reduction recommendations from birth
Media and manufacturers should follow safe-sleep guidelines in their messaging and advertising
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
2016 SIDS Task Force Policy Statement Level B Recommendations Avoid commercial devices that are inconsistent with
safe sleep recommendations Supervised awake tummy time is recommended to
facilitate development and to minimize development of positional plagiocephaly (flattening of skull)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
2016 SIDS Task Force Policy Statement Level C Recommendations Continue research and surveillance on the risk factors
causes and pathophysiological mechanisms of SIDS and other sleep-related infant deaths with the ultimate goal of eliminating these deaths entirely
There is no evidence to recommend swaddling as a strategy to reduce the risk of SIDS
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Correct Safe Sleep Environment
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
We Need to Move Beyond Back to Sleep
Shersquos on her back to sleep
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Sleep Position for Healthy Newborns
Skin-to-skin care is recommended for all mothers and newborns regardless of feeding or delivery method immediately following birtho Mom should be medically stable
awake and able to respond to baby When mother needs to sleep or take
care of other needs infant should be placed supine in a bassinet
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Sleep Position in Newborn Nursery Infants in the newborn nursery
and infants who are rooming in with their parents should be placed in the supine position as soon as they are ready to be placed in the bassinet o No evidence that placing infants
on the side during the first few hours of life promotes clearance of amniotic fluid and decreases the risk of aspiration
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Sleep Position and Reflux Infants with gastroesophageal (GE) reflux
should be kept supineo Unless the risk of death from complications
of GE reflux is greater than the risk of SIDS
Supine position does not increase the risk of choking and aspiration in infants with GE reflux o Protective airway mechanisms
Do NOT elevate the head of the infantrsquos cribo Ineffective in reducing GE refluxo Infant may slide to the foot of the cribmdashmay
compromise respiration
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
The Truth About Supine Sleep and Aspiration Ending the Fallacy Orientation of the Trachea to the Esophagus
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Title
Text
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Infant Sleep Location
Infants should sleep in parentsrsquo room close to parentsrsquo bed but on a separate surface designed for infants
Ideally for the first year of life but at least for the first 6 months
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Room-Share How Long Yoursquore Kidding Right
2011 ldquoall sleep recommendations are to be followed until 1 year of agerdquo
2016 ldquoroom-sharing without bed-sharinghellipideally until 1 year of age but at least for the first 6 monthsrdquo
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Supporting Data
3 case-control studies comparing sleeping in a separate room vs room-sharingo Tappin (Scotland) AOR 326 (95 CI 103-1035)
bull Protection is significant for smoker motherso Blair (England) AOR 1049 (95 CI 426-2581)
bull Protection is significant for both smoker and nonsmoker mothers
o New Zealand Cot Death study AOR 285(95 CI 204-385)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
More Recent Data
New Zealand SUDI studyo 64 protection with room-sharing AOR 036
(95 CI 019-071)
Estimate of 50 reduction is very conservative
None of the case-control studies stratify by age (months)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Why is Room-Sharing Protective
SIDSmdashfailure to arouse More small awakenings during the night
o Stirrings movement not fully awake Postulation protective effect from small awakenings Room-sharing facilitates breastfeeding
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Room-Sharing and Sleep Quality
Volkovich room-sharing vs solitary sleepo Room-sharing mothers with more sleep disturbanceso Infants with similar sleep quality
Mao Mindell room-sharing infantsmdashmore awakenings
Montgomery-Downs Doan sleep quality in breastfeeding mothers gt to formula feeding motherso Exclusive breastfeeding = 30 min more sleep
More study needed
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Insight Study (Paul 2017)
Sleep questionnaire at 4 9 12 and 30 monthso Sleep duration overnight behaviorso Compared early vs late independent infants
At 4 monthso Equal sleep durationo Early group had better sleep consolidationo Longest stretch 46 minutes
Paul IM Hohman EE Loken E et al Mother-infant room-sharing and sleep outcomes in the INSIGHT study Pediatrics 2017140(1)e20170122
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Insight Study (Paul 2017)
At 9 monthso Longer sleep duration (40 minnight) o Better consolidation (100 min)
At 30 monthso Longer sleep duration (45 minnight)
Room-sharing 4 times more likely to transition to bed sharing overnight
Paul IM Hohman EE Loken E et al Mother-infant room-sharing and sleep outcomes in the INSIGHT study Pediatrics 2017140(1)e20170122
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Insight Commentary (Hauck Moon)
Late room-sharing mean 7 hours longest sleep Is early consolidation desirable Differences related to bedtime routines
o Early bedtimeo Number of night feedso Feeding back to sleep
Focus on the routine not early separation
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Feeding the Baby at Night Acknowledgment that parents may fall
asleep while feeding babyo Safer to feed on bed than on sofa
couch or armchair if you might fall asleep
o No pillows sheets blankets or other items that could obstruct infant breathing or cause overheating should be in bed
o Return infant back to separate sleep surface as soon as parent awakens
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Say NO to Couches Sofas and Cushioned Armchairs Never place a baby for sleep on these surfaces Never sleep with a baby on these surfaces One of the MOST dangerous places for an infant
(OR 51-669)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
High-Risk Bed Sharing Situations Age lt4 months Preterm or low birth weight Smoked during pregnancy Bed sharer is current smoker (even if not
smoking in bed) Bed sharer has usedis using meds or
substances that could impair alertness or arousal
Bed sharer is not parent (including other children)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bedsharing in Low-Risk Breastfed Infants
Blair et al AOR 16 (95 CI 096-27) o Age lt14 weekso Parents No cigarettes or alcoholo Independent of feeding method
Carpenter et al AOR 51 (95 CI 23-114) o Age lt3 months o Parents did not smokeo Mother No alcohol or drugso Breastfed infants
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Independent Review (Dr Robert Platt)
Very small numbers of low-risk babieso 24 in Blairrsquos studyo 12 in Carpenterrsquos study
Does not believe that data support definitive differences in 2 studies
Some evidence of increased risk in this group but cannot say how large the increased risk is
Cannot conclude that bed sharing in this group is safe
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Unsafe Bedding NISP Trends 1993-2102
Shapiro-Mendoza CK Colson ER Willinger M Rybin DV Camperlengo L Corwin MJ Trends in infant bedding use National Infant Sleep Position study 1993ndash2010 Pediatrics 2015135(1)10-17
Decrease from 86 to 55 Rate of decline decreases
2001-10 835 for teen mothers Predictors of adjusted OR
gt15
o Young motherso Non-white race
ethnicityo Less than college
education
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Why Use Soft Bedding
ComfortWarmtho Extrapolation of own feelingso Misinterpret firm with taut
bull Soft + taut ne firm
Safetyo Blankets pillows rolls to prevent falls
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Soft Bedding for Older Infants
Many parents recognize soft bedding is a risk Increased complacency as baby gets older Soft bedding is THE most important risk factor for
infants 4-12 months old (Colvin 2015) Infants roll into bedding and cannot extract
themselves
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
To Swaddle or Not to Swaddle That is the Question Pros
o Calms the infant promotes sleep decreases number of awakenings
o Encourages use of the supine position
Conso Increased respiratory rate and
reduced functional residual lung capacity
o Exacerbates hip dysplasia if the hips are kept in extension and adduction
o ldquoLooserdquo swaddling becomes loose bedding
o Overheating especially if the head is covered or the infant has infection
o Effects on arousability to an external stimulus remain unclear (conflicting data) There may be minimal effects of routine swaddling on arousal
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Swaddling
There is insufficient evidence to recommend routine swaddling as a strategy to reduce the incidence of SIDS
Swaddling must be correctly applied to avoid the possible hazards
Swaddling does not reduce the necessity to follow recommended safe sleep practices Ambrogio Lorenzettis Madonna and Child (1319)
Wikipedia
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
McDonnell E Moon RY Infant deaths and injuries associated with wearable blankets swaddle wraps and swaddling J Pediatr 20141641152-1156
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
SwaddlingmdashMore Questionshellip
Pease 2016 Pediatrics Pooled OR = 138
o Prone = 1299 o Side = 316o Supine = 193
Increased risk with age Limitations
o Heterogeneity definitions other risk factorsPease AS Fleming PJ Hauck FR et al Swaddling and the risk of sudden infant death syndrome a meta-analysis Pediatrics 2016137(6)e20153
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
wwwhealthychildrenorg
Swaddling (wrapping a light blanket snuggly around a baby) may help calm a crying baby If you swaddle your baby be sure to place him on his back to sleep Stop swaddling your baby when he starts to roll
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers
AAP recommendation Consider offering a pacifier at nap time and bedtime
Studies consistently demonstrate a protective effect of pacifiers on SIDS
Mechanism unknowno Dislodge within 15 to 60 minuteso Decreased arousal threshold
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers and Breastfeeding Well-designed trials
o 2 found no association among term infants
o 1 found no association among preterm infants
o 1 found slightly decreased breastfeeding duration at one month if pacifier introduced in first week of life but NO difference if pacifier introduced after one month
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Baby Friendly USA Pacifiers
Breastfeeding babies should not be given pacifiers by the staff of the facility with the exception of o Limited use to decrease pain during procedures when
the baby cannot safely be held or breastfed (pacifiers used should be discarded after these procedures)
o Babies who are being tube-fed in NICUo Other rare specific medical reasons
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Addressing Sleep Deprivation
Give parents tools to cope with fussy babies
Sleep-deprived parents may make poor judgments
Make use of tools o Swaddling side carrying
shushing swinging and sucking
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Overcoming Barriers to Change What Parents are Sayinghellip
Prone positioning fear of choking Baby sleeps ldquobetterrdquo on stomach Soft things are safer for the baby SIDS is ldquoGodrsquos willrdquo Why bother Recommendations keep changing
anyway Vigilance sleep with baby for protection
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Factors Associated With Choice of Infant Sleep Position 3300 mothers from 32 hospitals 77 usually use supine position 49 exclusive use supine position Most likely to use prone
o African-American motherso Mothers with lt high school educationo Lack of perceived controlo Personal attitudesocietal norms
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
A continuum starting in childhoodo Secondary school baby sitting classes
Pre-pregnancy Pregnancyprenatal education
o Prior to baby showerhellipldquowrong giftsrdquo In-hospital education and modeling
o Include family friends baby sitters Re-enforcement in the doctorrsquos office
o Especially between 1 to 4 months Grandparents They hold great power The general public (day cares religious leaders)
A Lifetime of Infant Sleep Safety
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Chart1
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
14
139
13
13
12
13
117
17
103
269
087
386
074
353
077
531
072
557
067
644
062
666
056
716
057
711
053
728
056
701
055
722
055
757
057
703
055
721
054
741
051
728
048
042
04
039
Sheet1
Sheet1
ampA
Page ampP
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
Sheet2
Pre-AAP recommendation Post-AAP RecommendationBack to SleepSafe to Sleep Campaign
Sheet3
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Infant Sleep Safety
Requires a consistent and repetitive message in the community to prevent accidental deaths
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Safe Sleep Nurse Modeling
People trust nurses Whatever the nurse does must
be correct and it will be imitated in the home
Fact supine positioning in the nursery can almost DOUBLE its use in the home
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Physician Advocacy
Srivatsa 1997 HCP education to new familieshellip34 reduction in prone sleeping
Eron 2009 Study of Central NY state physicianshellip30 identified incorrect safest sleep positionhellip30 do not discuss with families
Colson 2009 Only 13 mothers advised by MD to use supine positionhellip3 times more likely to position the baby properly
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Healthcare Provider Advice to New Mothers Safe Sleep
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Chart1
Column1
[]
[]
[]
55
25
20
Sheet1
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Mason Clinical Peds 713
Bundled interventiono Nursing education policy model behavior safe sleep
video posters in rooms declaration of safe sleep practice
Safe sleep environment uarr from 25 to 58 Intention in home 95 supine none ldquoco-sleepingrdquo
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bundled Intervention = Behavior Change
QUESTION GROUP p-value
ISS Study NISP
Behavior Questions n = 490 n = 1046
Baby routinely placed to sleep on back 925 73 lt 0001
Baby routinely sleeps in bassinetcrib 995 71 lt 00001
Baby sleeps under a thin sheet 992 86 lt 0001
Baby given a pacifier for sleep 741 84 lt 0001Goodstein MH Bell T Krugman SD Improving infant sleep safety through a comprehensive hospital-based program Clinical Pediatrics 201554(3)212-221
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
o Baseline Safe sleep 49 of 264 infants o Post 312 of 234 infants (P lt 001) o Extra blankets most common o Baseline 77 vs 44 post-intervention o Mean number of unsafe items reduced by 50 (P lt 001)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Washington DC
2 urban DC nurseries 26 did not believe or unsure that infant positioning
was associated with SIDS Top 3 factors influencing sleep position
o 56 PERSONAL PREFERENCE Why non-supine Clinical experience (25)
o Increase risk aspirationo Decrease sleep and comfort
Bartow KL Nursesrsquo knowledge and adherence to sudden infant death syndrome prevention guidelines Pediatr Nurs 201642(1)7-13
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
TodaysBaby QI Safe Sleep Teaching
QI intervention median = 160 days Mothers reported receiving information 72 to 95
(increase of 24-57) 94 babies observed supine (plus 24) 88 infants in safe sleep environment
o Increase of 33 Gains maintained up to 12 months
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Social Media and Risk-Reduction Training Study (SMART) Cluster randomization 4 groups Safe sleep or breast feeding education Nursing QI and social media (mobile health) N = 1600 1263 responses (79) Safe sleep NQI and MHealth
o Supine sleep 925 o Room-sharing 859o No soft bedding 819o Pacifier use 762
Moon RY Hauck FR Colson ER et al The effect of nursing quality improvement and mobile health interventions on infant sleep practices a randomized clinical trial JAMA 2017318(4)351-359
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Hospital Initiative ComponentswwwcribsforkidsorgHospitalInitiativeToolkit INTRODUCTORY LETTER HOSPITAL INITIATIVE TOOL KIT
INSTRUCTIONS ORGANIZATIONAL CHART HOSPITAL POLICY ACKNOWLEDGMENT FORM (Engl amp
Span) SAFE SLEEP EDUCATIONAL FLIP CHART
NONCOMPLIANCE WAIVER (Engl amp Span)
NURSING EDUCATION MODULE
SAFE SLEEP POSTERS DOOR HANGERS (Engl amp Span) GRADUATION CERTIFICATE SAMPLE LETTER TO HOSPITALS SAMPLE LETTER TO PROVIDERS INFANT SAFE SLEEP BROCHURES
(Engl amp Span) PRESS KIT
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
All materials available on-lineo No major costs to the hospital
Easy on-line access for documentation
NO FEE FOR PARTICIPATION
wwwCribsforKidsorgHospitalInitiative
Tiffany Price (tpricecribsforkidsorg)
The National Safe Sleep Hospital Certification Program
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
TNmdash25 reduction in infant sleep-related deaths in 2 years
SDmdashOver 7915 Pack lsquon Plays distributed since 2012 Infant mortality rate decreased from 86 (2012) to 48 (2016)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
2009 to 2015 38 decrease in infant mortality Decreased from 135 to 84 per 1000 SUID decreased gt50 Decrease in racial disparityhttphealthybabiesbaltimorecomhome
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
And Finallyhellip
Health care providers should have open frank nonjudgmental conversations with families about their sleep practices
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Encouraging Parents to Take Action
According to the Social Learning Theory parents are more likely to recall and comply with instructions when
the health care provider
Uses a positive tone Provides adequate information Allows the parent to ask most of the questions
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Motivational Interviewing
ldquoa collaborative goal-oriented style of communication with particular attention to the language of changerdquo
o Strengthen personal motivation and commitment to a specific goal
o Explore onersquos reasons for change (barriers)o Patient generates own solutions
bull More likely to feel realisticbull Planting seeds of change
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Impact of Eliminating Sleep-Related Deaths
Every week we lose 70 children which is equivalent to 4 kindergarten classrooms
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Thank You
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Contact Information
mgoodsteinwellspanorg
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Visit Pediatric Care Online today for additional information on this and other topics
httppediatriccaresolutionsaaporgPediatric Care Online is a convenient electronic resource for immediate expert help with
virtually every pediatric clinical information need with must-have resources that are included in a comprehensive reference library and time-saving clinical tools
Donrsquot have a subscription to PCOThen take advantage of a free trial today
Call Mead Johnson Nutrition at 888363-2362 orfor more information go to
httppediatriccaresolutionsaaporgSSFree_Trialaspx
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
IMR over time Finland vs US
Slide Number 1
Disclaimer
Objectives for Todayrsquos Talk
Infant Mortality Rates for the Five Leading Causes of Infant Death in the United States 2005 and 2011
US Post-Neonatal Mortality 2015
FACT
What is SUID or SUDI
Some Causes of Deaths that Occur Suddenly and Unexpectedly during Infancy
What is SIDS
SIDS FACTS
SIDS FACTS
Triple Risk Model to Explain SIDS
Paterson DS Krous HF Kinney HC et al JAMA 2006
An Example of SIDS Pathogenesis
2016 AAP Recommendations Infant Sleep Safety
Strength of Recommendation
Recommendations Change as the Evidence Evolves
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
Correct Safe Sleep Environment
We Need to Move Beyond Back to Sleep
Sleep Position for Healthy Newborns
Sleep Position in Newborn Nursery
Sleep Position and Reflux
The Truth About Supine Sleep and Aspiration Ending the Fallacy
Title
Infant Sleep Location
Room-Share How Long Yoursquore Kidding Right
Supporting Data
More Recent Data
Why is Room-Sharing Protective
Room-Sharing and Sleep Quality
Insight Study (Paul 2017)
Insight Study (Paul 2017)
Insight Commentary (Hauck Moon)
Feeding the Baby at Night
Say NO to Couches Sofas and Cushioned Armchairs
High-Risk Bed Sharing Situations
Bedsharing in Low-Risk Breastfed Infants
Independent Review (Dr Robert Platt)
Bed Sharing
Bed Sharing
Bed Sharing with Overlay
Bed Sharing with Overlay
Bed Sharing with Overlay
Couch Sleeping
Couch Sleeping
Couch Sleeping
Unsafe Bedding NISP Trends 1993-2102
Why Use Soft Bedding
Soft Bedding for Older Infants
To Swaddle or Not to Swaddle That is the Question
Swaddling
SwaddlingmdashIs it Safe
SwaddlingmdashMore Questionshellip
wwwhealthychildrenorg
Pacifiers
Pacifiers and Breastfeeding
Baby Friendly USA Pacifiers
Addressing Sleep Deprivation
Overcoming Barriers to Change What Parents are Sayinghellip
Factors Associated With Choice of Infant Sleep Position
Slide Number 65
What is Working
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Infant Sleep Safety
Safe Sleep Nurse Modeling
Physician Advocacy
Healthcare Provider Advice to New Mothers Safe Sleep
Mason Clinical Peds 713
Bundled Intervention = Behavior Change
Hospital Unsafe Sleep Persists
Washington DC
TodaysBaby QI Safe Sleep Teaching
TodaysBaby QI Safe Sleep Teaching
Social Media and Risk-Reduction Training Study (SMART)
The National Safe Sleep Hospital Certification Program
Coordinated Education Efforts Work
Coordinated Education Efforts Work
And Finallyhellip
Encouraging Parents to Take Action
Motivational Interviewing
Impact of Eliminating Sleep-Related Deaths
Thank You
Contact Information
Slide Number 89
IMR over time Finland vs US
Column1
correct advice
55
incorrect advice
25
no advice
20
correct advice
incorrect advice
no advice
SIDS Rate
Percent Back Sleeping
1988
14
1989
139
1990
13
1991
13
1992
12
13
1993
117
17
1994
103
269
1995
087
386
1996
074
353
1997
077
531
1998
072
557
1999
067
644
2000
062
666
2001
056
716
2002
057
711
2003
053
728
2004
056
701
2005
055
722
2006
055
757
2007
057
703
2008
055
721
2009
054
741
2010
051
728
2011
048
2012
042
2013
04
2014
039
httpwwwcdcgovNCHSdatanvsrnvsr58nvsr58_19pdf
Xu JQ Kochanek KD Murphy SL Tejada-Vera B Deaths Final data for
2007
National vital statistics reports vol 58 no 19 Hyattsville MD
National Center for Health Statistics 2010
1988
1988
1989
1989
1990
1990
1991
1991
1992
1992
1993
1993
1994
1994
1995
1995
1996
1996
1997
1997
1998
1998
1999
1999
2000
2000
2001
2001
2002
2002
2003
2003
2004
2004
2005
2005
2006
2006
2007
2007
2008
2008
2009
2009
2010
2010
2011
2012
2013
2014
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
2016 SIDS Task Force Policy Statement Level A Recommendations Back to sleep for every sleep Use a firm sleep surface Keep soft objects and loose bedding out of the crib Room-sharingmdashInfant on separate sleep surface Breastfeeding is recommended Consider offering a pacifier at nap time and bedtime Avoid smoke exposure during pregnancy and after birth Avoid alcohol and illicit drug use during pregnancy and
after birth
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
2016 SIDS Task Force Policy Statement Level A Recommendations Avoid overheating Pregnant women should receive regular prenatal care Do not use home cardiorespiratory monitors as a strategy
for reducing the risk of SIDS Health care professionals staff in newborn nurseries and
NICUs and child care providers should endorse the SIDS risk-reduction recommendations from birth
Media and manufacturers should follow safe-sleep guidelines in their messaging and advertising
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
2016 SIDS Task Force Policy Statement Level B Recommendations Avoid commercial devices that are inconsistent with
safe sleep recommendations Supervised awake tummy time is recommended to
facilitate development and to minimize development of positional plagiocephaly (flattening of skull)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
2016 SIDS Task Force Policy Statement Level C Recommendations Continue research and surveillance on the risk factors
causes and pathophysiological mechanisms of SIDS and other sleep-related infant deaths with the ultimate goal of eliminating these deaths entirely
There is no evidence to recommend swaddling as a strategy to reduce the risk of SIDS
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Correct Safe Sleep Environment
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
We Need to Move Beyond Back to Sleep
Shersquos on her back to sleep
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Sleep Position for Healthy Newborns
Skin-to-skin care is recommended for all mothers and newborns regardless of feeding or delivery method immediately following birtho Mom should be medically stable
awake and able to respond to baby When mother needs to sleep or take
care of other needs infant should be placed supine in a bassinet
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Sleep Position in Newborn Nursery Infants in the newborn nursery
and infants who are rooming in with their parents should be placed in the supine position as soon as they are ready to be placed in the bassinet o No evidence that placing infants
on the side during the first few hours of life promotes clearance of amniotic fluid and decreases the risk of aspiration
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Sleep Position and Reflux Infants with gastroesophageal (GE) reflux
should be kept supineo Unless the risk of death from complications
of GE reflux is greater than the risk of SIDS
Supine position does not increase the risk of choking and aspiration in infants with GE reflux o Protective airway mechanisms
Do NOT elevate the head of the infantrsquos cribo Ineffective in reducing GE refluxo Infant may slide to the foot of the cribmdashmay
compromise respiration
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
The Truth About Supine Sleep and Aspiration Ending the Fallacy Orientation of the Trachea to the Esophagus
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Title
Text
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Infant Sleep Location
Infants should sleep in parentsrsquo room close to parentsrsquo bed but on a separate surface designed for infants
Ideally for the first year of life but at least for the first 6 months
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Room-Share How Long Yoursquore Kidding Right
2011 ldquoall sleep recommendations are to be followed until 1 year of agerdquo
2016 ldquoroom-sharing without bed-sharinghellipideally until 1 year of age but at least for the first 6 monthsrdquo
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Supporting Data
3 case-control studies comparing sleeping in a separate room vs room-sharingo Tappin (Scotland) AOR 326 (95 CI 103-1035)
bull Protection is significant for smoker motherso Blair (England) AOR 1049 (95 CI 426-2581)
bull Protection is significant for both smoker and nonsmoker mothers
o New Zealand Cot Death study AOR 285(95 CI 204-385)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
More Recent Data
New Zealand SUDI studyo 64 protection with room-sharing AOR 036
(95 CI 019-071)
Estimate of 50 reduction is very conservative
None of the case-control studies stratify by age (months)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Why is Room-Sharing Protective
SIDSmdashfailure to arouse More small awakenings during the night
o Stirrings movement not fully awake Postulation protective effect from small awakenings Room-sharing facilitates breastfeeding
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Room-Sharing and Sleep Quality
Volkovich room-sharing vs solitary sleepo Room-sharing mothers with more sleep disturbanceso Infants with similar sleep quality
Mao Mindell room-sharing infantsmdashmore awakenings
Montgomery-Downs Doan sleep quality in breastfeeding mothers gt to formula feeding motherso Exclusive breastfeeding = 30 min more sleep
More study needed
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Insight Study (Paul 2017)
Sleep questionnaire at 4 9 12 and 30 monthso Sleep duration overnight behaviorso Compared early vs late independent infants
At 4 monthso Equal sleep durationo Early group had better sleep consolidationo Longest stretch 46 minutes
Paul IM Hohman EE Loken E et al Mother-infant room-sharing and sleep outcomes in the INSIGHT study Pediatrics 2017140(1)e20170122
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Insight Study (Paul 2017)
At 9 monthso Longer sleep duration (40 minnight) o Better consolidation (100 min)
At 30 monthso Longer sleep duration (45 minnight)
Room-sharing 4 times more likely to transition to bed sharing overnight
Paul IM Hohman EE Loken E et al Mother-infant room-sharing and sleep outcomes in the INSIGHT study Pediatrics 2017140(1)e20170122
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Insight Commentary (Hauck Moon)
Late room-sharing mean 7 hours longest sleep Is early consolidation desirable Differences related to bedtime routines
o Early bedtimeo Number of night feedso Feeding back to sleep
Focus on the routine not early separation
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Feeding the Baby at Night Acknowledgment that parents may fall
asleep while feeding babyo Safer to feed on bed than on sofa
couch or armchair if you might fall asleep
o No pillows sheets blankets or other items that could obstruct infant breathing or cause overheating should be in bed
o Return infant back to separate sleep surface as soon as parent awakens
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Say NO to Couches Sofas and Cushioned Armchairs Never place a baby for sleep on these surfaces Never sleep with a baby on these surfaces One of the MOST dangerous places for an infant
(OR 51-669)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
High-Risk Bed Sharing Situations Age lt4 months Preterm or low birth weight Smoked during pregnancy Bed sharer is current smoker (even if not
smoking in bed) Bed sharer has usedis using meds or
substances that could impair alertness or arousal
Bed sharer is not parent (including other children)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bedsharing in Low-Risk Breastfed Infants
Blair et al AOR 16 (95 CI 096-27) o Age lt14 weekso Parents No cigarettes or alcoholo Independent of feeding method
Carpenter et al AOR 51 (95 CI 23-114) o Age lt3 months o Parents did not smokeo Mother No alcohol or drugso Breastfed infants
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Independent Review (Dr Robert Platt)
Very small numbers of low-risk babieso 24 in Blairrsquos studyo 12 in Carpenterrsquos study
Does not believe that data support definitive differences in 2 studies
Some evidence of increased risk in this group but cannot say how large the increased risk is
Cannot conclude that bed sharing in this group is safe
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Unsafe Bedding NISP Trends 1993-2102
Shapiro-Mendoza CK Colson ER Willinger M Rybin DV Camperlengo L Corwin MJ Trends in infant bedding use National Infant Sleep Position study 1993ndash2010 Pediatrics 2015135(1)10-17
Decrease from 86 to 55 Rate of decline decreases
2001-10 835 for teen mothers Predictors of adjusted OR
gt15
o Young motherso Non-white race
ethnicityo Less than college
education
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Why Use Soft Bedding
ComfortWarmtho Extrapolation of own feelingso Misinterpret firm with taut
bull Soft + taut ne firm
Safetyo Blankets pillows rolls to prevent falls
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Soft Bedding for Older Infants
Many parents recognize soft bedding is a risk Increased complacency as baby gets older Soft bedding is THE most important risk factor for
infants 4-12 months old (Colvin 2015) Infants roll into bedding and cannot extract
themselves
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
To Swaddle or Not to Swaddle That is the Question Pros
o Calms the infant promotes sleep decreases number of awakenings
o Encourages use of the supine position
Conso Increased respiratory rate and
reduced functional residual lung capacity
o Exacerbates hip dysplasia if the hips are kept in extension and adduction
o ldquoLooserdquo swaddling becomes loose bedding
o Overheating especially if the head is covered or the infant has infection
o Effects on arousability to an external stimulus remain unclear (conflicting data) There may be minimal effects of routine swaddling on arousal
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Swaddling
There is insufficient evidence to recommend routine swaddling as a strategy to reduce the incidence of SIDS
Swaddling must be correctly applied to avoid the possible hazards
Swaddling does not reduce the necessity to follow recommended safe sleep practices Ambrogio Lorenzettis Madonna and Child (1319)
Wikipedia
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
McDonnell E Moon RY Infant deaths and injuries associated with wearable blankets swaddle wraps and swaddling J Pediatr 20141641152-1156
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
SwaddlingmdashMore Questionshellip
Pease 2016 Pediatrics Pooled OR = 138
o Prone = 1299 o Side = 316o Supine = 193
Increased risk with age Limitations
o Heterogeneity definitions other risk factorsPease AS Fleming PJ Hauck FR et al Swaddling and the risk of sudden infant death syndrome a meta-analysis Pediatrics 2016137(6)e20153
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
wwwhealthychildrenorg
Swaddling (wrapping a light blanket snuggly around a baby) may help calm a crying baby If you swaddle your baby be sure to place him on his back to sleep Stop swaddling your baby when he starts to roll
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers
AAP recommendation Consider offering a pacifier at nap time and bedtime
Studies consistently demonstrate a protective effect of pacifiers on SIDS
Mechanism unknowno Dislodge within 15 to 60 minuteso Decreased arousal threshold
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers and Breastfeeding Well-designed trials
o 2 found no association among term infants
o 1 found no association among preterm infants
o 1 found slightly decreased breastfeeding duration at one month if pacifier introduced in first week of life but NO difference if pacifier introduced after one month
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Baby Friendly USA Pacifiers
Breastfeeding babies should not be given pacifiers by the staff of the facility with the exception of o Limited use to decrease pain during procedures when
the baby cannot safely be held or breastfed (pacifiers used should be discarded after these procedures)
o Babies who are being tube-fed in NICUo Other rare specific medical reasons
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Addressing Sleep Deprivation
Give parents tools to cope with fussy babies
Sleep-deprived parents may make poor judgments
Make use of tools o Swaddling side carrying
shushing swinging and sucking
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Overcoming Barriers to Change What Parents are Sayinghellip
Prone positioning fear of choking Baby sleeps ldquobetterrdquo on stomach Soft things are safer for the baby SIDS is ldquoGodrsquos willrdquo Why bother Recommendations keep changing
anyway Vigilance sleep with baby for protection
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Factors Associated With Choice of Infant Sleep Position 3300 mothers from 32 hospitals 77 usually use supine position 49 exclusive use supine position Most likely to use prone
o African-American motherso Mothers with lt high school educationo Lack of perceived controlo Personal attitudesocietal norms
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
A continuum starting in childhoodo Secondary school baby sitting classes
Pre-pregnancy Pregnancyprenatal education
o Prior to baby showerhellipldquowrong giftsrdquo In-hospital education and modeling
o Include family friends baby sitters Re-enforcement in the doctorrsquos office
o Especially between 1 to 4 months Grandparents They hold great power The general public (day cares religious leaders)
A Lifetime of Infant Sleep Safety
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Chart1
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
14
139
13
13
12
13
117
17
103
269
087
386
074
353
077
531
072
557
067
644
062
666
056
716
057
711
053
728
056
701
055
722
055
757
057
703
055
721
054
741
051
728
048
042
04
039
Sheet1
Sheet1
ampA
Page ampP
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
Sheet2
Pre-AAP recommendation Post-AAP RecommendationBack to SleepSafe to Sleep Campaign
Sheet3
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Infant Sleep Safety
Requires a consistent and repetitive message in the community to prevent accidental deaths
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Safe Sleep Nurse Modeling
People trust nurses Whatever the nurse does must
be correct and it will be imitated in the home
Fact supine positioning in the nursery can almost DOUBLE its use in the home
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Physician Advocacy
Srivatsa 1997 HCP education to new familieshellip34 reduction in prone sleeping
Eron 2009 Study of Central NY state physicianshellip30 identified incorrect safest sleep positionhellip30 do not discuss with families
Colson 2009 Only 13 mothers advised by MD to use supine positionhellip3 times more likely to position the baby properly
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Healthcare Provider Advice to New Mothers Safe Sleep
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Chart1
Column1
[]
[]
[]
55
25
20
Sheet1
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Mason Clinical Peds 713
Bundled interventiono Nursing education policy model behavior safe sleep
video posters in rooms declaration of safe sleep practice
Safe sleep environment uarr from 25 to 58 Intention in home 95 supine none ldquoco-sleepingrdquo
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bundled Intervention = Behavior Change
QUESTION GROUP p-value
ISS Study NISP
Behavior Questions n = 490 n = 1046
Baby routinely placed to sleep on back 925 73 lt 0001
Baby routinely sleeps in bassinetcrib 995 71 lt 00001
Baby sleeps under a thin sheet 992 86 lt 0001
Baby given a pacifier for sleep 741 84 lt 0001Goodstein MH Bell T Krugman SD Improving infant sleep safety through a comprehensive hospital-based program Clinical Pediatrics 201554(3)212-221
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
o Baseline Safe sleep 49 of 264 infants o Post 312 of 234 infants (P lt 001) o Extra blankets most common o Baseline 77 vs 44 post-intervention o Mean number of unsafe items reduced by 50 (P lt 001)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Washington DC
2 urban DC nurseries 26 did not believe or unsure that infant positioning
was associated with SIDS Top 3 factors influencing sleep position
o 56 PERSONAL PREFERENCE Why non-supine Clinical experience (25)
o Increase risk aspirationo Decrease sleep and comfort
Bartow KL Nursesrsquo knowledge and adherence to sudden infant death syndrome prevention guidelines Pediatr Nurs 201642(1)7-13
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
TodaysBaby QI Safe Sleep Teaching
QI intervention median = 160 days Mothers reported receiving information 72 to 95
(increase of 24-57) 94 babies observed supine (plus 24) 88 infants in safe sleep environment
o Increase of 33 Gains maintained up to 12 months
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Social Media and Risk-Reduction Training Study (SMART) Cluster randomization 4 groups Safe sleep or breast feeding education Nursing QI and social media (mobile health) N = 1600 1263 responses (79) Safe sleep NQI and MHealth
o Supine sleep 925 o Room-sharing 859o No soft bedding 819o Pacifier use 762
Moon RY Hauck FR Colson ER et al The effect of nursing quality improvement and mobile health interventions on infant sleep practices a randomized clinical trial JAMA 2017318(4)351-359
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Hospital Initiative ComponentswwwcribsforkidsorgHospitalInitiativeToolkit INTRODUCTORY LETTER HOSPITAL INITIATIVE TOOL KIT
INSTRUCTIONS ORGANIZATIONAL CHART HOSPITAL POLICY ACKNOWLEDGMENT FORM (Engl amp
Span) SAFE SLEEP EDUCATIONAL FLIP CHART
NONCOMPLIANCE WAIVER (Engl amp Span)
NURSING EDUCATION MODULE
SAFE SLEEP POSTERS DOOR HANGERS (Engl amp Span) GRADUATION CERTIFICATE SAMPLE LETTER TO HOSPITALS SAMPLE LETTER TO PROVIDERS INFANT SAFE SLEEP BROCHURES
(Engl amp Span) PRESS KIT
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
All materials available on-lineo No major costs to the hospital
Easy on-line access for documentation
NO FEE FOR PARTICIPATION
wwwCribsforKidsorgHospitalInitiative
Tiffany Price (tpricecribsforkidsorg)
The National Safe Sleep Hospital Certification Program
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
TNmdash25 reduction in infant sleep-related deaths in 2 years
SDmdashOver 7915 Pack lsquon Plays distributed since 2012 Infant mortality rate decreased from 86 (2012) to 48 (2016)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
2009 to 2015 38 decrease in infant mortality Decreased from 135 to 84 per 1000 SUID decreased gt50 Decrease in racial disparityhttphealthybabiesbaltimorecomhome
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
And Finallyhellip
Health care providers should have open frank nonjudgmental conversations with families about their sleep practices
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Encouraging Parents to Take Action
According to the Social Learning Theory parents are more likely to recall and comply with instructions when
the health care provider
Uses a positive tone Provides adequate information Allows the parent to ask most of the questions
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Motivational Interviewing
ldquoa collaborative goal-oriented style of communication with particular attention to the language of changerdquo
o Strengthen personal motivation and commitment to a specific goal
o Explore onersquos reasons for change (barriers)o Patient generates own solutions
bull More likely to feel realisticbull Planting seeds of change
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Impact of Eliminating Sleep-Related Deaths
Every week we lose 70 children which is equivalent to 4 kindergarten classrooms
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Thank You
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Contact Information
mgoodsteinwellspanorg
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Visit Pediatric Care Online today for additional information on this and other topics
httppediatriccaresolutionsaaporgPediatric Care Online is a convenient electronic resource for immediate expert help with
virtually every pediatric clinical information need with must-have resources that are included in a comprehensive reference library and time-saving clinical tools
Donrsquot have a subscription to PCOThen take advantage of a free trial today
Call Mead Johnson Nutrition at 888363-2362 orfor more information go to
httppediatriccaresolutionsaaporgSSFree_Trialaspx
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
IMR over time Finland vs US
Slide Number 1
Disclaimer
Objectives for Todayrsquos Talk
Infant Mortality Rates for the Five Leading Causes of Infant Death in the United States 2005 and 2011
US Post-Neonatal Mortality 2015
FACT
What is SUID or SUDI
Some Causes of Deaths that Occur Suddenly and Unexpectedly during Infancy
What is SIDS
SIDS FACTS
SIDS FACTS
Triple Risk Model to Explain SIDS
Paterson DS Krous HF Kinney HC et al JAMA 2006
An Example of SIDS Pathogenesis
2016 AAP Recommendations Infant Sleep Safety
Strength of Recommendation
Recommendations Change as the Evidence Evolves
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
Correct Safe Sleep Environment
We Need to Move Beyond Back to Sleep
Sleep Position for Healthy Newborns
Sleep Position in Newborn Nursery
Sleep Position and Reflux
The Truth About Supine Sleep and Aspiration Ending the Fallacy
Title
Infant Sleep Location
Room-Share How Long Yoursquore Kidding Right
Supporting Data
More Recent Data
Why is Room-Sharing Protective
Room-Sharing and Sleep Quality
Insight Study (Paul 2017)
Insight Study (Paul 2017)
Insight Commentary (Hauck Moon)
Feeding the Baby at Night
Say NO to Couches Sofas and Cushioned Armchairs
High-Risk Bed Sharing Situations
Bedsharing in Low-Risk Breastfed Infants
Independent Review (Dr Robert Platt)
Bed Sharing
Bed Sharing
Bed Sharing with Overlay
Bed Sharing with Overlay
Bed Sharing with Overlay
Couch Sleeping
Couch Sleeping
Couch Sleeping
Unsafe Bedding NISP Trends 1993-2102
Why Use Soft Bedding
Soft Bedding for Older Infants
To Swaddle or Not to Swaddle That is the Question
Swaddling
SwaddlingmdashIs it Safe
SwaddlingmdashMore Questionshellip
wwwhealthychildrenorg
Pacifiers
Pacifiers and Breastfeeding
Baby Friendly USA Pacifiers
Addressing Sleep Deprivation
Overcoming Barriers to Change What Parents are Sayinghellip
Factors Associated With Choice of Infant Sleep Position
Slide Number 65
What is Working
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Infant Sleep Safety
Safe Sleep Nurse Modeling
Physician Advocacy
Healthcare Provider Advice to New Mothers Safe Sleep
Mason Clinical Peds 713
Bundled Intervention = Behavior Change
Hospital Unsafe Sleep Persists
Washington DC
TodaysBaby QI Safe Sleep Teaching
TodaysBaby QI Safe Sleep Teaching
Social Media and Risk-Reduction Training Study (SMART)
The National Safe Sleep Hospital Certification Program
Coordinated Education Efforts Work
Coordinated Education Efforts Work
And Finallyhellip
Encouraging Parents to Take Action
Motivational Interviewing
Impact of Eliminating Sleep-Related Deaths
Thank You
Contact Information
Slide Number 89
IMR over time Finland vs US
Column1
correct advice
55
incorrect advice
25
no advice
20
correct advice
incorrect advice
no advice
SIDS Rate
Percent Back Sleeping
1988
14
1989
139
1990
13
1991
13
1992
12
13
1993
117
17
1994
103
269
1995
087
386
1996
074
353
1997
077
531
1998
072
557
1999
067
644
2000
062
666
2001
056
716
2002
057
711
2003
053
728
2004
056
701
2005
055
722
2006
055
757
2007
057
703
2008
055
721
2009
054
741
2010
051
728
2011
048
2012
042
2013
04
2014
039
httpwwwcdcgovNCHSdatanvsrnvsr58nvsr58_19pdf
Xu JQ Kochanek KD Murphy SL Tejada-Vera B Deaths Final data for
2007
National vital statistics reports vol 58 no 19 Hyattsville MD
National Center for Health Statistics 2010
1988
1988
1989
1989
1990
1990
1991
1991
1992
1992
1993
1993
1994
1994
1995
1995
1996
1996
1997
1997
1998
1998
1999
1999
2000
2000
2001
2001
2002
2002
2003
2003
2004
2004
2005
2005
2006
2006
2007
2007
2008
2008
2009
2009
2010
2010
2011
2012
2013
2014
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
2016 SIDS Task Force Policy Statement Level A Recommendations Avoid overheating Pregnant women should receive regular prenatal care Do not use home cardiorespiratory monitors as a strategy
for reducing the risk of SIDS Health care professionals staff in newborn nurseries and
NICUs and child care providers should endorse the SIDS risk-reduction recommendations from birth
Media and manufacturers should follow safe-sleep guidelines in their messaging and advertising
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
2016 SIDS Task Force Policy Statement Level B Recommendations Avoid commercial devices that are inconsistent with
safe sleep recommendations Supervised awake tummy time is recommended to
facilitate development and to minimize development of positional plagiocephaly (flattening of skull)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
2016 SIDS Task Force Policy Statement Level C Recommendations Continue research and surveillance on the risk factors
causes and pathophysiological mechanisms of SIDS and other sleep-related infant deaths with the ultimate goal of eliminating these deaths entirely
There is no evidence to recommend swaddling as a strategy to reduce the risk of SIDS
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Correct Safe Sleep Environment
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
We Need to Move Beyond Back to Sleep
Shersquos on her back to sleep
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Sleep Position for Healthy Newborns
Skin-to-skin care is recommended for all mothers and newborns regardless of feeding or delivery method immediately following birtho Mom should be medically stable
awake and able to respond to baby When mother needs to sleep or take
care of other needs infant should be placed supine in a bassinet
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Sleep Position in Newborn Nursery Infants in the newborn nursery
and infants who are rooming in with their parents should be placed in the supine position as soon as they are ready to be placed in the bassinet o No evidence that placing infants
on the side during the first few hours of life promotes clearance of amniotic fluid and decreases the risk of aspiration
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Sleep Position and Reflux Infants with gastroesophageal (GE) reflux
should be kept supineo Unless the risk of death from complications
of GE reflux is greater than the risk of SIDS
Supine position does not increase the risk of choking and aspiration in infants with GE reflux o Protective airway mechanisms
Do NOT elevate the head of the infantrsquos cribo Ineffective in reducing GE refluxo Infant may slide to the foot of the cribmdashmay
compromise respiration
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
The Truth About Supine Sleep and Aspiration Ending the Fallacy Orientation of the Trachea to the Esophagus
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Title
Text
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Infant Sleep Location
Infants should sleep in parentsrsquo room close to parentsrsquo bed but on a separate surface designed for infants
Ideally for the first year of life but at least for the first 6 months
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Room-Share How Long Yoursquore Kidding Right
2011 ldquoall sleep recommendations are to be followed until 1 year of agerdquo
2016 ldquoroom-sharing without bed-sharinghellipideally until 1 year of age but at least for the first 6 monthsrdquo
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Supporting Data
3 case-control studies comparing sleeping in a separate room vs room-sharingo Tappin (Scotland) AOR 326 (95 CI 103-1035)
bull Protection is significant for smoker motherso Blair (England) AOR 1049 (95 CI 426-2581)
bull Protection is significant for both smoker and nonsmoker mothers
o New Zealand Cot Death study AOR 285(95 CI 204-385)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
More Recent Data
New Zealand SUDI studyo 64 protection with room-sharing AOR 036
(95 CI 019-071)
Estimate of 50 reduction is very conservative
None of the case-control studies stratify by age (months)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Why is Room-Sharing Protective
SIDSmdashfailure to arouse More small awakenings during the night
o Stirrings movement not fully awake Postulation protective effect from small awakenings Room-sharing facilitates breastfeeding
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Room-Sharing and Sleep Quality
Volkovich room-sharing vs solitary sleepo Room-sharing mothers with more sleep disturbanceso Infants with similar sleep quality
Mao Mindell room-sharing infantsmdashmore awakenings
Montgomery-Downs Doan sleep quality in breastfeeding mothers gt to formula feeding motherso Exclusive breastfeeding = 30 min more sleep
More study needed
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Insight Study (Paul 2017)
Sleep questionnaire at 4 9 12 and 30 monthso Sleep duration overnight behaviorso Compared early vs late independent infants
At 4 monthso Equal sleep durationo Early group had better sleep consolidationo Longest stretch 46 minutes
Paul IM Hohman EE Loken E et al Mother-infant room-sharing and sleep outcomes in the INSIGHT study Pediatrics 2017140(1)e20170122
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Insight Study (Paul 2017)
At 9 monthso Longer sleep duration (40 minnight) o Better consolidation (100 min)
At 30 monthso Longer sleep duration (45 minnight)
Room-sharing 4 times more likely to transition to bed sharing overnight
Paul IM Hohman EE Loken E et al Mother-infant room-sharing and sleep outcomes in the INSIGHT study Pediatrics 2017140(1)e20170122
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Insight Commentary (Hauck Moon)
Late room-sharing mean 7 hours longest sleep Is early consolidation desirable Differences related to bedtime routines
o Early bedtimeo Number of night feedso Feeding back to sleep
Focus on the routine not early separation
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Feeding the Baby at Night Acknowledgment that parents may fall
asleep while feeding babyo Safer to feed on bed than on sofa
couch or armchair if you might fall asleep
o No pillows sheets blankets or other items that could obstruct infant breathing or cause overheating should be in bed
o Return infant back to separate sleep surface as soon as parent awakens
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Say NO to Couches Sofas and Cushioned Armchairs Never place a baby for sleep on these surfaces Never sleep with a baby on these surfaces One of the MOST dangerous places for an infant
(OR 51-669)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
High-Risk Bed Sharing Situations Age lt4 months Preterm or low birth weight Smoked during pregnancy Bed sharer is current smoker (even if not
smoking in bed) Bed sharer has usedis using meds or
substances that could impair alertness or arousal
Bed sharer is not parent (including other children)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bedsharing in Low-Risk Breastfed Infants
Blair et al AOR 16 (95 CI 096-27) o Age lt14 weekso Parents No cigarettes or alcoholo Independent of feeding method
Carpenter et al AOR 51 (95 CI 23-114) o Age lt3 months o Parents did not smokeo Mother No alcohol or drugso Breastfed infants
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Independent Review (Dr Robert Platt)
Very small numbers of low-risk babieso 24 in Blairrsquos studyo 12 in Carpenterrsquos study
Does not believe that data support definitive differences in 2 studies
Some evidence of increased risk in this group but cannot say how large the increased risk is
Cannot conclude that bed sharing in this group is safe
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Unsafe Bedding NISP Trends 1993-2102
Shapiro-Mendoza CK Colson ER Willinger M Rybin DV Camperlengo L Corwin MJ Trends in infant bedding use National Infant Sleep Position study 1993ndash2010 Pediatrics 2015135(1)10-17
Decrease from 86 to 55 Rate of decline decreases
2001-10 835 for teen mothers Predictors of adjusted OR
gt15
o Young motherso Non-white race
ethnicityo Less than college
education
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Why Use Soft Bedding
ComfortWarmtho Extrapolation of own feelingso Misinterpret firm with taut
bull Soft + taut ne firm
Safetyo Blankets pillows rolls to prevent falls
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Soft Bedding for Older Infants
Many parents recognize soft bedding is a risk Increased complacency as baby gets older Soft bedding is THE most important risk factor for
infants 4-12 months old (Colvin 2015) Infants roll into bedding and cannot extract
themselves
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
To Swaddle or Not to Swaddle That is the Question Pros
o Calms the infant promotes sleep decreases number of awakenings
o Encourages use of the supine position
Conso Increased respiratory rate and
reduced functional residual lung capacity
o Exacerbates hip dysplasia if the hips are kept in extension and adduction
o ldquoLooserdquo swaddling becomes loose bedding
o Overheating especially if the head is covered or the infant has infection
o Effects on arousability to an external stimulus remain unclear (conflicting data) There may be minimal effects of routine swaddling on arousal
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Swaddling
There is insufficient evidence to recommend routine swaddling as a strategy to reduce the incidence of SIDS
Swaddling must be correctly applied to avoid the possible hazards
Swaddling does not reduce the necessity to follow recommended safe sleep practices Ambrogio Lorenzettis Madonna and Child (1319)
Wikipedia
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
McDonnell E Moon RY Infant deaths and injuries associated with wearable blankets swaddle wraps and swaddling J Pediatr 20141641152-1156
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
SwaddlingmdashMore Questionshellip
Pease 2016 Pediatrics Pooled OR = 138
o Prone = 1299 o Side = 316o Supine = 193
Increased risk with age Limitations
o Heterogeneity definitions other risk factorsPease AS Fleming PJ Hauck FR et al Swaddling and the risk of sudden infant death syndrome a meta-analysis Pediatrics 2016137(6)e20153
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
wwwhealthychildrenorg
Swaddling (wrapping a light blanket snuggly around a baby) may help calm a crying baby If you swaddle your baby be sure to place him on his back to sleep Stop swaddling your baby when he starts to roll
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers
AAP recommendation Consider offering a pacifier at nap time and bedtime
Studies consistently demonstrate a protective effect of pacifiers on SIDS
Mechanism unknowno Dislodge within 15 to 60 minuteso Decreased arousal threshold
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers and Breastfeeding Well-designed trials
o 2 found no association among term infants
o 1 found no association among preterm infants
o 1 found slightly decreased breastfeeding duration at one month if pacifier introduced in first week of life but NO difference if pacifier introduced after one month
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Baby Friendly USA Pacifiers
Breastfeeding babies should not be given pacifiers by the staff of the facility with the exception of o Limited use to decrease pain during procedures when
the baby cannot safely be held or breastfed (pacifiers used should be discarded after these procedures)
o Babies who are being tube-fed in NICUo Other rare specific medical reasons
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Addressing Sleep Deprivation
Give parents tools to cope with fussy babies
Sleep-deprived parents may make poor judgments
Make use of tools o Swaddling side carrying
shushing swinging and sucking
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Overcoming Barriers to Change What Parents are Sayinghellip
Prone positioning fear of choking Baby sleeps ldquobetterrdquo on stomach Soft things are safer for the baby SIDS is ldquoGodrsquos willrdquo Why bother Recommendations keep changing
anyway Vigilance sleep with baby for protection
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Factors Associated With Choice of Infant Sleep Position 3300 mothers from 32 hospitals 77 usually use supine position 49 exclusive use supine position Most likely to use prone
o African-American motherso Mothers with lt high school educationo Lack of perceived controlo Personal attitudesocietal norms
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
A continuum starting in childhoodo Secondary school baby sitting classes
Pre-pregnancy Pregnancyprenatal education
o Prior to baby showerhellipldquowrong giftsrdquo In-hospital education and modeling
o Include family friends baby sitters Re-enforcement in the doctorrsquos office
o Especially between 1 to 4 months Grandparents They hold great power The general public (day cares religious leaders)
A Lifetime of Infant Sleep Safety
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Chart1
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
14
139
13
13
12
13
117
17
103
269
087
386
074
353
077
531
072
557
067
644
062
666
056
716
057
711
053
728
056
701
055
722
055
757
057
703
055
721
054
741
051
728
048
042
04
039
Sheet1
Sheet1
ampA
Page ampP
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
Sheet2
Pre-AAP recommendation Post-AAP RecommendationBack to SleepSafe to Sleep Campaign
Sheet3
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Infant Sleep Safety
Requires a consistent and repetitive message in the community to prevent accidental deaths
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Safe Sleep Nurse Modeling
People trust nurses Whatever the nurse does must
be correct and it will be imitated in the home
Fact supine positioning in the nursery can almost DOUBLE its use in the home
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Physician Advocacy
Srivatsa 1997 HCP education to new familieshellip34 reduction in prone sleeping
Eron 2009 Study of Central NY state physicianshellip30 identified incorrect safest sleep positionhellip30 do not discuss with families
Colson 2009 Only 13 mothers advised by MD to use supine positionhellip3 times more likely to position the baby properly
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Healthcare Provider Advice to New Mothers Safe Sleep
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Chart1
Column1
[]
[]
[]
55
25
20
Sheet1
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Mason Clinical Peds 713
Bundled interventiono Nursing education policy model behavior safe sleep
video posters in rooms declaration of safe sleep practice
Safe sleep environment uarr from 25 to 58 Intention in home 95 supine none ldquoco-sleepingrdquo
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bundled Intervention = Behavior Change
QUESTION GROUP p-value
ISS Study NISP
Behavior Questions n = 490 n = 1046
Baby routinely placed to sleep on back 925 73 lt 0001
Baby routinely sleeps in bassinetcrib 995 71 lt 00001
Baby sleeps under a thin sheet 992 86 lt 0001
Baby given a pacifier for sleep 741 84 lt 0001Goodstein MH Bell T Krugman SD Improving infant sleep safety through a comprehensive hospital-based program Clinical Pediatrics 201554(3)212-221
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
o Baseline Safe sleep 49 of 264 infants o Post 312 of 234 infants (P lt 001) o Extra blankets most common o Baseline 77 vs 44 post-intervention o Mean number of unsafe items reduced by 50 (P lt 001)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Washington DC
2 urban DC nurseries 26 did not believe or unsure that infant positioning
was associated with SIDS Top 3 factors influencing sleep position
o 56 PERSONAL PREFERENCE Why non-supine Clinical experience (25)
o Increase risk aspirationo Decrease sleep and comfort
Bartow KL Nursesrsquo knowledge and adherence to sudden infant death syndrome prevention guidelines Pediatr Nurs 201642(1)7-13
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
TodaysBaby QI Safe Sleep Teaching
QI intervention median = 160 days Mothers reported receiving information 72 to 95
(increase of 24-57) 94 babies observed supine (plus 24) 88 infants in safe sleep environment
o Increase of 33 Gains maintained up to 12 months
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Social Media and Risk-Reduction Training Study (SMART) Cluster randomization 4 groups Safe sleep or breast feeding education Nursing QI and social media (mobile health) N = 1600 1263 responses (79) Safe sleep NQI and MHealth
o Supine sleep 925 o Room-sharing 859o No soft bedding 819o Pacifier use 762
Moon RY Hauck FR Colson ER et al The effect of nursing quality improvement and mobile health interventions on infant sleep practices a randomized clinical trial JAMA 2017318(4)351-359
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Hospital Initiative ComponentswwwcribsforkidsorgHospitalInitiativeToolkit INTRODUCTORY LETTER HOSPITAL INITIATIVE TOOL KIT
INSTRUCTIONS ORGANIZATIONAL CHART HOSPITAL POLICY ACKNOWLEDGMENT FORM (Engl amp
Span) SAFE SLEEP EDUCATIONAL FLIP CHART
NONCOMPLIANCE WAIVER (Engl amp Span)
NURSING EDUCATION MODULE
SAFE SLEEP POSTERS DOOR HANGERS (Engl amp Span) GRADUATION CERTIFICATE SAMPLE LETTER TO HOSPITALS SAMPLE LETTER TO PROVIDERS INFANT SAFE SLEEP BROCHURES
(Engl amp Span) PRESS KIT
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
All materials available on-lineo No major costs to the hospital
Easy on-line access for documentation
NO FEE FOR PARTICIPATION
wwwCribsforKidsorgHospitalInitiative
Tiffany Price (tpricecribsforkidsorg)
The National Safe Sleep Hospital Certification Program
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
TNmdash25 reduction in infant sleep-related deaths in 2 years
SDmdashOver 7915 Pack lsquon Plays distributed since 2012 Infant mortality rate decreased from 86 (2012) to 48 (2016)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
2009 to 2015 38 decrease in infant mortality Decreased from 135 to 84 per 1000 SUID decreased gt50 Decrease in racial disparityhttphealthybabiesbaltimorecomhome
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
And Finallyhellip
Health care providers should have open frank nonjudgmental conversations with families about their sleep practices
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Encouraging Parents to Take Action
According to the Social Learning Theory parents are more likely to recall and comply with instructions when
the health care provider
Uses a positive tone Provides adequate information Allows the parent to ask most of the questions
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Motivational Interviewing
ldquoa collaborative goal-oriented style of communication with particular attention to the language of changerdquo
o Strengthen personal motivation and commitment to a specific goal
o Explore onersquos reasons for change (barriers)o Patient generates own solutions
bull More likely to feel realisticbull Planting seeds of change
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Impact of Eliminating Sleep-Related Deaths
Every week we lose 70 children which is equivalent to 4 kindergarten classrooms
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Thank You
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Contact Information
mgoodsteinwellspanorg
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Visit Pediatric Care Online today for additional information on this and other topics
httppediatriccaresolutionsaaporgPediatric Care Online is a convenient electronic resource for immediate expert help with
virtually every pediatric clinical information need with must-have resources that are included in a comprehensive reference library and time-saving clinical tools
Donrsquot have a subscription to PCOThen take advantage of a free trial today
Call Mead Johnson Nutrition at 888363-2362 orfor more information go to
httppediatriccaresolutionsaaporgSSFree_Trialaspx
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
IMR over time Finland vs US
Slide Number 1
Disclaimer
Objectives for Todayrsquos Talk
Infant Mortality Rates for the Five Leading Causes of Infant Death in the United States 2005 and 2011
US Post-Neonatal Mortality 2015
FACT
What is SUID or SUDI
Some Causes of Deaths that Occur Suddenly and Unexpectedly during Infancy
What is SIDS
SIDS FACTS
SIDS FACTS
Triple Risk Model to Explain SIDS
Paterson DS Krous HF Kinney HC et al JAMA 2006
An Example of SIDS Pathogenesis
2016 AAP Recommendations Infant Sleep Safety
Strength of Recommendation
Recommendations Change as the Evidence Evolves
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
Correct Safe Sleep Environment
We Need to Move Beyond Back to Sleep
Sleep Position for Healthy Newborns
Sleep Position in Newborn Nursery
Sleep Position and Reflux
The Truth About Supine Sleep and Aspiration Ending the Fallacy
Title
Infant Sleep Location
Room-Share How Long Yoursquore Kidding Right
Supporting Data
More Recent Data
Why is Room-Sharing Protective
Room-Sharing and Sleep Quality
Insight Study (Paul 2017)
Insight Study (Paul 2017)
Insight Commentary (Hauck Moon)
Feeding the Baby at Night
Say NO to Couches Sofas and Cushioned Armchairs
High-Risk Bed Sharing Situations
Bedsharing in Low-Risk Breastfed Infants
Independent Review (Dr Robert Platt)
Bed Sharing
Bed Sharing
Bed Sharing with Overlay
Bed Sharing with Overlay
Bed Sharing with Overlay
Couch Sleeping
Couch Sleeping
Couch Sleeping
Unsafe Bedding NISP Trends 1993-2102
Why Use Soft Bedding
Soft Bedding for Older Infants
To Swaddle or Not to Swaddle That is the Question
Swaddling
SwaddlingmdashIs it Safe
SwaddlingmdashMore Questionshellip
wwwhealthychildrenorg
Pacifiers
Pacifiers and Breastfeeding
Baby Friendly USA Pacifiers
Addressing Sleep Deprivation
Overcoming Barriers to Change What Parents are Sayinghellip
Factors Associated With Choice of Infant Sleep Position
Slide Number 65
What is Working
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Infant Sleep Safety
Safe Sleep Nurse Modeling
Physician Advocacy
Healthcare Provider Advice to New Mothers Safe Sleep
Mason Clinical Peds 713
Bundled Intervention = Behavior Change
Hospital Unsafe Sleep Persists
Washington DC
TodaysBaby QI Safe Sleep Teaching
TodaysBaby QI Safe Sleep Teaching
Social Media and Risk-Reduction Training Study (SMART)
The National Safe Sleep Hospital Certification Program
Coordinated Education Efforts Work
Coordinated Education Efforts Work
And Finallyhellip
Encouraging Parents to Take Action
Motivational Interviewing
Impact of Eliminating Sleep-Related Deaths
Thank You
Contact Information
Slide Number 89
IMR over time Finland vs US
Column1
correct advice
55
incorrect advice
25
no advice
20
correct advice
incorrect advice
no advice
SIDS Rate
Percent Back Sleeping
1988
14
1989
139
1990
13
1991
13
1992
12
13
1993
117
17
1994
103
269
1995
087
386
1996
074
353
1997
077
531
1998
072
557
1999
067
644
2000
062
666
2001
056
716
2002
057
711
2003
053
728
2004
056
701
2005
055
722
2006
055
757
2007
057
703
2008
055
721
2009
054
741
2010
051
728
2011
048
2012
042
2013
04
2014
039
httpwwwcdcgovNCHSdatanvsrnvsr58nvsr58_19pdf
Xu JQ Kochanek KD Murphy SL Tejada-Vera B Deaths Final data for
2007
National vital statistics reports vol 58 no 19 Hyattsville MD
National Center for Health Statistics 2010
1988
1988
1989
1989
1990
1990
1991
1991
1992
1992
1993
1993
1994
1994
1995
1995
1996
1996
1997
1997
1998
1998
1999
1999
2000
2000
2001
2001
2002
2002
2003
2003
2004
2004
2005
2005
2006
2006
2007
2007
2008
2008
2009
2009
2010
2010
2011
2012
2013
2014
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
2016 SIDS Task Force Policy Statement Level B Recommendations Avoid commercial devices that are inconsistent with
safe sleep recommendations Supervised awake tummy time is recommended to
facilitate development and to minimize development of positional plagiocephaly (flattening of skull)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
2016 SIDS Task Force Policy Statement Level C Recommendations Continue research and surveillance on the risk factors
causes and pathophysiological mechanisms of SIDS and other sleep-related infant deaths with the ultimate goal of eliminating these deaths entirely
There is no evidence to recommend swaddling as a strategy to reduce the risk of SIDS
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Correct Safe Sleep Environment
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
We Need to Move Beyond Back to Sleep
Shersquos on her back to sleep
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Sleep Position for Healthy Newborns
Skin-to-skin care is recommended for all mothers and newborns regardless of feeding or delivery method immediately following birtho Mom should be medically stable
awake and able to respond to baby When mother needs to sleep or take
care of other needs infant should be placed supine in a bassinet
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Sleep Position in Newborn Nursery Infants in the newborn nursery
and infants who are rooming in with their parents should be placed in the supine position as soon as they are ready to be placed in the bassinet o No evidence that placing infants
on the side during the first few hours of life promotes clearance of amniotic fluid and decreases the risk of aspiration
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Sleep Position and Reflux Infants with gastroesophageal (GE) reflux
should be kept supineo Unless the risk of death from complications
of GE reflux is greater than the risk of SIDS
Supine position does not increase the risk of choking and aspiration in infants with GE reflux o Protective airway mechanisms
Do NOT elevate the head of the infantrsquos cribo Ineffective in reducing GE refluxo Infant may slide to the foot of the cribmdashmay
compromise respiration
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
The Truth About Supine Sleep and Aspiration Ending the Fallacy Orientation of the Trachea to the Esophagus
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Title
Text
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Infant Sleep Location
Infants should sleep in parentsrsquo room close to parentsrsquo bed but on a separate surface designed for infants
Ideally for the first year of life but at least for the first 6 months
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Room-Share How Long Yoursquore Kidding Right
2011 ldquoall sleep recommendations are to be followed until 1 year of agerdquo
2016 ldquoroom-sharing without bed-sharinghellipideally until 1 year of age but at least for the first 6 monthsrdquo
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Supporting Data
3 case-control studies comparing sleeping in a separate room vs room-sharingo Tappin (Scotland) AOR 326 (95 CI 103-1035)
bull Protection is significant for smoker motherso Blair (England) AOR 1049 (95 CI 426-2581)
bull Protection is significant for both smoker and nonsmoker mothers
o New Zealand Cot Death study AOR 285(95 CI 204-385)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
More Recent Data
New Zealand SUDI studyo 64 protection with room-sharing AOR 036
(95 CI 019-071)
Estimate of 50 reduction is very conservative
None of the case-control studies stratify by age (months)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Why is Room-Sharing Protective
SIDSmdashfailure to arouse More small awakenings during the night
o Stirrings movement not fully awake Postulation protective effect from small awakenings Room-sharing facilitates breastfeeding
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Room-Sharing and Sleep Quality
Volkovich room-sharing vs solitary sleepo Room-sharing mothers with more sleep disturbanceso Infants with similar sleep quality
Mao Mindell room-sharing infantsmdashmore awakenings
Montgomery-Downs Doan sleep quality in breastfeeding mothers gt to formula feeding motherso Exclusive breastfeeding = 30 min more sleep
More study needed
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Insight Study (Paul 2017)
Sleep questionnaire at 4 9 12 and 30 monthso Sleep duration overnight behaviorso Compared early vs late independent infants
At 4 monthso Equal sleep durationo Early group had better sleep consolidationo Longest stretch 46 minutes
Paul IM Hohman EE Loken E et al Mother-infant room-sharing and sleep outcomes in the INSIGHT study Pediatrics 2017140(1)e20170122
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Insight Study (Paul 2017)
At 9 monthso Longer sleep duration (40 minnight) o Better consolidation (100 min)
At 30 monthso Longer sleep duration (45 minnight)
Room-sharing 4 times more likely to transition to bed sharing overnight
Paul IM Hohman EE Loken E et al Mother-infant room-sharing and sleep outcomes in the INSIGHT study Pediatrics 2017140(1)e20170122
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Insight Commentary (Hauck Moon)
Late room-sharing mean 7 hours longest sleep Is early consolidation desirable Differences related to bedtime routines
o Early bedtimeo Number of night feedso Feeding back to sleep
Focus on the routine not early separation
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Feeding the Baby at Night Acknowledgment that parents may fall
asleep while feeding babyo Safer to feed on bed than on sofa
couch or armchair if you might fall asleep
o No pillows sheets blankets or other items that could obstruct infant breathing or cause overheating should be in bed
o Return infant back to separate sleep surface as soon as parent awakens
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Say NO to Couches Sofas and Cushioned Armchairs Never place a baby for sleep on these surfaces Never sleep with a baby on these surfaces One of the MOST dangerous places for an infant
(OR 51-669)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
High-Risk Bed Sharing Situations Age lt4 months Preterm or low birth weight Smoked during pregnancy Bed sharer is current smoker (even if not
smoking in bed) Bed sharer has usedis using meds or
substances that could impair alertness or arousal
Bed sharer is not parent (including other children)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bedsharing in Low-Risk Breastfed Infants
Blair et al AOR 16 (95 CI 096-27) o Age lt14 weekso Parents No cigarettes or alcoholo Independent of feeding method
Carpenter et al AOR 51 (95 CI 23-114) o Age lt3 months o Parents did not smokeo Mother No alcohol or drugso Breastfed infants
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Independent Review (Dr Robert Platt)
Very small numbers of low-risk babieso 24 in Blairrsquos studyo 12 in Carpenterrsquos study
Does not believe that data support definitive differences in 2 studies
Some evidence of increased risk in this group but cannot say how large the increased risk is
Cannot conclude that bed sharing in this group is safe
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Unsafe Bedding NISP Trends 1993-2102
Shapiro-Mendoza CK Colson ER Willinger M Rybin DV Camperlengo L Corwin MJ Trends in infant bedding use National Infant Sleep Position study 1993ndash2010 Pediatrics 2015135(1)10-17
Decrease from 86 to 55 Rate of decline decreases
2001-10 835 for teen mothers Predictors of adjusted OR
gt15
o Young motherso Non-white race
ethnicityo Less than college
education
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Why Use Soft Bedding
ComfortWarmtho Extrapolation of own feelingso Misinterpret firm with taut
bull Soft + taut ne firm
Safetyo Blankets pillows rolls to prevent falls
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Soft Bedding for Older Infants
Many parents recognize soft bedding is a risk Increased complacency as baby gets older Soft bedding is THE most important risk factor for
infants 4-12 months old (Colvin 2015) Infants roll into bedding and cannot extract
themselves
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
To Swaddle or Not to Swaddle That is the Question Pros
o Calms the infant promotes sleep decreases number of awakenings
o Encourages use of the supine position
Conso Increased respiratory rate and
reduced functional residual lung capacity
o Exacerbates hip dysplasia if the hips are kept in extension and adduction
o ldquoLooserdquo swaddling becomes loose bedding
o Overheating especially if the head is covered or the infant has infection
o Effects on arousability to an external stimulus remain unclear (conflicting data) There may be minimal effects of routine swaddling on arousal
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Swaddling
There is insufficient evidence to recommend routine swaddling as a strategy to reduce the incidence of SIDS
Swaddling must be correctly applied to avoid the possible hazards
Swaddling does not reduce the necessity to follow recommended safe sleep practices Ambrogio Lorenzettis Madonna and Child (1319)
Wikipedia
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
McDonnell E Moon RY Infant deaths and injuries associated with wearable blankets swaddle wraps and swaddling J Pediatr 20141641152-1156
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
SwaddlingmdashMore Questionshellip
Pease 2016 Pediatrics Pooled OR = 138
o Prone = 1299 o Side = 316o Supine = 193
Increased risk with age Limitations
o Heterogeneity definitions other risk factorsPease AS Fleming PJ Hauck FR et al Swaddling and the risk of sudden infant death syndrome a meta-analysis Pediatrics 2016137(6)e20153
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
wwwhealthychildrenorg
Swaddling (wrapping a light blanket snuggly around a baby) may help calm a crying baby If you swaddle your baby be sure to place him on his back to sleep Stop swaddling your baby when he starts to roll
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers
AAP recommendation Consider offering a pacifier at nap time and bedtime
Studies consistently demonstrate a protective effect of pacifiers on SIDS
Mechanism unknowno Dislodge within 15 to 60 minuteso Decreased arousal threshold
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers and Breastfeeding Well-designed trials
o 2 found no association among term infants
o 1 found no association among preterm infants
o 1 found slightly decreased breastfeeding duration at one month if pacifier introduced in first week of life but NO difference if pacifier introduced after one month
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Baby Friendly USA Pacifiers
Breastfeeding babies should not be given pacifiers by the staff of the facility with the exception of o Limited use to decrease pain during procedures when
the baby cannot safely be held or breastfed (pacifiers used should be discarded after these procedures)
o Babies who are being tube-fed in NICUo Other rare specific medical reasons
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Addressing Sleep Deprivation
Give parents tools to cope with fussy babies
Sleep-deprived parents may make poor judgments
Make use of tools o Swaddling side carrying
shushing swinging and sucking
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Overcoming Barriers to Change What Parents are Sayinghellip
Prone positioning fear of choking Baby sleeps ldquobetterrdquo on stomach Soft things are safer for the baby SIDS is ldquoGodrsquos willrdquo Why bother Recommendations keep changing
anyway Vigilance sleep with baby for protection
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Factors Associated With Choice of Infant Sleep Position 3300 mothers from 32 hospitals 77 usually use supine position 49 exclusive use supine position Most likely to use prone
o African-American motherso Mothers with lt high school educationo Lack of perceived controlo Personal attitudesocietal norms
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
A continuum starting in childhoodo Secondary school baby sitting classes
Pre-pregnancy Pregnancyprenatal education
o Prior to baby showerhellipldquowrong giftsrdquo In-hospital education and modeling
o Include family friends baby sitters Re-enforcement in the doctorrsquos office
o Especially between 1 to 4 months Grandparents They hold great power The general public (day cares religious leaders)
A Lifetime of Infant Sleep Safety
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Chart1
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
14
139
13
13
12
13
117
17
103
269
087
386
074
353
077
531
072
557
067
644
062
666
056
716
057
711
053
728
056
701
055
722
055
757
057
703
055
721
054
741
051
728
048
042
04
039
Sheet1
Sheet1
ampA
Page ampP
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
Sheet2
Pre-AAP recommendation Post-AAP RecommendationBack to SleepSafe to Sleep Campaign
Sheet3
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Infant Sleep Safety
Requires a consistent and repetitive message in the community to prevent accidental deaths
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Safe Sleep Nurse Modeling
People trust nurses Whatever the nurse does must
be correct and it will be imitated in the home
Fact supine positioning in the nursery can almost DOUBLE its use in the home
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Physician Advocacy
Srivatsa 1997 HCP education to new familieshellip34 reduction in prone sleeping
Eron 2009 Study of Central NY state physicianshellip30 identified incorrect safest sleep positionhellip30 do not discuss with families
Colson 2009 Only 13 mothers advised by MD to use supine positionhellip3 times more likely to position the baby properly
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Healthcare Provider Advice to New Mothers Safe Sleep
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Chart1
Column1
[]
[]
[]
55
25
20
Sheet1
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Mason Clinical Peds 713
Bundled interventiono Nursing education policy model behavior safe sleep
video posters in rooms declaration of safe sleep practice
Safe sleep environment uarr from 25 to 58 Intention in home 95 supine none ldquoco-sleepingrdquo
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bundled Intervention = Behavior Change
QUESTION GROUP p-value
ISS Study NISP
Behavior Questions n = 490 n = 1046
Baby routinely placed to sleep on back 925 73 lt 0001
Baby routinely sleeps in bassinetcrib 995 71 lt 00001
Baby sleeps under a thin sheet 992 86 lt 0001
Baby given a pacifier for sleep 741 84 lt 0001Goodstein MH Bell T Krugman SD Improving infant sleep safety through a comprehensive hospital-based program Clinical Pediatrics 201554(3)212-221
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
o Baseline Safe sleep 49 of 264 infants o Post 312 of 234 infants (P lt 001) o Extra blankets most common o Baseline 77 vs 44 post-intervention o Mean number of unsafe items reduced by 50 (P lt 001)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Washington DC
2 urban DC nurseries 26 did not believe or unsure that infant positioning
was associated with SIDS Top 3 factors influencing sleep position
o 56 PERSONAL PREFERENCE Why non-supine Clinical experience (25)
o Increase risk aspirationo Decrease sleep and comfort
Bartow KL Nursesrsquo knowledge and adherence to sudden infant death syndrome prevention guidelines Pediatr Nurs 201642(1)7-13
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
TodaysBaby QI Safe Sleep Teaching
QI intervention median = 160 days Mothers reported receiving information 72 to 95
(increase of 24-57) 94 babies observed supine (plus 24) 88 infants in safe sleep environment
o Increase of 33 Gains maintained up to 12 months
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Social Media and Risk-Reduction Training Study (SMART) Cluster randomization 4 groups Safe sleep or breast feeding education Nursing QI and social media (mobile health) N = 1600 1263 responses (79) Safe sleep NQI and MHealth
o Supine sleep 925 o Room-sharing 859o No soft bedding 819o Pacifier use 762
Moon RY Hauck FR Colson ER et al The effect of nursing quality improvement and mobile health interventions on infant sleep practices a randomized clinical trial JAMA 2017318(4)351-359
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Hospital Initiative ComponentswwwcribsforkidsorgHospitalInitiativeToolkit INTRODUCTORY LETTER HOSPITAL INITIATIVE TOOL KIT
INSTRUCTIONS ORGANIZATIONAL CHART HOSPITAL POLICY ACKNOWLEDGMENT FORM (Engl amp
Span) SAFE SLEEP EDUCATIONAL FLIP CHART
NONCOMPLIANCE WAIVER (Engl amp Span)
NURSING EDUCATION MODULE
SAFE SLEEP POSTERS DOOR HANGERS (Engl amp Span) GRADUATION CERTIFICATE SAMPLE LETTER TO HOSPITALS SAMPLE LETTER TO PROVIDERS INFANT SAFE SLEEP BROCHURES
(Engl amp Span) PRESS KIT
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
All materials available on-lineo No major costs to the hospital
Easy on-line access for documentation
NO FEE FOR PARTICIPATION
wwwCribsforKidsorgHospitalInitiative
Tiffany Price (tpricecribsforkidsorg)
The National Safe Sleep Hospital Certification Program
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
TNmdash25 reduction in infant sleep-related deaths in 2 years
SDmdashOver 7915 Pack lsquon Plays distributed since 2012 Infant mortality rate decreased from 86 (2012) to 48 (2016)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
2009 to 2015 38 decrease in infant mortality Decreased from 135 to 84 per 1000 SUID decreased gt50 Decrease in racial disparityhttphealthybabiesbaltimorecomhome
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
And Finallyhellip
Health care providers should have open frank nonjudgmental conversations with families about their sleep practices
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Encouraging Parents to Take Action
According to the Social Learning Theory parents are more likely to recall and comply with instructions when
the health care provider
Uses a positive tone Provides adequate information Allows the parent to ask most of the questions
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Motivational Interviewing
ldquoa collaborative goal-oriented style of communication with particular attention to the language of changerdquo
o Strengthen personal motivation and commitment to a specific goal
o Explore onersquos reasons for change (barriers)o Patient generates own solutions
bull More likely to feel realisticbull Planting seeds of change
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Impact of Eliminating Sleep-Related Deaths
Every week we lose 70 children which is equivalent to 4 kindergarten classrooms
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Thank You
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Contact Information
mgoodsteinwellspanorg
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Visit Pediatric Care Online today for additional information on this and other topics
httppediatriccaresolutionsaaporgPediatric Care Online is a convenient electronic resource for immediate expert help with
virtually every pediatric clinical information need with must-have resources that are included in a comprehensive reference library and time-saving clinical tools
Donrsquot have a subscription to PCOThen take advantage of a free trial today
Call Mead Johnson Nutrition at 888363-2362 orfor more information go to
httppediatriccaresolutionsaaporgSSFree_Trialaspx
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
IMR over time Finland vs US
Slide Number 1
Disclaimer
Objectives for Todayrsquos Talk
Infant Mortality Rates for the Five Leading Causes of Infant Death in the United States 2005 and 2011
US Post-Neonatal Mortality 2015
FACT
What is SUID or SUDI
Some Causes of Deaths that Occur Suddenly and Unexpectedly during Infancy
What is SIDS
SIDS FACTS
SIDS FACTS
Triple Risk Model to Explain SIDS
Paterson DS Krous HF Kinney HC et al JAMA 2006
An Example of SIDS Pathogenesis
2016 AAP Recommendations Infant Sleep Safety
Strength of Recommendation
Recommendations Change as the Evidence Evolves
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
Correct Safe Sleep Environment
We Need to Move Beyond Back to Sleep
Sleep Position for Healthy Newborns
Sleep Position in Newborn Nursery
Sleep Position and Reflux
The Truth About Supine Sleep and Aspiration Ending the Fallacy
Title
Infant Sleep Location
Room-Share How Long Yoursquore Kidding Right
Supporting Data
More Recent Data
Why is Room-Sharing Protective
Room-Sharing and Sleep Quality
Insight Study (Paul 2017)
Insight Study (Paul 2017)
Insight Commentary (Hauck Moon)
Feeding the Baby at Night
Say NO to Couches Sofas and Cushioned Armchairs
High-Risk Bed Sharing Situations
Bedsharing in Low-Risk Breastfed Infants
Independent Review (Dr Robert Platt)
Bed Sharing
Bed Sharing
Bed Sharing with Overlay
Bed Sharing with Overlay
Bed Sharing with Overlay
Couch Sleeping
Couch Sleeping
Couch Sleeping
Unsafe Bedding NISP Trends 1993-2102
Why Use Soft Bedding
Soft Bedding for Older Infants
To Swaddle or Not to Swaddle That is the Question
Swaddling
SwaddlingmdashIs it Safe
SwaddlingmdashMore Questionshellip
wwwhealthychildrenorg
Pacifiers
Pacifiers and Breastfeeding
Baby Friendly USA Pacifiers
Addressing Sleep Deprivation
Overcoming Barriers to Change What Parents are Sayinghellip
Factors Associated With Choice of Infant Sleep Position
Slide Number 65
What is Working
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Infant Sleep Safety
Safe Sleep Nurse Modeling
Physician Advocacy
Healthcare Provider Advice to New Mothers Safe Sleep
Mason Clinical Peds 713
Bundled Intervention = Behavior Change
Hospital Unsafe Sleep Persists
Washington DC
TodaysBaby QI Safe Sleep Teaching
TodaysBaby QI Safe Sleep Teaching
Social Media and Risk-Reduction Training Study (SMART)
The National Safe Sleep Hospital Certification Program
Coordinated Education Efforts Work
Coordinated Education Efforts Work
And Finallyhellip
Encouraging Parents to Take Action
Motivational Interviewing
Impact of Eliminating Sleep-Related Deaths
Thank You
Contact Information
Slide Number 89
IMR over time Finland vs US
Column1
correct advice
55
incorrect advice
25
no advice
20
correct advice
incorrect advice
no advice
SIDS Rate
Percent Back Sleeping
1988
14
1989
139
1990
13
1991
13
1992
12
13
1993
117
17
1994
103
269
1995
087
386
1996
074
353
1997
077
531
1998
072
557
1999
067
644
2000
062
666
2001
056
716
2002
057
711
2003
053
728
2004
056
701
2005
055
722
2006
055
757
2007
057
703
2008
055
721
2009
054
741
2010
051
728
2011
048
2012
042
2013
04
2014
039
httpwwwcdcgovNCHSdatanvsrnvsr58nvsr58_19pdf
Xu JQ Kochanek KD Murphy SL Tejada-Vera B Deaths Final data for
2007
National vital statistics reports vol 58 no 19 Hyattsville MD
National Center for Health Statistics 2010
1988
1988
1989
1989
1990
1990
1991
1991
1992
1992
1993
1993
1994
1994
1995
1995
1996
1996
1997
1997
1998
1998
1999
1999
2000
2000
2001
2001
2002
2002
2003
2003
2004
2004
2005
2005
2006
2006
2007
2007
2008
2008
2009
2009
2010
2010
2011
2012
2013
2014
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
2016 SIDS Task Force Policy Statement Level C Recommendations Continue research and surveillance on the risk factors
causes and pathophysiological mechanisms of SIDS and other sleep-related infant deaths with the ultimate goal of eliminating these deaths entirely
There is no evidence to recommend swaddling as a strategy to reduce the risk of SIDS
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Correct Safe Sleep Environment
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
We Need to Move Beyond Back to Sleep
Shersquos on her back to sleep
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Sleep Position for Healthy Newborns
Skin-to-skin care is recommended for all mothers and newborns regardless of feeding or delivery method immediately following birtho Mom should be medically stable
awake and able to respond to baby When mother needs to sleep or take
care of other needs infant should be placed supine in a bassinet
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Sleep Position in Newborn Nursery Infants in the newborn nursery
and infants who are rooming in with their parents should be placed in the supine position as soon as they are ready to be placed in the bassinet o No evidence that placing infants
on the side during the first few hours of life promotes clearance of amniotic fluid and decreases the risk of aspiration
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Sleep Position and Reflux Infants with gastroesophageal (GE) reflux
should be kept supineo Unless the risk of death from complications
of GE reflux is greater than the risk of SIDS
Supine position does not increase the risk of choking and aspiration in infants with GE reflux o Protective airway mechanisms
Do NOT elevate the head of the infantrsquos cribo Ineffective in reducing GE refluxo Infant may slide to the foot of the cribmdashmay
compromise respiration
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
The Truth About Supine Sleep and Aspiration Ending the Fallacy Orientation of the Trachea to the Esophagus
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Title
Text
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Infant Sleep Location
Infants should sleep in parentsrsquo room close to parentsrsquo bed but on a separate surface designed for infants
Ideally for the first year of life but at least for the first 6 months
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Room-Share How Long Yoursquore Kidding Right
2011 ldquoall sleep recommendations are to be followed until 1 year of agerdquo
2016 ldquoroom-sharing without bed-sharinghellipideally until 1 year of age but at least for the first 6 monthsrdquo
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Supporting Data
3 case-control studies comparing sleeping in a separate room vs room-sharingo Tappin (Scotland) AOR 326 (95 CI 103-1035)
bull Protection is significant for smoker motherso Blair (England) AOR 1049 (95 CI 426-2581)
bull Protection is significant for both smoker and nonsmoker mothers
o New Zealand Cot Death study AOR 285(95 CI 204-385)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
More Recent Data
New Zealand SUDI studyo 64 protection with room-sharing AOR 036
(95 CI 019-071)
Estimate of 50 reduction is very conservative
None of the case-control studies stratify by age (months)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Why is Room-Sharing Protective
SIDSmdashfailure to arouse More small awakenings during the night
o Stirrings movement not fully awake Postulation protective effect from small awakenings Room-sharing facilitates breastfeeding
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Room-Sharing and Sleep Quality
Volkovich room-sharing vs solitary sleepo Room-sharing mothers with more sleep disturbanceso Infants with similar sleep quality
Mao Mindell room-sharing infantsmdashmore awakenings
Montgomery-Downs Doan sleep quality in breastfeeding mothers gt to formula feeding motherso Exclusive breastfeeding = 30 min more sleep
More study needed
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Insight Study (Paul 2017)
Sleep questionnaire at 4 9 12 and 30 monthso Sleep duration overnight behaviorso Compared early vs late independent infants
At 4 monthso Equal sleep durationo Early group had better sleep consolidationo Longest stretch 46 minutes
Paul IM Hohman EE Loken E et al Mother-infant room-sharing and sleep outcomes in the INSIGHT study Pediatrics 2017140(1)e20170122
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Insight Study (Paul 2017)
At 9 monthso Longer sleep duration (40 minnight) o Better consolidation (100 min)
At 30 monthso Longer sleep duration (45 minnight)
Room-sharing 4 times more likely to transition to bed sharing overnight
Paul IM Hohman EE Loken E et al Mother-infant room-sharing and sleep outcomes in the INSIGHT study Pediatrics 2017140(1)e20170122
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Insight Commentary (Hauck Moon)
Late room-sharing mean 7 hours longest sleep Is early consolidation desirable Differences related to bedtime routines
o Early bedtimeo Number of night feedso Feeding back to sleep
Focus on the routine not early separation
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Feeding the Baby at Night Acknowledgment that parents may fall
asleep while feeding babyo Safer to feed on bed than on sofa
couch or armchair if you might fall asleep
o No pillows sheets blankets or other items that could obstruct infant breathing or cause overheating should be in bed
o Return infant back to separate sleep surface as soon as parent awakens
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Say NO to Couches Sofas and Cushioned Armchairs Never place a baby for sleep on these surfaces Never sleep with a baby on these surfaces One of the MOST dangerous places for an infant
(OR 51-669)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
High-Risk Bed Sharing Situations Age lt4 months Preterm or low birth weight Smoked during pregnancy Bed sharer is current smoker (even if not
smoking in bed) Bed sharer has usedis using meds or
substances that could impair alertness or arousal
Bed sharer is not parent (including other children)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bedsharing in Low-Risk Breastfed Infants
Blair et al AOR 16 (95 CI 096-27) o Age lt14 weekso Parents No cigarettes or alcoholo Independent of feeding method
Carpenter et al AOR 51 (95 CI 23-114) o Age lt3 months o Parents did not smokeo Mother No alcohol or drugso Breastfed infants
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Independent Review (Dr Robert Platt)
Very small numbers of low-risk babieso 24 in Blairrsquos studyo 12 in Carpenterrsquos study
Does not believe that data support definitive differences in 2 studies
Some evidence of increased risk in this group but cannot say how large the increased risk is
Cannot conclude that bed sharing in this group is safe
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Unsafe Bedding NISP Trends 1993-2102
Shapiro-Mendoza CK Colson ER Willinger M Rybin DV Camperlengo L Corwin MJ Trends in infant bedding use National Infant Sleep Position study 1993ndash2010 Pediatrics 2015135(1)10-17
Decrease from 86 to 55 Rate of decline decreases
2001-10 835 for teen mothers Predictors of adjusted OR
gt15
o Young motherso Non-white race
ethnicityo Less than college
education
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Why Use Soft Bedding
ComfortWarmtho Extrapolation of own feelingso Misinterpret firm with taut
bull Soft + taut ne firm
Safetyo Blankets pillows rolls to prevent falls
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Soft Bedding for Older Infants
Many parents recognize soft bedding is a risk Increased complacency as baby gets older Soft bedding is THE most important risk factor for
infants 4-12 months old (Colvin 2015) Infants roll into bedding and cannot extract
themselves
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
To Swaddle or Not to Swaddle That is the Question Pros
o Calms the infant promotes sleep decreases number of awakenings
o Encourages use of the supine position
Conso Increased respiratory rate and
reduced functional residual lung capacity
o Exacerbates hip dysplasia if the hips are kept in extension and adduction
o ldquoLooserdquo swaddling becomes loose bedding
o Overheating especially if the head is covered or the infant has infection
o Effects on arousability to an external stimulus remain unclear (conflicting data) There may be minimal effects of routine swaddling on arousal
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Swaddling
There is insufficient evidence to recommend routine swaddling as a strategy to reduce the incidence of SIDS
Swaddling must be correctly applied to avoid the possible hazards
Swaddling does not reduce the necessity to follow recommended safe sleep practices Ambrogio Lorenzettis Madonna and Child (1319)
Wikipedia
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
McDonnell E Moon RY Infant deaths and injuries associated with wearable blankets swaddle wraps and swaddling J Pediatr 20141641152-1156
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
SwaddlingmdashMore Questionshellip
Pease 2016 Pediatrics Pooled OR = 138
o Prone = 1299 o Side = 316o Supine = 193
Increased risk with age Limitations
o Heterogeneity definitions other risk factorsPease AS Fleming PJ Hauck FR et al Swaddling and the risk of sudden infant death syndrome a meta-analysis Pediatrics 2016137(6)e20153
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
wwwhealthychildrenorg
Swaddling (wrapping a light blanket snuggly around a baby) may help calm a crying baby If you swaddle your baby be sure to place him on his back to sleep Stop swaddling your baby when he starts to roll
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers
AAP recommendation Consider offering a pacifier at nap time and bedtime
Studies consistently demonstrate a protective effect of pacifiers on SIDS
Mechanism unknowno Dislodge within 15 to 60 minuteso Decreased arousal threshold
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers and Breastfeeding Well-designed trials
o 2 found no association among term infants
o 1 found no association among preterm infants
o 1 found slightly decreased breastfeeding duration at one month if pacifier introduced in first week of life but NO difference if pacifier introduced after one month
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Baby Friendly USA Pacifiers
Breastfeeding babies should not be given pacifiers by the staff of the facility with the exception of o Limited use to decrease pain during procedures when
the baby cannot safely be held or breastfed (pacifiers used should be discarded after these procedures)
o Babies who are being tube-fed in NICUo Other rare specific medical reasons
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Addressing Sleep Deprivation
Give parents tools to cope with fussy babies
Sleep-deprived parents may make poor judgments
Make use of tools o Swaddling side carrying
shushing swinging and sucking
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Overcoming Barriers to Change What Parents are Sayinghellip
Prone positioning fear of choking Baby sleeps ldquobetterrdquo on stomach Soft things are safer for the baby SIDS is ldquoGodrsquos willrdquo Why bother Recommendations keep changing
anyway Vigilance sleep with baby for protection
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Factors Associated With Choice of Infant Sleep Position 3300 mothers from 32 hospitals 77 usually use supine position 49 exclusive use supine position Most likely to use prone
o African-American motherso Mothers with lt high school educationo Lack of perceived controlo Personal attitudesocietal norms
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
A continuum starting in childhoodo Secondary school baby sitting classes
Pre-pregnancy Pregnancyprenatal education
o Prior to baby showerhellipldquowrong giftsrdquo In-hospital education and modeling
o Include family friends baby sitters Re-enforcement in the doctorrsquos office
o Especially between 1 to 4 months Grandparents They hold great power The general public (day cares religious leaders)
A Lifetime of Infant Sleep Safety
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Chart1
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
14
139
13
13
12
13
117
17
103
269
087
386
074
353
077
531
072
557
067
644
062
666
056
716
057
711
053
728
056
701
055
722
055
757
057
703
055
721
054
741
051
728
048
042
04
039
Sheet1
Sheet1
ampA
Page ampP
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
Sheet2
Pre-AAP recommendation Post-AAP RecommendationBack to SleepSafe to Sleep Campaign
Sheet3
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Infant Sleep Safety
Requires a consistent and repetitive message in the community to prevent accidental deaths
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Safe Sleep Nurse Modeling
People trust nurses Whatever the nurse does must
be correct and it will be imitated in the home
Fact supine positioning in the nursery can almost DOUBLE its use in the home
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Physician Advocacy
Srivatsa 1997 HCP education to new familieshellip34 reduction in prone sleeping
Eron 2009 Study of Central NY state physicianshellip30 identified incorrect safest sleep positionhellip30 do not discuss with families
Colson 2009 Only 13 mothers advised by MD to use supine positionhellip3 times more likely to position the baby properly
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Healthcare Provider Advice to New Mothers Safe Sleep
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Chart1
Column1
[]
[]
[]
55
25
20
Sheet1
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Mason Clinical Peds 713
Bundled interventiono Nursing education policy model behavior safe sleep
video posters in rooms declaration of safe sleep practice
Safe sleep environment uarr from 25 to 58 Intention in home 95 supine none ldquoco-sleepingrdquo
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bundled Intervention = Behavior Change
QUESTION GROUP p-value
ISS Study NISP
Behavior Questions n = 490 n = 1046
Baby routinely placed to sleep on back 925 73 lt 0001
Baby routinely sleeps in bassinetcrib 995 71 lt 00001
Baby sleeps under a thin sheet 992 86 lt 0001
Baby given a pacifier for sleep 741 84 lt 0001Goodstein MH Bell T Krugman SD Improving infant sleep safety through a comprehensive hospital-based program Clinical Pediatrics 201554(3)212-221
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
o Baseline Safe sleep 49 of 264 infants o Post 312 of 234 infants (P lt 001) o Extra blankets most common o Baseline 77 vs 44 post-intervention o Mean number of unsafe items reduced by 50 (P lt 001)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Washington DC
2 urban DC nurseries 26 did not believe or unsure that infant positioning
was associated with SIDS Top 3 factors influencing sleep position
o 56 PERSONAL PREFERENCE Why non-supine Clinical experience (25)
o Increase risk aspirationo Decrease sleep and comfort
Bartow KL Nursesrsquo knowledge and adherence to sudden infant death syndrome prevention guidelines Pediatr Nurs 201642(1)7-13
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
TodaysBaby QI Safe Sleep Teaching
QI intervention median = 160 days Mothers reported receiving information 72 to 95
(increase of 24-57) 94 babies observed supine (plus 24) 88 infants in safe sleep environment
o Increase of 33 Gains maintained up to 12 months
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Social Media and Risk-Reduction Training Study (SMART) Cluster randomization 4 groups Safe sleep or breast feeding education Nursing QI and social media (mobile health) N = 1600 1263 responses (79) Safe sleep NQI and MHealth
o Supine sleep 925 o Room-sharing 859o No soft bedding 819o Pacifier use 762
Moon RY Hauck FR Colson ER et al The effect of nursing quality improvement and mobile health interventions on infant sleep practices a randomized clinical trial JAMA 2017318(4)351-359
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Hospital Initiative ComponentswwwcribsforkidsorgHospitalInitiativeToolkit INTRODUCTORY LETTER HOSPITAL INITIATIVE TOOL KIT
INSTRUCTIONS ORGANIZATIONAL CHART HOSPITAL POLICY ACKNOWLEDGMENT FORM (Engl amp
Span) SAFE SLEEP EDUCATIONAL FLIP CHART
NONCOMPLIANCE WAIVER (Engl amp Span)
NURSING EDUCATION MODULE
SAFE SLEEP POSTERS DOOR HANGERS (Engl amp Span) GRADUATION CERTIFICATE SAMPLE LETTER TO HOSPITALS SAMPLE LETTER TO PROVIDERS INFANT SAFE SLEEP BROCHURES
(Engl amp Span) PRESS KIT
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
All materials available on-lineo No major costs to the hospital
Easy on-line access for documentation
NO FEE FOR PARTICIPATION
wwwCribsforKidsorgHospitalInitiative
Tiffany Price (tpricecribsforkidsorg)
The National Safe Sleep Hospital Certification Program
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
TNmdash25 reduction in infant sleep-related deaths in 2 years
SDmdashOver 7915 Pack lsquon Plays distributed since 2012 Infant mortality rate decreased from 86 (2012) to 48 (2016)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
2009 to 2015 38 decrease in infant mortality Decreased from 135 to 84 per 1000 SUID decreased gt50 Decrease in racial disparityhttphealthybabiesbaltimorecomhome
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
And Finallyhellip
Health care providers should have open frank nonjudgmental conversations with families about their sleep practices
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Encouraging Parents to Take Action
According to the Social Learning Theory parents are more likely to recall and comply with instructions when
the health care provider
Uses a positive tone Provides adequate information Allows the parent to ask most of the questions
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Motivational Interviewing
ldquoa collaborative goal-oriented style of communication with particular attention to the language of changerdquo
o Strengthen personal motivation and commitment to a specific goal
o Explore onersquos reasons for change (barriers)o Patient generates own solutions
bull More likely to feel realisticbull Planting seeds of change
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Impact of Eliminating Sleep-Related Deaths
Every week we lose 70 children which is equivalent to 4 kindergarten classrooms
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Thank You
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Contact Information
mgoodsteinwellspanorg
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Visit Pediatric Care Online today for additional information on this and other topics
httppediatriccaresolutionsaaporgPediatric Care Online is a convenient electronic resource for immediate expert help with
virtually every pediatric clinical information need with must-have resources that are included in a comprehensive reference library and time-saving clinical tools
Donrsquot have a subscription to PCOThen take advantage of a free trial today
Call Mead Johnson Nutrition at 888363-2362 orfor more information go to
httppediatriccaresolutionsaaporgSSFree_Trialaspx
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
IMR over time Finland vs US
Slide Number 1
Disclaimer
Objectives for Todayrsquos Talk
Infant Mortality Rates for the Five Leading Causes of Infant Death in the United States 2005 and 2011
US Post-Neonatal Mortality 2015
FACT
What is SUID or SUDI
Some Causes of Deaths that Occur Suddenly and Unexpectedly during Infancy
What is SIDS
SIDS FACTS
SIDS FACTS
Triple Risk Model to Explain SIDS
Paterson DS Krous HF Kinney HC et al JAMA 2006
An Example of SIDS Pathogenesis
2016 AAP Recommendations Infant Sleep Safety
Strength of Recommendation
Recommendations Change as the Evidence Evolves
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
Correct Safe Sleep Environment
We Need to Move Beyond Back to Sleep
Sleep Position for Healthy Newborns
Sleep Position in Newborn Nursery
Sleep Position and Reflux
The Truth About Supine Sleep and Aspiration Ending the Fallacy
Title
Infant Sleep Location
Room-Share How Long Yoursquore Kidding Right
Supporting Data
More Recent Data
Why is Room-Sharing Protective
Room-Sharing and Sleep Quality
Insight Study (Paul 2017)
Insight Study (Paul 2017)
Insight Commentary (Hauck Moon)
Feeding the Baby at Night
Say NO to Couches Sofas and Cushioned Armchairs
High-Risk Bed Sharing Situations
Bedsharing in Low-Risk Breastfed Infants
Independent Review (Dr Robert Platt)
Bed Sharing
Bed Sharing
Bed Sharing with Overlay
Bed Sharing with Overlay
Bed Sharing with Overlay
Couch Sleeping
Couch Sleeping
Couch Sleeping
Unsafe Bedding NISP Trends 1993-2102
Why Use Soft Bedding
Soft Bedding for Older Infants
To Swaddle or Not to Swaddle That is the Question
Swaddling
SwaddlingmdashIs it Safe
SwaddlingmdashMore Questionshellip
wwwhealthychildrenorg
Pacifiers
Pacifiers and Breastfeeding
Baby Friendly USA Pacifiers
Addressing Sleep Deprivation
Overcoming Barriers to Change What Parents are Sayinghellip
Factors Associated With Choice of Infant Sleep Position
Slide Number 65
What is Working
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Infant Sleep Safety
Safe Sleep Nurse Modeling
Physician Advocacy
Healthcare Provider Advice to New Mothers Safe Sleep
Mason Clinical Peds 713
Bundled Intervention = Behavior Change
Hospital Unsafe Sleep Persists
Washington DC
TodaysBaby QI Safe Sleep Teaching
TodaysBaby QI Safe Sleep Teaching
Social Media and Risk-Reduction Training Study (SMART)
The National Safe Sleep Hospital Certification Program
Coordinated Education Efforts Work
Coordinated Education Efforts Work
And Finallyhellip
Encouraging Parents to Take Action
Motivational Interviewing
Impact of Eliminating Sleep-Related Deaths
Thank You
Contact Information
Slide Number 89
IMR over time Finland vs US
Column1
correct advice
55
incorrect advice
25
no advice
20
correct advice
incorrect advice
no advice
SIDS Rate
Percent Back Sleeping
1988
14
1989
139
1990
13
1991
13
1992
12
13
1993
117
17
1994
103
269
1995
087
386
1996
074
353
1997
077
531
1998
072
557
1999
067
644
2000
062
666
2001
056
716
2002
057
711
2003
053
728
2004
056
701
2005
055
722
2006
055
757
2007
057
703
2008
055
721
2009
054
741
2010
051
728
2011
048
2012
042
2013
04
2014
039
httpwwwcdcgovNCHSdatanvsrnvsr58nvsr58_19pdf
Xu JQ Kochanek KD Murphy SL Tejada-Vera B Deaths Final data for
2007
National vital statistics reports vol 58 no 19 Hyattsville MD
National Center for Health Statistics 2010
1988
1988
1989
1989
1990
1990
1991
1991
1992
1992
1993
1993
1994
1994
1995
1995
1996
1996
1997
1997
1998
1998
1999
1999
2000
2000
2001
2001
2002
2002
2003
2003
2004
2004
2005
2005
2006
2006
2007
2007
2008
2008
2009
2009
2010
2010
2011
2012
2013
2014
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Correct Safe Sleep Environment
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
We Need to Move Beyond Back to Sleep
Shersquos on her back to sleep
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Sleep Position for Healthy Newborns
Skin-to-skin care is recommended for all mothers and newborns regardless of feeding or delivery method immediately following birtho Mom should be medically stable
awake and able to respond to baby When mother needs to sleep or take
care of other needs infant should be placed supine in a bassinet
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Sleep Position in Newborn Nursery Infants in the newborn nursery
and infants who are rooming in with their parents should be placed in the supine position as soon as they are ready to be placed in the bassinet o No evidence that placing infants
on the side during the first few hours of life promotes clearance of amniotic fluid and decreases the risk of aspiration
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Sleep Position and Reflux Infants with gastroesophageal (GE) reflux
should be kept supineo Unless the risk of death from complications
of GE reflux is greater than the risk of SIDS
Supine position does not increase the risk of choking and aspiration in infants with GE reflux o Protective airway mechanisms
Do NOT elevate the head of the infantrsquos cribo Ineffective in reducing GE refluxo Infant may slide to the foot of the cribmdashmay
compromise respiration
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
The Truth About Supine Sleep and Aspiration Ending the Fallacy Orientation of the Trachea to the Esophagus
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Title
Text
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Infant Sleep Location
Infants should sleep in parentsrsquo room close to parentsrsquo bed but on a separate surface designed for infants
Ideally for the first year of life but at least for the first 6 months
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Room-Share How Long Yoursquore Kidding Right
2011 ldquoall sleep recommendations are to be followed until 1 year of agerdquo
2016 ldquoroom-sharing without bed-sharinghellipideally until 1 year of age but at least for the first 6 monthsrdquo
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Supporting Data
3 case-control studies comparing sleeping in a separate room vs room-sharingo Tappin (Scotland) AOR 326 (95 CI 103-1035)
bull Protection is significant for smoker motherso Blair (England) AOR 1049 (95 CI 426-2581)
bull Protection is significant for both smoker and nonsmoker mothers
o New Zealand Cot Death study AOR 285(95 CI 204-385)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
More Recent Data
New Zealand SUDI studyo 64 protection with room-sharing AOR 036
(95 CI 019-071)
Estimate of 50 reduction is very conservative
None of the case-control studies stratify by age (months)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Why is Room-Sharing Protective
SIDSmdashfailure to arouse More small awakenings during the night
o Stirrings movement not fully awake Postulation protective effect from small awakenings Room-sharing facilitates breastfeeding
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Room-Sharing and Sleep Quality
Volkovich room-sharing vs solitary sleepo Room-sharing mothers with more sleep disturbanceso Infants with similar sleep quality
Mao Mindell room-sharing infantsmdashmore awakenings
Montgomery-Downs Doan sleep quality in breastfeeding mothers gt to formula feeding motherso Exclusive breastfeeding = 30 min more sleep
More study needed
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Insight Study (Paul 2017)
Sleep questionnaire at 4 9 12 and 30 monthso Sleep duration overnight behaviorso Compared early vs late independent infants
At 4 monthso Equal sleep durationo Early group had better sleep consolidationo Longest stretch 46 minutes
Paul IM Hohman EE Loken E et al Mother-infant room-sharing and sleep outcomes in the INSIGHT study Pediatrics 2017140(1)e20170122
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Insight Study (Paul 2017)
At 9 monthso Longer sleep duration (40 minnight) o Better consolidation (100 min)
At 30 monthso Longer sleep duration (45 minnight)
Room-sharing 4 times more likely to transition to bed sharing overnight
Paul IM Hohman EE Loken E et al Mother-infant room-sharing and sleep outcomes in the INSIGHT study Pediatrics 2017140(1)e20170122
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Insight Commentary (Hauck Moon)
Late room-sharing mean 7 hours longest sleep Is early consolidation desirable Differences related to bedtime routines
o Early bedtimeo Number of night feedso Feeding back to sleep
Focus on the routine not early separation
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Feeding the Baby at Night Acknowledgment that parents may fall
asleep while feeding babyo Safer to feed on bed than on sofa
couch or armchair if you might fall asleep
o No pillows sheets blankets or other items that could obstruct infant breathing or cause overheating should be in bed
o Return infant back to separate sleep surface as soon as parent awakens
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Say NO to Couches Sofas and Cushioned Armchairs Never place a baby for sleep on these surfaces Never sleep with a baby on these surfaces One of the MOST dangerous places for an infant
(OR 51-669)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
High-Risk Bed Sharing Situations Age lt4 months Preterm or low birth weight Smoked during pregnancy Bed sharer is current smoker (even if not
smoking in bed) Bed sharer has usedis using meds or
substances that could impair alertness or arousal
Bed sharer is not parent (including other children)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bedsharing in Low-Risk Breastfed Infants
Blair et al AOR 16 (95 CI 096-27) o Age lt14 weekso Parents No cigarettes or alcoholo Independent of feeding method
Carpenter et al AOR 51 (95 CI 23-114) o Age lt3 months o Parents did not smokeo Mother No alcohol or drugso Breastfed infants
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Independent Review (Dr Robert Platt)
Very small numbers of low-risk babieso 24 in Blairrsquos studyo 12 in Carpenterrsquos study
Does not believe that data support definitive differences in 2 studies
Some evidence of increased risk in this group but cannot say how large the increased risk is
Cannot conclude that bed sharing in this group is safe
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Unsafe Bedding NISP Trends 1993-2102
Shapiro-Mendoza CK Colson ER Willinger M Rybin DV Camperlengo L Corwin MJ Trends in infant bedding use National Infant Sleep Position study 1993ndash2010 Pediatrics 2015135(1)10-17
Decrease from 86 to 55 Rate of decline decreases
2001-10 835 for teen mothers Predictors of adjusted OR
gt15
o Young motherso Non-white race
ethnicityo Less than college
education
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Why Use Soft Bedding
ComfortWarmtho Extrapolation of own feelingso Misinterpret firm with taut
bull Soft + taut ne firm
Safetyo Blankets pillows rolls to prevent falls
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Soft Bedding for Older Infants
Many parents recognize soft bedding is a risk Increased complacency as baby gets older Soft bedding is THE most important risk factor for
infants 4-12 months old (Colvin 2015) Infants roll into bedding and cannot extract
themselves
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
To Swaddle or Not to Swaddle That is the Question Pros
o Calms the infant promotes sleep decreases number of awakenings
o Encourages use of the supine position
Conso Increased respiratory rate and
reduced functional residual lung capacity
o Exacerbates hip dysplasia if the hips are kept in extension and adduction
o ldquoLooserdquo swaddling becomes loose bedding
o Overheating especially if the head is covered or the infant has infection
o Effects on arousability to an external stimulus remain unclear (conflicting data) There may be minimal effects of routine swaddling on arousal
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Swaddling
There is insufficient evidence to recommend routine swaddling as a strategy to reduce the incidence of SIDS
Swaddling must be correctly applied to avoid the possible hazards
Swaddling does not reduce the necessity to follow recommended safe sleep practices Ambrogio Lorenzettis Madonna and Child (1319)
Wikipedia
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
McDonnell E Moon RY Infant deaths and injuries associated with wearable blankets swaddle wraps and swaddling J Pediatr 20141641152-1156
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
SwaddlingmdashMore Questionshellip
Pease 2016 Pediatrics Pooled OR = 138
o Prone = 1299 o Side = 316o Supine = 193
Increased risk with age Limitations
o Heterogeneity definitions other risk factorsPease AS Fleming PJ Hauck FR et al Swaddling and the risk of sudden infant death syndrome a meta-analysis Pediatrics 2016137(6)e20153
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
wwwhealthychildrenorg
Swaddling (wrapping a light blanket snuggly around a baby) may help calm a crying baby If you swaddle your baby be sure to place him on his back to sleep Stop swaddling your baby when he starts to roll
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers
AAP recommendation Consider offering a pacifier at nap time and bedtime
Studies consistently demonstrate a protective effect of pacifiers on SIDS
Mechanism unknowno Dislodge within 15 to 60 minuteso Decreased arousal threshold
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers and Breastfeeding Well-designed trials
o 2 found no association among term infants
o 1 found no association among preterm infants
o 1 found slightly decreased breastfeeding duration at one month if pacifier introduced in first week of life but NO difference if pacifier introduced after one month
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Baby Friendly USA Pacifiers
Breastfeeding babies should not be given pacifiers by the staff of the facility with the exception of o Limited use to decrease pain during procedures when
the baby cannot safely be held or breastfed (pacifiers used should be discarded after these procedures)
o Babies who are being tube-fed in NICUo Other rare specific medical reasons
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Addressing Sleep Deprivation
Give parents tools to cope with fussy babies
Sleep-deprived parents may make poor judgments
Make use of tools o Swaddling side carrying
shushing swinging and sucking
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Overcoming Barriers to Change What Parents are Sayinghellip
Prone positioning fear of choking Baby sleeps ldquobetterrdquo on stomach Soft things are safer for the baby SIDS is ldquoGodrsquos willrdquo Why bother Recommendations keep changing
anyway Vigilance sleep with baby for protection
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Factors Associated With Choice of Infant Sleep Position 3300 mothers from 32 hospitals 77 usually use supine position 49 exclusive use supine position Most likely to use prone
o African-American motherso Mothers with lt high school educationo Lack of perceived controlo Personal attitudesocietal norms
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
A continuum starting in childhoodo Secondary school baby sitting classes
Pre-pregnancy Pregnancyprenatal education
o Prior to baby showerhellipldquowrong giftsrdquo In-hospital education and modeling
o Include family friends baby sitters Re-enforcement in the doctorrsquos office
o Especially between 1 to 4 months Grandparents They hold great power The general public (day cares religious leaders)
A Lifetime of Infant Sleep Safety
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Chart1
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
14
139
13
13
12
13
117
17
103
269
087
386
074
353
077
531
072
557
067
644
062
666
056
716
057
711
053
728
056
701
055
722
055
757
057
703
055
721
054
741
051
728
048
042
04
039
Sheet1
Sheet1
ampA
Page ampP
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
Sheet2
Pre-AAP recommendation Post-AAP RecommendationBack to SleepSafe to Sleep Campaign
Sheet3
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Infant Sleep Safety
Requires a consistent and repetitive message in the community to prevent accidental deaths
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Safe Sleep Nurse Modeling
People trust nurses Whatever the nurse does must
be correct and it will be imitated in the home
Fact supine positioning in the nursery can almost DOUBLE its use in the home
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Physician Advocacy
Srivatsa 1997 HCP education to new familieshellip34 reduction in prone sleeping
Eron 2009 Study of Central NY state physicianshellip30 identified incorrect safest sleep positionhellip30 do not discuss with families
Colson 2009 Only 13 mothers advised by MD to use supine positionhellip3 times more likely to position the baby properly
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Healthcare Provider Advice to New Mothers Safe Sleep
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Chart1
Column1
[]
[]
[]
55
25
20
Sheet1
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Mason Clinical Peds 713
Bundled interventiono Nursing education policy model behavior safe sleep
video posters in rooms declaration of safe sleep practice
Safe sleep environment uarr from 25 to 58 Intention in home 95 supine none ldquoco-sleepingrdquo
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bundled Intervention = Behavior Change
QUESTION GROUP p-value
ISS Study NISP
Behavior Questions n = 490 n = 1046
Baby routinely placed to sleep on back 925 73 lt 0001
Baby routinely sleeps in bassinetcrib 995 71 lt 00001
Baby sleeps under a thin sheet 992 86 lt 0001
Baby given a pacifier for sleep 741 84 lt 0001Goodstein MH Bell T Krugman SD Improving infant sleep safety through a comprehensive hospital-based program Clinical Pediatrics 201554(3)212-221
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
o Baseline Safe sleep 49 of 264 infants o Post 312 of 234 infants (P lt 001) o Extra blankets most common o Baseline 77 vs 44 post-intervention o Mean number of unsafe items reduced by 50 (P lt 001)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Washington DC
2 urban DC nurseries 26 did not believe or unsure that infant positioning
was associated with SIDS Top 3 factors influencing sleep position
o 56 PERSONAL PREFERENCE Why non-supine Clinical experience (25)
o Increase risk aspirationo Decrease sleep and comfort
Bartow KL Nursesrsquo knowledge and adherence to sudden infant death syndrome prevention guidelines Pediatr Nurs 201642(1)7-13
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
TodaysBaby QI Safe Sleep Teaching
QI intervention median = 160 days Mothers reported receiving information 72 to 95
(increase of 24-57) 94 babies observed supine (plus 24) 88 infants in safe sleep environment
o Increase of 33 Gains maintained up to 12 months
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Social Media and Risk-Reduction Training Study (SMART) Cluster randomization 4 groups Safe sleep or breast feeding education Nursing QI and social media (mobile health) N = 1600 1263 responses (79) Safe sleep NQI and MHealth
o Supine sleep 925 o Room-sharing 859o No soft bedding 819o Pacifier use 762
Moon RY Hauck FR Colson ER et al The effect of nursing quality improvement and mobile health interventions on infant sleep practices a randomized clinical trial JAMA 2017318(4)351-359
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Hospital Initiative ComponentswwwcribsforkidsorgHospitalInitiativeToolkit INTRODUCTORY LETTER HOSPITAL INITIATIVE TOOL KIT
INSTRUCTIONS ORGANIZATIONAL CHART HOSPITAL POLICY ACKNOWLEDGMENT FORM (Engl amp
Span) SAFE SLEEP EDUCATIONAL FLIP CHART
NONCOMPLIANCE WAIVER (Engl amp Span)
NURSING EDUCATION MODULE
SAFE SLEEP POSTERS DOOR HANGERS (Engl amp Span) GRADUATION CERTIFICATE SAMPLE LETTER TO HOSPITALS SAMPLE LETTER TO PROVIDERS INFANT SAFE SLEEP BROCHURES
(Engl amp Span) PRESS KIT
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
All materials available on-lineo No major costs to the hospital
Easy on-line access for documentation
NO FEE FOR PARTICIPATION
wwwCribsforKidsorgHospitalInitiative
Tiffany Price (tpricecribsforkidsorg)
The National Safe Sleep Hospital Certification Program
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
TNmdash25 reduction in infant sleep-related deaths in 2 years
SDmdashOver 7915 Pack lsquon Plays distributed since 2012 Infant mortality rate decreased from 86 (2012) to 48 (2016)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
2009 to 2015 38 decrease in infant mortality Decreased from 135 to 84 per 1000 SUID decreased gt50 Decrease in racial disparityhttphealthybabiesbaltimorecomhome
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
And Finallyhellip
Health care providers should have open frank nonjudgmental conversations with families about their sleep practices
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Encouraging Parents to Take Action
According to the Social Learning Theory parents are more likely to recall and comply with instructions when
the health care provider
Uses a positive tone Provides adequate information Allows the parent to ask most of the questions
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Motivational Interviewing
ldquoa collaborative goal-oriented style of communication with particular attention to the language of changerdquo
o Strengthen personal motivation and commitment to a specific goal
o Explore onersquos reasons for change (barriers)o Patient generates own solutions
bull More likely to feel realisticbull Planting seeds of change
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Impact of Eliminating Sleep-Related Deaths
Every week we lose 70 children which is equivalent to 4 kindergarten classrooms
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Thank You
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Contact Information
mgoodsteinwellspanorg
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Visit Pediatric Care Online today for additional information on this and other topics
httppediatriccaresolutionsaaporgPediatric Care Online is a convenient electronic resource for immediate expert help with
virtually every pediatric clinical information need with must-have resources that are included in a comprehensive reference library and time-saving clinical tools
Donrsquot have a subscription to PCOThen take advantage of a free trial today
Call Mead Johnson Nutrition at 888363-2362 orfor more information go to
httppediatriccaresolutionsaaporgSSFree_Trialaspx
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
IMR over time Finland vs US
Slide Number 1
Disclaimer
Objectives for Todayrsquos Talk
Infant Mortality Rates for the Five Leading Causes of Infant Death in the United States 2005 and 2011
US Post-Neonatal Mortality 2015
FACT
What is SUID or SUDI
Some Causes of Deaths that Occur Suddenly and Unexpectedly during Infancy
What is SIDS
SIDS FACTS
SIDS FACTS
Triple Risk Model to Explain SIDS
Paterson DS Krous HF Kinney HC et al JAMA 2006
An Example of SIDS Pathogenesis
2016 AAP Recommendations Infant Sleep Safety
Strength of Recommendation
Recommendations Change as the Evidence Evolves
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
Correct Safe Sleep Environment
We Need to Move Beyond Back to Sleep
Sleep Position for Healthy Newborns
Sleep Position in Newborn Nursery
Sleep Position and Reflux
The Truth About Supine Sleep and Aspiration Ending the Fallacy
Title
Infant Sleep Location
Room-Share How Long Yoursquore Kidding Right
Supporting Data
More Recent Data
Why is Room-Sharing Protective
Room-Sharing and Sleep Quality
Insight Study (Paul 2017)
Insight Study (Paul 2017)
Insight Commentary (Hauck Moon)
Feeding the Baby at Night
Say NO to Couches Sofas and Cushioned Armchairs
High-Risk Bed Sharing Situations
Bedsharing in Low-Risk Breastfed Infants
Independent Review (Dr Robert Platt)
Bed Sharing
Bed Sharing
Bed Sharing with Overlay
Bed Sharing with Overlay
Bed Sharing with Overlay
Couch Sleeping
Couch Sleeping
Couch Sleeping
Unsafe Bedding NISP Trends 1993-2102
Why Use Soft Bedding
Soft Bedding for Older Infants
To Swaddle or Not to Swaddle That is the Question
Swaddling
SwaddlingmdashIs it Safe
SwaddlingmdashMore Questionshellip
wwwhealthychildrenorg
Pacifiers
Pacifiers and Breastfeeding
Baby Friendly USA Pacifiers
Addressing Sleep Deprivation
Overcoming Barriers to Change What Parents are Sayinghellip
Factors Associated With Choice of Infant Sleep Position
Slide Number 65
What is Working
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Infant Sleep Safety
Safe Sleep Nurse Modeling
Physician Advocacy
Healthcare Provider Advice to New Mothers Safe Sleep
Mason Clinical Peds 713
Bundled Intervention = Behavior Change
Hospital Unsafe Sleep Persists
Washington DC
TodaysBaby QI Safe Sleep Teaching
TodaysBaby QI Safe Sleep Teaching
Social Media and Risk-Reduction Training Study (SMART)
The National Safe Sleep Hospital Certification Program
Coordinated Education Efforts Work
Coordinated Education Efforts Work
And Finallyhellip
Encouraging Parents to Take Action
Motivational Interviewing
Impact of Eliminating Sleep-Related Deaths
Thank You
Contact Information
Slide Number 89
IMR over time Finland vs US
Column1
correct advice
55
incorrect advice
25
no advice
20
correct advice
incorrect advice
no advice
SIDS Rate
Percent Back Sleeping
1988
14
1989
139
1990
13
1991
13
1992
12
13
1993
117
17
1994
103
269
1995
087
386
1996
074
353
1997
077
531
1998
072
557
1999
067
644
2000
062
666
2001
056
716
2002
057
711
2003
053
728
2004
056
701
2005
055
722
2006
055
757
2007
057
703
2008
055
721
2009
054
741
2010
051
728
2011
048
2012
042
2013
04
2014
039
httpwwwcdcgovNCHSdatanvsrnvsr58nvsr58_19pdf
Xu JQ Kochanek KD Murphy SL Tejada-Vera B Deaths Final data for
2007
National vital statistics reports vol 58 no 19 Hyattsville MD
National Center for Health Statistics 2010
1988
1988
1989
1989
1990
1990
1991
1991
1992
1992
1993
1993
1994
1994
1995
1995
1996
1996
1997
1997
1998
1998
1999
1999
2000
2000
2001
2001
2002
2002
2003
2003
2004
2004
2005
2005
2006
2006
2007
2007
2008
2008
2009
2009
2010
2010
2011
2012
2013
2014
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
We Need to Move Beyond Back to Sleep
Shersquos on her back to sleep
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Sleep Position for Healthy Newborns
Skin-to-skin care is recommended for all mothers and newborns regardless of feeding or delivery method immediately following birtho Mom should be medically stable
awake and able to respond to baby When mother needs to sleep or take
care of other needs infant should be placed supine in a bassinet
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Sleep Position in Newborn Nursery Infants in the newborn nursery
and infants who are rooming in with their parents should be placed in the supine position as soon as they are ready to be placed in the bassinet o No evidence that placing infants
on the side during the first few hours of life promotes clearance of amniotic fluid and decreases the risk of aspiration
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Sleep Position and Reflux Infants with gastroesophageal (GE) reflux
should be kept supineo Unless the risk of death from complications
of GE reflux is greater than the risk of SIDS
Supine position does not increase the risk of choking and aspiration in infants with GE reflux o Protective airway mechanisms
Do NOT elevate the head of the infantrsquos cribo Ineffective in reducing GE refluxo Infant may slide to the foot of the cribmdashmay
compromise respiration
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
The Truth About Supine Sleep and Aspiration Ending the Fallacy Orientation of the Trachea to the Esophagus
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Title
Text
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Infant Sleep Location
Infants should sleep in parentsrsquo room close to parentsrsquo bed but on a separate surface designed for infants
Ideally for the first year of life but at least for the first 6 months
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Room-Share How Long Yoursquore Kidding Right
2011 ldquoall sleep recommendations are to be followed until 1 year of agerdquo
2016 ldquoroom-sharing without bed-sharinghellipideally until 1 year of age but at least for the first 6 monthsrdquo
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Supporting Data
3 case-control studies comparing sleeping in a separate room vs room-sharingo Tappin (Scotland) AOR 326 (95 CI 103-1035)
bull Protection is significant for smoker motherso Blair (England) AOR 1049 (95 CI 426-2581)
bull Protection is significant for both smoker and nonsmoker mothers
o New Zealand Cot Death study AOR 285(95 CI 204-385)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
More Recent Data
New Zealand SUDI studyo 64 protection with room-sharing AOR 036
(95 CI 019-071)
Estimate of 50 reduction is very conservative
None of the case-control studies stratify by age (months)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Why is Room-Sharing Protective
SIDSmdashfailure to arouse More small awakenings during the night
o Stirrings movement not fully awake Postulation protective effect from small awakenings Room-sharing facilitates breastfeeding
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Room-Sharing and Sleep Quality
Volkovich room-sharing vs solitary sleepo Room-sharing mothers with more sleep disturbanceso Infants with similar sleep quality
Mao Mindell room-sharing infantsmdashmore awakenings
Montgomery-Downs Doan sleep quality in breastfeeding mothers gt to formula feeding motherso Exclusive breastfeeding = 30 min more sleep
More study needed
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Insight Study (Paul 2017)
Sleep questionnaire at 4 9 12 and 30 monthso Sleep duration overnight behaviorso Compared early vs late independent infants
At 4 monthso Equal sleep durationo Early group had better sleep consolidationo Longest stretch 46 minutes
Paul IM Hohman EE Loken E et al Mother-infant room-sharing and sleep outcomes in the INSIGHT study Pediatrics 2017140(1)e20170122
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Insight Study (Paul 2017)
At 9 monthso Longer sleep duration (40 minnight) o Better consolidation (100 min)
At 30 monthso Longer sleep duration (45 minnight)
Room-sharing 4 times more likely to transition to bed sharing overnight
Paul IM Hohman EE Loken E et al Mother-infant room-sharing and sleep outcomes in the INSIGHT study Pediatrics 2017140(1)e20170122
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Insight Commentary (Hauck Moon)
Late room-sharing mean 7 hours longest sleep Is early consolidation desirable Differences related to bedtime routines
o Early bedtimeo Number of night feedso Feeding back to sleep
Focus on the routine not early separation
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Feeding the Baby at Night Acknowledgment that parents may fall
asleep while feeding babyo Safer to feed on bed than on sofa
couch or armchair if you might fall asleep
o No pillows sheets blankets or other items that could obstruct infant breathing or cause overheating should be in bed
o Return infant back to separate sleep surface as soon as parent awakens
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Say NO to Couches Sofas and Cushioned Armchairs Never place a baby for sleep on these surfaces Never sleep with a baby on these surfaces One of the MOST dangerous places for an infant
(OR 51-669)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
High-Risk Bed Sharing Situations Age lt4 months Preterm or low birth weight Smoked during pregnancy Bed sharer is current smoker (even if not
smoking in bed) Bed sharer has usedis using meds or
substances that could impair alertness or arousal
Bed sharer is not parent (including other children)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bedsharing in Low-Risk Breastfed Infants
Blair et al AOR 16 (95 CI 096-27) o Age lt14 weekso Parents No cigarettes or alcoholo Independent of feeding method
Carpenter et al AOR 51 (95 CI 23-114) o Age lt3 months o Parents did not smokeo Mother No alcohol or drugso Breastfed infants
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Independent Review (Dr Robert Platt)
Very small numbers of low-risk babieso 24 in Blairrsquos studyo 12 in Carpenterrsquos study
Does not believe that data support definitive differences in 2 studies
Some evidence of increased risk in this group but cannot say how large the increased risk is
Cannot conclude that bed sharing in this group is safe
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Unsafe Bedding NISP Trends 1993-2102
Shapiro-Mendoza CK Colson ER Willinger M Rybin DV Camperlengo L Corwin MJ Trends in infant bedding use National Infant Sleep Position study 1993ndash2010 Pediatrics 2015135(1)10-17
Decrease from 86 to 55 Rate of decline decreases
2001-10 835 for teen mothers Predictors of adjusted OR
gt15
o Young motherso Non-white race
ethnicityo Less than college
education
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Why Use Soft Bedding
ComfortWarmtho Extrapolation of own feelingso Misinterpret firm with taut
bull Soft + taut ne firm
Safetyo Blankets pillows rolls to prevent falls
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Soft Bedding for Older Infants
Many parents recognize soft bedding is a risk Increased complacency as baby gets older Soft bedding is THE most important risk factor for
infants 4-12 months old (Colvin 2015) Infants roll into bedding and cannot extract
themselves
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
To Swaddle or Not to Swaddle That is the Question Pros
o Calms the infant promotes sleep decreases number of awakenings
o Encourages use of the supine position
Conso Increased respiratory rate and
reduced functional residual lung capacity
o Exacerbates hip dysplasia if the hips are kept in extension and adduction
o ldquoLooserdquo swaddling becomes loose bedding
o Overheating especially if the head is covered or the infant has infection
o Effects on arousability to an external stimulus remain unclear (conflicting data) There may be minimal effects of routine swaddling on arousal
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Swaddling
There is insufficient evidence to recommend routine swaddling as a strategy to reduce the incidence of SIDS
Swaddling must be correctly applied to avoid the possible hazards
Swaddling does not reduce the necessity to follow recommended safe sleep practices Ambrogio Lorenzettis Madonna and Child (1319)
Wikipedia
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
McDonnell E Moon RY Infant deaths and injuries associated with wearable blankets swaddle wraps and swaddling J Pediatr 20141641152-1156
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
SwaddlingmdashMore Questionshellip
Pease 2016 Pediatrics Pooled OR = 138
o Prone = 1299 o Side = 316o Supine = 193
Increased risk with age Limitations
o Heterogeneity definitions other risk factorsPease AS Fleming PJ Hauck FR et al Swaddling and the risk of sudden infant death syndrome a meta-analysis Pediatrics 2016137(6)e20153
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
wwwhealthychildrenorg
Swaddling (wrapping a light blanket snuggly around a baby) may help calm a crying baby If you swaddle your baby be sure to place him on his back to sleep Stop swaddling your baby when he starts to roll
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers
AAP recommendation Consider offering a pacifier at nap time and bedtime
Studies consistently demonstrate a protective effect of pacifiers on SIDS
Mechanism unknowno Dislodge within 15 to 60 minuteso Decreased arousal threshold
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers and Breastfeeding Well-designed trials
o 2 found no association among term infants
o 1 found no association among preterm infants
o 1 found slightly decreased breastfeeding duration at one month if pacifier introduced in first week of life but NO difference if pacifier introduced after one month
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Baby Friendly USA Pacifiers
Breastfeeding babies should not be given pacifiers by the staff of the facility with the exception of o Limited use to decrease pain during procedures when
the baby cannot safely be held or breastfed (pacifiers used should be discarded after these procedures)
o Babies who are being tube-fed in NICUo Other rare specific medical reasons
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Addressing Sleep Deprivation
Give parents tools to cope with fussy babies
Sleep-deprived parents may make poor judgments
Make use of tools o Swaddling side carrying
shushing swinging and sucking
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Overcoming Barriers to Change What Parents are Sayinghellip
Prone positioning fear of choking Baby sleeps ldquobetterrdquo on stomach Soft things are safer for the baby SIDS is ldquoGodrsquos willrdquo Why bother Recommendations keep changing
anyway Vigilance sleep with baby for protection
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Factors Associated With Choice of Infant Sleep Position 3300 mothers from 32 hospitals 77 usually use supine position 49 exclusive use supine position Most likely to use prone
o African-American motherso Mothers with lt high school educationo Lack of perceived controlo Personal attitudesocietal norms
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
A continuum starting in childhoodo Secondary school baby sitting classes
Pre-pregnancy Pregnancyprenatal education
o Prior to baby showerhellipldquowrong giftsrdquo In-hospital education and modeling
o Include family friends baby sitters Re-enforcement in the doctorrsquos office
o Especially between 1 to 4 months Grandparents They hold great power The general public (day cares religious leaders)
A Lifetime of Infant Sleep Safety
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Chart1
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
14
139
13
13
12
13
117
17
103
269
087
386
074
353
077
531
072
557
067
644
062
666
056
716
057
711
053
728
056
701
055
722
055
757
057
703
055
721
054
741
051
728
048
042
04
039
Sheet1
Sheet1
ampA
Page ampP
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
Sheet2
Pre-AAP recommendation Post-AAP RecommendationBack to SleepSafe to Sleep Campaign
Sheet3
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Infant Sleep Safety
Requires a consistent and repetitive message in the community to prevent accidental deaths
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Safe Sleep Nurse Modeling
People trust nurses Whatever the nurse does must
be correct and it will be imitated in the home
Fact supine positioning in the nursery can almost DOUBLE its use in the home
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Physician Advocacy
Srivatsa 1997 HCP education to new familieshellip34 reduction in prone sleeping
Eron 2009 Study of Central NY state physicianshellip30 identified incorrect safest sleep positionhellip30 do not discuss with families
Colson 2009 Only 13 mothers advised by MD to use supine positionhellip3 times more likely to position the baby properly
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Healthcare Provider Advice to New Mothers Safe Sleep
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Chart1
Column1
[]
[]
[]
55
25
20
Sheet1
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Mason Clinical Peds 713
Bundled interventiono Nursing education policy model behavior safe sleep
video posters in rooms declaration of safe sleep practice
Safe sleep environment uarr from 25 to 58 Intention in home 95 supine none ldquoco-sleepingrdquo
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bundled Intervention = Behavior Change
QUESTION GROUP p-value
ISS Study NISP
Behavior Questions n = 490 n = 1046
Baby routinely placed to sleep on back 925 73 lt 0001
Baby routinely sleeps in bassinetcrib 995 71 lt 00001
Baby sleeps under a thin sheet 992 86 lt 0001
Baby given a pacifier for sleep 741 84 lt 0001Goodstein MH Bell T Krugman SD Improving infant sleep safety through a comprehensive hospital-based program Clinical Pediatrics 201554(3)212-221
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
o Baseline Safe sleep 49 of 264 infants o Post 312 of 234 infants (P lt 001) o Extra blankets most common o Baseline 77 vs 44 post-intervention o Mean number of unsafe items reduced by 50 (P lt 001)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Washington DC
2 urban DC nurseries 26 did not believe or unsure that infant positioning
was associated with SIDS Top 3 factors influencing sleep position
o 56 PERSONAL PREFERENCE Why non-supine Clinical experience (25)
o Increase risk aspirationo Decrease sleep and comfort
Bartow KL Nursesrsquo knowledge and adherence to sudden infant death syndrome prevention guidelines Pediatr Nurs 201642(1)7-13
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
TodaysBaby QI Safe Sleep Teaching
QI intervention median = 160 days Mothers reported receiving information 72 to 95
(increase of 24-57) 94 babies observed supine (plus 24) 88 infants in safe sleep environment
o Increase of 33 Gains maintained up to 12 months
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Social Media and Risk-Reduction Training Study (SMART) Cluster randomization 4 groups Safe sleep or breast feeding education Nursing QI and social media (mobile health) N = 1600 1263 responses (79) Safe sleep NQI and MHealth
o Supine sleep 925 o Room-sharing 859o No soft bedding 819o Pacifier use 762
Moon RY Hauck FR Colson ER et al The effect of nursing quality improvement and mobile health interventions on infant sleep practices a randomized clinical trial JAMA 2017318(4)351-359
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Hospital Initiative ComponentswwwcribsforkidsorgHospitalInitiativeToolkit INTRODUCTORY LETTER HOSPITAL INITIATIVE TOOL KIT
INSTRUCTIONS ORGANIZATIONAL CHART HOSPITAL POLICY ACKNOWLEDGMENT FORM (Engl amp
Span) SAFE SLEEP EDUCATIONAL FLIP CHART
NONCOMPLIANCE WAIVER (Engl amp Span)
NURSING EDUCATION MODULE
SAFE SLEEP POSTERS DOOR HANGERS (Engl amp Span) GRADUATION CERTIFICATE SAMPLE LETTER TO HOSPITALS SAMPLE LETTER TO PROVIDERS INFANT SAFE SLEEP BROCHURES
(Engl amp Span) PRESS KIT
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
All materials available on-lineo No major costs to the hospital
Easy on-line access for documentation
NO FEE FOR PARTICIPATION
wwwCribsforKidsorgHospitalInitiative
Tiffany Price (tpricecribsforkidsorg)
The National Safe Sleep Hospital Certification Program
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
TNmdash25 reduction in infant sleep-related deaths in 2 years
SDmdashOver 7915 Pack lsquon Plays distributed since 2012 Infant mortality rate decreased from 86 (2012) to 48 (2016)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
2009 to 2015 38 decrease in infant mortality Decreased from 135 to 84 per 1000 SUID decreased gt50 Decrease in racial disparityhttphealthybabiesbaltimorecomhome
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
And Finallyhellip
Health care providers should have open frank nonjudgmental conversations with families about their sleep practices
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Encouraging Parents to Take Action
According to the Social Learning Theory parents are more likely to recall and comply with instructions when
the health care provider
Uses a positive tone Provides adequate information Allows the parent to ask most of the questions
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Motivational Interviewing
ldquoa collaborative goal-oriented style of communication with particular attention to the language of changerdquo
o Strengthen personal motivation and commitment to a specific goal
o Explore onersquos reasons for change (barriers)o Patient generates own solutions
bull More likely to feel realisticbull Planting seeds of change
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Impact of Eliminating Sleep-Related Deaths
Every week we lose 70 children which is equivalent to 4 kindergarten classrooms
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Thank You
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Contact Information
mgoodsteinwellspanorg
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Visit Pediatric Care Online today for additional information on this and other topics
httppediatriccaresolutionsaaporgPediatric Care Online is a convenient electronic resource for immediate expert help with
virtually every pediatric clinical information need with must-have resources that are included in a comprehensive reference library and time-saving clinical tools
Donrsquot have a subscription to PCOThen take advantage of a free trial today
Call Mead Johnson Nutrition at 888363-2362 orfor more information go to
httppediatriccaresolutionsaaporgSSFree_Trialaspx
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
IMR over time Finland vs US
Slide Number 1
Disclaimer
Objectives for Todayrsquos Talk
Infant Mortality Rates for the Five Leading Causes of Infant Death in the United States 2005 and 2011
US Post-Neonatal Mortality 2015
FACT
What is SUID or SUDI
Some Causes of Deaths that Occur Suddenly and Unexpectedly during Infancy
What is SIDS
SIDS FACTS
SIDS FACTS
Triple Risk Model to Explain SIDS
Paterson DS Krous HF Kinney HC et al JAMA 2006
An Example of SIDS Pathogenesis
2016 AAP Recommendations Infant Sleep Safety
Strength of Recommendation
Recommendations Change as the Evidence Evolves
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
Correct Safe Sleep Environment
We Need to Move Beyond Back to Sleep
Sleep Position for Healthy Newborns
Sleep Position in Newborn Nursery
Sleep Position and Reflux
The Truth About Supine Sleep and Aspiration Ending the Fallacy
Title
Infant Sleep Location
Room-Share How Long Yoursquore Kidding Right
Supporting Data
More Recent Data
Why is Room-Sharing Protective
Room-Sharing and Sleep Quality
Insight Study (Paul 2017)
Insight Study (Paul 2017)
Insight Commentary (Hauck Moon)
Feeding the Baby at Night
Say NO to Couches Sofas and Cushioned Armchairs
High-Risk Bed Sharing Situations
Bedsharing in Low-Risk Breastfed Infants
Independent Review (Dr Robert Platt)
Bed Sharing
Bed Sharing
Bed Sharing with Overlay
Bed Sharing with Overlay
Bed Sharing with Overlay
Couch Sleeping
Couch Sleeping
Couch Sleeping
Unsafe Bedding NISP Trends 1993-2102
Why Use Soft Bedding
Soft Bedding for Older Infants
To Swaddle or Not to Swaddle That is the Question
Swaddling
SwaddlingmdashIs it Safe
SwaddlingmdashMore Questionshellip
wwwhealthychildrenorg
Pacifiers
Pacifiers and Breastfeeding
Baby Friendly USA Pacifiers
Addressing Sleep Deprivation
Overcoming Barriers to Change What Parents are Sayinghellip
Factors Associated With Choice of Infant Sleep Position
Slide Number 65
What is Working
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Infant Sleep Safety
Safe Sleep Nurse Modeling
Physician Advocacy
Healthcare Provider Advice to New Mothers Safe Sleep
Mason Clinical Peds 713
Bundled Intervention = Behavior Change
Hospital Unsafe Sleep Persists
Washington DC
TodaysBaby QI Safe Sleep Teaching
TodaysBaby QI Safe Sleep Teaching
Social Media and Risk-Reduction Training Study (SMART)
The National Safe Sleep Hospital Certification Program
Coordinated Education Efforts Work
Coordinated Education Efforts Work
And Finallyhellip
Encouraging Parents to Take Action
Motivational Interviewing
Impact of Eliminating Sleep-Related Deaths
Thank You
Contact Information
Slide Number 89
IMR over time Finland vs US
Column1
correct advice
55
incorrect advice
25
no advice
20
correct advice
incorrect advice
no advice
SIDS Rate
Percent Back Sleeping
1988
14
1989
139
1990
13
1991
13
1992
12
13
1993
117
17
1994
103
269
1995
087
386
1996
074
353
1997
077
531
1998
072
557
1999
067
644
2000
062
666
2001
056
716
2002
057
711
2003
053
728
2004
056
701
2005
055
722
2006
055
757
2007
057
703
2008
055
721
2009
054
741
2010
051
728
2011
048
2012
042
2013
04
2014
039
httpwwwcdcgovNCHSdatanvsrnvsr58nvsr58_19pdf
Xu JQ Kochanek KD Murphy SL Tejada-Vera B Deaths Final data for
2007
National vital statistics reports vol 58 no 19 Hyattsville MD
National Center for Health Statistics 2010
1988
1988
1989
1989
1990
1990
1991
1991
1992
1992
1993
1993
1994
1994
1995
1995
1996
1996
1997
1997
1998
1998
1999
1999
2000
2000
2001
2001
2002
2002
2003
2003
2004
2004
2005
2005
2006
2006
2007
2007
2008
2008
2009
2009
2010
2010
2011
2012
2013
2014
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Sleep Position for Healthy Newborns
Skin-to-skin care is recommended for all mothers and newborns regardless of feeding or delivery method immediately following birtho Mom should be medically stable
awake and able to respond to baby When mother needs to sleep or take
care of other needs infant should be placed supine in a bassinet
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Sleep Position in Newborn Nursery Infants in the newborn nursery
and infants who are rooming in with their parents should be placed in the supine position as soon as they are ready to be placed in the bassinet o No evidence that placing infants
on the side during the first few hours of life promotes clearance of amniotic fluid and decreases the risk of aspiration
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Sleep Position and Reflux Infants with gastroesophageal (GE) reflux
should be kept supineo Unless the risk of death from complications
of GE reflux is greater than the risk of SIDS
Supine position does not increase the risk of choking and aspiration in infants with GE reflux o Protective airway mechanisms
Do NOT elevate the head of the infantrsquos cribo Ineffective in reducing GE refluxo Infant may slide to the foot of the cribmdashmay
compromise respiration
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
The Truth About Supine Sleep and Aspiration Ending the Fallacy Orientation of the Trachea to the Esophagus
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Title
Text
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Infant Sleep Location
Infants should sleep in parentsrsquo room close to parentsrsquo bed but on a separate surface designed for infants
Ideally for the first year of life but at least for the first 6 months
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Room-Share How Long Yoursquore Kidding Right
2011 ldquoall sleep recommendations are to be followed until 1 year of agerdquo
2016 ldquoroom-sharing without bed-sharinghellipideally until 1 year of age but at least for the first 6 monthsrdquo
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Supporting Data
3 case-control studies comparing sleeping in a separate room vs room-sharingo Tappin (Scotland) AOR 326 (95 CI 103-1035)
bull Protection is significant for smoker motherso Blair (England) AOR 1049 (95 CI 426-2581)
bull Protection is significant for both smoker and nonsmoker mothers
o New Zealand Cot Death study AOR 285(95 CI 204-385)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
More Recent Data
New Zealand SUDI studyo 64 protection with room-sharing AOR 036
(95 CI 019-071)
Estimate of 50 reduction is very conservative
None of the case-control studies stratify by age (months)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Why is Room-Sharing Protective
SIDSmdashfailure to arouse More small awakenings during the night
o Stirrings movement not fully awake Postulation protective effect from small awakenings Room-sharing facilitates breastfeeding
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Room-Sharing and Sleep Quality
Volkovich room-sharing vs solitary sleepo Room-sharing mothers with more sleep disturbanceso Infants with similar sleep quality
Mao Mindell room-sharing infantsmdashmore awakenings
Montgomery-Downs Doan sleep quality in breastfeeding mothers gt to formula feeding motherso Exclusive breastfeeding = 30 min more sleep
More study needed
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Insight Study (Paul 2017)
Sleep questionnaire at 4 9 12 and 30 monthso Sleep duration overnight behaviorso Compared early vs late independent infants
At 4 monthso Equal sleep durationo Early group had better sleep consolidationo Longest stretch 46 minutes
Paul IM Hohman EE Loken E et al Mother-infant room-sharing and sleep outcomes in the INSIGHT study Pediatrics 2017140(1)e20170122
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Insight Study (Paul 2017)
At 9 monthso Longer sleep duration (40 minnight) o Better consolidation (100 min)
At 30 monthso Longer sleep duration (45 minnight)
Room-sharing 4 times more likely to transition to bed sharing overnight
Paul IM Hohman EE Loken E et al Mother-infant room-sharing and sleep outcomes in the INSIGHT study Pediatrics 2017140(1)e20170122
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Insight Commentary (Hauck Moon)
Late room-sharing mean 7 hours longest sleep Is early consolidation desirable Differences related to bedtime routines
o Early bedtimeo Number of night feedso Feeding back to sleep
Focus on the routine not early separation
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Feeding the Baby at Night Acknowledgment that parents may fall
asleep while feeding babyo Safer to feed on bed than on sofa
couch or armchair if you might fall asleep
o No pillows sheets blankets or other items that could obstruct infant breathing or cause overheating should be in bed
o Return infant back to separate sleep surface as soon as parent awakens
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Say NO to Couches Sofas and Cushioned Armchairs Never place a baby for sleep on these surfaces Never sleep with a baby on these surfaces One of the MOST dangerous places for an infant
(OR 51-669)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
High-Risk Bed Sharing Situations Age lt4 months Preterm or low birth weight Smoked during pregnancy Bed sharer is current smoker (even if not
smoking in bed) Bed sharer has usedis using meds or
substances that could impair alertness or arousal
Bed sharer is not parent (including other children)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bedsharing in Low-Risk Breastfed Infants
Blair et al AOR 16 (95 CI 096-27) o Age lt14 weekso Parents No cigarettes or alcoholo Independent of feeding method
Carpenter et al AOR 51 (95 CI 23-114) o Age lt3 months o Parents did not smokeo Mother No alcohol or drugso Breastfed infants
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Independent Review (Dr Robert Platt)
Very small numbers of low-risk babieso 24 in Blairrsquos studyo 12 in Carpenterrsquos study
Does not believe that data support definitive differences in 2 studies
Some evidence of increased risk in this group but cannot say how large the increased risk is
Cannot conclude that bed sharing in this group is safe
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Unsafe Bedding NISP Trends 1993-2102
Shapiro-Mendoza CK Colson ER Willinger M Rybin DV Camperlengo L Corwin MJ Trends in infant bedding use National Infant Sleep Position study 1993ndash2010 Pediatrics 2015135(1)10-17
Decrease from 86 to 55 Rate of decline decreases
2001-10 835 for teen mothers Predictors of adjusted OR
gt15
o Young motherso Non-white race
ethnicityo Less than college
education
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Why Use Soft Bedding
ComfortWarmtho Extrapolation of own feelingso Misinterpret firm with taut
bull Soft + taut ne firm
Safetyo Blankets pillows rolls to prevent falls
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Soft Bedding for Older Infants
Many parents recognize soft bedding is a risk Increased complacency as baby gets older Soft bedding is THE most important risk factor for
infants 4-12 months old (Colvin 2015) Infants roll into bedding and cannot extract
themselves
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
To Swaddle or Not to Swaddle That is the Question Pros
o Calms the infant promotes sleep decreases number of awakenings
o Encourages use of the supine position
Conso Increased respiratory rate and
reduced functional residual lung capacity
o Exacerbates hip dysplasia if the hips are kept in extension and adduction
o ldquoLooserdquo swaddling becomes loose bedding
o Overheating especially if the head is covered or the infant has infection
o Effects on arousability to an external stimulus remain unclear (conflicting data) There may be minimal effects of routine swaddling on arousal
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Swaddling
There is insufficient evidence to recommend routine swaddling as a strategy to reduce the incidence of SIDS
Swaddling must be correctly applied to avoid the possible hazards
Swaddling does not reduce the necessity to follow recommended safe sleep practices Ambrogio Lorenzettis Madonna and Child (1319)
Wikipedia
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
McDonnell E Moon RY Infant deaths and injuries associated with wearable blankets swaddle wraps and swaddling J Pediatr 20141641152-1156
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
SwaddlingmdashMore Questionshellip
Pease 2016 Pediatrics Pooled OR = 138
o Prone = 1299 o Side = 316o Supine = 193
Increased risk with age Limitations
o Heterogeneity definitions other risk factorsPease AS Fleming PJ Hauck FR et al Swaddling and the risk of sudden infant death syndrome a meta-analysis Pediatrics 2016137(6)e20153
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
wwwhealthychildrenorg
Swaddling (wrapping a light blanket snuggly around a baby) may help calm a crying baby If you swaddle your baby be sure to place him on his back to sleep Stop swaddling your baby when he starts to roll
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers
AAP recommendation Consider offering a pacifier at nap time and bedtime
Studies consistently demonstrate a protective effect of pacifiers on SIDS
Mechanism unknowno Dislodge within 15 to 60 minuteso Decreased arousal threshold
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers and Breastfeeding Well-designed trials
o 2 found no association among term infants
o 1 found no association among preterm infants
o 1 found slightly decreased breastfeeding duration at one month if pacifier introduced in first week of life but NO difference if pacifier introduced after one month
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Baby Friendly USA Pacifiers
Breastfeeding babies should not be given pacifiers by the staff of the facility with the exception of o Limited use to decrease pain during procedures when
the baby cannot safely be held or breastfed (pacifiers used should be discarded after these procedures)
o Babies who are being tube-fed in NICUo Other rare specific medical reasons
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Addressing Sleep Deprivation
Give parents tools to cope with fussy babies
Sleep-deprived parents may make poor judgments
Make use of tools o Swaddling side carrying
shushing swinging and sucking
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Overcoming Barriers to Change What Parents are Sayinghellip
Prone positioning fear of choking Baby sleeps ldquobetterrdquo on stomach Soft things are safer for the baby SIDS is ldquoGodrsquos willrdquo Why bother Recommendations keep changing
anyway Vigilance sleep with baby for protection
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Factors Associated With Choice of Infant Sleep Position 3300 mothers from 32 hospitals 77 usually use supine position 49 exclusive use supine position Most likely to use prone
o African-American motherso Mothers with lt high school educationo Lack of perceived controlo Personal attitudesocietal norms
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
A continuum starting in childhoodo Secondary school baby sitting classes
Pre-pregnancy Pregnancyprenatal education
o Prior to baby showerhellipldquowrong giftsrdquo In-hospital education and modeling
o Include family friends baby sitters Re-enforcement in the doctorrsquos office
o Especially between 1 to 4 months Grandparents They hold great power The general public (day cares religious leaders)
A Lifetime of Infant Sleep Safety
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Chart1
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
14
139
13
13
12
13
117
17
103
269
087
386
074
353
077
531
072
557
067
644
062
666
056
716
057
711
053
728
056
701
055
722
055
757
057
703
055
721
054
741
051
728
048
042
04
039
Sheet1
Sheet1
ampA
Page ampP
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
Sheet2
Pre-AAP recommendation Post-AAP RecommendationBack to SleepSafe to Sleep Campaign
Sheet3
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Infant Sleep Safety
Requires a consistent and repetitive message in the community to prevent accidental deaths
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Safe Sleep Nurse Modeling
People trust nurses Whatever the nurse does must
be correct and it will be imitated in the home
Fact supine positioning in the nursery can almost DOUBLE its use in the home
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Physician Advocacy
Srivatsa 1997 HCP education to new familieshellip34 reduction in prone sleeping
Eron 2009 Study of Central NY state physicianshellip30 identified incorrect safest sleep positionhellip30 do not discuss with families
Colson 2009 Only 13 mothers advised by MD to use supine positionhellip3 times more likely to position the baby properly
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Healthcare Provider Advice to New Mothers Safe Sleep
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Chart1
Column1
[]
[]
[]
55
25
20
Sheet1
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Mason Clinical Peds 713
Bundled interventiono Nursing education policy model behavior safe sleep
video posters in rooms declaration of safe sleep practice
Safe sleep environment uarr from 25 to 58 Intention in home 95 supine none ldquoco-sleepingrdquo
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bundled Intervention = Behavior Change
QUESTION GROUP p-value
ISS Study NISP
Behavior Questions n = 490 n = 1046
Baby routinely placed to sleep on back 925 73 lt 0001
Baby routinely sleeps in bassinetcrib 995 71 lt 00001
Baby sleeps under a thin sheet 992 86 lt 0001
Baby given a pacifier for sleep 741 84 lt 0001Goodstein MH Bell T Krugman SD Improving infant sleep safety through a comprehensive hospital-based program Clinical Pediatrics 201554(3)212-221
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
o Baseline Safe sleep 49 of 264 infants o Post 312 of 234 infants (P lt 001) o Extra blankets most common o Baseline 77 vs 44 post-intervention o Mean number of unsafe items reduced by 50 (P lt 001)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Washington DC
2 urban DC nurseries 26 did not believe or unsure that infant positioning
was associated with SIDS Top 3 factors influencing sleep position
o 56 PERSONAL PREFERENCE Why non-supine Clinical experience (25)
o Increase risk aspirationo Decrease sleep and comfort
Bartow KL Nursesrsquo knowledge and adherence to sudden infant death syndrome prevention guidelines Pediatr Nurs 201642(1)7-13
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
TodaysBaby QI Safe Sleep Teaching
QI intervention median = 160 days Mothers reported receiving information 72 to 95
(increase of 24-57) 94 babies observed supine (plus 24) 88 infants in safe sleep environment
o Increase of 33 Gains maintained up to 12 months
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Social Media and Risk-Reduction Training Study (SMART) Cluster randomization 4 groups Safe sleep or breast feeding education Nursing QI and social media (mobile health) N = 1600 1263 responses (79) Safe sleep NQI and MHealth
o Supine sleep 925 o Room-sharing 859o No soft bedding 819o Pacifier use 762
Moon RY Hauck FR Colson ER et al The effect of nursing quality improvement and mobile health interventions on infant sleep practices a randomized clinical trial JAMA 2017318(4)351-359
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Hospital Initiative ComponentswwwcribsforkidsorgHospitalInitiativeToolkit INTRODUCTORY LETTER HOSPITAL INITIATIVE TOOL KIT
INSTRUCTIONS ORGANIZATIONAL CHART HOSPITAL POLICY ACKNOWLEDGMENT FORM (Engl amp
Span) SAFE SLEEP EDUCATIONAL FLIP CHART
NONCOMPLIANCE WAIVER (Engl amp Span)
NURSING EDUCATION MODULE
SAFE SLEEP POSTERS DOOR HANGERS (Engl amp Span) GRADUATION CERTIFICATE SAMPLE LETTER TO HOSPITALS SAMPLE LETTER TO PROVIDERS INFANT SAFE SLEEP BROCHURES
(Engl amp Span) PRESS KIT
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
All materials available on-lineo No major costs to the hospital
Easy on-line access for documentation
NO FEE FOR PARTICIPATION
wwwCribsforKidsorgHospitalInitiative
Tiffany Price (tpricecribsforkidsorg)
The National Safe Sleep Hospital Certification Program
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
TNmdash25 reduction in infant sleep-related deaths in 2 years
SDmdashOver 7915 Pack lsquon Plays distributed since 2012 Infant mortality rate decreased from 86 (2012) to 48 (2016)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
2009 to 2015 38 decrease in infant mortality Decreased from 135 to 84 per 1000 SUID decreased gt50 Decrease in racial disparityhttphealthybabiesbaltimorecomhome
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
And Finallyhellip
Health care providers should have open frank nonjudgmental conversations with families about their sleep practices
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Encouraging Parents to Take Action
According to the Social Learning Theory parents are more likely to recall and comply with instructions when
the health care provider
Uses a positive tone Provides adequate information Allows the parent to ask most of the questions
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Motivational Interviewing
ldquoa collaborative goal-oriented style of communication with particular attention to the language of changerdquo
o Strengthen personal motivation and commitment to a specific goal
o Explore onersquos reasons for change (barriers)o Patient generates own solutions
bull More likely to feel realisticbull Planting seeds of change
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Impact of Eliminating Sleep-Related Deaths
Every week we lose 70 children which is equivalent to 4 kindergarten classrooms
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Thank You
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Contact Information
mgoodsteinwellspanorg
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Visit Pediatric Care Online today for additional information on this and other topics
httppediatriccaresolutionsaaporgPediatric Care Online is a convenient electronic resource for immediate expert help with
virtually every pediatric clinical information need with must-have resources that are included in a comprehensive reference library and time-saving clinical tools
Donrsquot have a subscription to PCOThen take advantage of a free trial today
Call Mead Johnson Nutrition at 888363-2362 orfor more information go to
httppediatriccaresolutionsaaporgSSFree_Trialaspx
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
IMR over time Finland vs US
Slide Number 1
Disclaimer
Objectives for Todayrsquos Talk
Infant Mortality Rates for the Five Leading Causes of Infant Death in the United States 2005 and 2011
US Post-Neonatal Mortality 2015
FACT
What is SUID or SUDI
Some Causes of Deaths that Occur Suddenly and Unexpectedly during Infancy
What is SIDS
SIDS FACTS
SIDS FACTS
Triple Risk Model to Explain SIDS
Paterson DS Krous HF Kinney HC et al JAMA 2006
An Example of SIDS Pathogenesis
2016 AAP Recommendations Infant Sleep Safety
Strength of Recommendation
Recommendations Change as the Evidence Evolves
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
Correct Safe Sleep Environment
We Need to Move Beyond Back to Sleep
Sleep Position for Healthy Newborns
Sleep Position in Newborn Nursery
Sleep Position and Reflux
The Truth About Supine Sleep and Aspiration Ending the Fallacy
Title
Infant Sleep Location
Room-Share How Long Yoursquore Kidding Right
Supporting Data
More Recent Data
Why is Room-Sharing Protective
Room-Sharing and Sleep Quality
Insight Study (Paul 2017)
Insight Study (Paul 2017)
Insight Commentary (Hauck Moon)
Feeding the Baby at Night
Say NO to Couches Sofas and Cushioned Armchairs
High-Risk Bed Sharing Situations
Bedsharing in Low-Risk Breastfed Infants
Independent Review (Dr Robert Platt)
Bed Sharing
Bed Sharing
Bed Sharing with Overlay
Bed Sharing with Overlay
Bed Sharing with Overlay
Couch Sleeping
Couch Sleeping
Couch Sleeping
Unsafe Bedding NISP Trends 1993-2102
Why Use Soft Bedding
Soft Bedding for Older Infants
To Swaddle or Not to Swaddle That is the Question
Swaddling
SwaddlingmdashIs it Safe
SwaddlingmdashMore Questionshellip
wwwhealthychildrenorg
Pacifiers
Pacifiers and Breastfeeding
Baby Friendly USA Pacifiers
Addressing Sleep Deprivation
Overcoming Barriers to Change What Parents are Sayinghellip
Factors Associated With Choice of Infant Sleep Position
Slide Number 65
What is Working
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Infant Sleep Safety
Safe Sleep Nurse Modeling
Physician Advocacy
Healthcare Provider Advice to New Mothers Safe Sleep
Mason Clinical Peds 713
Bundled Intervention = Behavior Change
Hospital Unsafe Sleep Persists
Washington DC
TodaysBaby QI Safe Sleep Teaching
TodaysBaby QI Safe Sleep Teaching
Social Media and Risk-Reduction Training Study (SMART)
The National Safe Sleep Hospital Certification Program
Coordinated Education Efforts Work
Coordinated Education Efforts Work
And Finallyhellip
Encouraging Parents to Take Action
Motivational Interviewing
Impact of Eliminating Sleep-Related Deaths
Thank You
Contact Information
Slide Number 89
IMR over time Finland vs US
Column1
correct advice
55
incorrect advice
25
no advice
20
correct advice
incorrect advice
no advice
SIDS Rate
Percent Back Sleeping
1988
14
1989
139
1990
13
1991
13
1992
12
13
1993
117
17
1994
103
269
1995
087
386
1996
074
353
1997
077
531
1998
072
557
1999
067
644
2000
062
666
2001
056
716
2002
057
711
2003
053
728
2004
056
701
2005
055
722
2006
055
757
2007
057
703
2008
055
721
2009
054
741
2010
051
728
2011
048
2012
042
2013
04
2014
039
httpwwwcdcgovNCHSdatanvsrnvsr58nvsr58_19pdf
Xu JQ Kochanek KD Murphy SL Tejada-Vera B Deaths Final data for
2007
National vital statistics reports vol 58 no 19 Hyattsville MD
National Center for Health Statistics 2010
1988
1988
1989
1989
1990
1990
1991
1991
1992
1992
1993
1993
1994
1994
1995
1995
1996
1996
1997
1997
1998
1998
1999
1999
2000
2000
2001
2001
2002
2002
2003
2003
2004
2004
2005
2005
2006
2006
2007
2007
2008
2008
2009
2009
2010
2010
2011
2012
2013
2014
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Sleep Position in Newborn Nursery Infants in the newborn nursery
and infants who are rooming in with their parents should be placed in the supine position as soon as they are ready to be placed in the bassinet o No evidence that placing infants
on the side during the first few hours of life promotes clearance of amniotic fluid and decreases the risk of aspiration
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Sleep Position and Reflux Infants with gastroesophageal (GE) reflux
should be kept supineo Unless the risk of death from complications
of GE reflux is greater than the risk of SIDS
Supine position does not increase the risk of choking and aspiration in infants with GE reflux o Protective airway mechanisms
Do NOT elevate the head of the infantrsquos cribo Ineffective in reducing GE refluxo Infant may slide to the foot of the cribmdashmay
compromise respiration
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
The Truth About Supine Sleep and Aspiration Ending the Fallacy Orientation of the Trachea to the Esophagus
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Title
Text
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Infant Sleep Location
Infants should sleep in parentsrsquo room close to parentsrsquo bed but on a separate surface designed for infants
Ideally for the first year of life but at least for the first 6 months
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Room-Share How Long Yoursquore Kidding Right
2011 ldquoall sleep recommendations are to be followed until 1 year of agerdquo
2016 ldquoroom-sharing without bed-sharinghellipideally until 1 year of age but at least for the first 6 monthsrdquo
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Supporting Data
3 case-control studies comparing sleeping in a separate room vs room-sharingo Tappin (Scotland) AOR 326 (95 CI 103-1035)
bull Protection is significant for smoker motherso Blair (England) AOR 1049 (95 CI 426-2581)
bull Protection is significant for both smoker and nonsmoker mothers
o New Zealand Cot Death study AOR 285(95 CI 204-385)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
More Recent Data
New Zealand SUDI studyo 64 protection with room-sharing AOR 036
(95 CI 019-071)
Estimate of 50 reduction is very conservative
None of the case-control studies stratify by age (months)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Why is Room-Sharing Protective
SIDSmdashfailure to arouse More small awakenings during the night
o Stirrings movement not fully awake Postulation protective effect from small awakenings Room-sharing facilitates breastfeeding
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Room-Sharing and Sleep Quality
Volkovich room-sharing vs solitary sleepo Room-sharing mothers with more sleep disturbanceso Infants with similar sleep quality
Mao Mindell room-sharing infantsmdashmore awakenings
Montgomery-Downs Doan sleep quality in breastfeeding mothers gt to formula feeding motherso Exclusive breastfeeding = 30 min more sleep
More study needed
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Insight Study (Paul 2017)
Sleep questionnaire at 4 9 12 and 30 monthso Sleep duration overnight behaviorso Compared early vs late independent infants
At 4 monthso Equal sleep durationo Early group had better sleep consolidationo Longest stretch 46 minutes
Paul IM Hohman EE Loken E et al Mother-infant room-sharing and sleep outcomes in the INSIGHT study Pediatrics 2017140(1)e20170122
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Insight Study (Paul 2017)
At 9 monthso Longer sleep duration (40 minnight) o Better consolidation (100 min)
At 30 monthso Longer sleep duration (45 minnight)
Room-sharing 4 times more likely to transition to bed sharing overnight
Paul IM Hohman EE Loken E et al Mother-infant room-sharing and sleep outcomes in the INSIGHT study Pediatrics 2017140(1)e20170122
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Insight Commentary (Hauck Moon)
Late room-sharing mean 7 hours longest sleep Is early consolidation desirable Differences related to bedtime routines
o Early bedtimeo Number of night feedso Feeding back to sleep
Focus on the routine not early separation
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Feeding the Baby at Night Acknowledgment that parents may fall
asleep while feeding babyo Safer to feed on bed than on sofa
couch or armchair if you might fall asleep
o No pillows sheets blankets or other items that could obstruct infant breathing or cause overheating should be in bed
o Return infant back to separate sleep surface as soon as parent awakens
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Say NO to Couches Sofas and Cushioned Armchairs Never place a baby for sleep on these surfaces Never sleep with a baby on these surfaces One of the MOST dangerous places for an infant
(OR 51-669)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
High-Risk Bed Sharing Situations Age lt4 months Preterm or low birth weight Smoked during pregnancy Bed sharer is current smoker (even if not
smoking in bed) Bed sharer has usedis using meds or
substances that could impair alertness or arousal
Bed sharer is not parent (including other children)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bedsharing in Low-Risk Breastfed Infants
Blair et al AOR 16 (95 CI 096-27) o Age lt14 weekso Parents No cigarettes or alcoholo Independent of feeding method
Carpenter et al AOR 51 (95 CI 23-114) o Age lt3 months o Parents did not smokeo Mother No alcohol or drugso Breastfed infants
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Independent Review (Dr Robert Platt)
Very small numbers of low-risk babieso 24 in Blairrsquos studyo 12 in Carpenterrsquos study
Does not believe that data support definitive differences in 2 studies
Some evidence of increased risk in this group but cannot say how large the increased risk is
Cannot conclude that bed sharing in this group is safe
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Unsafe Bedding NISP Trends 1993-2102
Shapiro-Mendoza CK Colson ER Willinger M Rybin DV Camperlengo L Corwin MJ Trends in infant bedding use National Infant Sleep Position study 1993ndash2010 Pediatrics 2015135(1)10-17
Decrease from 86 to 55 Rate of decline decreases
2001-10 835 for teen mothers Predictors of adjusted OR
gt15
o Young motherso Non-white race
ethnicityo Less than college
education
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Why Use Soft Bedding
ComfortWarmtho Extrapolation of own feelingso Misinterpret firm with taut
bull Soft + taut ne firm
Safetyo Blankets pillows rolls to prevent falls
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Soft Bedding for Older Infants
Many parents recognize soft bedding is a risk Increased complacency as baby gets older Soft bedding is THE most important risk factor for
infants 4-12 months old (Colvin 2015) Infants roll into bedding and cannot extract
themselves
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
To Swaddle or Not to Swaddle That is the Question Pros
o Calms the infant promotes sleep decreases number of awakenings
o Encourages use of the supine position
Conso Increased respiratory rate and
reduced functional residual lung capacity
o Exacerbates hip dysplasia if the hips are kept in extension and adduction
o ldquoLooserdquo swaddling becomes loose bedding
o Overheating especially if the head is covered or the infant has infection
o Effects on arousability to an external stimulus remain unclear (conflicting data) There may be minimal effects of routine swaddling on arousal
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Swaddling
There is insufficient evidence to recommend routine swaddling as a strategy to reduce the incidence of SIDS
Swaddling must be correctly applied to avoid the possible hazards
Swaddling does not reduce the necessity to follow recommended safe sleep practices Ambrogio Lorenzettis Madonna and Child (1319)
Wikipedia
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
McDonnell E Moon RY Infant deaths and injuries associated with wearable blankets swaddle wraps and swaddling J Pediatr 20141641152-1156
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
SwaddlingmdashMore Questionshellip
Pease 2016 Pediatrics Pooled OR = 138
o Prone = 1299 o Side = 316o Supine = 193
Increased risk with age Limitations
o Heterogeneity definitions other risk factorsPease AS Fleming PJ Hauck FR et al Swaddling and the risk of sudden infant death syndrome a meta-analysis Pediatrics 2016137(6)e20153
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
wwwhealthychildrenorg
Swaddling (wrapping a light blanket snuggly around a baby) may help calm a crying baby If you swaddle your baby be sure to place him on his back to sleep Stop swaddling your baby when he starts to roll
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers
AAP recommendation Consider offering a pacifier at nap time and bedtime
Studies consistently demonstrate a protective effect of pacifiers on SIDS
Mechanism unknowno Dislodge within 15 to 60 minuteso Decreased arousal threshold
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers and Breastfeeding Well-designed trials
o 2 found no association among term infants
o 1 found no association among preterm infants
o 1 found slightly decreased breastfeeding duration at one month if pacifier introduced in first week of life but NO difference if pacifier introduced after one month
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Baby Friendly USA Pacifiers
Breastfeeding babies should not be given pacifiers by the staff of the facility with the exception of o Limited use to decrease pain during procedures when
the baby cannot safely be held or breastfed (pacifiers used should be discarded after these procedures)
o Babies who are being tube-fed in NICUo Other rare specific medical reasons
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Addressing Sleep Deprivation
Give parents tools to cope with fussy babies
Sleep-deprived parents may make poor judgments
Make use of tools o Swaddling side carrying
shushing swinging and sucking
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Overcoming Barriers to Change What Parents are Sayinghellip
Prone positioning fear of choking Baby sleeps ldquobetterrdquo on stomach Soft things are safer for the baby SIDS is ldquoGodrsquos willrdquo Why bother Recommendations keep changing
anyway Vigilance sleep with baby for protection
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Factors Associated With Choice of Infant Sleep Position 3300 mothers from 32 hospitals 77 usually use supine position 49 exclusive use supine position Most likely to use prone
o African-American motherso Mothers with lt high school educationo Lack of perceived controlo Personal attitudesocietal norms
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
A continuum starting in childhoodo Secondary school baby sitting classes
Pre-pregnancy Pregnancyprenatal education
o Prior to baby showerhellipldquowrong giftsrdquo In-hospital education and modeling
o Include family friends baby sitters Re-enforcement in the doctorrsquos office
o Especially between 1 to 4 months Grandparents They hold great power The general public (day cares religious leaders)
A Lifetime of Infant Sleep Safety
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Chart1
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
14
139
13
13
12
13
117
17
103
269
087
386
074
353
077
531
072
557
067
644
062
666
056
716
057
711
053
728
056
701
055
722
055
757
057
703
055
721
054
741
051
728
048
042
04
039
Sheet1
Sheet1
ampA
Page ampP
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
Sheet2
Pre-AAP recommendation Post-AAP RecommendationBack to SleepSafe to Sleep Campaign
Sheet3
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Infant Sleep Safety
Requires a consistent and repetitive message in the community to prevent accidental deaths
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Safe Sleep Nurse Modeling
People trust nurses Whatever the nurse does must
be correct and it will be imitated in the home
Fact supine positioning in the nursery can almost DOUBLE its use in the home
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Physician Advocacy
Srivatsa 1997 HCP education to new familieshellip34 reduction in prone sleeping
Eron 2009 Study of Central NY state physicianshellip30 identified incorrect safest sleep positionhellip30 do not discuss with families
Colson 2009 Only 13 mothers advised by MD to use supine positionhellip3 times more likely to position the baby properly
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Healthcare Provider Advice to New Mothers Safe Sleep
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Chart1
Column1
[]
[]
[]
55
25
20
Sheet1
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Mason Clinical Peds 713
Bundled interventiono Nursing education policy model behavior safe sleep
video posters in rooms declaration of safe sleep practice
Safe sleep environment uarr from 25 to 58 Intention in home 95 supine none ldquoco-sleepingrdquo
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bundled Intervention = Behavior Change
QUESTION GROUP p-value
ISS Study NISP
Behavior Questions n = 490 n = 1046
Baby routinely placed to sleep on back 925 73 lt 0001
Baby routinely sleeps in bassinetcrib 995 71 lt 00001
Baby sleeps under a thin sheet 992 86 lt 0001
Baby given a pacifier for sleep 741 84 lt 0001Goodstein MH Bell T Krugman SD Improving infant sleep safety through a comprehensive hospital-based program Clinical Pediatrics 201554(3)212-221
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
o Baseline Safe sleep 49 of 264 infants o Post 312 of 234 infants (P lt 001) o Extra blankets most common o Baseline 77 vs 44 post-intervention o Mean number of unsafe items reduced by 50 (P lt 001)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Washington DC
2 urban DC nurseries 26 did not believe or unsure that infant positioning
was associated with SIDS Top 3 factors influencing sleep position
o 56 PERSONAL PREFERENCE Why non-supine Clinical experience (25)
o Increase risk aspirationo Decrease sleep and comfort
Bartow KL Nursesrsquo knowledge and adherence to sudden infant death syndrome prevention guidelines Pediatr Nurs 201642(1)7-13
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
TodaysBaby QI Safe Sleep Teaching
QI intervention median = 160 days Mothers reported receiving information 72 to 95
(increase of 24-57) 94 babies observed supine (plus 24) 88 infants in safe sleep environment
o Increase of 33 Gains maintained up to 12 months
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Social Media and Risk-Reduction Training Study (SMART) Cluster randomization 4 groups Safe sleep or breast feeding education Nursing QI and social media (mobile health) N = 1600 1263 responses (79) Safe sleep NQI and MHealth
o Supine sleep 925 o Room-sharing 859o No soft bedding 819o Pacifier use 762
Moon RY Hauck FR Colson ER et al The effect of nursing quality improvement and mobile health interventions on infant sleep practices a randomized clinical trial JAMA 2017318(4)351-359
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Hospital Initiative ComponentswwwcribsforkidsorgHospitalInitiativeToolkit INTRODUCTORY LETTER HOSPITAL INITIATIVE TOOL KIT
INSTRUCTIONS ORGANIZATIONAL CHART HOSPITAL POLICY ACKNOWLEDGMENT FORM (Engl amp
Span) SAFE SLEEP EDUCATIONAL FLIP CHART
NONCOMPLIANCE WAIVER (Engl amp Span)
NURSING EDUCATION MODULE
SAFE SLEEP POSTERS DOOR HANGERS (Engl amp Span) GRADUATION CERTIFICATE SAMPLE LETTER TO HOSPITALS SAMPLE LETTER TO PROVIDERS INFANT SAFE SLEEP BROCHURES
(Engl amp Span) PRESS KIT
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
All materials available on-lineo No major costs to the hospital
Easy on-line access for documentation
NO FEE FOR PARTICIPATION
wwwCribsforKidsorgHospitalInitiative
Tiffany Price (tpricecribsforkidsorg)
The National Safe Sleep Hospital Certification Program
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
TNmdash25 reduction in infant sleep-related deaths in 2 years
SDmdashOver 7915 Pack lsquon Plays distributed since 2012 Infant mortality rate decreased from 86 (2012) to 48 (2016)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
2009 to 2015 38 decrease in infant mortality Decreased from 135 to 84 per 1000 SUID decreased gt50 Decrease in racial disparityhttphealthybabiesbaltimorecomhome
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
And Finallyhellip
Health care providers should have open frank nonjudgmental conversations with families about their sleep practices
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Encouraging Parents to Take Action
According to the Social Learning Theory parents are more likely to recall and comply with instructions when
the health care provider
Uses a positive tone Provides adequate information Allows the parent to ask most of the questions
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Motivational Interviewing
ldquoa collaborative goal-oriented style of communication with particular attention to the language of changerdquo
o Strengthen personal motivation and commitment to a specific goal
o Explore onersquos reasons for change (barriers)o Patient generates own solutions
bull More likely to feel realisticbull Planting seeds of change
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Impact of Eliminating Sleep-Related Deaths
Every week we lose 70 children which is equivalent to 4 kindergarten classrooms
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Thank You
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Contact Information
mgoodsteinwellspanorg
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Visit Pediatric Care Online today for additional information on this and other topics
httppediatriccaresolutionsaaporgPediatric Care Online is a convenient electronic resource for immediate expert help with
virtually every pediatric clinical information need with must-have resources that are included in a comprehensive reference library and time-saving clinical tools
Donrsquot have a subscription to PCOThen take advantage of a free trial today
Call Mead Johnson Nutrition at 888363-2362 orfor more information go to
httppediatriccaresolutionsaaporgSSFree_Trialaspx
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
IMR over time Finland vs US
Slide Number 1
Disclaimer
Objectives for Todayrsquos Talk
Infant Mortality Rates for the Five Leading Causes of Infant Death in the United States 2005 and 2011
US Post-Neonatal Mortality 2015
FACT
What is SUID or SUDI
Some Causes of Deaths that Occur Suddenly and Unexpectedly during Infancy
What is SIDS
SIDS FACTS
SIDS FACTS
Triple Risk Model to Explain SIDS
Paterson DS Krous HF Kinney HC et al JAMA 2006
An Example of SIDS Pathogenesis
2016 AAP Recommendations Infant Sleep Safety
Strength of Recommendation
Recommendations Change as the Evidence Evolves
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
Correct Safe Sleep Environment
We Need to Move Beyond Back to Sleep
Sleep Position for Healthy Newborns
Sleep Position in Newborn Nursery
Sleep Position and Reflux
The Truth About Supine Sleep and Aspiration Ending the Fallacy
Title
Infant Sleep Location
Room-Share How Long Yoursquore Kidding Right
Supporting Data
More Recent Data
Why is Room-Sharing Protective
Room-Sharing and Sleep Quality
Insight Study (Paul 2017)
Insight Study (Paul 2017)
Insight Commentary (Hauck Moon)
Feeding the Baby at Night
Say NO to Couches Sofas and Cushioned Armchairs
High-Risk Bed Sharing Situations
Bedsharing in Low-Risk Breastfed Infants
Independent Review (Dr Robert Platt)
Bed Sharing
Bed Sharing
Bed Sharing with Overlay
Bed Sharing with Overlay
Bed Sharing with Overlay
Couch Sleeping
Couch Sleeping
Couch Sleeping
Unsafe Bedding NISP Trends 1993-2102
Why Use Soft Bedding
Soft Bedding for Older Infants
To Swaddle or Not to Swaddle That is the Question
Swaddling
SwaddlingmdashIs it Safe
SwaddlingmdashMore Questionshellip
wwwhealthychildrenorg
Pacifiers
Pacifiers and Breastfeeding
Baby Friendly USA Pacifiers
Addressing Sleep Deprivation
Overcoming Barriers to Change What Parents are Sayinghellip
Factors Associated With Choice of Infant Sleep Position
Slide Number 65
What is Working
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Infant Sleep Safety
Safe Sleep Nurse Modeling
Physician Advocacy
Healthcare Provider Advice to New Mothers Safe Sleep
Mason Clinical Peds 713
Bundled Intervention = Behavior Change
Hospital Unsafe Sleep Persists
Washington DC
TodaysBaby QI Safe Sleep Teaching
TodaysBaby QI Safe Sleep Teaching
Social Media and Risk-Reduction Training Study (SMART)
The National Safe Sleep Hospital Certification Program
Coordinated Education Efforts Work
Coordinated Education Efforts Work
And Finallyhellip
Encouraging Parents to Take Action
Motivational Interviewing
Impact of Eliminating Sleep-Related Deaths
Thank You
Contact Information
Slide Number 89
IMR over time Finland vs US
Column1
correct advice
55
incorrect advice
25
no advice
20
correct advice
incorrect advice
no advice
SIDS Rate
Percent Back Sleeping
1988
14
1989
139
1990
13
1991
13
1992
12
13
1993
117
17
1994
103
269
1995
087
386
1996
074
353
1997
077
531
1998
072
557
1999
067
644
2000
062
666
2001
056
716
2002
057
711
2003
053
728
2004
056
701
2005
055
722
2006
055
757
2007
057
703
2008
055
721
2009
054
741
2010
051
728
2011
048
2012
042
2013
04
2014
039
httpwwwcdcgovNCHSdatanvsrnvsr58nvsr58_19pdf
Xu JQ Kochanek KD Murphy SL Tejada-Vera B Deaths Final data for
2007
National vital statistics reports vol 58 no 19 Hyattsville MD
National Center for Health Statistics 2010
1988
1988
1989
1989
1990
1990
1991
1991
1992
1992
1993
1993
1994
1994
1995
1995
1996
1996
1997
1997
1998
1998
1999
1999
2000
2000
2001
2001
2002
2002
2003
2003
2004
2004
2005
2005
2006
2006
2007
2007
2008
2008
2009
2009
2010
2010
2011
2012
2013
2014
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Sleep Position and Reflux Infants with gastroesophageal (GE) reflux
should be kept supineo Unless the risk of death from complications
of GE reflux is greater than the risk of SIDS
Supine position does not increase the risk of choking and aspiration in infants with GE reflux o Protective airway mechanisms
Do NOT elevate the head of the infantrsquos cribo Ineffective in reducing GE refluxo Infant may slide to the foot of the cribmdashmay
compromise respiration
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
The Truth About Supine Sleep and Aspiration Ending the Fallacy Orientation of the Trachea to the Esophagus
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Title
Text
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Infant Sleep Location
Infants should sleep in parentsrsquo room close to parentsrsquo bed but on a separate surface designed for infants
Ideally for the first year of life but at least for the first 6 months
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Room-Share How Long Yoursquore Kidding Right
2011 ldquoall sleep recommendations are to be followed until 1 year of agerdquo
2016 ldquoroom-sharing without bed-sharinghellipideally until 1 year of age but at least for the first 6 monthsrdquo
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Supporting Data
3 case-control studies comparing sleeping in a separate room vs room-sharingo Tappin (Scotland) AOR 326 (95 CI 103-1035)
bull Protection is significant for smoker motherso Blair (England) AOR 1049 (95 CI 426-2581)
bull Protection is significant for both smoker and nonsmoker mothers
o New Zealand Cot Death study AOR 285(95 CI 204-385)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
More Recent Data
New Zealand SUDI studyo 64 protection with room-sharing AOR 036
(95 CI 019-071)
Estimate of 50 reduction is very conservative
None of the case-control studies stratify by age (months)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Why is Room-Sharing Protective
SIDSmdashfailure to arouse More small awakenings during the night
o Stirrings movement not fully awake Postulation protective effect from small awakenings Room-sharing facilitates breastfeeding
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Room-Sharing and Sleep Quality
Volkovich room-sharing vs solitary sleepo Room-sharing mothers with more sleep disturbanceso Infants with similar sleep quality
Mao Mindell room-sharing infantsmdashmore awakenings
Montgomery-Downs Doan sleep quality in breastfeeding mothers gt to formula feeding motherso Exclusive breastfeeding = 30 min more sleep
More study needed
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Insight Study (Paul 2017)
Sleep questionnaire at 4 9 12 and 30 monthso Sleep duration overnight behaviorso Compared early vs late independent infants
At 4 monthso Equal sleep durationo Early group had better sleep consolidationo Longest stretch 46 minutes
Paul IM Hohman EE Loken E et al Mother-infant room-sharing and sleep outcomes in the INSIGHT study Pediatrics 2017140(1)e20170122
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Insight Study (Paul 2017)
At 9 monthso Longer sleep duration (40 minnight) o Better consolidation (100 min)
At 30 monthso Longer sleep duration (45 minnight)
Room-sharing 4 times more likely to transition to bed sharing overnight
Paul IM Hohman EE Loken E et al Mother-infant room-sharing and sleep outcomes in the INSIGHT study Pediatrics 2017140(1)e20170122
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Insight Commentary (Hauck Moon)
Late room-sharing mean 7 hours longest sleep Is early consolidation desirable Differences related to bedtime routines
o Early bedtimeo Number of night feedso Feeding back to sleep
Focus on the routine not early separation
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Feeding the Baby at Night Acknowledgment that parents may fall
asleep while feeding babyo Safer to feed on bed than on sofa
couch or armchair if you might fall asleep
o No pillows sheets blankets or other items that could obstruct infant breathing or cause overheating should be in bed
o Return infant back to separate sleep surface as soon as parent awakens
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Say NO to Couches Sofas and Cushioned Armchairs Never place a baby for sleep on these surfaces Never sleep with a baby on these surfaces One of the MOST dangerous places for an infant
(OR 51-669)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
High-Risk Bed Sharing Situations Age lt4 months Preterm or low birth weight Smoked during pregnancy Bed sharer is current smoker (even if not
smoking in bed) Bed sharer has usedis using meds or
substances that could impair alertness or arousal
Bed sharer is not parent (including other children)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bedsharing in Low-Risk Breastfed Infants
Blair et al AOR 16 (95 CI 096-27) o Age lt14 weekso Parents No cigarettes or alcoholo Independent of feeding method
Carpenter et al AOR 51 (95 CI 23-114) o Age lt3 months o Parents did not smokeo Mother No alcohol or drugso Breastfed infants
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Independent Review (Dr Robert Platt)
Very small numbers of low-risk babieso 24 in Blairrsquos studyo 12 in Carpenterrsquos study
Does not believe that data support definitive differences in 2 studies
Some evidence of increased risk in this group but cannot say how large the increased risk is
Cannot conclude that bed sharing in this group is safe
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Unsafe Bedding NISP Trends 1993-2102
Shapiro-Mendoza CK Colson ER Willinger M Rybin DV Camperlengo L Corwin MJ Trends in infant bedding use National Infant Sleep Position study 1993ndash2010 Pediatrics 2015135(1)10-17
Decrease from 86 to 55 Rate of decline decreases
2001-10 835 for teen mothers Predictors of adjusted OR
gt15
o Young motherso Non-white race
ethnicityo Less than college
education
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Why Use Soft Bedding
ComfortWarmtho Extrapolation of own feelingso Misinterpret firm with taut
bull Soft + taut ne firm
Safetyo Blankets pillows rolls to prevent falls
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Soft Bedding for Older Infants
Many parents recognize soft bedding is a risk Increased complacency as baby gets older Soft bedding is THE most important risk factor for
infants 4-12 months old (Colvin 2015) Infants roll into bedding and cannot extract
themselves
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
To Swaddle or Not to Swaddle That is the Question Pros
o Calms the infant promotes sleep decreases number of awakenings
o Encourages use of the supine position
Conso Increased respiratory rate and
reduced functional residual lung capacity
o Exacerbates hip dysplasia if the hips are kept in extension and adduction
o ldquoLooserdquo swaddling becomes loose bedding
o Overheating especially if the head is covered or the infant has infection
o Effects on arousability to an external stimulus remain unclear (conflicting data) There may be minimal effects of routine swaddling on arousal
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Swaddling
There is insufficient evidence to recommend routine swaddling as a strategy to reduce the incidence of SIDS
Swaddling must be correctly applied to avoid the possible hazards
Swaddling does not reduce the necessity to follow recommended safe sleep practices Ambrogio Lorenzettis Madonna and Child (1319)
Wikipedia
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
McDonnell E Moon RY Infant deaths and injuries associated with wearable blankets swaddle wraps and swaddling J Pediatr 20141641152-1156
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
SwaddlingmdashMore Questionshellip
Pease 2016 Pediatrics Pooled OR = 138
o Prone = 1299 o Side = 316o Supine = 193
Increased risk with age Limitations
o Heterogeneity definitions other risk factorsPease AS Fleming PJ Hauck FR et al Swaddling and the risk of sudden infant death syndrome a meta-analysis Pediatrics 2016137(6)e20153
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
wwwhealthychildrenorg
Swaddling (wrapping a light blanket snuggly around a baby) may help calm a crying baby If you swaddle your baby be sure to place him on his back to sleep Stop swaddling your baby when he starts to roll
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers
AAP recommendation Consider offering a pacifier at nap time and bedtime
Studies consistently demonstrate a protective effect of pacifiers on SIDS
Mechanism unknowno Dislodge within 15 to 60 minuteso Decreased arousal threshold
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers and Breastfeeding Well-designed trials
o 2 found no association among term infants
o 1 found no association among preterm infants
o 1 found slightly decreased breastfeeding duration at one month if pacifier introduced in first week of life but NO difference if pacifier introduced after one month
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Baby Friendly USA Pacifiers
Breastfeeding babies should not be given pacifiers by the staff of the facility with the exception of o Limited use to decrease pain during procedures when
the baby cannot safely be held or breastfed (pacifiers used should be discarded after these procedures)
o Babies who are being tube-fed in NICUo Other rare specific medical reasons
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Addressing Sleep Deprivation
Give parents tools to cope with fussy babies
Sleep-deprived parents may make poor judgments
Make use of tools o Swaddling side carrying
shushing swinging and sucking
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Overcoming Barriers to Change What Parents are Sayinghellip
Prone positioning fear of choking Baby sleeps ldquobetterrdquo on stomach Soft things are safer for the baby SIDS is ldquoGodrsquos willrdquo Why bother Recommendations keep changing
anyway Vigilance sleep with baby for protection
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Factors Associated With Choice of Infant Sleep Position 3300 mothers from 32 hospitals 77 usually use supine position 49 exclusive use supine position Most likely to use prone
o African-American motherso Mothers with lt high school educationo Lack of perceived controlo Personal attitudesocietal norms
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
A continuum starting in childhoodo Secondary school baby sitting classes
Pre-pregnancy Pregnancyprenatal education
o Prior to baby showerhellipldquowrong giftsrdquo In-hospital education and modeling
o Include family friends baby sitters Re-enforcement in the doctorrsquos office
o Especially between 1 to 4 months Grandparents They hold great power The general public (day cares religious leaders)
A Lifetime of Infant Sleep Safety
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Chart1
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
14
139
13
13
12
13
117
17
103
269
087
386
074
353
077
531
072
557
067
644
062
666
056
716
057
711
053
728
056
701
055
722
055
757
057
703
055
721
054
741
051
728
048
042
04
039
Sheet1
Sheet1
ampA
Page ampP
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
Sheet2
Pre-AAP recommendation Post-AAP RecommendationBack to SleepSafe to Sleep Campaign
Sheet3
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Infant Sleep Safety
Requires a consistent and repetitive message in the community to prevent accidental deaths
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Safe Sleep Nurse Modeling
People trust nurses Whatever the nurse does must
be correct and it will be imitated in the home
Fact supine positioning in the nursery can almost DOUBLE its use in the home
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Physician Advocacy
Srivatsa 1997 HCP education to new familieshellip34 reduction in prone sleeping
Eron 2009 Study of Central NY state physicianshellip30 identified incorrect safest sleep positionhellip30 do not discuss with families
Colson 2009 Only 13 mothers advised by MD to use supine positionhellip3 times more likely to position the baby properly
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Healthcare Provider Advice to New Mothers Safe Sleep
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Chart1
Column1
[]
[]
[]
55
25
20
Sheet1
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Mason Clinical Peds 713
Bundled interventiono Nursing education policy model behavior safe sleep
video posters in rooms declaration of safe sleep practice
Safe sleep environment uarr from 25 to 58 Intention in home 95 supine none ldquoco-sleepingrdquo
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bundled Intervention = Behavior Change
QUESTION GROUP p-value
ISS Study NISP
Behavior Questions n = 490 n = 1046
Baby routinely placed to sleep on back 925 73 lt 0001
Baby routinely sleeps in bassinetcrib 995 71 lt 00001
Baby sleeps under a thin sheet 992 86 lt 0001
Baby given a pacifier for sleep 741 84 lt 0001Goodstein MH Bell T Krugman SD Improving infant sleep safety through a comprehensive hospital-based program Clinical Pediatrics 201554(3)212-221
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
o Baseline Safe sleep 49 of 264 infants o Post 312 of 234 infants (P lt 001) o Extra blankets most common o Baseline 77 vs 44 post-intervention o Mean number of unsafe items reduced by 50 (P lt 001)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Washington DC
2 urban DC nurseries 26 did not believe or unsure that infant positioning
was associated with SIDS Top 3 factors influencing sleep position
o 56 PERSONAL PREFERENCE Why non-supine Clinical experience (25)
o Increase risk aspirationo Decrease sleep and comfort
Bartow KL Nursesrsquo knowledge and adherence to sudden infant death syndrome prevention guidelines Pediatr Nurs 201642(1)7-13
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
TodaysBaby QI Safe Sleep Teaching
QI intervention median = 160 days Mothers reported receiving information 72 to 95
(increase of 24-57) 94 babies observed supine (plus 24) 88 infants in safe sleep environment
o Increase of 33 Gains maintained up to 12 months
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Social Media and Risk-Reduction Training Study (SMART) Cluster randomization 4 groups Safe sleep or breast feeding education Nursing QI and social media (mobile health) N = 1600 1263 responses (79) Safe sleep NQI and MHealth
o Supine sleep 925 o Room-sharing 859o No soft bedding 819o Pacifier use 762
Moon RY Hauck FR Colson ER et al The effect of nursing quality improvement and mobile health interventions on infant sleep practices a randomized clinical trial JAMA 2017318(4)351-359
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Hospital Initiative ComponentswwwcribsforkidsorgHospitalInitiativeToolkit INTRODUCTORY LETTER HOSPITAL INITIATIVE TOOL KIT
INSTRUCTIONS ORGANIZATIONAL CHART HOSPITAL POLICY ACKNOWLEDGMENT FORM (Engl amp
Span) SAFE SLEEP EDUCATIONAL FLIP CHART
NONCOMPLIANCE WAIVER (Engl amp Span)
NURSING EDUCATION MODULE
SAFE SLEEP POSTERS DOOR HANGERS (Engl amp Span) GRADUATION CERTIFICATE SAMPLE LETTER TO HOSPITALS SAMPLE LETTER TO PROVIDERS INFANT SAFE SLEEP BROCHURES
(Engl amp Span) PRESS KIT
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
All materials available on-lineo No major costs to the hospital
Easy on-line access for documentation
NO FEE FOR PARTICIPATION
wwwCribsforKidsorgHospitalInitiative
Tiffany Price (tpricecribsforkidsorg)
The National Safe Sleep Hospital Certification Program
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
TNmdash25 reduction in infant sleep-related deaths in 2 years
SDmdashOver 7915 Pack lsquon Plays distributed since 2012 Infant mortality rate decreased from 86 (2012) to 48 (2016)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
2009 to 2015 38 decrease in infant mortality Decreased from 135 to 84 per 1000 SUID decreased gt50 Decrease in racial disparityhttphealthybabiesbaltimorecomhome
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
And Finallyhellip
Health care providers should have open frank nonjudgmental conversations with families about their sleep practices
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Encouraging Parents to Take Action
According to the Social Learning Theory parents are more likely to recall and comply with instructions when
the health care provider
Uses a positive tone Provides adequate information Allows the parent to ask most of the questions
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Motivational Interviewing
ldquoa collaborative goal-oriented style of communication with particular attention to the language of changerdquo
o Strengthen personal motivation and commitment to a specific goal
o Explore onersquos reasons for change (barriers)o Patient generates own solutions
bull More likely to feel realisticbull Planting seeds of change
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Impact of Eliminating Sleep-Related Deaths
Every week we lose 70 children which is equivalent to 4 kindergarten classrooms
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Thank You
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Contact Information
mgoodsteinwellspanorg
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Visit Pediatric Care Online today for additional information on this and other topics
httppediatriccaresolutionsaaporgPediatric Care Online is a convenient electronic resource for immediate expert help with
virtually every pediatric clinical information need with must-have resources that are included in a comprehensive reference library and time-saving clinical tools
Donrsquot have a subscription to PCOThen take advantage of a free trial today
Call Mead Johnson Nutrition at 888363-2362 orfor more information go to
httppediatriccaresolutionsaaporgSSFree_Trialaspx
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
IMR over time Finland vs US
Slide Number 1
Disclaimer
Objectives for Todayrsquos Talk
Infant Mortality Rates for the Five Leading Causes of Infant Death in the United States 2005 and 2011
US Post-Neonatal Mortality 2015
FACT
What is SUID or SUDI
Some Causes of Deaths that Occur Suddenly and Unexpectedly during Infancy
What is SIDS
SIDS FACTS
SIDS FACTS
Triple Risk Model to Explain SIDS
Paterson DS Krous HF Kinney HC et al JAMA 2006
An Example of SIDS Pathogenesis
2016 AAP Recommendations Infant Sleep Safety
Strength of Recommendation
Recommendations Change as the Evidence Evolves
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
Correct Safe Sleep Environment
We Need to Move Beyond Back to Sleep
Sleep Position for Healthy Newborns
Sleep Position in Newborn Nursery
Sleep Position and Reflux
The Truth About Supine Sleep and Aspiration Ending the Fallacy
Title
Infant Sleep Location
Room-Share How Long Yoursquore Kidding Right
Supporting Data
More Recent Data
Why is Room-Sharing Protective
Room-Sharing and Sleep Quality
Insight Study (Paul 2017)
Insight Study (Paul 2017)
Insight Commentary (Hauck Moon)
Feeding the Baby at Night
Say NO to Couches Sofas and Cushioned Armchairs
High-Risk Bed Sharing Situations
Bedsharing in Low-Risk Breastfed Infants
Independent Review (Dr Robert Platt)
Bed Sharing
Bed Sharing
Bed Sharing with Overlay
Bed Sharing with Overlay
Bed Sharing with Overlay
Couch Sleeping
Couch Sleeping
Couch Sleeping
Unsafe Bedding NISP Trends 1993-2102
Why Use Soft Bedding
Soft Bedding for Older Infants
To Swaddle or Not to Swaddle That is the Question
Swaddling
SwaddlingmdashIs it Safe
SwaddlingmdashMore Questionshellip
wwwhealthychildrenorg
Pacifiers
Pacifiers and Breastfeeding
Baby Friendly USA Pacifiers
Addressing Sleep Deprivation
Overcoming Barriers to Change What Parents are Sayinghellip
Factors Associated With Choice of Infant Sleep Position
Slide Number 65
What is Working
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Infant Sleep Safety
Safe Sleep Nurse Modeling
Physician Advocacy
Healthcare Provider Advice to New Mothers Safe Sleep
Mason Clinical Peds 713
Bundled Intervention = Behavior Change
Hospital Unsafe Sleep Persists
Washington DC
TodaysBaby QI Safe Sleep Teaching
TodaysBaby QI Safe Sleep Teaching
Social Media and Risk-Reduction Training Study (SMART)
The National Safe Sleep Hospital Certification Program
Coordinated Education Efforts Work
Coordinated Education Efforts Work
And Finallyhellip
Encouraging Parents to Take Action
Motivational Interviewing
Impact of Eliminating Sleep-Related Deaths
Thank You
Contact Information
Slide Number 89
IMR over time Finland vs US
Column1
correct advice
55
incorrect advice
25
no advice
20
correct advice
incorrect advice
no advice
SIDS Rate
Percent Back Sleeping
1988
14
1989
139
1990
13
1991
13
1992
12
13
1993
117
17
1994
103
269
1995
087
386
1996
074
353
1997
077
531
1998
072
557
1999
067
644
2000
062
666
2001
056
716
2002
057
711
2003
053
728
2004
056
701
2005
055
722
2006
055
757
2007
057
703
2008
055
721
2009
054
741
2010
051
728
2011
048
2012
042
2013
04
2014
039
httpwwwcdcgovNCHSdatanvsrnvsr58nvsr58_19pdf
Xu JQ Kochanek KD Murphy SL Tejada-Vera B Deaths Final data for
2007
National vital statistics reports vol 58 no 19 Hyattsville MD
National Center for Health Statistics 2010
1988
1988
1989
1989
1990
1990
1991
1991
1992
1992
1993
1993
1994
1994
1995
1995
1996
1996
1997
1997
1998
1998
1999
1999
2000
2000
2001
2001
2002
2002
2003
2003
2004
2004
2005
2005
2006
2006
2007
2007
2008
2008
2009
2009
2010
2010
2011
2012
2013
2014
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
The Truth About Supine Sleep and Aspiration Ending the Fallacy Orientation of the Trachea to the Esophagus
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Title
Text
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Infant Sleep Location
Infants should sleep in parentsrsquo room close to parentsrsquo bed but on a separate surface designed for infants
Ideally for the first year of life but at least for the first 6 months
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Room-Share How Long Yoursquore Kidding Right
2011 ldquoall sleep recommendations are to be followed until 1 year of agerdquo
2016 ldquoroom-sharing without bed-sharinghellipideally until 1 year of age but at least for the first 6 monthsrdquo
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Supporting Data
3 case-control studies comparing sleeping in a separate room vs room-sharingo Tappin (Scotland) AOR 326 (95 CI 103-1035)
bull Protection is significant for smoker motherso Blair (England) AOR 1049 (95 CI 426-2581)
bull Protection is significant for both smoker and nonsmoker mothers
o New Zealand Cot Death study AOR 285(95 CI 204-385)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
More Recent Data
New Zealand SUDI studyo 64 protection with room-sharing AOR 036
(95 CI 019-071)
Estimate of 50 reduction is very conservative
None of the case-control studies stratify by age (months)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Why is Room-Sharing Protective
SIDSmdashfailure to arouse More small awakenings during the night
o Stirrings movement not fully awake Postulation protective effect from small awakenings Room-sharing facilitates breastfeeding
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Room-Sharing and Sleep Quality
Volkovich room-sharing vs solitary sleepo Room-sharing mothers with more sleep disturbanceso Infants with similar sleep quality
Mao Mindell room-sharing infantsmdashmore awakenings
Montgomery-Downs Doan sleep quality in breastfeeding mothers gt to formula feeding motherso Exclusive breastfeeding = 30 min more sleep
More study needed
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Insight Study (Paul 2017)
Sleep questionnaire at 4 9 12 and 30 monthso Sleep duration overnight behaviorso Compared early vs late independent infants
At 4 monthso Equal sleep durationo Early group had better sleep consolidationo Longest stretch 46 minutes
Paul IM Hohman EE Loken E et al Mother-infant room-sharing and sleep outcomes in the INSIGHT study Pediatrics 2017140(1)e20170122
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Insight Study (Paul 2017)
At 9 monthso Longer sleep duration (40 minnight) o Better consolidation (100 min)
At 30 monthso Longer sleep duration (45 minnight)
Room-sharing 4 times more likely to transition to bed sharing overnight
Paul IM Hohman EE Loken E et al Mother-infant room-sharing and sleep outcomes in the INSIGHT study Pediatrics 2017140(1)e20170122
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Insight Commentary (Hauck Moon)
Late room-sharing mean 7 hours longest sleep Is early consolidation desirable Differences related to bedtime routines
o Early bedtimeo Number of night feedso Feeding back to sleep
Focus on the routine not early separation
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Feeding the Baby at Night Acknowledgment that parents may fall
asleep while feeding babyo Safer to feed on bed than on sofa
couch or armchair if you might fall asleep
o No pillows sheets blankets or other items that could obstruct infant breathing or cause overheating should be in bed
o Return infant back to separate sleep surface as soon as parent awakens
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Say NO to Couches Sofas and Cushioned Armchairs Never place a baby for sleep on these surfaces Never sleep with a baby on these surfaces One of the MOST dangerous places for an infant
(OR 51-669)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
High-Risk Bed Sharing Situations Age lt4 months Preterm or low birth weight Smoked during pregnancy Bed sharer is current smoker (even if not
smoking in bed) Bed sharer has usedis using meds or
substances that could impair alertness or arousal
Bed sharer is not parent (including other children)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bedsharing in Low-Risk Breastfed Infants
Blair et al AOR 16 (95 CI 096-27) o Age lt14 weekso Parents No cigarettes or alcoholo Independent of feeding method
Carpenter et al AOR 51 (95 CI 23-114) o Age lt3 months o Parents did not smokeo Mother No alcohol or drugso Breastfed infants
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Independent Review (Dr Robert Platt)
Very small numbers of low-risk babieso 24 in Blairrsquos studyo 12 in Carpenterrsquos study
Does not believe that data support definitive differences in 2 studies
Some evidence of increased risk in this group but cannot say how large the increased risk is
Cannot conclude that bed sharing in this group is safe
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Unsafe Bedding NISP Trends 1993-2102
Shapiro-Mendoza CK Colson ER Willinger M Rybin DV Camperlengo L Corwin MJ Trends in infant bedding use National Infant Sleep Position study 1993ndash2010 Pediatrics 2015135(1)10-17
Decrease from 86 to 55 Rate of decline decreases
2001-10 835 for teen mothers Predictors of adjusted OR
gt15
o Young motherso Non-white race
ethnicityo Less than college
education
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Why Use Soft Bedding
ComfortWarmtho Extrapolation of own feelingso Misinterpret firm with taut
bull Soft + taut ne firm
Safetyo Blankets pillows rolls to prevent falls
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Soft Bedding for Older Infants
Many parents recognize soft bedding is a risk Increased complacency as baby gets older Soft bedding is THE most important risk factor for
infants 4-12 months old (Colvin 2015) Infants roll into bedding and cannot extract
themselves
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
To Swaddle or Not to Swaddle That is the Question Pros
o Calms the infant promotes sleep decreases number of awakenings
o Encourages use of the supine position
Conso Increased respiratory rate and
reduced functional residual lung capacity
o Exacerbates hip dysplasia if the hips are kept in extension and adduction
o ldquoLooserdquo swaddling becomes loose bedding
o Overheating especially if the head is covered or the infant has infection
o Effects on arousability to an external stimulus remain unclear (conflicting data) There may be minimal effects of routine swaddling on arousal
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Swaddling
There is insufficient evidence to recommend routine swaddling as a strategy to reduce the incidence of SIDS
Swaddling must be correctly applied to avoid the possible hazards
Swaddling does not reduce the necessity to follow recommended safe sleep practices Ambrogio Lorenzettis Madonna and Child (1319)
Wikipedia
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
McDonnell E Moon RY Infant deaths and injuries associated with wearable blankets swaddle wraps and swaddling J Pediatr 20141641152-1156
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
SwaddlingmdashMore Questionshellip
Pease 2016 Pediatrics Pooled OR = 138
o Prone = 1299 o Side = 316o Supine = 193
Increased risk with age Limitations
o Heterogeneity definitions other risk factorsPease AS Fleming PJ Hauck FR et al Swaddling and the risk of sudden infant death syndrome a meta-analysis Pediatrics 2016137(6)e20153
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
wwwhealthychildrenorg
Swaddling (wrapping a light blanket snuggly around a baby) may help calm a crying baby If you swaddle your baby be sure to place him on his back to sleep Stop swaddling your baby when he starts to roll
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers
AAP recommendation Consider offering a pacifier at nap time and bedtime
Studies consistently demonstrate a protective effect of pacifiers on SIDS
Mechanism unknowno Dislodge within 15 to 60 minuteso Decreased arousal threshold
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers and Breastfeeding Well-designed trials
o 2 found no association among term infants
o 1 found no association among preterm infants
o 1 found slightly decreased breastfeeding duration at one month if pacifier introduced in first week of life but NO difference if pacifier introduced after one month
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Baby Friendly USA Pacifiers
Breastfeeding babies should not be given pacifiers by the staff of the facility with the exception of o Limited use to decrease pain during procedures when
the baby cannot safely be held or breastfed (pacifiers used should be discarded after these procedures)
o Babies who are being tube-fed in NICUo Other rare specific medical reasons
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Addressing Sleep Deprivation
Give parents tools to cope with fussy babies
Sleep-deprived parents may make poor judgments
Make use of tools o Swaddling side carrying
shushing swinging and sucking
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Overcoming Barriers to Change What Parents are Sayinghellip
Prone positioning fear of choking Baby sleeps ldquobetterrdquo on stomach Soft things are safer for the baby SIDS is ldquoGodrsquos willrdquo Why bother Recommendations keep changing
anyway Vigilance sleep with baby for protection
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Factors Associated With Choice of Infant Sleep Position 3300 mothers from 32 hospitals 77 usually use supine position 49 exclusive use supine position Most likely to use prone
o African-American motherso Mothers with lt high school educationo Lack of perceived controlo Personal attitudesocietal norms
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
A continuum starting in childhoodo Secondary school baby sitting classes
Pre-pregnancy Pregnancyprenatal education
o Prior to baby showerhellipldquowrong giftsrdquo In-hospital education and modeling
o Include family friends baby sitters Re-enforcement in the doctorrsquos office
o Especially between 1 to 4 months Grandparents They hold great power The general public (day cares religious leaders)
A Lifetime of Infant Sleep Safety
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Chart1
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
14
139
13
13
12
13
117
17
103
269
087
386
074
353
077
531
072
557
067
644
062
666
056
716
057
711
053
728
056
701
055
722
055
757
057
703
055
721
054
741
051
728
048
042
04
039
Sheet1
Sheet1
ampA
Page ampP
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
Sheet2
Pre-AAP recommendation Post-AAP RecommendationBack to SleepSafe to Sleep Campaign
Sheet3
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Infant Sleep Safety
Requires a consistent and repetitive message in the community to prevent accidental deaths
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Safe Sleep Nurse Modeling
People trust nurses Whatever the nurse does must
be correct and it will be imitated in the home
Fact supine positioning in the nursery can almost DOUBLE its use in the home
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Physician Advocacy
Srivatsa 1997 HCP education to new familieshellip34 reduction in prone sleeping
Eron 2009 Study of Central NY state physicianshellip30 identified incorrect safest sleep positionhellip30 do not discuss with families
Colson 2009 Only 13 mothers advised by MD to use supine positionhellip3 times more likely to position the baby properly
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Healthcare Provider Advice to New Mothers Safe Sleep
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Chart1
Column1
[]
[]
[]
55
25
20
Sheet1
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Mason Clinical Peds 713
Bundled interventiono Nursing education policy model behavior safe sleep
video posters in rooms declaration of safe sleep practice
Safe sleep environment uarr from 25 to 58 Intention in home 95 supine none ldquoco-sleepingrdquo
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bundled Intervention = Behavior Change
QUESTION GROUP p-value
ISS Study NISP
Behavior Questions n = 490 n = 1046
Baby routinely placed to sleep on back 925 73 lt 0001
Baby routinely sleeps in bassinetcrib 995 71 lt 00001
Baby sleeps under a thin sheet 992 86 lt 0001
Baby given a pacifier for sleep 741 84 lt 0001Goodstein MH Bell T Krugman SD Improving infant sleep safety through a comprehensive hospital-based program Clinical Pediatrics 201554(3)212-221
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
o Baseline Safe sleep 49 of 264 infants o Post 312 of 234 infants (P lt 001) o Extra blankets most common o Baseline 77 vs 44 post-intervention o Mean number of unsafe items reduced by 50 (P lt 001)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Washington DC
2 urban DC nurseries 26 did not believe or unsure that infant positioning
was associated with SIDS Top 3 factors influencing sleep position
o 56 PERSONAL PREFERENCE Why non-supine Clinical experience (25)
o Increase risk aspirationo Decrease sleep and comfort
Bartow KL Nursesrsquo knowledge and adherence to sudden infant death syndrome prevention guidelines Pediatr Nurs 201642(1)7-13
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
TodaysBaby QI Safe Sleep Teaching
QI intervention median = 160 days Mothers reported receiving information 72 to 95
(increase of 24-57) 94 babies observed supine (plus 24) 88 infants in safe sleep environment
o Increase of 33 Gains maintained up to 12 months
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Social Media and Risk-Reduction Training Study (SMART) Cluster randomization 4 groups Safe sleep or breast feeding education Nursing QI and social media (mobile health) N = 1600 1263 responses (79) Safe sleep NQI and MHealth
o Supine sleep 925 o Room-sharing 859o No soft bedding 819o Pacifier use 762
Moon RY Hauck FR Colson ER et al The effect of nursing quality improvement and mobile health interventions on infant sleep practices a randomized clinical trial JAMA 2017318(4)351-359
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Hospital Initiative ComponentswwwcribsforkidsorgHospitalInitiativeToolkit INTRODUCTORY LETTER HOSPITAL INITIATIVE TOOL KIT
INSTRUCTIONS ORGANIZATIONAL CHART HOSPITAL POLICY ACKNOWLEDGMENT FORM (Engl amp
Span) SAFE SLEEP EDUCATIONAL FLIP CHART
NONCOMPLIANCE WAIVER (Engl amp Span)
NURSING EDUCATION MODULE
SAFE SLEEP POSTERS DOOR HANGERS (Engl amp Span) GRADUATION CERTIFICATE SAMPLE LETTER TO HOSPITALS SAMPLE LETTER TO PROVIDERS INFANT SAFE SLEEP BROCHURES
(Engl amp Span) PRESS KIT
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
All materials available on-lineo No major costs to the hospital
Easy on-line access for documentation
NO FEE FOR PARTICIPATION
wwwCribsforKidsorgHospitalInitiative
Tiffany Price (tpricecribsforkidsorg)
The National Safe Sleep Hospital Certification Program
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
TNmdash25 reduction in infant sleep-related deaths in 2 years
SDmdashOver 7915 Pack lsquon Plays distributed since 2012 Infant mortality rate decreased from 86 (2012) to 48 (2016)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
2009 to 2015 38 decrease in infant mortality Decreased from 135 to 84 per 1000 SUID decreased gt50 Decrease in racial disparityhttphealthybabiesbaltimorecomhome
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
And Finallyhellip
Health care providers should have open frank nonjudgmental conversations with families about their sleep practices
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Encouraging Parents to Take Action
According to the Social Learning Theory parents are more likely to recall and comply with instructions when
the health care provider
Uses a positive tone Provides adequate information Allows the parent to ask most of the questions
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Motivational Interviewing
ldquoa collaborative goal-oriented style of communication with particular attention to the language of changerdquo
o Strengthen personal motivation and commitment to a specific goal
o Explore onersquos reasons for change (barriers)o Patient generates own solutions
bull More likely to feel realisticbull Planting seeds of change
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Impact of Eliminating Sleep-Related Deaths
Every week we lose 70 children which is equivalent to 4 kindergarten classrooms
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Thank You
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Contact Information
mgoodsteinwellspanorg
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Visit Pediatric Care Online today for additional information on this and other topics
httppediatriccaresolutionsaaporgPediatric Care Online is a convenient electronic resource for immediate expert help with
virtually every pediatric clinical information need with must-have resources that are included in a comprehensive reference library and time-saving clinical tools
Donrsquot have a subscription to PCOThen take advantage of a free trial today
Call Mead Johnson Nutrition at 888363-2362 orfor more information go to
httppediatriccaresolutionsaaporgSSFree_Trialaspx
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
IMR over time Finland vs US
Slide Number 1
Disclaimer
Objectives for Todayrsquos Talk
Infant Mortality Rates for the Five Leading Causes of Infant Death in the United States 2005 and 2011
US Post-Neonatal Mortality 2015
FACT
What is SUID or SUDI
Some Causes of Deaths that Occur Suddenly and Unexpectedly during Infancy
What is SIDS
SIDS FACTS
SIDS FACTS
Triple Risk Model to Explain SIDS
Paterson DS Krous HF Kinney HC et al JAMA 2006
An Example of SIDS Pathogenesis
2016 AAP Recommendations Infant Sleep Safety
Strength of Recommendation
Recommendations Change as the Evidence Evolves
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
Correct Safe Sleep Environment
We Need to Move Beyond Back to Sleep
Sleep Position for Healthy Newborns
Sleep Position in Newborn Nursery
Sleep Position and Reflux
The Truth About Supine Sleep and Aspiration Ending the Fallacy
Title
Infant Sleep Location
Room-Share How Long Yoursquore Kidding Right
Supporting Data
More Recent Data
Why is Room-Sharing Protective
Room-Sharing and Sleep Quality
Insight Study (Paul 2017)
Insight Study (Paul 2017)
Insight Commentary (Hauck Moon)
Feeding the Baby at Night
Say NO to Couches Sofas and Cushioned Armchairs
High-Risk Bed Sharing Situations
Bedsharing in Low-Risk Breastfed Infants
Independent Review (Dr Robert Platt)
Bed Sharing
Bed Sharing
Bed Sharing with Overlay
Bed Sharing with Overlay
Bed Sharing with Overlay
Couch Sleeping
Couch Sleeping
Couch Sleeping
Unsafe Bedding NISP Trends 1993-2102
Why Use Soft Bedding
Soft Bedding for Older Infants
To Swaddle or Not to Swaddle That is the Question
Swaddling
SwaddlingmdashIs it Safe
SwaddlingmdashMore Questionshellip
wwwhealthychildrenorg
Pacifiers
Pacifiers and Breastfeeding
Baby Friendly USA Pacifiers
Addressing Sleep Deprivation
Overcoming Barriers to Change What Parents are Sayinghellip
Factors Associated With Choice of Infant Sleep Position
Slide Number 65
What is Working
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Infant Sleep Safety
Safe Sleep Nurse Modeling
Physician Advocacy
Healthcare Provider Advice to New Mothers Safe Sleep
Mason Clinical Peds 713
Bundled Intervention = Behavior Change
Hospital Unsafe Sleep Persists
Washington DC
TodaysBaby QI Safe Sleep Teaching
TodaysBaby QI Safe Sleep Teaching
Social Media and Risk-Reduction Training Study (SMART)
The National Safe Sleep Hospital Certification Program
Coordinated Education Efforts Work
Coordinated Education Efforts Work
And Finallyhellip
Encouraging Parents to Take Action
Motivational Interviewing
Impact of Eliminating Sleep-Related Deaths
Thank You
Contact Information
Slide Number 89
IMR over time Finland vs US
Column1
correct advice
55
incorrect advice
25
no advice
20
correct advice
incorrect advice
no advice
SIDS Rate
Percent Back Sleeping
1988
14
1989
139
1990
13
1991
13
1992
12
13
1993
117
17
1994
103
269
1995
087
386
1996
074
353
1997
077
531
1998
072
557
1999
067
644
2000
062
666
2001
056
716
2002
057
711
2003
053
728
2004
056
701
2005
055
722
2006
055
757
2007
057
703
2008
055
721
2009
054
741
2010
051
728
2011
048
2012
042
2013
04
2014
039
httpwwwcdcgovNCHSdatanvsrnvsr58nvsr58_19pdf
Xu JQ Kochanek KD Murphy SL Tejada-Vera B Deaths Final data for
2007
National vital statistics reports vol 58 no 19 Hyattsville MD
National Center for Health Statistics 2010
1988
1988
1989
1989
1990
1990
1991
1991
1992
1992
1993
1993
1994
1994
1995
1995
1996
1996
1997
1997
1998
1998
1999
1999
2000
2000
2001
2001
2002
2002
2003
2003
2004
2004
2005
2005
2006
2006
2007
2007
2008
2008
2009
2009
2010
2010
2011
2012
2013
2014
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Title
Text
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Infant Sleep Location
Infants should sleep in parentsrsquo room close to parentsrsquo bed but on a separate surface designed for infants
Ideally for the first year of life but at least for the first 6 months
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Room-Share How Long Yoursquore Kidding Right
2011 ldquoall sleep recommendations are to be followed until 1 year of agerdquo
2016 ldquoroom-sharing without bed-sharinghellipideally until 1 year of age but at least for the first 6 monthsrdquo
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Supporting Data
3 case-control studies comparing sleeping in a separate room vs room-sharingo Tappin (Scotland) AOR 326 (95 CI 103-1035)
bull Protection is significant for smoker motherso Blair (England) AOR 1049 (95 CI 426-2581)
bull Protection is significant for both smoker and nonsmoker mothers
o New Zealand Cot Death study AOR 285(95 CI 204-385)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
More Recent Data
New Zealand SUDI studyo 64 protection with room-sharing AOR 036
(95 CI 019-071)
Estimate of 50 reduction is very conservative
None of the case-control studies stratify by age (months)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Why is Room-Sharing Protective
SIDSmdashfailure to arouse More small awakenings during the night
o Stirrings movement not fully awake Postulation protective effect from small awakenings Room-sharing facilitates breastfeeding
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Room-Sharing and Sleep Quality
Volkovich room-sharing vs solitary sleepo Room-sharing mothers with more sleep disturbanceso Infants with similar sleep quality
Mao Mindell room-sharing infantsmdashmore awakenings
Montgomery-Downs Doan sleep quality in breastfeeding mothers gt to formula feeding motherso Exclusive breastfeeding = 30 min more sleep
More study needed
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Insight Study (Paul 2017)
Sleep questionnaire at 4 9 12 and 30 monthso Sleep duration overnight behaviorso Compared early vs late independent infants
At 4 monthso Equal sleep durationo Early group had better sleep consolidationo Longest stretch 46 minutes
Paul IM Hohman EE Loken E et al Mother-infant room-sharing and sleep outcomes in the INSIGHT study Pediatrics 2017140(1)e20170122
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Insight Study (Paul 2017)
At 9 monthso Longer sleep duration (40 minnight) o Better consolidation (100 min)
At 30 monthso Longer sleep duration (45 minnight)
Room-sharing 4 times more likely to transition to bed sharing overnight
Paul IM Hohman EE Loken E et al Mother-infant room-sharing and sleep outcomes in the INSIGHT study Pediatrics 2017140(1)e20170122
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Insight Commentary (Hauck Moon)
Late room-sharing mean 7 hours longest sleep Is early consolidation desirable Differences related to bedtime routines
o Early bedtimeo Number of night feedso Feeding back to sleep
Focus on the routine not early separation
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Feeding the Baby at Night Acknowledgment that parents may fall
asleep while feeding babyo Safer to feed on bed than on sofa
couch or armchair if you might fall asleep
o No pillows sheets blankets or other items that could obstruct infant breathing or cause overheating should be in bed
o Return infant back to separate sleep surface as soon as parent awakens
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Say NO to Couches Sofas and Cushioned Armchairs Never place a baby for sleep on these surfaces Never sleep with a baby on these surfaces One of the MOST dangerous places for an infant
(OR 51-669)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
High-Risk Bed Sharing Situations Age lt4 months Preterm or low birth weight Smoked during pregnancy Bed sharer is current smoker (even if not
smoking in bed) Bed sharer has usedis using meds or
substances that could impair alertness or arousal
Bed sharer is not parent (including other children)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bedsharing in Low-Risk Breastfed Infants
Blair et al AOR 16 (95 CI 096-27) o Age lt14 weekso Parents No cigarettes or alcoholo Independent of feeding method
Carpenter et al AOR 51 (95 CI 23-114) o Age lt3 months o Parents did not smokeo Mother No alcohol or drugso Breastfed infants
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Independent Review (Dr Robert Platt)
Very small numbers of low-risk babieso 24 in Blairrsquos studyo 12 in Carpenterrsquos study
Does not believe that data support definitive differences in 2 studies
Some evidence of increased risk in this group but cannot say how large the increased risk is
Cannot conclude that bed sharing in this group is safe
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Unsafe Bedding NISP Trends 1993-2102
Shapiro-Mendoza CK Colson ER Willinger M Rybin DV Camperlengo L Corwin MJ Trends in infant bedding use National Infant Sleep Position study 1993ndash2010 Pediatrics 2015135(1)10-17
Decrease from 86 to 55 Rate of decline decreases
2001-10 835 for teen mothers Predictors of adjusted OR
gt15
o Young motherso Non-white race
ethnicityo Less than college
education
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Why Use Soft Bedding
ComfortWarmtho Extrapolation of own feelingso Misinterpret firm with taut
bull Soft + taut ne firm
Safetyo Blankets pillows rolls to prevent falls
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Soft Bedding for Older Infants
Many parents recognize soft bedding is a risk Increased complacency as baby gets older Soft bedding is THE most important risk factor for
infants 4-12 months old (Colvin 2015) Infants roll into bedding and cannot extract
themselves
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
To Swaddle or Not to Swaddle That is the Question Pros
o Calms the infant promotes sleep decreases number of awakenings
o Encourages use of the supine position
Conso Increased respiratory rate and
reduced functional residual lung capacity
o Exacerbates hip dysplasia if the hips are kept in extension and adduction
o ldquoLooserdquo swaddling becomes loose bedding
o Overheating especially if the head is covered or the infant has infection
o Effects on arousability to an external stimulus remain unclear (conflicting data) There may be minimal effects of routine swaddling on arousal
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Swaddling
There is insufficient evidence to recommend routine swaddling as a strategy to reduce the incidence of SIDS
Swaddling must be correctly applied to avoid the possible hazards
Swaddling does not reduce the necessity to follow recommended safe sleep practices Ambrogio Lorenzettis Madonna and Child (1319)
Wikipedia
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
McDonnell E Moon RY Infant deaths and injuries associated with wearable blankets swaddle wraps and swaddling J Pediatr 20141641152-1156
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
SwaddlingmdashMore Questionshellip
Pease 2016 Pediatrics Pooled OR = 138
o Prone = 1299 o Side = 316o Supine = 193
Increased risk with age Limitations
o Heterogeneity definitions other risk factorsPease AS Fleming PJ Hauck FR et al Swaddling and the risk of sudden infant death syndrome a meta-analysis Pediatrics 2016137(6)e20153
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
wwwhealthychildrenorg
Swaddling (wrapping a light blanket snuggly around a baby) may help calm a crying baby If you swaddle your baby be sure to place him on his back to sleep Stop swaddling your baby when he starts to roll
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers
AAP recommendation Consider offering a pacifier at nap time and bedtime
Studies consistently demonstrate a protective effect of pacifiers on SIDS
Mechanism unknowno Dislodge within 15 to 60 minuteso Decreased arousal threshold
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers and Breastfeeding Well-designed trials
o 2 found no association among term infants
o 1 found no association among preterm infants
o 1 found slightly decreased breastfeeding duration at one month if pacifier introduced in first week of life but NO difference if pacifier introduced after one month
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Baby Friendly USA Pacifiers
Breastfeeding babies should not be given pacifiers by the staff of the facility with the exception of o Limited use to decrease pain during procedures when
the baby cannot safely be held or breastfed (pacifiers used should be discarded after these procedures)
o Babies who are being tube-fed in NICUo Other rare specific medical reasons
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Addressing Sleep Deprivation
Give parents tools to cope with fussy babies
Sleep-deprived parents may make poor judgments
Make use of tools o Swaddling side carrying
shushing swinging and sucking
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Overcoming Barriers to Change What Parents are Sayinghellip
Prone positioning fear of choking Baby sleeps ldquobetterrdquo on stomach Soft things are safer for the baby SIDS is ldquoGodrsquos willrdquo Why bother Recommendations keep changing
anyway Vigilance sleep with baby for protection
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Factors Associated With Choice of Infant Sleep Position 3300 mothers from 32 hospitals 77 usually use supine position 49 exclusive use supine position Most likely to use prone
o African-American motherso Mothers with lt high school educationo Lack of perceived controlo Personal attitudesocietal norms
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
A continuum starting in childhoodo Secondary school baby sitting classes
Pre-pregnancy Pregnancyprenatal education
o Prior to baby showerhellipldquowrong giftsrdquo In-hospital education and modeling
o Include family friends baby sitters Re-enforcement in the doctorrsquos office
o Especially between 1 to 4 months Grandparents They hold great power The general public (day cares religious leaders)
A Lifetime of Infant Sleep Safety
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Chart1
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
14
139
13
13
12
13
117
17
103
269
087
386
074
353
077
531
072
557
067
644
062
666
056
716
057
711
053
728
056
701
055
722
055
757
057
703
055
721
054
741
051
728
048
042
04
039
Sheet1
Sheet1
ampA
Page ampP
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
Sheet2
Pre-AAP recommendation Post-AAP RecommendationBack to SleepSafe to Sleep Campaign
Sheet3
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Infant Sleep Safety
Requires a consistent and repetitive message in the community to prevent accidental deaths
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Safe Sleep Nurse Modeling
People trust nurses Whatever the nurse does must
be correct and it will be imitated in the home
Fact supine positioning in the nursery can almost DOUBLE its use in the home
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Physician Advocacy
Srivatsa 1997 HCP education to new familieshellip34 reduction in prone sleeping
Eron 2009 Study of Central NY state physicianshellip30 identified incorrect safest sleep positionhellip30 do not discuss with families
Colson 2009 Only 13 mothers advised by MD to use supine positionhellip3 times more likely to position the baby properly
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Healthcare Provider Advice to New Mothers Safe Sleep
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Chart1
Column1
[]
[]
[]
55
25
20
Sheet1
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Mason Clinical Peds 713
Bundled interventiono Nursing education policy model behavior safe sleep
video posters in rooms declaration of safe sleep practice
Safe sleep environment uarr from 25 to 58 Intention in home 95 supine none ldquoco-sleepingrdquo
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bundled Intervention = Behavior Change
QUESTION GROUP p-value
ISS Study NISP
Behavior Questions n = 490 n = 1046
Baby routinely placed to sleep on back 925 73 lt 0001
Baby routinely sleeps in bassinetcrib 995 71 lt 00001
Baby sleeps under a thin sheet 992 86 lt 0001
Baby given a pacifier for sleep 741 84 lt 0001Goodstein MH Bell T Krugman SD Improving infant sleep safety through a comprehensive hospital-based program Clinical Pediatrics 201554(3)212-221
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
o Baseline Safe sleep 49 of 264 infants o Post 312 of 234 infants (P lt 001) o Extra blankets most common o Baseline 77 vs 44 post-intervention o Mean number of unsafe items reduced by 50 (P lt 001)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Washington DC
2 urban DC nurseries 26 did not believe or unsure that infant positioning
was associated with SIDS Top 3 factors influencing sleep position
o 56 PERSONAL PREFERENCE Why non-supine Clinical experience (25)
o Increase risk aspirationo Decrease sleep and comfort
Bartow KL Nursesrsquo knowledge and adherence to sudden infant death syndrome prevention guidelines Pediatr Nurs 201642(1)7-13
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
TodaysBaby QI Safe Sleep Teaching
QI intervention median = 160 days Mothers reported receiving information 72 to 95
(increase of 24-57) 94 babies observed supine (plus 24) 88 infants in safe sleep environment
o Increase of 33 Gains maintained up to 12 months
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Social Media and Risk-Reduction Training Study (SMART) Cluster randomization 4 groups Safe sleep or breast feeding education Nursing QI and social media (mobile health) N = 1600 1263 responses (79) Safe sleep NQI and MHealth
o Supine sleep 925 o Room-sharing 859o No soft bedding 819o Pacifier use 762
Moon RY Hauck FR Colson ER et al The effect of nursing quality improvement and mobile health interventions on infant sleep practices a randomized clinical trial JAMA 2017318(4)351-359
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Hospital Initiative ComponentswwwcribsforkidsorgHospitalInitiativeToolkit INTRODUCTORY LETTER HOSPITAL INITIATIVE TOOL KIT
INSTRUCTIONS ORGANIZATIONAL CHART HOSPITAL POLICY ACKNOWLEDGMENT FORM (Engl amp
Span) SAFE SLEEP EDUCATIONAL FLIP CHART
NONCOMPLIANCE WAIVER (Engl amp Span)
NURSING EDUCATION MODULE
SAFE SLEEP POSTERS DOOR HANGERS (Engl amp Span) GRADUATION CERTIFICATE SAMPLE LETTER TO HOSPITALS SAMPLE LETTER TO PROVIDERS INFANT SAFE SLEEP BROCHURES
(Engl amp Span) PRESS KIT
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
All materials available on-lineo No major costs to the hospital
Easy on-line access for documentation
NO FEE FOR PARTICIPATION
wwwCribsforKidsorgHospitalInitiative
Tiffany Price (tpricecribsforkidsorg)
The National Safe Sleep Hospital Certification Program
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
TNmdash25 reduction in infant sleep-related deaths in 2 years
SDmdashOver 7915 Pack lsquon Plays distributed since 2012 Infant mortality rate decreased from 86 (2012) to 48 (2016)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
2009 to 2015 38 decrease in infant mortality Decreased from 135 to 84 per 1000 SUID decreased gt50 Decrease in racial disparityhttphealthybabiesbaltimorecomhome
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
And Finallyhellip
Health care providers should have open frank nonjudgmental conversations with families about their sleep practices
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Encouraging Parents to Take Action
According to the Social Learning Theory parents are more likely to recall and comply with instructions when
the health care provider
Uses a positive tone Provides adequate information Allows the parent to ask most of the questions
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Motivational Interviewing
ldquoa collaborative goal-oriented style of communication with particular attention to the language of changerdquo
o Strengthen personal motivation and commitment to a specific goal
o Explore onersquos reasons for change (barriers)o Patient generates own solutions
bull More likely to feel realisticbull Planting seeds of change
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Impact of Eliminating Sleep-Related Deaths
Every week we lose 70 children which is equivalent to 4 kindergarten classrooms
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Thank You
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Contact Information
mgoodsteinwellspanorg
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Visit Pediatric Care Online today for additional information on this and other topics
httppediatriccaresolutionsaaporgPediatric Care Online is a convenient electronic resource for immediate expert help with
virtually every pediatric clinical information need with must-have resources that are included in a comprehensive reference library and time-saving clinical tools
Donrsquot have a subscription to PCOThen take advantage of a free trial today
Call Mead Johnson Nutrition at 888363-2362 orfor more information go to
httppediatriccaresolutionsaaporgSSFree_Trialaspx
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
IMR over time Finland vs US
Slide Number 1
Disclaimer
Objectives for Todayrsquos Talk
Infant Mortality Rates for the Five Leading Causes of Infant Death in the United States 2005 and 2011
US Post-Neonatal Mortality 2015
FACT
What is SUID or SUDI
Some Causes of Deaths that Occur Suddenly and Unexpectedly during Infancy
What is SIDS
SIDS FACTS
SIDS FACTS
Triple Risk Model to Explain SIDS
Paterson DS Krous HF Kinney HC et al JAMA 2006
An Example of SIDS Pathogenesis
2016 AAP Recommendations Infant Sleep Safety
Strength of Recommendation
Recommendations Change as the Evidence Evolves
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
Correct Safe Sleep Environment
We Need to Move Beyond Back to Sleep
Sleep Position for Healthy Newborns
Sleep Position in Newborn Nursery
Sleep Position and Reflux
The Truth About Supine Sleep and Aspiration Ending the Fallacy
Title
Infant Sleep Location
Room-Share How Long Yoursquore Kidding Right
Supporting Data
More Recent Data
Why is Room-Sharing Protective
Room-Sharing and Sleep Quality
Insight Study (Paul 2017)
Insight Study (Paul 2017)
Insight Commentary (Hauck Moon)
Feeding the Baby at Night
Say NO to Couches Sofas and Cushioned Armchairs
High-Risk Bed Sharing Situations
Bedsharing in Low-Risk Breastfed Infants
Independent Review (Dr Robert Platt)
Bed Sharing
Bed Sharing
Bed Sharing with Overlay
Bed Sharing with Overlay
Bed Sharing with Overlay
Couch Sleeping
Couch Sleeping
Couch Sleeping
Unsafe Bedding NISP Trends 1993-2102
Why Use Soft Bedding
Soft Bedding for Older Infants
To Swaddle or Not to Swaddle That is the Question
Swaddling
SwaddlingmdashIs it Safe
SwaddlingmdashMore Questionshellip
wwwhealthychildrenorg
Pacifiers
Pacifiers and Breastfeeding
Baby Friendly USA Pacifiers
Addressing Sleep Deprivation
Overcoming Barriers to Change What Parents are Sayinghellip
Factors Associated With Choice of Infant Sleep Position
Slide Number 65
What is Working
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Infant Sleep Safety
Safe Sleep Nurse Modeling
Physician Advocacy
Healthcare Provider Advice to New Mothers Safe Sleep
Mason Clinical Peds 713
Bundled Intervention = Behavior Change
Hospital Unsafe Sleep Persists
Washington DC
TodaysBaby QI Safe Sleep Teaching
TodaysBaby QI Safe Sleep Teaching
Social Media and Risk-Reduction Training Study (SMART)
The National Safe Sleep Hospital Certification Program
Coordinated Education Efforts Work
Coordinated Education Efforts Work
And Finallyhellip
Encouraging Parents to Take Action
Motivational Interviewing
Impact of Eliminating Sleep-Related Deaths
Thank You
Contact Information
Slide Number 89
IMR over time Finland vs US
Column1
correct advice
55
incorrect advice
25
no advice
20
correct advice
incorrect advice
no advice
SIDS Rate
Percent Back Sleeping
1988
14
1989
139
1990
13
1991
13
1992
12
13
1993
117
17
1994
103
269
1995
087
386
1996
074
353
1997
077
531
1998
072
557
1999
067
644
2000
062
666
2001
056
716
2002
057
711
2003
053
728
2004
056
701
2005
055
722
2006
055
757
2007
057
703
2008
055
721
2009
054
741
2010
051
728
2011
048
2012
042
2013
04
2014
039
httpwwwcdcgovNCHSdatanvsrnvsr58nvsr58_19pdf
Xu JQ Kochanek KD Murphy SL Tejada-Vera B Deaths Final data for
2007
National vital statistics reports vol 58 no 19 Hyattsville MD
National Center for Health Statistics 2010
1988
1988
1989
1989
1990
1990
1991
1991
1992
1992
1993
1993
1994
1994
1995
1995
1996
1996
1997
1997
1998
1998
1999
1999
2000
2000
2001
2001
2002
2002
2003
2003
2004
2004
2005
2005
2006
2006
2007
2007
2008
2008
2009
2009
2010
2010
2011
2012
2013
2014
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Infant Sleep Location
Infants should sleep in parentsrsquo room close to parentsrsquo bed but on a separate surface designed for infants
Ideally for the first year of life but at least for the first 6 months
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Room-Share How Long Yoursquore Kidding Right
2011 ldquoall sleep recommendations are to be followed until 1 year of agerdquo
2016 ldquoroom-sharing without bed-sharinghellipideally until 1 year of age but at least for the first 6 monthsrdquo
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Supporting Data
3 case-control studies comparing sleeping in a separate room vs room-sharingo Tappin (Scotland) AOR 326 (95 CI 103-1035)
bull Protection is significant for smoker motherso Blair (England) AOR 1049 (95 CI 426-2581)
bull Protection is significant for both smoker and nonsmoker mothers
o New Zealand Cot Death study AOR 285(95 CI 204-385)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
More Recent Data
New Zealand SUDI studyo 64 protection with room-sharing AOR 036
(95 CI 019-071)
Estimate of 50 reduction is very conservative
None of the case-control studies stratify by age (months)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Why is Room-Sharing Protective
SIDSmdashfailure to arouse More small awakenings during the night
o Stirrings movement not fully awake Postulation protective effect from small awakenings Room-sharing facilitates breastfeeding
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Room-Sharing and Sleep Quality
Volkovich room-sharing vs solitary sleepo Room-sharing mothers with more sleep disturbanceso Infants with similar sleep quality
Mao Mindell room-sharing infantsmdashmore awakenings
Montgomery-Downs Doan sleep quality in breastfeeding mothers gt to formula feeding motherso Exclusive breastfeeding = 30 min more sleep
More study needed
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Insight Study (Paul 2017)
Sleep questionnaire at 4 9 12 and 30 monthso Sleep duration overnight behaviorso Compared early vs late independent infants
At 4 monthso Equal sleep durationo Early group had better sleep consolidationo Longest stretch 46 minutes
Paul IM Hohman EE Loken E et al Mother-infant room-sharing and sleep outcomes in the INSIGHT study Pediatrics 2017140(1)e20170122
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Insight Study (Paul 2017)
At 9 monthso Longer sleep duration (40 minnight) o Better consolidation (100 min)
At 30 monthso Longer sleep duration (45 minnight)
Room-sharing 4 times more likely to transition to bed sharing overnight
Paul IM Hohman EE Loken E et al Mother-infant room-sharing and sleep outcomes in the INSIGHT study Pediatrics 2017140(1)e20170122
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Insight Commentary (Hauck Moon)
Late room-sharing mean 7 hours longest sleep Is early consolidation desirable Differences related to bedtime routines
o Early bedtimeo Number of night feedso Feeding back to sleep
Focus on the routine not early separation
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Feeding the Baby at Night Acknowledgment that parents may fall
asleep while feeding babyo Safer to feed on bed than on sofa
couch or armchair if you might fall asleep
o No pillows sheets blankets or other items that could obstruct infant breathing or cause overheating should be in bed
o Return infant back to separate sleep surface as soon as parent awakens
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Say NO to Couches Sofas and Cushioned Armchairs Never place a baby for sleep on these surfaces Never sleep with a baby on these surfaces One of the MOST dangerous places for an infant
(OR 51-669)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
High-Risk Bed Sharing Situations Age lt4 months Preterm or low birth weight Smoked during pregnancy Bed sharer is current smoker (even if not
smoking in bed) Bed sharer has usedis using meds or
substances that could impair alertness or arousal
Bed sharer is not parent (including other children)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bedsharing in Low-Risk Breastfed Infants
Blair et al AOR 16 (95 CI 096-27) o Age lt14 weekso Parents No cigarettes or alcoholo Independent of feeding method
Carpenter et al AOR 51 (95 CI 23-114) o Age lt3 months o Parents did not smokeo Mother No alcohol or drugso Breastfed infants
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Independent Review (Dr Robert Platt)
Very small numbers of low-risk babieso 24 in Blairrsquos studyo 12 in Carpenterrsquos study
Does not believe that data support definitive differences in 2 studies
Some evidence of increased risk in this group but cannot say how large the increased risk is
Cannot conclude that bed sharing in this group is safe
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Unsafe Bedding NISP Trends 1993-2102
Shapiro-Mendoza CK Colson ER Willinger M Rybin DV Camperlengo L Corwin MJ Trends in infant bedding use National Infant Sleep Position study 1993ndash2010 Pediatrics 2015135(1)10-17
Decrease from 86 to 55 Rate of decline decreases
2001-10 835 for teen mothers Predictors of adjusted OR
gt15
o Young motherso Non-white race
ethnicityo Less than college
education
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Why Use Soft Bedding
ComfortWarmtho Extrapolation of own feelingso Misinterpret firm with taut
bull Soft + taut ne firm
Safetyo Blankets pillows rolls to prevent falls
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Soft Bedding for Older Infants
Many parents recognize soft bedding is a risk Increased complacency as baby gets older Soft bedding is THE most important risk factor for
infants 4-12 months old (Colvin 2015) Infants roll into bedding and cannot extract
themselves
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
To Swaddle or Not to Swaddle That is the Question Pros
o Calms the infant promotes sleep decreases number of awakenings
o Encourages use of the supine position
Conso Increased respiratory rate and
reduced functional residual lung capacity
o Exacerbates hip dysplasia if the hips are kept in extension and adduction
o ldquoLooserdquo swaddling becomes loose bedding
o Overheating especially if the head is covered or the infant has infection
o Effects on arousability to an external stimulus remain unclear (conflicting data) There may be minimal effects of routine swaddling on arousal
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Swaddling
There is insufficient evidence to recommend routine swaddling as a strategy to reduce the incidence of SIDS
Swaddling must be correctly applied to avoid the possible hazards
Swaddling does not reduce the necessity to follow recommended safe sleep practices Ambrogio Lorenzettis Madonna and Child (1319)
Wikipedia
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
McDonnell E Moon RY Infant deaths and injuries associated with wearable blankets swaddle wraps and swaddling J Pediatr 20141641152-1156
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
SwaddlingmdashMore Questionshellip
Pease 2016 Pediatrics Pooled OR = 138
o Prone = 1299 o Side = 316o Supine = 193
Increased risk with age Limitations
o Heterogeneity definitions other risk factorsPease AS Fleming PJ Hauck FR et al Swaddling and the risk of sudden infant death syndrome a meta-analysis Pediatrics 2016137(6)e20153
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
wwwhealthychildrenorg
Swaddling (wrapping a light blanket snuggly around a baby) may help calm a crying baby If you swaddle your baby be sure to place him on his back to sleep Stop swaddling your baby when he starts to roll
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers
AAP recommendation Consider offering a pacifier at nap time and bedtime
Studies consistently demonstrate a protective effect of pacifiers on SIDS
Mechanism unknowno Dislodge within 15 to 60 minuteso Decreased arousal threshold
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers and Breastfeeding Well-designed trials
o 2 found no association among term infants
o 1 found no association among preterm infants
o 1 found slightly decreased breastfeeding duration at one month if pacifier introduced in first week of life but NO difference if pacifier introduced after one month
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Baby Friendly USA Pacifiers
Breastfeeding babies should not be given pacifiers by the staff of the facility with the exception of o Limited use to decrease pain during procedures when
the baby cannot safely be held or breastfed (pacifiers used should be discarded after these procedures)
o Babies who are being tube-fed in NICUo Other rare specific medical reasons
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Addressing Sleep Deprivation
Give parents tools to cope with fussy babies
Sleep-deprived parents may make poor judgments
Make use of tools o Swaddling side carrying
shushing swinging and sucking
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Overcoming Barriers to Change What Parents are Sayinghellip
Prone positioning fear of choking Baby sleeps ldquobetterrdquo on stomach Soft things are safer for the baby SIDS is ldquoGodrsquos willrdquo Why bother Recommendations keep changing
anyway Vigilance sleep with baby for protection
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Factors Associated With Choice of Infant Sleep Position 3300 mothers from 32 hospitals 77 usually use supine position 49 exclusive use supine position Most likely to use prone
o African-American motherso Mothers with lt high school educationo Lack of perceived controlo Personal attitudesocietal norms
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
A continuum starting in childhoodo Secondary school baby sitting classes
Pre-pregnancy Pregnancyprenatal education
o Prior to baby showerhellipldquowrong giftsrdquo In-hospital education and modeling
o Include family friends baby sitters Re-enforcement in the doctorrsquos office
o Especially between 1 to 4 months Grandparents They hold great power The general public (day cares religious leaders)
A Lifetime of Infant Sleep Safety
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Chart1
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
14
139
13
13
12
13
117
17
103
269
087
386
074
353
077
531
072
557
067
644
062
666
056
716
057
711
053
728
056
701
055
722
055
757
057
703
055
721
054
741
051
728
048
042
04
039
Sheet1
Sheet1
ampA
Page ampP
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
Sheet2
Pre-AAP recommendation Post-AAP RecommendationBack to SleepSafe to Sleep Campaign
Sheet3
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Infant Sleep Safety
Requires a consistent and repetitive message in the community to prevent accidental deaths
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Safe Sleep Nurse Modeling
People trust nurses Whatever the nurse does must
be correct and it will be imitated in the home
Fact supine positioning in the nursery can almost DOUBLE its use in the home
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Physician Advocacy
Srivatsa 1997 HCP education to new familieshellip34 reduction in prone sleeping
Eron 2009 Study of Central NY state physicianshellip30 identified incorrect safest sleep positionhellip30 do not discuss with families
Colson 2009 Only 13 mothers advised by MD to use supine positionhellip3 times more likely to position the baby properly
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Healthcare Provider Advice to New Mothers Safe Sleep
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Chart1
Column1
[]
[]
[]
55
25
20
Sheet1
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Mason Clinical Peds 713
Bundled interventiono Nursing education policy model behavior safe sleep
video posters in rooms declaration of safe sleep practice
Safe sleep environment uarr from 25 to 58 Intention in home 95 supine none ldquoco-sleepingrdquo
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bundled Intervention = Behavior Change
QUESTION GROUP p-value
ISS Study NISP
Behavior Questions n = 490 n = 1046
Baby routinely placed to sleep on back 925 73 lt 0001
Baby routinely sleeps in bassinetcrib 995 71 lt 00001
Baby sleeps under a thin sheet 992 86 lt 0001
Baby given a pacifier for sleep 741 84 lt 0001Goodstein MH Bell T Krugman SD Improving infant sleep safety through a comprehensive hospital-based program Clinical Pediatrics 201554(3)212-221
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
o Baseline Safe sleep 49 of 264 infants o Post 312 of 234 infants (P lt 001) o Extra blankets most common o Baseline 77 vs 44 post-intervention o Mean number of unsafe items reduced by 50 (P lt 001)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Washington DC
2 urban DC nurseries 26 did not believe or unsure that infant positioning
was associated with SIDS Top 3 factors influencing sleep position
o 56 PERSONAL PREFERENCE Why non-supine Clinical experience (25)
o Increase risk aspirationo Decrease sleep and comfort
Bartow KL Nursesrsquo knowledge and adherence to sudden infant death syndrome prevention guidelines Pediatr Nurs 201642(1)7-13
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
TodaysBaby QI Safe Sleep Teaching
QI intervention median = 160 days Mothers reported receiving information 72 to 95
(increase of 24-57) 94 babies observed supine (plus 24) 88 infants in safe sleep environment
o Increase of 33 Gains maintained up to 12 months
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Social Media and Risk-Reduction Training Study (SMART) Cluster randomization 4 groups Safe sleep or breast feeding education Nursing QI and social media (mobile health) N = 1600 1263 responses (79) Safe sleep NQI and MHealth
o Supine sleep 925 o Room-sharing 859o No soft bedding 819o Pacifier use 762
Moon RY Hauck FR Colson ER et al The effect of nursing quality improvement and mobile health interventions on infant sleep practices a randomized clinical trial JAMA 2017318(4)351-359
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Hospital Initiative ComponentswwwcribsforkidsorgHospitalInitiativeToolkit INTRODUCTORY LETTER HOSPITAL INITIATIVE TOOL KIT
INSTRUCTIONS ORGANIZATIONAL CHART HOSPITAL POLICY ACKNOWLEDGMENT FORM (Engl amp
Span) SAFE SLEEP EDUCATIONAL FLIP CHART
NONCOMPLIANCE WAIVER (Engl amp Span)
NURSING EDUCATION MODULE
SAFE SLEEP POSTERS DOOR HANGERS (Engl amp Span) GRADUATION CERTIFICATE SAMPLE LETTER TO HOSPITALS SAMPLE LETTER TO PROVIDERS INFANT SAFE SLEEP BROCHURES
(Engl amp Span) PRESS KIT
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
All materials available on-lineo No major costs to the hospital
Easy on-line access for documentation
NO FEE FOR PARTICIPATION
wwwCribsforKidsorgHospitalInitiative
Tiffany Price (tpricecribsforkidsorg)
The National Safe Sleep Hospital Certification Program
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
TNmdash25 reduction in infant sleep-related deaths in 2 years
SDmdashOver 7915 Pack lsquon Plays distributed since 2012 Infant mortality rate decreased from 86 (2012) to 48 (2016)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
2009 to 2015 38 decrease in infant mortality Decreased from 135 to 84 per 1000 SUID decreased gt50 Decrease in racial disparityhttphealthybabiesbaltimorecomhome
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
And Finallyhellip
Health care providers should have open frank nonjudgmental conversations with families about their sleep practices
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Encouraging Parents to Take Action
According to the Social Learning Theory parents are more likely to recall and comply with instructions when
the health care provider
Uses a positive tone Provides adequate information Allows the parent to ask most of the questions
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Motivational Interviewing
ldquoa collaborative goal-oriented style of communication with particular attention to the language of changerdquo
o Strengthen personal motivation and commitment to a specific goal
o Explore onersquos reasons for change (barriers)o Patient generates own solutions
bull More likely to feel realisticbull Planting seeds of change
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Impact of Eliminating Sleep-Related Deaths
Every week we lose 70 children which is equivalent to 4 kindergarten classrooms
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Thank You
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Contact Information
mgoodsteinwellspanorg
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Visit Pediatric Care Online today for additional information on this and other topics
httppediatriccaresolutionsaaporgPediatric Care Online is a convenient electronic resource for immediate expert help with
virtually every pediatric clinical information need with must-have resources that are included in a comprehensive reference library and time-saving clinical tools
Donrsquot have a subscription to PCOThen take advantage of a free trial today
Call Mead Johnson Nutrition at 888363-2362 orfor more information go to
httppediatriccaresolutionsaaporgSSFree_Trialaspx
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
IMR over time Finland vs US
Slide Number 1
Disclaimer
Objectives for Todayrsquos Talk
Infant Mortality Rates for the Five Leading Causes of Infant Death in the United States 2005 and 2011
US Post-Neonatal Mortality 2015
FACT
What is SUID or SUDI
Some Causes of Deaths that Occur Suddenly and Unexpectedly during Infancy
What is SIDS
SIDS FACTS
SIDS FACTS
Triple Risk Model to Explain SIDS
Paterson DS Krous HF Kinney HC et al JAMA 2006
An Example of SIDS Pathogenesis
2016 AAP Recommendations Infant Sleep Safety
Strength of Recommendation
Recommendations Change as the Evidence Evolves
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
Correct Safe Sleep Environment
We Need to Move Beyond Back to Sleep
Sleep Position for Healthy Newborns
Sleep Position in Newborn Nursery
Sleep Position and Reflux
The Truth About Supine Sleep and Aspiration Ending the Fallacy
Title
Infant Sleep Location
Room-Share How Long Yoursquore Kidding Right
Supporting Data
More Recent Data
Why is Room-Sharing Protective
Room-Sharing and Sleep Quality
Insight Study (Paul 2017)
Insight Study (Paul 2017)
Insight Commentary (Hauck Moon)
Feeding the Baby at Night
Say NO to Couches Sofas and Cushioned Armchairs
High-Risk Bed Sharing Situations
Bedsharing in Low-Risk Breastfed Infants
Independent Review (Dr Robert Platt)
Bed Sharing
Bed Sharing
Bed Sharing with Overlay
Bed Sharing with Overlay
Bed Sharing with Overlay
Couch Sleeping
Couch Sleeping
Couch Sleeping
Unsafe Bedding NISP Trends 1993-2102
Why Use Soft Bedding
Soft Bedding for Older Infants
To Swaddle or Not to Swaddle That is the Question
Swaddling
SwaddlingmdashIs it Safe
SwaddlingmdashMore Questionshellip
wwwhealthychildrenorg
Pacifiers
Pacifiers and Breastfeeding
Baby Friendly USA Pacifiers
Addressing Sleep Deprivation
Overcoming Barriers to Change What Parents are Sayinghellip
Factors Associated With Choice of Infant Sleep Position
Slide Number 65
What is Working
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Infant Sleep Safety
Safe Sleep Nurse Modeling
Physician Advocacy
Healthcare Provider Advice to New Mothers Safe Sleep
Mason Clinical Peds 713
Bundled Intervention = Behavior Change
Hospital Unsafe Sleep Persists
Washington DC
TodaysBaby QI Safe Sleep Teaching
TodaysBaby QI Safe Sleep Teaching
Social Media and Risk-Reduction Training Study (SMART)
The National Safe Sleep Hospital Certification Program
Coordinated Education Efforts Work
Coordinated Education Efforts Work
And Finallyhellip
Encouraging Parents to Take Action
Motivational Interviewing
Impact of Eliminating Sleep-Related Deaths
Thank You
Contact Information
Slide Number 89
IMR over time Finland vs US
Column1
correct advice
55
incorrect advice
25
no advice
20
correct advice
incorrect advice
no advice
SIDS Rate
Percent Back Sleeping
1988
14
1989
139
1990
13
1991
13
1992
12
13
1993
117
17
1994
103
269
1995
087
386
1996
074
353
1997
077
531
1998
072
557
1999
067
644
2000
062
666
2001
056
716
2002
057
711
2003
053
728
2004
056
701
2005
055
722
2006
055
757
2007
057
703
2008
055
721
2009
054
741
2010
051
728
2011
048
2012
042
2013
04
2014
039
httpwwwcdcgovNCHSdatanvsrnvsr58nvsr58_19pdf
Xu JQ Kochanek KD Murphy SL Tejada-Vera B Deaths Final data for
2007
National vital statistics reports vol 58 no 19 Hyattsville MD
National Center for Health Statistics 2010
1988
1988
1989
1989
1990
1990
1991
1991
1992
1992
1993
1993
1994
1994
1995
1995
1996
1996
1997
1997
1998
1998
1999
1999
2000
2000
2001
2001
2002
2002
2003
2003
2004
2004
2005
2005
2006
2006
2007
2007
2008
2008
2009
2009
2010
2010
2011
2012
2013
2014
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Room-Share How Long Yoursquore Kidding Right
2011 ldquoall sleep recommendations are to be followed until 1 year of agerdquo
2016 ldquoroom-sharing without bed-sharinghellipideally until 1 year of age but at least for the first 6 monthsrdquo
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Supporting Data
3 case-control studies comparing sleeping in a separate room vs room-sharingo Tappin (Scotland) AOR 326 (95 CI 103-1035)
bull Protection is significant for smoker motherso Blair (England) AOR 1049 (95 CI 426-2581)
bull Protection is significant for both smoker and nonsmoker mothers
o New Zealand Cot Death study AOR 285(95 CI 204-385)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
More Recent Data
New Zealand SUDI studyo 64 protection with room-sharing AOR 036
(95 CI 019-071)
Estimate of 50 reduction is very conservative
None of the case-control studies stratify by age (months)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Why is Room-Sharing Protective
SIDSmdashfailure to arouse More small awakenings during the night
o Stirrings movement not fully awake Postulation protective effect from small awakenings Room-sharing facilitates breastfeeding
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Room-Sharing and Sleep Quality
Volkovich room-sharing vs solitary sleepo Room-sharing mothers with more sleep disturbanceso Infants with similar sleep quality
Mao Mindell room-sharing infantsmdashmore awakenings
Montgomery-Downs Doan sleep quality in breastfeeding mothers gt to formula feeding motherso Exclusive breastfeeding = 30 min more sleep
More study needed
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Insight Study (Paul 2017)
Sleep questionnaire at 4 9 12 and 30 monthso Sleep duration overnight behaviorso Compared early vs late independent infants
At 4 monthso Equal sleep durationo Early group had better sleep consolidationo Longest stretch 46 minutes
Paul IM Hohman EE Loken E et al Mother-infant room-sharing and sleep outcomes in the INSIGHT study Pediatrics 2017140(1)e20170122
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Insight Study (Paul 2017)
At 9 monthso Longer sleep duration (40 minnight) o Better consolidation (100 min)
At 30 monthso Longer sleep duration (45 minnight)
Room-sharing 4 times more likely to transition to bed sharing overnight
Paul IM Hohman EE Loken E et al Mother-infant room-sharing and sleep outcomes in the INSIGHT study Pediatrics 2017140(1)e20170122
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Insight Commentary (Hauck Moon)
Late room-sharing mean 7 hours longest sleep Is early consolidation desirable Differences related to bedtime routines
o Early bedtimeo Number of night feedso Feeding back to sleep
Focus on the routine not early separation
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Feeding the Baby at Night Acknowledgment that parents may fall
asleep while feeding babyo Safer to feed on bed than on sofa
couch or armchair if you might fall asleep
o No pillows sheets blankets or other items that could obstruct infant breathing or cause overheating should be in bed
o Return infant back to separate sleep surface as soon as parent awakens
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Say NO to Couches Sofas and Cushioned Armchairs Never place a baby for sleep on these surfaces Never sleep with a baby on these surfaces One of the MOST dangerous places for an infant
(OR 51-669)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
High-Risk Bed Sharing Situations Age lt4 months Preterm or low birth weight Smoked during pregnancy Bed sharer is current smoker (even if not
smoking in bed) Bed sharer has usedis using meds or
substances that could impair alertness or arousal
Bed sharer is not parent (including other children)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bedsharing in Low-Risk Breastfed Infants
Blair et al AOR 16 (95 CI 096-27) o Age lt14 weekso Parents No cigarettes or alcoholo Independent of feeding method
Carpenter et al AOR 51 (95 CI 23-114) o Age lt3 months o Parents did not smokeo Mother No alcohol or drugso Breastfed infants
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Independent Review (Dr Robert Platt)
Very small numbers of low-risk babieso 24 in Blairrsquos studyo 12 in Carpenterrsquos study
Does not believe that data support definitive differences in 2 studies
Some evidence of increased risk in this group but cannot say how large the increased risk is
Cannot conclude that bed sharing in this group is safe
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Unsafe Bedding NISP Trends 1993-2102
Shapiro-Mendoza CK Colson ER Willinger M Rybin DV Camperlengo L Corwin MJ Trends in infant bedding use National Infant Sleep Position study 1993ndash2010 Pediatrics 2015135(1)10-17
Decrease from 86 to 55 Rate of decline decreases
2001-10 835 for teen mothers Predictors of adjusted OR
gt15
o Young motherso Non-white race
ethnicityo Less than college
education
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Why Use Soft Bedding
ComfortWarmtho Extrapolation of own feelingso Misinterpret firm with taut
bull Soft + taut ne firm
Safetyo Blankets pillows rolls to prevent falls
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Soft Bedding for Older Infants
Many parents recognize soft bedding is a risk Increased complacency as baby gets older Soft bedding is THE most important risk factor for
infants 4-12 months old (Colvin 2015) Infants roll into bedding and cannot extract
themselves
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
To Swaddle or Not to Swaddle That is the Question Pros
o Calms the infant promotes sleep decreases number of awakenings
o Encourages use of the supine position
Conso Increased respiratory rate and
reduced functional residual lung capacity
o Exacerbates hip dysplasia if the hips are kept in extension and adduction
o ldquoLooserdquo swaddling becomes loose bedding
o Overheating especially if the head is covered or the infant has infection
o Effects on arousability to an external stimulus remain unclear (conflicting data) There may be minimal effects of routine swaddling on arousal
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Swaddling
There is insufficient evidence to recommend routine swaddling as a strategy to reduce the incidence of SIDS
Swaddling must be correctly applied to avoid the possible hazards
Swaddling does not reduce the necessity to follow recommended safe sleep practices Ambrogio Lorenzettis Madonna and Child (1319)
Wikipedia
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
McDonnell E Moon RY Infant deaths and injuries associated with wearable blankets swaddle wraps and swaddling J Pediatr 20141641152-1156
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
SwaddlingmdashMore Questionshellip
Pease 2016 Pediatrics Pooled OR = 138
o Prone = 1299 o Side = 316o Supine = 193
Increased risk with age Limitations
o Heterogeneity definitions other risk factorsPease AS Fleming PJ Hauck FR et al Swaddling and the risk of sudden infant death syndrome a meta-analysis Pediatrics 2016137(6)e20153
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
wwwhealthychildrenorg
Swaddling (wrapping a light blanket snuggly around a baby) may help calm a crying baby If you swaddle your baby be sure to place him on his back to sleep Stop swaddling your baby when he starts to roll
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers
AAP recommendation Consider offering a pacifier at nap time and bedtime
Studies consistently demonstrate a protective effect of pacifiers on SIDS
Mechanism unknowno Dislodge within 15 to 60 minuteso Decreased arousal threshold
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers and Breastfeeding Well-designed trials
o 2 found no association among term infants
o 1 found no association among preterm infants
o 1 found slightly decreased breastfeeding duration at one month if pacifier introduced in first week of life but NO difference if pacifier introduced after one month
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Baby Friendly USA Pacifiers
Breastfeeding babies should not be given pacifiers by the staff of the facility with the exception of o Limited use to decrease pain during procedures when
the baby cannot safely be held or breastfed (pacifiers used should be discarded after these procedures)
o Babies who are being tube-fed in NICUo Other rare specific medical reasons
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Addressing Sleep Deprivation
Give parents tools to cope with fussy babies
Sleep-deprived parents may make poor judgments
Make use of tools o Swaddling side carrying
shushing swinging and sucking
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Overcoming Barriers to Change What Parents are Sayinghellip
Prone positioning fear of choking Baby sleeps ldquobetterrdquo on stomach Soft things are safer for the baby SIDS is ldquoGodrsquos willrdquo Why bother Recommendations keep changing
anyway Vigilance sleep with baby for protection
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Factors Associated With Choice of Infant Sleep Position 3300 mothers from 32 hospitals 77 usually use supine position 49 exclusive use supine position Most likely to use prone
o African-American motherso Mothers with lt high school educationo Lack of perceived controlo Personal attitudesocietal norms
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
A continuum starting in childhoodo Secondary school baby sitting classes
Pre-pregnancy Pregnancyprenatal education
o Prior to baby showerhellipldquowrong giftsrdquo In-hospital education and modeling
o Include family friends baby sitters Re-enforcement in the doctorrsquos office
o Especially between 1 to 4 months Grandparents They hold great power The general public (day cares religious leaders)
A Lifetime of Infant Sleep Safety
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Chart1
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
14
139
13
13
12
13
117
17
103
269
087
386
074
353
077
531
072
557
067
644
062
666
056
716
057
711
053
728
056
701
055
722
055
757
057
703
055
721
054
741
051
728
048
042
04
039
Sheet1
Sheet1
ampA
Page ampP
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
Sheet2
Pre-AAP recommendation Post-AAP RecommendationBack to SleepSafe to Sleep Campaign
Sheet3
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Infant Sleep Safety
Requires a consistent and repetitive message in the community to prevent accidental deaths
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Safe Sleep Nurse Modeling
People trust nurses Whatever the nurse does must
be correct and it will be imitated in the home
Fact supine positioning in the nursery can almost DOUBLE its use in the home
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Physician Advocacy
Srivatsa 1997 HCP education to new familieshellip34 reduction in prone sleeping
Eron 2009 Study of Central NY state physicianshellip30 identified incorrect safest sleep positionhellip30 do not discuss with families
Colson 2009 Only 13 mothers advised by MD to use supine positionhellip3 times more likely to position the baby properly
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Healthcare Provider Advice to New Mothers Safe Sleep
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Chart1
Column1
[]
[]
[]
55
25
20
Sheet1
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Mason Clinical Peds 713
Bundled interventiono Nursing education policy model behavior safe sleep
video posters in rooms declaration of safe sleep practice
Safe sleep environment uarr from 25 to 58 Intention in home 95 supine none ldquoco-sleepingrdquo
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bundled Intervention = Behavior Change
QUESTION GROUP p-value
ISS Study NISP
Behavior Questions n = 490 n = 1046
Baby routinely placed to sleep on back 925 73 lt 0001
Baby routinely sleeps in bassinetcrib 995 71 lt 00001
Baby sleeps under a thin sheet 992 86 lt 0001
Baby given a pacifier for sleep 741 84 lt 0001Goodstein MH Bell T Krugman SD Improving infant sleep safety through a comprehensive hospital-based program Clinical Pediatrics 201554(3)212-221
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
o Baseline Safe sleep 49 of 264 infants o Post 312 of 234 infants (P lt 001) o Extra blankets most common o Baseline 77 vs 44 post-intervention o Mean number of unsafe items reduced by 50 (P lt 001)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Washington DC
2 urban DC nurseries 26 did not believe or unsure that infant positioning
was associated with SIDS Top 3 factors influencing sleep position
o 56 PERSONAL PREFERENCE Why non-supine Clinical experience (25)
o Increase risk aspirationo Decrease sleep and comfort
Bartow KL Nursesrsquo knowledge and adherence to sudden infant death syndrome prevention guidelines Pediatr Nurs 201642(1)7-13
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
TodaysBaby QI Safe Sleep Teaching
QI intervention median = 160 days Mothers reported receiving information 72 to 95
(increase of 24-57) 94 babies observed supine (plus 24) 88 infants in safe sleep environment
o Increase of 33 Gains maintained up to 12 months
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Social Media and Risk-Reduction Training Study (SMART) Cluster randomization 4 groups Safe sleep or breast feeding education Nursing QI and social media (mobile health) N = 1600 1263 responses (79) Safe sleep NQI and MHealth
o Supine sleep 925 o Room-sharing 859o No soft bedding 819o Pacifier use 762
Moon RY Hauck FR Colson ER et al The effect of nursing quality improvement and mobile health interventions on infant sleep practices a randomized clinical trial JAMA 2017318(4)351-359
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Hospital Initiative ComponentswwwcribsforkidsorgHospitalInitiativeToolkit INTRODUCTORY LETTER HOSPITAL INITIATIVE TOOL KIT
INSTRUCTIONS ORGANIZATIONAL CHART HOSPITAL POLICY ACKNOWLEDGMENT FORM (Engl amp
Span) SAFE SLEEP EDUCATIONAL FLIP CHART
NONCOMPLIANCE WAIVER (Engl amp Span)
NURSING EDUCATION MODULE
SAFE SLEEP POSTERS DOOR HANGERS (Engl amp Span) GRADUATION CERTIFICATE SAMPLE LETTER TO HOSPITALS SAMPLE LETTER TO PROVIDERS INFANT SAFE SLEEP BROCHURES
(Engl amp Span) PRESS KIT
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
All materials available on-lineo No major costs to the hospital
Easy on-line access for documentation
NO FEE FOR PARTICIPATION
wwwCribsforKidsorgHospitalInitiative
Tiffany Price (tpricecribsforkidsorg)
The National Safe Sleep Hospital Certification Program
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
TNmdash25 reduction in infant sleep-related deaths in 2 years
SDmdashOver 7915 Pack lsquon Plays distributed since 2012 Infant mortality rate decreased from 86 (2012) to 48 (2016)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
2009 to 2015 38 decrease in infant mortality Decreased from 135 to 84 per 1000 SUID decreased gt50 Decrease in racial disparityhttphealthybabiesbaltimorecomhome
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
And Finallyhellip
Health care providers should have open frank nonjudgmental conversations with families about their sleep practices
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Encouraging Parents to Take Action
According to the Social Learning Theory parents are more likely to recall and comply with instructions when
the health care provider
Uses a positive tone Provides adequate information Allows the parent to ask most of the questions
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Motivational Interviewing
ldquoa collaborative goal-oriented style of communication with particular attention to the language of changerdquo
o Strengthen personal motivation and commitment to a specific goal
o Explore onersquos reasons for change (barriers)o Patient generates own solutions
bull More likely to feel realisticbull Planting seeds of change
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Impact of Eliminating Sleep-Related Deaths
Every week we lose 70 children which is equivalent to 4 kindergarten classrooms
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Thank You
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Contact Information
mgoodsteinwellspanorg
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Visit Pediatric Care Online today for additional information on this and other topics
httppediatriccaresolutionsaaporgPediatric Care Online is a convenient electronic resource for immediate expert help with
virtually every pediatric clinical information need with must-have resources that are included in a comprehensive reference library and time-saving clinical tools
Donrsquot have a subscription to PCOThen take advantage of a free trial today
Call Mead Johnson Nutrition at 888363-2362 orfor more information go to
httppediatriccaresolutionsaaporgSSFree_Trialaspx
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
IMR over time Finland vs US
Slide Number 1
Disclaimer
Objectives for Todayrsquos Talk
Infant Mortality Rates for the Five Leading Causes of Infant Death in the United States 2005 and 2011
US Post-Neonatal Mortality 2015
FACT
What is SUID or SUDI
Some Causes of Deaths that Occur Suddenly and Unexpectedly during Infancy
What is SIDS
SIDS FACTS
SIDS FACTS
Triple Risk Model to Explain SIDS
Paterson DS Krous HF Kinney HC et al JAMA 2006
An Example of SIDS Pathogenesis
2016 AAP Recommendations Infant Sleep Safety
Strength of Recommendation
Recommendations Change as the Evidence Evolves
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
Correct Safe Sleep Environment
We Need to Move Beyond Back to Sleep
Sleep Position for Healthy Newborns
Sleep Position in Newborn Nursery
Sleep Position and Reflux
The Truth About Supine Sleep and Aspiration Ending the Fallacy
Title
Infant Sleep Location
Room-Share How Long Yoursquore Kidding Right
Supporting Data
More Recent Data
Why is Room-Sharing Protective
Room-Sharing and Sleep Quality
Insight Study (Paul 2017)
Insight Study (Paul 2017)
Insight Commentary (Hauck Moon)
Feeding the Baby at Night
Say NO to Couches Sofas and Cushioned Armchairs
High-Risk Bed Sharing Situations
Bedsharing in Low-Risk Breastfed Infants
Independent Review (Dr Robert Platt)
Bed Sharing
Bed Sharing
Bed Sharing with Overlay
Bed Sharing with Overlay
Bed Sharing with Overlay
Couch Sleeping
Couch Sleeping
Couch Sleeping
Unsafe Bedding NISP Trends 1993-2102
Why Use Soft Bedding
Soft Bedding for Older Infants
To Swaddle or Not to Swaddle That is the Question
Swaddling
SwaddlingmdashIs it Safe
SwaddlingmdashMore Questionshellip
wwwhealthychildrenorg
Pacifiers
Pacifiers and Breastfeeding
Baby Friendly USA Pacifiers
Addressing Sleep Deprivation
Overcoming Barriers to Change What Parents are Sayinghellip
Factors Associated With Choice of Infant Sleep Position
Slide Number 65
What is Working
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Infant Sleep Safety
Safe Sleep Nurse Modeling
Physician Advocacy
Healthcare Provider Advice to New Mothers Safe Sleep
Mason Clinical Peds 713
Bundled Intervention = Behavior Change
Hospital Unsafe Sleep Persists
Washington DC
TodaysBaby QI Safe Sleep Teaching
TodaysBaby QI Safe Sleep Teaching
Social Media and Risk-Reduction Training Study (SMART)
The National Safe Sleep Hospital Certification Program
Coordinated Education Efforts Work
Coordinated Education Efforts Work
And Finallyhellip
Encouraging Parents to Take Action
Motivational Interviewing
Impact of Eliminating Sleep-Related Deaths
Thank You
Contact Information
Slide Number 89
IMR over time Finland vs US
Column1
correct advice
55
incorrect advice
25
no advice
20
correct advice
incorrect advice
no advice
SIDS Rate
Percent Back Sleeping
1988
14
1989
139
1990
13
1991
13
1992
12
13
1993
117
17
1994
103
269
1995
087
386
1996
074
353
1997
077
531
1998
072
557
1999
067
644
2000
062
666
2001
056
716
2002
057
711
2003
053
728
2004
056
701
2005
055
722
2006
055
757
2007
057
703
2008
055
721
2009
054
741
2010
051
728
2011
048
2012
042
2013
04
2014
039
httpwwwcdcgovNCHSdatanvsrnvsr58nvsr58_19pdf
Xu JQ Kochanek KD Murphy SL Tejada-Vera B Deaths Final data for
2007
National vital statistics reports vol 58 no 19 Hyattsville MD
National Center for Health Statistics 2010
1988
1988
1989
1989
1990
1990
1991
1991
1992
1992
1993
1993
1994
1994
1995
1995
1996
1996
1997
1997
1998
1998
1999
1999
2000
2000
2001
2001
2002
2002
2003
2003
2004
2004
2005
2005
2006
2006
2007
2007
2008
2008
2009
2009
2010
2010
2011
2012
2013
2014
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Supporting Data
3 case-control studies comparing sleeping in a separate room vs room-sharingo Tappin (Scotland) AOR 326 (95 CI 103-1035)
bull Protection is significant for smoker motherso Blair (England) AOR 1049 (95 CI 426-2581)
bull Protection is significant for both smoker and nonsmoker mothers
o New Zealand Cot Death study AOR 285(95 CI 204-385)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
More Recent Data
New Zealand SUDI studyo 64 protection with room-sharing AOR 036
(95 CI 019-071)
Estimate of 50 reduction is very conservative
None of the case-control studies stratify by age (months)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Why is Room-Sharing Protective
SIDSmdashfailure to arouse More small awakenings during the night
o Stirrings movement not fully awake Postulation protective effect from small awakenings Room-sharing facilitates breastfeeding
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Room-Sharing and Sleep Quality
Volkovich room-sharing vs solitary sleepo Room-sharing mothers with more sleep disturbanceso Infants with similar sleep quality
Mao Mindell room-sharing infantsmdashmore awakenings
Montgomery-Downs Doan sleep quality in breastfeeding mothers gt to formula feeding motherso Exclusive breastfeeding = 30 min more sleep
More study needed
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Insight Study (Paul 2017)
Sleep questionnaire at 4 9 12 and 30 monthso Sleep duration overnight behaviorso Compared early vs late independent infants
At 4 monthso Equal sleep durationo Early group had better sleep consolidationo Longest stretch 46 minutes
Paul IM Hohman EE Loken E et al Mother-infant room-sharing and sleep outcomes in the INSIGHT study Pediatrics 2017140(1)e20170122
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Insight Study (Paul 2017)
At 9 monthso Longer sleep duration (40 minnight) o Better consolidation (100 min)
At 30 monthso Longer sleep duration (45 minnight)
Room-sharing 4 times more likely to transition to bed sharing overnight
Paul IM Hohman EE Loken E et al Mother-infant room-sharing and sleep outcomes in the INSIGHT study Pediatrics 2017140(1)e20170122
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Insight Commentary (Hauck Moon)
Late room-sharing mean 7 hours longest sleep Is early consolidation desirable Differences related to bedtime routines
o Early bedtimeo Number of night feedso Feeding back to sleep
Focus on the routine not early separation
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Feeding the Baby at Night Acknowledgment that parents may fall
asleep while feeding babyo Safer to feed on bed than on sofa
couch or armchair if you might fall asleep
o No pillows sheets blankets or other items that could obstruct infant breathing or cause overheating should be in bed
o Return infant back to separate sleep surface as soon as parent awakens
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Say NO to Couches Sofas and Cushioned Armchairs Never place a baby for sleep on these surfaces Never sleep with a baby on these surfaces One of the MOST dangerous places for an infant
(OR 51-669)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
High-Risk Bed Sharing Situations Age lt4 months Preterm or low birth weight Smoked during pregnancy Bed sharer is current smoker (even if not
smoking in bed) Bed sharer has usedis using meds or
substances that could impair alertness or arousal
Bed sharer is not parent (including other children)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bedsharing in Low-Risk Breastfed Infants
Blair et al AOR 16 (95 CI 096-27) o Age lt14 weekso Parents No cigarettes or alcoholo Independent of feeding method
Carpenter et al AOR 51 (95 CI 23-114) o Age lt3 months o Parents did not smokeo Mother No alcohol or drugso Breastfed infants
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Independent Review (Dr Robert Platt)
Very small numbers of low-risk babieso 24 in Blairrsquos studyo 12 in Carpenterrsquos study
Does not believe that data support definitive differences in 2 studies
Some evidence of increased risk in this group but cannot say how large the increased risk is
Cannot conclude that bed sharing in this group is safe
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Unsafe Bedding NISP Trends 1993-2102
Shapiro-Mendoza CK Colson ER Willinger M Rybin DV Camperlengo L Corwin MJ Trends in infant bedding use National Infant Sleep Position study 1993ndash2010 Pediatrics 2015135(1)10-17
Decrease from 86 to 55 Rate of decline decreases
2001-10 835 for teen mothers Predictors of adjusted OR
gt15
o Young motherso Non-white race
ethnicityo Less than college
education
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Why Use Soft Bedding
ComfortWarmtho Extrapolation of own feelingso Misinterpret firm with taut
bull Soft + taut ne firm
Safetyo Blankets pillows rolls to prevent falls
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Soft Bedding for Older Infants
Many parents recognize soft bedding is a risk Increased complacency as baby gets older Soft bedding is THE most important risk factor for
infants 4-12 months old (Colvin 2015) Infants roll into bedding and cannot extract
themselves
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
To Swaddle or Not to Swaddle That is the Question Pros
o Calms the infant promotes sleep decreases number of awakenings
o Encourages use of the supine position
Conso Increased respiratory rate and
reduced functional residual lung capacity
o Exacerbates hip dysplasia if the hips are kept in extension and adduction
o ldquoLooserdquo swaddling becomes loose bedding
o Overheating especially if the head is covered or the infant has infection
o Effects on arousability to an external stimulus remain unclear (conflicting data) There may be minimal effects of routine swaddling on arousal
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Swaddling
There is insufficient evidence to recommend routine swaddling as a strategy to reduce the incidence of SIDS
Swaddling must be correctly applied to avoid the possible hazards
Swaddling does not reduce the necessity to follow recommended safe sleep practices Ambrogio Lorenzettis Madonna and Child (1319)
Wikipedia
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
McDonnell E Moon RY Infant deaths and injuries associated with wearable blankets swaddle wraps and swaddling J Pediatr 20141641152-1156
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
SwaddlingmdashMore Questionshellip
Pease 2016 Pediatrics Pooled OR = 138
o Prone = 1299 o Side = 316o Supine = 193
Increased risk with age Limitations
o Heterogeneity definitions other risk factorsPease AS Fleming PJ Hauck FR et al Swaddling and the risk of sudden infant death syndrome a meta-analysis Pediatrics 2016137(6)e20153
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
wwwhealthychildrenorg
Swaddling (wrapping a light blanket snuggly around a baby) may help calm a crying baby If you swaddle your baby be sure to place him on his back to sleep Stop swaddling your baby when he starts to roll
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers
AAP recommendation Consider offering a pacifier at nap time and bedtime
Studies consistently demonstrate a protective effect of pacifiers on SIDS
Mechanism unknowno Dislodge within 15 to 60 minuteso Decreased arousal threshold
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers and Breastfeeding Well-designed trials
o 2 found no association among term infants
o 1 found no association among preterm infants
o 1 found slightly decreased breastfeeding duration at one month if pacifier introduced in first week of life but NO difference if pacifier introduced after one month
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Baby Friendly USA Pacifiers
Breastfeeding babies should not be given pacifiers by the staff of the facility with the exception of o Limited use to decrease pain during procedures when
the baby cannot safely be held or breastfed (pacifiers used should be discarded after these procedures)
o Babies who are being tube-fed in NICUo Other rare specific medical reasons
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Addressing Sleep Deprivation
Give parents tools to cope with fussy babies
Sleep-deprived parents may make poor judgments
Make use of tools o Swaddling side carrying
shushing swinging and sucking
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Overcoming Barriers to Change What Parents are Sayinghellip
Prone positioning fear of choking Baby sleeps ldquobetterrdquo on stomach Soft things are safer for the baby SIDS is ldquoGodrsquos willrdquo Why bother Recommendations keep changing
anyway Vigilance sleep with baby for protection
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Factors Associated With Choice of Infant Sleep Position 3300 mothers from 32 hospitals 77 usually use supine position 49 exclusive use supine position Most likely to use prone
o African-American motherso Mothers with lt high school educationo Lack of perceived controlo Personal attitudesocietal norms
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
A continuum starting in childhoodo Secondary school baby sitting classes
Pre-pregnancy Pregnancyprenatal education
o Prior to baby showerhellipldquowrong giftsrdquo In-hospital education and modeling
o Include family friends baby sitters Re-enforcement in the doctorrsquos office
o Especially between 1 to 4 months Grandparents They hold great power The general public (day cares religious leaders)
A Lifetime of Infant Sleep Safety
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Chart1
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
14
139
13
13
12
13
117
17
103
269
087
386
074
353
077
531
072
557
067
644
062
666
056
716
057
711
053
728
056
701
055
722
055
757
057
703
055
721
054
741
051
728
048
042
04
039
Sheet1
Sheet1
ampA
Page ampP
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
Sheet2
Pre-AAP recommendation Post-AAP RecommendationBack to SleepSafe to Sleep Campaign
Sheet3
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Infant Sleep Safety
Requires a consistent and repetitive message in the community to prevent accidental deaths
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Safe Sleep Nurse Modeling
People trust nurses Whatever the nurse does must
be correct and it will be imitated in the home
Fact supine positioning in the nursery can almost DOUBLE its use in the home
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Physician Advocacy
Srivatsa 1997 HCP education to new familieshellip34 reduction in prone sleeping
Eron 2009 Study of Central NY state physicianshellip30 identified incorrect safest sleep positionhellip30 do not discuss with families
Colson 2009 Only 13 mothers advised by MD to use supine positionhellip3 times more likely to position the baby properly
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Healthcare Provider Advice to New Mothers Safe Sleep
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Chart1
Column1
[]
[]
[]
55
25
20
Sheet1
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Mason Clinical Peds 713
Bundled interventiono Nursing education policy model behavior safe sleep
video posters in rooms declaration of safe sleep practice
Safe sleep environment uarr from 25 to 58 Intention in home 95 supine none ldquoco-sleepingrdquo
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bundled Intervention = Behavior Change
QUESTION GROUP p-value
ISS Study NISP
Behavior Questions n = 490 n = 1046
Baby routinely placed to sleep on back 925 73 lt 0001
Baby routinely sleeps in bassinetcrib 995 71 lt 00001
Baby sleeps under a thin sheet 992 86 lt 0001
Baby given a pacifier for sleep 741 84 lt 0001Goodstein MH Bell T Krugman SD Improving infant sleep safety through a comprehensive hospital-based program Clinical Pediatrics 201554(3)212-221
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
o Baseline Safe sleep 49 of 264 infants o Post 312 of 234 infants (P lt 001) o Extra blankets most common o Baseline 77 vs 44 post-intervention o Mean number of unsafe items reduced by 50 (P lt 001)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Washington DC
2 urban DC nurseries 26 did not believe or unsure that infant positioning
was associated with SIDS Top 3 factors influencing sleep position
o 56 PERSONAL PREFERENCE Why non-supine Clinical experience (25)
o Increase risk aspirationo Decrease sleep and comfort
Bartow KL Nursesrsquo knowledge and adherence to sudden infant death syndrome prevention guidelines Pediatr Nurs 201642(1)7-13
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
TodaysBaby QI Safe Sleep Teaching
QI intervention median = 160 days Mothers reported receiving information 72 to 95
(increase of 24-57) 94 babies observed supine (plus 24) 88 infants in safe sleep environment
o Increase of 33 Gains maintained up to 12 months
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Social Media and Risk-Reduction Training Study (SMART) Cluster randomization 4 groups Safe sleep or breast feeding education Nursing QI and social media (mobile health) N = 1600 1263 responses (79) Safe sleep NQI and MHealth
o Supine sleep 925 o Room-sharing 859o No soft bedding 819o Pacifier use 762
Moon RY Hauck FR Colson ER et al The effect of nursing quality improvement and mobile health interventions on infant sleep practices a randomized clinical trial JAMA 2017318(4)351-359
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Hospital Initiative ComponentswwwcribsforkidsorgHospitalInitiativeToolkit INTRODUCTORY LETTER HOSPITAL INITIATIVE TOOL KIT
INSTRUCTIONS ORGANIZATIONAL CHART HOSPITAL POLICY ACKNOWLEDGMENT FORM (Engl amp
Span) SAFE SLEEP EDUCATIONAL FLIP CHART
NONCOMPLIANCE WAIVER (Engl amp Span)
NURSING EDUCATION MODULE
SAFE SLEEP POSTERS DOOR HANGERS (Engl amp Span) GRADUATION CERTIFICATE SAMPLE LETTER TO HOSPITALS SAMPLE LETTER TO PROVIDERS INFANT SAFE SLEEP BROCHURES
(Engl amp Span) PRESS KIT
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
All materials available on-lineo No major costs to the hospital
Easy on-line access for documentation
NO FEE FOR PARTICIPATION
wwwCribsforKidsorgHospitalInitiative
Tiffany Price (tpricecribsforkidsorg)
The National Safe Sleep Hospital Certification Program
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
TNmdash25 reduction in infant sleep-related deaths in 2 years
SDmdashOver 7915 Pack lsquon Plays distributed since 2012 Infant mortality rate decreased from 86 (2012) to 48 (2016)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
2009 to 2015 38 decrease in infant mortality Decreased from 135 to 84 per 1000 SUID decreased gt50 Decrease in racial disparityhttphealthybabiesbaltimorecomhome
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
And Finallyhellip
Health care providers should have open frank nonjudgmental conversations with families about their sleep practices
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Encouraging Parents to Take Action
According to the Social Learning Theory parents are more likely to recall and comply with instructions when
the health care provider
Uses a positive tone Provides adequate information Allows the parent to ask most of the questions
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Motivational Interviewing
ldquoa collaborative goal-oriented style of communication with particular attention to the language of changerdquo
o Strengthen personal motivation and commitment to a specific goal
o Explore onersquos reasons for change (barriers)o Patient generates own solutions
bull More likely to feel realisticbull Planting seeds of change
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Impact of Eliminating Sleep-Related Deaths
Every week we lose 70 children which is equivalent to 4 kindergarten classrooms
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Thank You
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Contact Information
mgoodsteinwellspanorg
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Visit Pediatric Care Online today for additional information on this and other topics
httppediatriccaresolutionsaaporgPediatric Care Online is a convenient electronic resource for immediate expert help with
virtually every pediatric clinical information need with must-have resources that are included in a comprehensive reference library and time-saving clinical tools
Donrsquot have a subscription to PCOThen take advantage of a free trial today
Call Mead Johnson Nutrition at 888363-2362 orfor more information go to
httppediatriccaresolutionsaaporgSSFree_Trialaspx
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
IMR over time Finland vs US
Slide Number 1
Disclaimer
Objectives for Todayrsquos Talk
Infant Mortality Rates for the Five Leading Causes of Infant Death in the United States 2005 and 2011
US Post-Neonatal Mortality 2015
FACT
What is SUID or SUDI
Some Causes of Deaths that Occur Suddenly and Unexpectedly during Infancy
What is SIDS
SIDS FACTS
SIDS FACTS
Triple Risk Model to Explain SIDS
Paterson DS Krous HF Kinney HC et al JAMA 2006
An Example of SIDS Pathogenesis
2016 AAP Recommendations Infant Sleep Safety
Strength of Recommendation
Recommendations Change as the Evidence Evolves
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
Correct Safe Sleep Environment
We Need to Move Beyond Back to Sleep
Sleep Position for Healthy Newborns
Sleep Position in Newborn Nursery
Sleep Position and Reflux
The Truth About Supine Sleep and Aspiration Ending the Fallacy
Title
Infant Sleep Location
Room-Share How Long Yoursquore Kidding Right
Supporting Data
More Recent Data
Why is Room-Sharing Protective
Room-Sharing and Sleep Quality
Insight Study (Paul 2017)
Insight Study (Paul 2017)
Insight Commentary (Hauck Moon)
Feeding the Baby at Night
Say NO to Couches Sofas and Cushioned Armchairs
High-Risk Bed Sharing Situations
Bedsharing in Low-Risk Breastfed Infants
Independent Review (Dr Robert Platt)
Bed Sharing
Bed Sharing
Bed Sharing with Overlay
Bed Sharing with Overlay
Bed Sharing with Overlay
Couch Sleeping
Couch Sleeping
Couch Sleeping
Unsafe Bedding NISP Trends 1993-2102
Why Use Soft Bedding
Soft Bedding for Older Infants
To Swaddle or Not to Swaddle That is the Question
Swaddling
SwaddlingmdashIs it Safe
SwaddlingmdashMore Questionshellip
wwwhealthychildrenorg
Pacifiers
Pacifiers and Breastfeeding
Baby Friendly USA Pacifiers
Addressing Sleep Deprivation
Overcoming Barriers to Change What Parents are Sayinghellip
Factors Associated With Choice of Infant Sleep Position
Slide Number 65
What is Working
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Infant Sleep Safety
Safe Sleep Nurse Modeling
Physician Advocacy
Healthcare Provider Advice to New Mothers Safe Sleep
Mason Clinical Peds 713
Bundled Intervention = Behavior Change
Hospital Unsafe Sleep Persists
Washington DC
TodaysBaby QI Safe Sleep Teaching
TodaysBaby QI Safe Sleep Teaching
Social Media and Risk-Reduction Training Study (SMART)
The National Safe Sleep Hospital Certification Program
Coordinated Education Efforts Work
Coordinated Education Efforts Work
And Finallyhellip
Encouraging Parents to Take Action
Motivational Interviewing
Impact of Eliminating Sleep-Related Deaths
Thank You
Contact Information
Slide Number 89
IMR over time Finland vs US
Column1
correct advice
55
incorrect advice
25
no advice
20
correct advice
incorrect advice
no advice
SIDS Rate
Percent Back Sleeping
1988
14
1989
139
1990
13
1991
13
1992
12
13
1993
117
17
1994
103
269
1995
087
386
1996
074
353
1997
077
531
1998
072
557
1999
067
644
2000
062
666
2001
056
716
2002
057
711
2003
053
728
2004
056
701
2005
055
722
2006
055
757
2007
057
703
2008
055
721
2009
054
741
2010
051
728
2011
048
2012
042
2013
04
2014
039
httpwwwcdcgovNCHSdatanvsrnvsr58nvsr58_19pdf
Xu JQ Kochanek KD Murphy SL Tejada-Vera B Deaths Final data for
2007
National vital statistics reports vol 58 no 19 Hyattsville MD
National Center for Health Statistics 2010
1988
1988
1989
1989
1990
1990
1991
1991
1992
1992
1993
1993
1994
1994
1995
1995
1996
1996
1997
1997
1998
1998
1999
1999
2000
2000
2001
2001
2002
2002
2003
2003
2004
2004
2005
2005
2006
2006
2007
2007
2008
2008
2009
2009
2010
2010
2011
2012
2013
2014
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
More Recent Data
New Zealand SUDI studyo 64 protection with room-sharing AOR 036
(95 CI 019-071)
Estimate of 50 reduction is very conservative
None of the case-control studies stratify by age (months)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Why is Room-Sharing Protective
SIDSmdashfailure to arouse More small awakenings during the night
o Stirrings movement not fully awake Postulation protective effect from small awakenings Room-sharing facilitates breastfeeding
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Room-Sharing and Sleep Quality
Volkovich room-sharing vs solitary sleepo Room-sharing mothers with more sleep disturbanceso Infants with similar sleep quality
Mao Mindell room-sharing infantsmdashmore awakenings
Montgomery-Downs Doan sleep quality in breastfeeding mothers gt to formula feeding motherso Exclusive breastfeeding = 30 min more sleep
More study needed
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Insight Study (Paul 2017)
Sleep questionnaire at 4 9 12 and 30 monthso Sleep duration overnight behaviorso Compared early vs late independent infants
At 4 monthso Equal sleep durationo Early group had better sleep consolidationo Longest stretch 46 minutes
Paul IM Hohman EE Loken E et al Mother-infant room-sharing and sleep outcomes in the INSIGHT study Pediatrics 2017140(1)e20170122
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Insight Study (Paul 2017)
At 9 monthso Longer sleep duration (40 minnight) o Better consolidation (100 min)
At 30 monthso Longer sleep duration (45 minnight)
Room-sharing 4 times more likely to transition to bed sharing overnight
Paul IM Hohman EE Loken E et al Mother-infant room-sharing and sleep outcomes in the INSIGHT study Pediatrics 2017140(1)e20170122
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Insight Commentary (Hauck Moon)
Late room-sharing mean 7 hours longest sleep Is early consolidation desirable Differences related to bedtime routines
o Early bedtimeo Number of night feedso Feeding back to sleep
Focus on the routine not early separation
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Feeding the Baby at Night Acknowledgment that parents may fall
asleep while feeding babyo Safer to feed on bed than on sofa
couch or armchair if you might fall asleep
o No pillows sheets blankets or other items that could obstruct infant breathing or cause overheating should be in bed
o Return infant back to separate sleep surface as soon as parent awakens
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Say NO to Couches Sofas and Cushioned Armchairs Never place a baby for sleep on these surfaces Never sleep with a baby on these surfaces One of the MOST dangerous places for an infant
(OR 51-669)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
High-Risk Bed Sharing Situations Age lt4 months Preterm or low birth weight Smoked during pregnancy Bed sharer is current smoker (even if not
smoking in bed) Bed sharer has usedis using meds or
substances that could impair alertness or arousal
Bed sharer is not parent (including other children)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bedsharing in Low-Risk Breastfed Infants
Blair et al AOR 16 (95 CI 096-27) o Age lt14 weekso Parents No cigarettes or alcoholo Independent of feeding method
Carpenter et al AOR 51 (95 CI 23-114) o Age lt3 months o Parents did not smokeo Mother No alcohol or drugso Breastfed infants
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Independent Review (Dr Robert Platt)
Very small numbers of low-risk babieso 24 in Blairrsquos studyo 12 in Carpenterrsquos study
Does not believe that data support definitive differences in 2 studies
Some evidence of increased risk in this group but cannot say how large the increased risk is
Cannot conclude that bed sharing in this group is safe
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Unsafe Bedding NISP Trends 1993-2102
Shapiro-Mendoza CK Colson ER Willinger M Rybin DV Camperlengo L Corwin MJ Trends in infant bedding use National Infant Sleep Position study 1993ndash2010 Pediatrics 2015135(1)10-17
Decrease from 86 to 55 Rate of decline decreases
2001-10 835 for teen mothers Predictors of adjusted OR
gt15
o Young motherso Non-white race
ethnicityo Less than college
education
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Why Use Soft Bedding
ComfortWarmtho Extrapolation of own feelingso Misinterpret firm with taut
bull Soft + taut ne firm
Safetyo Blankets pillows rolls to prevent falls
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Soft Bedding for Older Infants
Many parents recognize soft bedding is a risk Increased complacency as baby gets older Soft bedding is THE most important risk factor for
infants 4-12 months old (Colvin 2015) Infants roll into bedding and cannot extract
themselves
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
To Swaddle or Not to Swaddle That is the Question Pros
o Calms the infant promotes sleep decreases number of awakenings
o Encourages use of the supine position
Conso Increased respiratory rate and
reduced functional residual lung capacity
o Exacerbates hip dysplasia if the hips are kept in extension and adduction
o ldquoLooserdquo swaddling becomes loose bedding
o Overheating especially if the head is covered or the infant has infection
o Effects on arousability to an external stimulus remain unclear (conflicting data) There may be minimal effects of routine swaddling on arousal
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Swaddling
There is insufficient evidence to recommend routine swaddling as a strategy to reduce the incidence of SIDS
Swaddling must be correctly applied to avoid the possible hazards
Swaddling does not reduce the necessity to follow recommended safe sleep practices Ambrogio Lorenzettis Madonna and Child (1319)
Wikipedia
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
McDonnell E Moon RY Infant deaths and injuries associated with wearable blankets swaddle wraps and swaddling J Pediatr 20141641152-1156
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
SwaddlingmdashMore Questionshellip
Pease 2016 Pediatrics Pooled OR = 138
o Prone = 1299 o Side = 316o Supine = 193
Increased risk with age Limitations
o Heterogeneity definitions other risk factorsPease AS Fleming PJ Hauck FR et al Swaddling and the risk of sudden infant death syndrome a meta-analysis Pediatrics 2016137(6)e20153
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
wwwhealthychildrenorg
Swaddling (wrapping a light blanket snuggly around a baby) may help calm a crying baby If you swaddle your baby be sure to place him on his back to sleep Stop swaddling your baby when he starts to roll
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers
AAP recommendation Consider offering a pacifier at nap time and bedtime
Studies consistently demonstrate a protective effect of pacifiers on SIDS
Mechanism unknowno Dislodge within 15 to 60 minuteso Decreased arousal threshold
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers and Breastfeeding Well-designed trials
o 2 found no association among term infants
o 1 found no association among preterm infants
o 1 found slightly decreased breastfeeding duration at one month if pacifier introduced in first week of life but NO difference if pacifier introduced after one month
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Baby Friendly USA Pacifiers
Breastfeeding babies should not be given pacifiers by the staff of the facility with the exception of o Limited use to decrease pain during procedures when
the baby cannot safely be held or breastfed (pacifiers used should be discarded after these procedures)
o Babies who are being tube-fed in NICUo Other rare specific medical reasons
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Addressing Sleep Deprivation
Give parents tools to cope with fussy babies
Sleep-deprived parents may make poor judgments
Make use of tools o Swaddling side carrying
shushing swinging and sucking
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Overcoming Barriers to Change What Parents are Sayinghellip
Prone positioning fear of choking Baby sleeps ldquobetterrdquo on stomach Soft things are safer for the baby SIDS is ldquoGodrsquos willrdquo Why bother Recommendations keep changing
anyway Vigilance sleep with baby for protection
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Factors Associated With Choice of Infant Sleep Position 3300 mothers from 32 hospitals 77 usually use supine position 49 exclusive use supine position Most likely to use prone
o African-American motherso Mothers with lt high school educationo Lack of perceived controlo Personal attitudesocietal norms
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
A continuum starting in childhoodo Secondary school baby sitting classes
Pre-pregnancy Pregnancyprenatal education
o Prior to baby showerhellipldquowrong giftsrdquo In-hospital education and modeling
o Include family friends baby sitters Re-enforcement in the doctorrsquos office
o Especially between 1 to 4 months Grandparents They hold great power The general public (day cares religious leaders)
A Lifetime of Infant Sleep Safety
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Chart1
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
14
139
13
13
12
13
117
17
103
269
087
386
074
353
077
531
072
557
067
644
062
666
056
716
057
711
053
728
056
701
055
722
055
757
057
703
055
721
054
741
051
728
048
042
04
039
Sheet1
Sheet1
ampA
Page ampP
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
Sheet2
Pre-AAP recommendation Post-AAP RecommendationBack to SleepSafe to Sleep Campaign
Sheet3
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Infant Sleep Safety
Requires a consistent and repetitive message in the community to prevent accidental deaths
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Safe Sleep Nurse Modeling
People trust nurses Whatever the nurse does must
be correct and it will be imitated in the home
Fact supine positioning in the nursery can almost DOUBLE its use in the home
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Physician Advocacy
Srivatsa 1997 HCP education to new familieshellip34 reduction in prone sleeping
Eron 2009 Study of Central NY state physicianshellip30 identified incorrect safest sleep positionhellip30 do not discuss with families
Colson 2009 Only 13 mothers advised by MD to use supine positionhellip3 times more likely to position the baby properly
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Healthcare Provider Advice to New Mothers Safe Sleep
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Chart1
Column1
[]
[]
[]
55
25
20
Sheet1
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Mason Clinical Peds 713
Bundled interventiono Nursing education policy model behavior safe sleep
video posters in rooms declaration of safe sleep practice
Safe sleep environment uarr from 25 to 58 Intention in home 95 supine none ldquoco-sleepingrdquo
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bundled Intervention = Behavior Change
QUESTION GROUP p-value
ISS Study NISP
Behavior Questions n = 490 n = 1046
Baby routinely placed to sleep on back 925 73 lt 0001
Baby routinely sleeps in bassinetcrib 995 71 lt 00001
Baby sleeps under a thin sheet 992 86 lt 0001
Baby given a pacifier for sleep 741 84 lt 0001Goodstein MH Bell T Krugman SD Improving infant sleep safety through a comprehensive hospital-based program Clinical Pediatrics 201554(3)212-221
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
o Baseline Safe sleep 49 of 264 infants o Post 312 of 234 infants (P lt 001) o Extra blankets most common o Baseline 77 vs 44 post-intervention o Mean number of unsafe items reduced by 50 (P lt 001)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Washington DC
2 urban DC nurseries 26 did not believe or unsure that infant positioning
was associated with SIDS Top 3 factors influencing sleep position
o 56 PERSONAL PREFERENCE Why non-supine Clinical experience (25)
o Increase risk aspirationo Decrease sleep and comfort
Bartow KL Nursesrsquo knowledge and adherence to sudden infant death syndrome prevention guidelines Pediatr Nurs 201642(1)7-13
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
TodaysBaby QI Safe Sleep Teaching
QI intervention median = 160 days Mothers reported receiving information 72 to 95
(increase of 24-57) 94 babies observed supine (plus 24) 88 infants in safe sleep environment
o Increase of 33 Gains maintained up to 12 months
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Social Media and Risk-Reduction Training Study (SMART) Cluster randomization 4 groups Safe sleep or breast feeding education Nursing QI and social media (mobile health) N = 1600 1263 responses (79) Safe sleep NQI and MHealth
o Supine sleep 925 o Room-sharing 859o No soft bedding 819o Pacifier use 762
Moon RY Hauck FR Colson ER et al The effect of nursing quality improvement and mobile health interventions on infant sleep practices a randomized clinical trial JAMA 2017318(4)351-359
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Hospital Initiative ComponentswwwcribsforkidsorgHospitalInitiativeToolkit INTRODUCTORY LETTER HOSPITAL INITIATIVE TOOL KIT
INSTRUCTIONS ORGANIZATIONAL CHART HOSPITAL POLICY ACKNOWLEDGMENT FORM (Engl amp
Span) SAFE SLEEP EDUCATIONAL FLIP CHART
NONCOMPLIANCE WAIVER (Engl amp Span)
NURSING EDUCATION MODULE
SAFE SLEEP POSTERS DOOR HANGERS (Engl amp Span) GRADUATION CERTIFICATE SAMPLE LETTER TO HOSPITALS SAMPLE LETTER TO PROVIDERS INFANT SAFE SLEEP BROCHURES
(Engl amp Span) PRESS KIT
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
All materials available on-lineo No major costs to the hospital
Easy on-line access for documentation
NO FEE FOR PARTICIPATION
wwwCribsforKidsorgHospitalInitiative
Tiffany Price (tpricecribsforkidsorg)
The National Safe Sleep Hospital Certification Program
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
TNmdash25 reduction in infant sleep-related deaths in 2 years
SDmdashOver 7915 Pack lsquon Plays distributed since 2012 Infant mortality rate decreased from 86 (2012) to 48 (2016)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
2009 to 2015 38 decrease in infant mortality Decreased from 135 to 84 per 1000 SUID decreased gt50 Decrease in racial disparityhttphealthybabiesbaltimorecomhome
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
And Finallyhellip
Health care providers should have open frank nonjudgmental conversations with families about their sleep practices
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Encouraging Parents to Take Action
According to the Social Learning Theory parents are more likely to recall and comply with instructions when
the health care provider
Uses a positive tone Provides adequate information Allows the parent to ask most of the questions
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Motivational Interviewing
ldquoa collaborative goal-oriented style of communication with particular attention to the language of changerdquo
o Strengthen personal motivation and commitment to a specific goal
o Explore onersquos reasons for change (barriers)o Patient generates own solutions
bull More likely to feel realisticbull Planting seeds of change
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Impact of Eliminating Sleep-Related Deaths
Every week we lose 70 children which is equivalent to 4 kindergarten classrooms
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Thank You
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Contact Information
mgoodsteinwellspanorg
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Visit Pediatric Care Online today for additional information on this and other topics
httppediatriccaresolutionsaaporgPediatric Care Online is a convenient electronic resource for immediate expert help with
virtually every pediatric clinical information need with must-have resources that are included in a comprehensive reference library and time-saving clinical tools
Donrsquot have a subscription to PCOThen take advantage of a free trial today
Call Mead Johnson Nutrition at 888363-2362 orfor more information go to
httppediatriccaresolutionsaaporgSSFree_Trialaspx
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
IMR over time Finland vs US
Slide Number 1
Disclaimer
Objectives for Todayrsquos Talk
Infant Mortality Rates for the Five Leading Causes of Infant Death in the United States 2005 and 2011
US Post-Neonatal Mortality 2015
FACT
What is SUID or SUDI
Some Causes of Deaths that Occur Suddenly and Unexpectedly during Infancy
What is SIDS
SIDS FACTS
SIDS FACTS
Triple Risk Model to Explain SIDS
Paterson DS Krous HF Kinney HC et al JAMA 2006
An Example of SIDS Pathogenesis
2016 AAP Recommendations Infant Sleep Safety
Strength of Recommendation
Recommendations Change as the Evidence Evolves
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
Correct Safe Sleep Environment
We Need to Move Beyond Back to Sleep
Sleep Position for Healthy Newborns
Sleep Position in Newborn Nursery
Sleep Position and Reflux
The Truth About Supine Sleep and Aspiration Ending the Fallacy
Title
Infant Sleep Location
Room-Share How Long Yoursquore Kidding Right
Supporting Data
More Recent Data
Why is Room-Sharing Protective
Room-Sharing and Sleep Quality
Insight Study (Paul 2017)
Insight Study (Paul 2017)
Insight Commentary (Hauck Moon)
Feeding the Baby at Night
Say NO to Couches Sofas and Cushioned Armchairs
High-Risk Bed Sharing Situations
Bedsharing in Low-Risk Breastfed Infants
Independent Review (Dr Robert Platt)
Bed Sharing
Bed Sharing
Bed Sharing with Overlay
Bed Sharing with Overlay
Bed Sharing with Overlay
Couch Sleeping
Couch Sleeping
Couch Sleeping
Unsafe Bedding NISP Trends 1993-2102
Why Use Soft Bedding
Soft Bedding for Older Infants
To Swaddle or Not to Swaddle That is the Question
Swaddling
SwaddlingmdashIs it Safe
SwaddlingmdashMore Questionshellip
wwwhealthychildrenorg
Pacifiers
Pacifiers and Breastfeeding
Baby Friendly USA Pacifiers
Addressing Sleep Deprivation
Overcoming Barriers to Change What Parents are Sayinghellip
Factors Associated With Choice of Infant Sleep Position
Slide Number 65
What is Working
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Infant Sleep Safety
Safe Sleep Nurse Modeling
Physician Advocacy
Healthcare Provider Advice to New Mothers Safe Sleep
Mason Clinical Peds 713
Bundled Intervention = Behavior Change
Hospital Unsafe Sleep Persists
Washington DC
TodaysBaby QI Safe Sleep Teaching
TodaysBaby QI Safe Sleep Teaching
Social Media and Risk-Reduction Training Study (SMART)
The National Safe Sleep Hospital Certification Program
Coordinated Education Efforts Work
Coordinated Education Efforts Work
And Finallyhellip
Encouraging Parents to Take Action
Motivational Interviewing
Impact of Eliminating Sleep-Related Deaths
Thank You
Contact Information
Slide Number 89
IMR over time Finland vs US
Column1
correct advice
55
incorrect advice
25
no advice
20
correct advice
incorrect advice
no advice
SIDS Rate
Percent Back Sleeping
1988
14
1989
139
1990
13
1991
13
1992
12
13
1993
117
17
1994
103
269
1995
087
386
1996
074
353
1997
077
531
1998
072
557
1999
067
644
2000
062
666
2001
056
716
2002
057
711
2003
053
728
2004
056
701
2005
055
722
2006
055
757
2007
057
703
2008
055
721
2009
054
741
2010
051
728
2011
048
2012
042
2013
04
2014
039
httpwwwcdcgovNCHSdatanvsrnvsr58nvsr58_19pdf
Xu JQ Kochanek KD Murphy SL Tejada-Vera B Deaths Final data for
2007
National vital statistics reports vol 58 no 19 Hyattsville MD
National Center for Health Statistics 2010
1988
1988
1989
1989
1990
1990
1991
1991
1992
1992
1993
1993
1994
1994
1995
1995
1996
1996
1997
1997
1998
1998
1999
1999
2000
2000
2001
2001
2002
2002
2003
2003
2004
2004
2005
2005
2006
2006
2007
2007
2008
2008
2009
2009
2010
2010
2011
2012
2013
2014
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Why is Room-Sharing Protective
SIDSmdashfailure to arouse More small awakenings during the night
o Stirrings movement not fully awake Postulation protective effect from small awakenings Room-sharing facilitates breastfeeding
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Room-Sharing and Sleep Quality
Volkovich room-sharing vs solitary sleepo Room-sharing mothers with more sleep disturbanceso Infants with similar sleep quality
Mao Mindell room-sharing infantsmdashmore awakenings
Montgomery-Downs Doan sleep quality in breastfeeding mothers gt to formula feeding motherso Exclusive breastfeeding = 30 min more sleep
More study needed
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Insight Study (Paul 2017)
Sleep questionnaire at 4 9 12 and 30 monthso Sleep duration overnight behaviorso Compared early vs late independent infants
At 4 monthso Equal sleep durationo Early group had better sleep consolidationo Longest stretch 46 minutes
Paul IM Hohman EE Loken E et al Mother-infant room-sharing and sleep outcomes in the INSIGHT study Pediatrics 2017140(1)e20170122
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Insight Study (Paul 2017)
At 9 monthso Longer sleep duration (40 minnight) o Better consolidation (100 min)
At 30 monthso Longer sleep duration (45 minnight)
Room-sharing 4 times more likely to transition to bed sharing overnight
Paul IM Hohman EE Loken E et al Mother-infant room-sharing and sleep outcomes in the INSIGHT study Pediatrics 2017140(1)e20170122
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Insight Commentary (Hauck Moon)
Late room-sharing mean 7 hours longest sleep Is early consolidation desirable Differences related to bedtime routines
o Early bedtimeo Number of night feedso Feeding back to sleep
Focus on the routine not early separation
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Feeding the Baby at Night Acknowledgment that parents may fall
asleep while feeding babyo Safer to feed on bed than on sofa
couch or armchair if you might fall asleep
o No pillows sheets blankets or other items that could obstruct infant breathing or cause overheating should be in bed
o Return infant back to separate sleep surface as soon as parent awakens
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Say NO to Couches Sofas and Cushioned Armchairs Never place a baby for sleep on these surfaces Never sleep with a baby on these surfaces One of the MOST dangerous places for an infant
(OR 51-669)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
High-Risk Bed Sharing Situations Age lt4 months Preterm or low birth weight Smoked during pregnancy Bed sharer is current smoker (even if not
smoking in bed) Bed sharer has usedis using meds or
substances that could impair alertness or arousal
Bed sharer is not parent (including other children)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bedsharing in Low-Risk Breastfed Infants
Blair et al AOR 16 (95 CI 096-27) o Age lt14 weekso Parents No cigarettes or alcoholo Independent of feeding method
Carpenter et al AOR 51 (95 CI 23-114) o Age lt3 months o Parents did not smokeo Mother No alcohol or drugso Breastfed infants
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Independent Review (Dr Robert Platt)
Very small numbers of low-risk babieso 24 in Blairrsquos studyo 12 in Carpenterrsquos study
Does not believe that data support definitive differences in 2 studies
Some evidence of increased risk in this group but cannot say how large the increased risk is
Cannot conclude that bed sharing in this group is safe
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Unsafe Bedding NISP Trends 1993-2102
Shapiro-Mendoza CK Colson ER Willinger M Rybin DV Camperlengo L Corwin MJ Trends in infant bedding use National Infant Sleep Position study 1993ndash2010 Pediatrics 2015135(1)10-17
Decrease from 86 to 55 Rate of decline decreases
2001-10 835 for teen mothers Predictors of adjusted OR
gt15
o Young motherso Non-white race
ethnicityo Less than college
education
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Why Use Soft Bedding
ComfortWarmtho Extrapolation of own feelingso Misinterpret firm with taut
bull Soft + taut ne firm
Safetyo Blankets pillows rolls to prevent falls
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Soft Bedding for Older Infants
Many parents recognize soft bedding is a risk Increased complacency as baby gets older Soft bedding is THE most important risk factor for
infants 4-12 months old (Colvin 2015) Infants roll into bedding and cannot extract
themselves
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
To Swaddle or Not to Swaddle That is the Question Pros
o Calms the infant promotes sleep decreases number of awakenings
o Encourages use of the supine position
Conso Increased respiratory rate and
reduced functional residual lung capacity
o Exacerbates hip dysplasia if the hips are kept in extension and adduction
o ldquoLooserdquo swaddling becomes loose bedding
o Overheating especially if the head is covered or the infant has infection
o Effects on arousability to an external stimulus remain unclear (conflicting data) There may be minimal effects of routine swaddling on arousal
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Swaddling
There is insufficient evidence to recommend routine swaddling as a strategy to reduce the incidence of SIDS
Swaddling must be correctly applied to avoid the possible hazards
Swaddling does not reduce the necessity to follow recommended safe sleep practices Ambrogio Lorenzettis Madonna and Child (1319)
Wikipedia
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
McDonnell E Moon RY Infant deaths and injuries associated with wearable blankets swaddle wraps and swaddling J Pediatr 20141641152-1156
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
SwaddlingmdashMore Questionshellip
Pease 2016 Pediatrics Pooled OR = 138
o Prone = 1299 o Side = 316o Supine = 193
Increased risk with age Limitations
o Heterogeneity definitions other risk factorsPease AS Fleming PJ Hauck FR et al Swaddling and the risk of sudden infant death syndrome a meta-analysis Pediatrics 2016137(6)e20153
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
wwwhealthychildrenorg
Swaddling (wrapping a light blanket snuggly around a baby) may help calm a crying baby If you swaddle your baby be sure to place him on his back to sleep Stop swaddling your baby when he starts to roll
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers
AAP recommendation Consider offering a pacifier at nap time and bedtime
Studies consistently demonstrate a protective effect of pacifiers on SIDS
Mechanism unknowno Dislodge within 15 to 60 minuteso Decreased arousal threshold
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers and Breastfeeding Well-designed trials
o 2 found no association among term infants
o 1 found no association among preterm infants
o 1 found slightly decreased breastfeeding duration at one month if pacifier introduced in first week of life but NO difference if pacifier introduced after one month
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Baby Friendly USA Pacifiers
Breastfeeding babies should not be given pacifiers by the staff of the facility with the exception of o Limited use to decrease pain during procedures when
the baby cannot safely be held or breastfed (pacifiers used should be discarded after these procedures)
o Babies who are being tube-fed in NICUo Other rare specific medical reasons
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Addressing Sleep Deprivation
Give parents tools to cope with fussy babies
Sleep-deprived parents may make poor judgments
Make use of tools o Swaddling side carrying
shushing swinging and sucking
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Overcoming Barriers to Change What Parents are Sayinghellip
Prone positioning fear of choking Baby sleeps ldquobetterrdquo on stomach Soft things are safer for the baby SIDS is ldquoGodrsquos willrdquo Why bother Recommendations keep changing
anyway Vigilance sleep with baby for protection
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Factors Associated With Choice of Infant Sleep Position 3300 mothers from 32 hospitals 77 usually use supine position 49 exclusive use supine position Most likely to use prone
o African-American motherso Mothers with lt high school educationo Lack of perceived controlo Personal attitudesocietal norms
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
A continuum starting in childhoodo Secondary school baby sitting classes
Pre-pregnancy Pregnancyprenatal education
o Prior to baby showerhellipldquowrong giftsrdquo In-hospital education and modeling
o Include family friends baby sitters Re-enforcement in the doctorrsquos office
o Especially between 1 to 4 months Grandparents They hold great power The general public (day cares religious leaders)
A Lifetime of Infant Sleep Safety
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Chart1
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
14
139
13
13
12
13
117
17
103
269
087
386
074
353
077
531
072
557
067
644
062
666
056
716
057
711
053
728
056
701
055
722
055
757
057
703
055
721
054
741
051
728
048
042
04
039
Sheet1
Sheet1
ampA
Page ampP
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
Sheet2
Pre-AAP recommendation Post-AAP RecommendationBack to SleepSafe to Sleep Campaign
Sheet3
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Infant Sleep Safety
Requires a consistent and repetitive message in the community to prevent accidental deaths
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Safe Sleep Nurse Modeling
People trust nurses Whatever the nurse does must
be correct and it will be imitated in the home
Fact supine positioning in the nursery can almost DOUBLE its use in the home
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Physician Advocacy
Srivatsa 1997 HCP education to new familieshellip34 reduction in prone sleeping
Eron 2009 Study of Central NY state physicianshellip30 identified incorrect safest sleep positionhellip30 do not discuss with families
Colson 2009 Only 13 mothers advised by MD to use supine positionhellip3 times more likely to position the baby properly
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Healthcare Provider Advice to New Mothers Safe Sleep
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Chart1
Column1
[]
[]
[]
55
25
20
Sheet1
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Mason Clinical Peds 713
Bundled interventiono Nursing education policy model behavior safe sleep
video posters in rooms declaration of safe sleep practice
Safe sleep environment uarr from 25 to 58 Intention in home 95 supine none ldquoco-sleepingrdquo
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bundled Intervention = Behavior Change
QUESTION GROUP p-value
ISS Study NISP
Behavior Questions n = 490 n = 1046
Baby routinely placed to sleep on back 925 73 lt 0001
Baby routinely sleeps in bassinetcrib 995 71 lt 00001
Baby sleeps under a thin sheet 992 86 lt 0001
Baby given a pacifier for sleep 741 84 lt 0001Goodstein MH Bell T Krugman SD Improving infant sleep safety through a comprehensive hospital-based program Clinical Pediatrics 201554(3)212-221
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
o Baseline Safe sleep 49 of 264 infants o Post 312 of 234 infants (P lt 001) o Extra blankets most common o Baseline 77 vs 44 post-intervention o Mean number of unsafe items reduced by 50 (P lt 001)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Washington DC
2 urban DC nurseries 26 did not believe or unsure that infant positioning
was associated with SIDS Top 3 factors influencing sleep position
o 56 PERSONAL PREFERENCE Why non-supine Clinical experience (25)
o Increase risk aspirationo Decrease sleep and comfort
Bartow KL Nursesrsquo knowledge and adherence to sudden infant death syndrome prevention guidelines Pediatr Nurs 201642(1)7-13
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
TodaysBaby QI Safe Sleep Teaching
QI intervention median = 160 days Mothers reported receiving information 72 to 95
(increase of 24-57) 94 babies observed supine (plus 24) 88 infants in safe sleep environment
o Increase of 33 Gains maintained up to 12 months
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Social Media and Risk-Reduction Training Study (SMART) Cluster randomization 4 groups Safe sleep or breast feeding education Nursing QI and social media (mobile health) N = 1600 1263 responses (79) Safe sleep NQI and MHealth
o Supine sleep 925 o Room-sharing 859o No soft bedding 819o Pacifier use 762
Moon RY Hauck FR Colson ER et al The effect of nursing quality improvement and mobile health interventions on infant sleep practices a randomized clinical trial JAMA 2017318(4)351-359
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Hospital Initiative ComponentswwwcribsforkidsorgHospitalInitiativeToolkit INTRODUCTORY LETTER HOSPITAL INITIATIVE TOOL KIT
INSTRUCTIONS ORGANIZATIONAL CHART HOSPITAL POLICY ACKNOWLEDGMENT FORM (Engl amp
Span) SAFE SLEEP EDUCATIONAL FLIP CHART
NONCOMPLIANCE WAIVER (Engl amp Span)
NURSING EDUCATION MODULE
SAFE SLEEP POSTERS DOOR HANGERS (Engl amp Span) GRADUATION CERTIFICATE SAMPLE LETTER TO HOSPITALS SAMPLE LETTER TO PROVIDERS INFANT SAFE SLEEP BROCHURES
(Engl amp Span) PRESS KIT
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
All materials available on-lineo No major costs to the hospital
Easy on-line access for documentation
NO FEE FOR PARTICIPATION
wwwCribsforKidsorgHospitalInitiative
Tiffany Price (tpricecribsforkidsorg)
The National Safe Sleep Hospital Certification Program
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
TNmdash25 reduction in infant sleep-related deaths in 2 years
SDmdashOver 7915 Pack lsquon Plays distributed since 2012 Infant mortality rate decreased from 86 (2012) to 48 (2016)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
2009 to 2015 38 decrease in infant mortality Decreased from 135 to 84 per 1000 SUID decreased gt50 Decrease in racial disparityhttphealthybabiesbaltimorecomhome
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
And Finallyhellip
Health care providers should have open frank nonjudgmental conversations with families about their sleep practices
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Encouraging Parents to Take Action
According to the Social Learning Theory parents are more likely to recall and comply with instructions when
the health care provider
Uses a positive tone Provides adequate information Allows the parent to ask most of the questions
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Motivational Interviewing
ldquoa collaborative goal-oriented style of communication with particular attention to the language of changerdquo
o Strengthen personal motivation and commitment to a specific goal
o Explore onersquos reasons for change (barriers)o Patient generates own solutions
bull More likely to feel realisticbull Planting seeds of change
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Impact of Eliminating Sleep-Related Deaths
Every week we lose 70 children which is equivalent to 4 kindergarten classrooms
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Thank You
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Contact Information
mgoodsteinwellspanorg
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Visit Pediatric Care Online today for additional information on this and other topics
httppediatriccaresolutionsaaporgPediatric Care Online is a convenient electronic resource for immediate expert help with
virtually every pediatric clinical information need with must-have resources that are included in a comprehensive reference library and time-saving clinical tools
Donrsquot have a subscription to PCOThen take advantage of a free trial today
Call Mead Johnson Nutrition at 888363-2362 orfor more information go to
httppediatriccaresolutionsaaporgSSFree_Trialaspx
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
IMR over time Finland vs US
Slide Number 1
Disclaimer
Objectives for Todayrsquos Talk
Infant Mortality Rates for the Five Leading Causes of Infant Death in the United States 2005 and 2011
US Post-Neonatal Mortality 2015
FACT
What is SUID or SUDI
Some Causes of Deaths that Occur Suddenly and Unexpectedly during Infancy
What is SIDS
SIDS FACTS
SIDS FACTS
Triple Risk Model to Explain SIDS
Paterson DS Krous HF Kinney HC et al JAMA 2006
An Example of SIDS Pathogenesis
2016 AAP Recommendations Infant Sleep Safety
Strength of Recommendation
Recommendations Change as the Evidence Evolves
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
Correct Safe Sleep Environment
We Need to Move Beyond Back to Sleep
Sleep Position for Healthy Newborns
Sleep Position in Newborn Nursery
Sleep Position and Reflux
The Truth About Supine Sleep and Aspiration Ending the Fallacy
Title
Infant Sleep Location
Room-Share How Long Yoursquore Kidding Right
Supporting Data
More Recent Data
Why is Room-Sharing Protective
Room-Sharing and Sleep Quality
Insight Study (Paul 2017)
Insight Study (Paul 2017)
Insight Commentary (Hauck Moon)
Feeding the Baby at Night
Say NO to Couches Sofas and Cushioned Armchairs
High-Risk Bed Sharing Situations
Bedsharing in Low-Risk Breastfed Infants
Independent Review (Dr Robert Platt)
Bed Sharing
Bed Sharing
Bed Sharing with Overlay
Bed Sharing with Overlay
Bed Sharing with Overlay
Couch Sleeping
Couch Sleeping
Couch Sleeping
Unsafe Bedding NISP Trends 1993-2102
Why Use Soft Bedding
Soft Bedding for Older Infants
To Swaddle or Not to Swaddle That is the Question
Swaddling
SwaddlingmdashIs it Safe
SwaddlingmdashMore Questionshellip
wwwhealthychildrenorg
Pacifiers
Pacifiers and Breastfeeding
Baby Friendly USA Pacifiers
Addressing Sleep Deprivation
Overcoming Barriers to Change What Parents are Sayinghellip
Factors Associated With Choice of Infant Sleep Position
Slide Number 65
What is Working
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Infant Sleep Safety
Safe Sleep Nurse Modeling
Physician Advocacy
Healthcare Provider Advice to New Mothers Safe Sleep
Mason Clinical Peds 713
Bundled Intervention = Behavior Change
Hospital Unsafe Sleep Persists
Washington DC
TodaysBaby QI Safe Sleep Teaching
TodaysBaby QI Safe Sleep Teaching
Social Media and Risk-Reduction Training Study (SMART)
The National Safe Sleep Hospital Certification Program
Coordinated Education Efforts Work
Coordinated Education Efforts Work
And Finallyhellip
Encouraging Parents to Take Action
Motivational Interviewing
Impact of Eliminating Sleep-Related Deaths
Thank You
Contact Information
Slide Number 89
IMR over time Finland vs US
Column1
correct advice
55
incorrect advice
25
no advice
20
correct advice
incorrect advice
no advice
SIDS Rate
Percent Back Sleeping
1988
14
1989
139
1990
13
1991
13
1992
12
13
1993
117
17
1994
103
269
1995
087
386
1996
074
353
1997
077
531
1998
072
557
1999
067
644
2000
062
666
2001
056
716
2002
057
711
2003
053
728
2004
056
701
2005
055
722
2006
055
757
2007
057
703
2008
055
721
2009
054
741
2010
051
728
2011
048
2012
042
2013
04
2014
039
httpwwwcdcgovNCHSdatanvsrnvsr58nvsr58_19pdf
Xu JQ Kochanek KD Murphy SL Tejada-Vera B Deaths Final data for
2007
National vital statistics reports vol 58 no 19 Hyattsville MD
National Center for Health Statistics 2010
1988
1988
1989
1989
1990
1990
1991
1991
1992
1992
1993
1993
1994
1994
1995
1995
1996
1996
1997
1997
1998
1998
1999
1999
2000
2000
2001
2001
2002
2002
2003
2003
2004
2004
2005
2005
2006
2006
2007
2007
2008
2008
2009
2009
2010
2010
2011
2012
2013
2014
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Room-Sharing and Sleep Quality
Volkovich room-sharing vs solitary sleepo Room-sharing mothers with more sleep disturbanceso Infants with similar sleep quality
Mao Mindell room-sharing infantsmdashmore awakenings
Montgomery-Downs Doan sleep quality in breastfeeding mothers gt to formula feeding motherso Exclusive breastfeeding = 30 min more sleep
More study needed
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Insight Study (Paul 2017)
Sleep questionnaire at 4 9 12 and 30 monthso Sleep duration overnight behaviorso Compared early vs late independent infants
At 4 monthso Equal sleep durationo Early group had better sleep consolidationo Longest stretch 46 minutes
Paul IM Hohman EE Loken E et al Mother-infant room-sharing and sleep outcomes in the INSIGHT study Pediatrics 2017140(1)e20170122
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Insight Study (Paul 2017)
At 9 monthso Longer sleep duration (40 minnight) o Better consolidation (100 min)
At 30 monthso Longer sleep duration (45 minnight)
Room-sharing 4 times more likely to transition to bed sharing overnight
Paul IM Hohman EE Loken E et al Mother-infant room-sharing and sleep outcomes in the INSIGHT study Pediatrics 2017140(1)e20170122
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Insight Commentary (Hauck Moon)
Late room-sharing mean 7 hours longest sleep Is early consolidation desirable Differences related to bedtime routines
o Early bedtimeo Number of night feedso Feeding back to sleep
Focus on the routine not early separation
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Feeding the Baby at Night Acknowledgment that parents may fall
asleep while feeding babyo Safer to feed on bed than on sofa
couch or armchair if you might fall asleep
o No pillows sheets blankets or other items that could obstruct infant breathing or cause overheating should be in bed
o Return infant back to separate sleep surface as soon as parent awakens
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Say NO to Couches Sofas and Cushioned Armchairs Never place a baby for sleep on these surfaces Never sleep with a baby on these surfaces One of the MOST dangerous places for an infant
(OR 51-669)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
High-Risk Bed Sharing Situations Age lt4 months Preterm or low birth weight Smoked during pregnancy Bed sharer is current smoker (even if not
smoking in bed) Bed sharer has usedis using meds or
substances that could impair alertness or arousal
Bed sharer is not parent (including other children)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bedsharing in Low-Risk Breastfed Infants
Blair et al AOR 16 (95 CI 096-27) o Age lt14 weekso Parents No cigarettes or alcoholo Independent of feeding method
Carpenter et al AOR 51 (95 CI 23-114) o Age lt3 months o Parents did not smokeo Mother No alcohol or drugso Breastfed infants
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Independent Review (Dr Robert Platt)
Very small numbers of low-risk babieso 24 in Blairrsquos studyo 12 in Carpenterrsquos study
Does not believe that data support definitive differences in 2 studies
Some evidence of increased risk in this group but cannot say how large the increased risk is
Cannot conclude that bed sharing in this group is safe
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Unsafe Bedding NISP Trends 1993-2102
Shapiro-Mendoza CK Colson ER Willinger M Rybin DV Camperlengo L Corwin MJ Trends in infant bedding use National Infant Sleep Position study 1993ndash2010 Pediatrics 2015135(1)10-17
Decrease from 86 to 55 Rate of decline decreases
2001-10 835 for teen mothers Predictors of adjusted OR
gt15
o Young motherso Non-white race
ethnicityo Less than college
education
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Why Use Soft Bedding
ComfortWarmtho Extrapolation of own feelingso Misinterpret firm with taut
bull Soft + taut ne firm
Safetyo Blankets pillows rolls to prevent falls
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Soft Bedding for Older Infants
Many parents recognize soft bedding is a risk Increased complacency as baby gets older Soft bedding is THE most important risk factor for
infants 4-12 months old (Colvin 2015) Infants roll into bedding and cannot extract
themselves
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
To Swaddle or Not to Swaddle That is the Question Pros
o Calms the infant promotes sleep decreases number of awakenings
o Encourages use of the supine position
Conso Increased respiratory rate and
reduced functional residual lung capacity
o Exacerbates hip dysplasia if the hips are kept in extension and adduction
o ldquoLooserdquo swaddling becomes loose bedding
o Overheating especially if the head is covered or the infant has infection
o Effects on arousability to an external stimulus remain unclear (conflicting data) There may be minimal effects of routine swaddling on arousal
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Swaddling
There is insufficient evidence to recommend routine swaddling as a strategy to reduce the incidence of SIDS
Swaddling must be correctly applied to avoid the possible hazards
Swaddling does not reduce the necessity to follow recommended safe sleep practices Ambrogio Lorenzettis Madonna and Child (1319)
Wikipedia
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
McDonnell E Moon RY Infant deaths and injuries associated with wearable blankets swaddle wraps and swaddling J Pediatr 20141641152-1156
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
SwaddlingmdashMore Questionshellip
Pease 2016 Pediatrics Pooled OR = 138
o Prone = 1299 o Side = 316o Supine = 193
Increased risk with age Limitations
o Heterogeneity definitions other risk factorsPease AS Fleming PJ Hauck FR et al Swaddling and the risk of sudden infant death syndrome a meta-analysis Pediatrics 2016137(6)e20153
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
wwwhealthychildrenorg
Swaddling (wrapping a light blanket snuggly around a baby) may help calm a crying baby If you swaddle your baby be sure to place him on his back to sleep Stop swaddling your baby when he starts to roll
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers
AAP recommendation Consider offering a pacifier at nap time and bedtime
Studies consistently demonstrate a protective effect of pacifiers on SIDS
Mechanism unknowno Dislodge within 15 to 60 minuteso Decreased arousal threshold
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers and Breastfeeding Well-designed trials
o 2 found no association among term infants
o 1 found no association among preterm infants
o 1 found slightly decreased breastfeeding duration at one month if pacifier introduced in first week of life but NO difference if pacifier introduced after one month
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Baby Friendly USA Pacifiers
Breastfeeding babies should not be given pacifiers by the staff of the facility with the exception of o Limited use to decrease pain during procedures when
the baby cannot safely be held or breastfed (pacifiers used should be discarded after these procedures)
o Babies who are being tube-fed in NICUo Other rare specific medical reasons
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Addressing Sleep Deprivation
Give parents tools to cope with fussy babies
Sleep-deprived parents may make poor judgments
Make use of tools o Swaddling side carrying
shushing swinging and sucking
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Overcoming Barriers to Change What Parents are Sayinghellip
Prone positioning fear of choking Baby sleeps ldquobetterrdquo on stomach Soft things are safer for the baby SIDS is ldquoGodrsquos willrdquo Why bother Recommendations keep changing
anyway Vigilance sleep with baby for protection
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Factors Associated With Choice of Infant Sleep Position 3300 mothers from 32 hospitals 77 usually use supine position 49 exclusive use supine position Most likely to use prone
o African-American motherso Mothers with lt high school educationo Lack of perceived controlo Personal attitudesocietal norms
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
A continuum starting in childhoodo Secondary school baby sitting classes
Pre-pregnancy Pregnancyprenatal education
o Prior to baby showerhellipldquowrong giftsrdquo In-hospital education and modeling
o Include family friends baby sitters Re-enforcement in the doctorrsquos office
o Especially between 1 to 4 months Grandparents They hold great power The general public (day cares religious leaders)
A Lifetime of Infant Sleep Safety
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Chart1
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
14
139
13
13
12
13
117
17
103
269
087
386
074
353
077
531
072
557
067
644
062
666
056
716
057
711
053
728
056
701
055
722
055
757
057
703
055
721
054
741
051
728
048
042
04
039
Sheet1
Sheet1
ampA
Page ampP
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
Sheet2
Pre-AAP recommendation Post-AAP RecommendationBack to SleepSafe to Sleep Campaign
Sheet3
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Infant Sleep Safety
Requires a consistent and repetitive message in the community to prevent accidental deaths
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Safe Sleep Nurse Modeling
People trust nurses Whatever the nurse does must
be correct and it will be imitated in the home
Fact supine positioning in the nursery can almost DOUBLE its use in the home
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Physician Advocacy
Srivatsa 1997 HCP education to new familieshellip34 reduction in prone sleeping
Eron 2009 Study of Central NY state physicianshellip30 identified incorrect safest sleep positionhellip30 do not discuss with families
Colson 2009 Only 13 mothers advised by MD to use supine positionhellip3 times more likely to position the baby properly
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Healthcare Provider Advice to New Mothers Safe Sleep
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Chart1
Column1
[]
[]
[]
55
25
20
Sheet1
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Mason Clinical Peds 713
Bundled interventiono Nursing education policy model behavior safe sleep
video posters in rooms declaration of safe sleep practice
Safe sleep environment uarr from 25 to 58 Intention in home 95 supine none ldquoco-sleepingrdquo
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bundled Intervention = Behavior Change
QUESTION GROUP p-value
ISS Study NISP
Behavior Questions n = 490 n = 1046
Baby routinely placed to sleep on back 925 73 lt 0001
Baby routinely sleeps in bassinetcrib 995 71 lt 00001
Baby sleeps under a thin sheet 992 86 lt 0001
Baby given a pacifier for sleep 741 84 lt 0001Goodstein MH Bell T Krugman SD Improving infant sleep safety through a comprehensive hospital-based program Clinical Pediatrics 201554(3)212-221
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
o Baseline Safe sleep 49 of 264 infants o Post 312 of 234 infants (P lt 001) o Extra blankets most common o Baseline 77 vs 44 post-intervention o Mean number of unsafe items reduced by 50 (P lt 001)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Washington DC
2 urban DC nurseries 26 did not believe or unsure that infant positioning
was associated with SIDS Top 3 factors influencing sleep position
o 56 PERSONAL PREFERENCE Why non-supine Clinical experience (25)
o Increase risk aspirationo Decrease sleep and comfort
Bartow KL Nursesrsquo knowledge and adherence to sudden infant death syndrome prevention guidelines Pediatr Nurs 201642(1)7-13
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
TodaysBaby QI Safe Sleep Teaching
QI intervention median = 160 days Mothers reported receiving information 72 to 95
(increase of 24-57) 94 babies observed supine (plus 24) 88 infants in safe sleep environment
o Increase of 33 Gains maintained up to 12 months
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Social Media and Risk-Reduction Training Study (SMART) Cluster randomization 4 groups Safe sleep or breast feeding education Nursing QI and social media (mobile health) N = 1600 1263 responses (79) Safe sleep NQI and MHealth
o Supine sleep 925 o Room-sharing 859o No soft bedding 819o Pacifier use 762
Moon RY Hauck FR Colson ER et al The effect of nursing quality improvement and mobile health interventions on infant sleep practices a randomized clinical trial JAMA 2017318(4)351-359
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Hospital Initiative ComponentswwwcribsforkidsorgHospitalInitiativeToolkit INTRODUCTORY LETTER HOSPITAL INITIATIVE TOOL KIT
INSTRUCTIONS ORGANIZATIONAL CHART HOSPITAL POLICY ACKNOWLEDGMENT FORM (Engl amp
Span) SAFE SLEEP EDUCATIONAL FLIP CHART
NONCOMPLIANCE WAIVER (Engl amp Span)
NURSING EDUCATION MODULE
SAFE SLEEP POSTERS DOOR HANGERS (Engl amp Span) GRADUATION CERTIFICATE SAMPLE LETTER TO HOSPITALS SAMPLE LETTER TO PROVIDERS INFANT SAFE SLEEP BROCHURES
(Engl amp Span) PRESS KIT
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
All materials available on-lineo No major costs to the hospital
Easy on-line access for documentation
NO FEE FOR PARTICIPATION
wwwCribsforKidsorgHospitalInitiative
Tiffany Price (tpricecribsforkidsorg)
The National Safe Sleep Hospital Certification Program
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
TNmdash25 reduction in infant sleep-related deaths in 2 years
SDmdashOver 7915 Pack lsquon Plays distributed since 2012 Infant mortality rate decreased from 86 (2012) to 48 (2016)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
2009 to 2015 38 decrease in infant mortality Decreased from 135 to 84 per 1000 SUID decreased gt50 Decrease in racial disparityhttphealthybabiesbaltimorecomhome
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
And Finallyhellip
Health care providers should have open frank nonjudgmental conversations with families about their sleep practices
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Encouraging Parents to Take Action
According to the Social Learning Theory parents are more likely to recall and comply with instructions when
the health care provider
Uses a positive tone Provides adequate information Allows the parent to ask most of the questions
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Motivational Interviewing
ldquoa collaborative goal-oriented style of communication with particular attention to the language of changerdquo
o Strengthen personal motivation and commitment to a specific goal
o Explore onersquos reasons for change (barriers)o Patient generates own solutions
bull More likely to feel realisticbull Planting seeds of change
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Impact of Eliminating Sleep-Related Deaths
Every week we lose 70 children which is equivalent to 4 kindergarten classrooms
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Thank You
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Contact Information
mgoodsteinwellspanorg
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Visit Pediatric Care Online today for additional information on this and other topics
httppediatriccaresolutionsaaporgPediatric Care Online is a convenient electronic resource for immediate expert help with
virtually every pediatric clinical information need with must-have resources that are included in a comprehensive reference library and time-saving clinical tools
Donrsquot have a subscription to PCOThen take advantage of a free trial today
Call Mead Johnson Nutrition at 888363-2362 orfor more information go to
httppediatriccaresolutionsaaporgSSFree_Trialaspx
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
IMR over time Finland vs US
Slide Number 1
Disclaimer
Objectives for Todayrsquos Talk
Infant Mortality Rates for the Five Leading Causes of Infant Death in the United States 2005 and 2011
US Post-Neonatal Mortality 2015
FACT
What is SUID or SUDI
Some Causes of Deaths that Occur Suddenly and Unexpectedly during Infancy
What is SIDS
SIDS FACTS
SIDS FACTS
Triple Risk Model to Explain SIDS
Paterson DS Krous HF Kinney HC et al JAMA 2006
An Example of SIDS Pathogenesis
2016 AAP Recommendations Infant Sleep Safety
Strength of Recommendation
Recommendations Change as the Evidence Evolves
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
Correct Safe Sleep Environment
We Need to Move Beyond Back to Sleep
Sleep Position for Healthy Newborns
Sleep Position in Newborn Nursery
Sleep Position and Reflux
The Truth About Supine Sleep and Aspiration Ending the Fallacy
Title
Infant Sleep Location
Room-Share How Long Yoursquore Kidding Right
Supporting Data
More Recent Data
Why is Room-Sharing Protective
Room-Sharing and Sleep Quality
Insight Study (Paul 2017)
Insight Study (Paul 2017)
Insight Commentary (Hauck Moon)
Feeding the Baby at Night
Say NO to Couches Sofas and Cushioned Armchairs
High-Risk Bed Sharing Situations
Bedsharing in Low-Risk Breastfed Infants
Independent Review (Dr Robert Platt)
Bed Sharing
Bed Sharing
Bed Sharing with Overlay
Bed Sharing with Overlay
Bed Sharing with Overlay
Couch Sleeping
Couch Sleeping
Couch Sleeping
Unsafe Bedding NISP Trends 1993-2102
Why Use Soft Bedding
Soft Bedding for Older Infants
To Swaddle or Not to Swaddle That is the Question
Swaddling
SwaddlingmdashIs it Safe
SwaddlingmdashMore Questionshellip
wwwhealthychildrenorg
Pacifiers
Pacifiers and Breastfeeding
Baby Friendly USA Pacifiers
Addressing Sleep Deprivation
Overcoming Barriers to Change What Parents are Sayinghellip
Factors Associated With Choice of Infant Sleep Position
Slide Number 65
What is Working
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Infant Sleep Safety
Safe Sleep Nurse Modeling
Physician Advocacy
Healthcare Provider Advice to New Mothers Safe Sleep
Mason Clinical Peds 713
Bundled Intervention = Behavior Change
Hospital Unsafe Sleep Persists
Washington DC
TodaysBaby QI Safe Sleep Teaching
TodaysBaby QI Safe Sleep Teaching
Social Media and Risk-Reduction Training Study (SMART)
The National Safe Sleep Hospital Certification Program
Coordinated Education Efforts Work
Coordinated Education Efforts Work
And Finallyhellip
Encouraging Parents to Take Action
Motivational Interviewing
Impact of Eliminating Sleep-Related Deaths
Thank You
Contact Information
Slide Number 89
IMR over time Finland vs US
Column1
correct advice
55
incorrect advice
25
no advice
20
correct advice
incorrect advice
no advice
SIDS Rate
Percent Back Sleeping
1988
14
1989
139
1990
13
1991
13
1992
12
13
1993
117
17
1994
103
269
1995
087
386
1996
074
353
1997
077
531
1998
072
557
1999
067
644
2000
062
666
2001
056
716
2002
057
711
2003
053
728
2004
056
701
2005
055
722
2006
055
757
2007
057
703
2008
055
721
2009
054
741
2010
051
728
2011
048
2012
042
2013
04
2014
039
httpwwwcdcgovNCHSdatanvsrnvsr58nvsr58_19pdf
Xu JQ Kochanek KD Murphy SL Tejada-Vera B Deaths Final data for
2007
National vital statistics reports vol 58 no 19 Hyattsville MD
National Center for Health Statistics 2010
1988
1988
1989
1989
1990
1990
1991
1991
1992
1992
1993
1993
1994
1994
1995
1995
1996
1996
1997
1997
1998
1998
1999
1999
2000
2000
2001
2001
2002
2002
2003
2003
2004
2004
2005
2005
2006
2006
2007
2007
2008
2008
2009
2009
2010
2010
2011
2012
2013
2014
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Insight Study (Paul 2017)
Sleep questionnaire at 4 9 12 and 30 monthso Sleep duration overnight behaviorso Compared early vs late independent infants
At 4 monthso Equal sleep durationo Early group had better sleep consolidationo Longest stretch 46 minutes
Paul IM Hohman EE Loken E et al Mother-infant room-sharing and sleep outcomes in the INSIGHT study Pediatrics 2017140(1)e20170122
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Insight Study (Paul 2017)
At 9 monthso Longer sleep duration (40 minnight) o Better consolidation (100 min)
At 30 monthso Longer sleep duration (45 minnight)
Room-sharing 4 times more likely to transition to bed sharing overnight
Paul IM Hohman EE Loken E et al Mother-infant room-sharing and sleep outcomes in the INSIGHT study Pediatrics 2017140(1)e20170122
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Insight Commentary (Hauck Moon)
Late room-sharing mean 7 hours longest sleep Is early consolidation desirable Differences related to bedtime routines
o Early bedtimeo Number of night feedso Feeding back to sleep
Focus on the routine not early separation
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Feeding the Baby at Night Acknowledgment that parents may fall
asleep while feeding babyo Safer to feed on bed than on sofa
couch or armchair if you might fall asleep
o No pillows sheets blankets or other items that could obstruct infant breathing or cause overheating should be in bed
o Return infant back to separate sleep surface as soon as parent awakens
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Say NO to Couches Sofas and Cushioned Armchairs Never place a baby for sleep on these surfaces Never sleep with a baby on these surfaces One of the MOST dangerous places for an infant
(OR 51-669)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
High-Risk Bed Sharing Situations Age lt4 months Preterm or low birth weight Smoked during pregnancy Bed sharer is current smoker (even if not
smoking in bed) Bed sharer has usedis using meds or
substances that could impair alertness or arousal
Bed sharer is not parent (including other children)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bedsharing in Low-Risk Breastfed Infants
Blair et al AOR 16 (95 CI 096-27) o Age lt14 weekso Parents No cigarettes or alcoholo Independent of feeding method
Carpenter et al AOR 51 (95 CI 23-114) o Age lt3 months o Parents did not smokeo Mother No alcohol or drugso Breastfed infants
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Independent Review (Dr Robert Platt)
Very small numbers of low-risk babieso 24 in Blairrsquos studyo 12 in Carpenterrsquos study
Does not believe that data support definitive differences in 2 studies
Some evidence of increased risk in this group but cannot say how large the increased risk is
Cannot conclude that bed sharing in this group is safe
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Unsafe Bedding NISP Trends 1993-2102
Shapiro-Mendoza CK Colson ER Willinger M Rybin DV Camperlengo L Corwin MJ Trends in infant bedding use National Infant Sleep Position study 1993ndash2010 Pediatrics 2015135(1)10-17
Decrease from 86 to 55 Rate of decline decreases
2001-10 835 for teen mothers Predictors of adjusted OR
gt15
o Young motherso Non-white race
ethnicityo Less than college
education
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Why Use Soft Bedding
ComfortWarmtho Extrapolation of own feelingso Misinterpret firm with taut
bull Soft + taut ne firm
Safetyo Blankets pillows rolls to prevent falls
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Soft Bedding for Older Infants
Many parents recognize soft bedding is a risk Increased complacency as baby gets older Soft bedding is THE most important risk factor for
infants 4-12 months old (Colvin 2015) Infants roll into bedding and cannot extract
themselves
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
To Swaddle or Not to Swaddle That is the Question Pros
o Calms the infant promotes sleep decreases number of awakenings
o Encourages use of the supine position
Conso Increased respiratory rate and
reduced functional residual lung capacity
o Exacerbates hip dysplasia if the hips are kept in extension and adduction
o ldquoLooserdquo swaddling becomes loose bedding
o Overheating especially if the head is covered or the infant has infection
o Effects on arousability to an external stimulus remain unclear (conflicting data) There may be minimal effects of routine swaddling on arousal
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Swaddling
There is insufficient evidence to recommend routine swaddling as a strategy to reduce the incidence of SIDS
Swaddling must be correctly applied to avoid the possible hazards
Swaddling does not reduce the necessity to follow recommended safe sleep practices Ambrogio Lorenzettis Madonna and Child (1319)
Wikipedia
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
McDonnell E Moon RY Infant deaths and injuries associated with wearable blankets swaddle wraps and swaddling J Pediatr 20141641152-1156
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
SwaddlingmdashMore Questionshellip
Pease 2016 Pediatrics Pooled OR = 138
o Prone = 1299 o Side = 316o Supine = 193
Increased risk with age Limitations
o Heterogeneity definitions other risk factorsPease AS Fleming PJ Hauck FR et al Swaddling and the risk of sudden infant death syndrome a meta-analysis Pediatrics 2016137(6)e20153
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
wwwhealthychildrenorg
Swaddling (wrapping a light blanket snuggly around a baby) may help calm a crying baby If you swaddle your baby be sure to place him on his back to sleep Stop swaddling your baby when he starts to roll
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers
AAP recommendation Consider offering a pacifier at nap time and bedtime
Studies consistently demonstrate a protective effect of pacifiers on SIDS
Mechanism unknowno Dislodge within 15 to 60 minuteso Decreased arousal threshold
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers and Breastfeeding Well-designed trials
o 2 found no association among term infants
o 1 found no association among preterm infants
o 1 found slightly decreased breastfeeding duration at one month if pacifier introduced in first week of life but NO difference if pacifier introduced after one month
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Baby Friendly USA Pacifiers
Breastfeeding babies should not be given pacifiers by the staff of the facility with the exception of o Limited use to decrease pain during procedures when
the baby cannot safely be held or breastfed (pacifiers used should be discarded after these procedures)
o Babies who are being tube-fed in NICUo Other rare specific medical reasons
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Addressing Sleep Deprivation
Give parents tools to cope with fussy babies
Sleep-deprived parents may make poor judgments
Make use of tools o Swaddling side carrying
shushing swinging and sucking
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Overcoming Barriers to Change What Parents are Sayinghellip
Prone positioning fear of choking Baby sleeps ldquobetterrdquo on stomach Soft things are safer for the baby SIDS is ldquoGodrsquos willrdquo Why bother Recommendations keep changing
anyway Vigilance sleep with baby for protection
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Factors Associated With Choice of Infant Sleep Position 3300 mothers from 32 hospitals 77 usually use supine position 49 exclusive use supine position Most likely to use prone
o African-American motherso Mothers with lt high school educationo Lack of perceived controlo Personal attitudesocietal norms
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
A continuum starting in childhoodo Secondary school baby sitting classes
Pre-pregnancy Pregnancyprenatal education
o Prior to baby showerhellipldquowrong giftsrdquo In-hospital education and modeling
o Include family friends baby sitters Re-enforcement in the doctorrsquos office
o Especially between 1 to 4 months Grandparents They hold great power The general public (day cares religious leaders)
A Lifetime of Infant Sleep Safety
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Chart1
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
14
139
13
13
12
13
117
17
103
269
087
386
074
353
077
531
072
557
067
644
062
666
056
716
057
711
053
728
056
701
055
722
055
757
057
703
055
721
054
741
051
728
048
042
04
039
Sheet1
Sheet1
ampA
Page ampP
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
Sheet2
Pre-AAP recommendation Post-AAP RecommendationBack to SleepSafe to Sleep Campaign
Sheet3
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Infant Sleep Safety
Requires a consistent and repetitive message in the community to prevent accidental deaths
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Safe Sleep Nurse Modeling
People trust nurses Whatever the nurse does must
be correct and it will be imitated in the home
Fact supine positioning in the nursery can almost DOUBLE its use in the home
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Physician Advocacy
Srivatsa 1997 HCP education to new familieshellip34 reduction in prone sleeping
Eron 2009 Study of Central NY state physicianshellip30 identified incorrect safest sleep positionhellip30 do not discuss with families
Colson 2009 Only 13 mothers advised by MD to use supine positionhellip3 times more likely to position the baby properly
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Healthcare Provider Advice to New Mothers Safe Sleep
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Chart1
Column1
[]
[]
[]
55
25
20
Sheet1
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Mason Clinical Peds 713
Bundled interventiono Nursing education policy model behavior safe sleep
video posters in rooms declaration of safe sleep practice
Safe sleep environment uarr from 25 to 58 Intention in home 95 supine none ldquoco-sleepingrdquo
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bundled Intervention = Behavior Change
QUESTION GROUP p-value
ISS Study NISP
Behavior Questions n = 490 n = 1046
Baby routinely placed to sleep on back 925 73 lt 0001
Baby routinely sleeps in bassinetcrib 995 71 lt 00001
Baby sleeps under a thin sheet 992 86 lt 0001
Baby given a pacifier for sleep 741 84 lt 0001Goodstein MH Bell T Krugman SD Improving infant sleep safety through a comprehensive hospital-based program Clinical Pediatrics 201554(3)212-221
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
o Baseline Safe sleep 49 of 264 infants o Post 312 of 234 infants (P lt 001) o Extra blankets most common o Baseline 77 vs 44 post-intervention o Mean number of unsafe items reduced by 50 (P lt 001)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Washington DC
2 urban DC nurseries 26 did not believe or unsure that infant positioning
was associated with SIDS Top 3 factors influencing sleep position
o 56 PERSONAL PREFERENCE Why non-supine Clinical experience (25)
o Increase risk aspirationo Decrease sleep and comfort
Bartow KL Nursesrsquo knowledge and adherence to sudden infant death syndrome prevention guidelines Pediatr Nurs 201642(1)7-13
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
TodaysBaby QI Safe Sleep Teaching
QI intervention median = 160 days Mothers reported receiving information 72 to 95
(increase of 24-57) 94 babies observed supine (plus 24) 88 infants in safe sleep environment
o Increase of 33 Gains maintained up to 12 months
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Social Media and Risk-Reduction Training Study (SMART) Cluster randomization 4 groups Safe sleep or breast feeding education Nursing QI and social media (mobile health) N = 1600 1263 responses (79) Safe sleep NQI and MHealth
o Supine sleep 925 o Room-sharing 859o No soft bedding 819o Pacifier use 762
Moon RY Hauck FR Colson ER et al The effect of nursing quality improvement and mobile health interventions on infant sleep practices a randomized clinical trial JAMA 2017318(4)351-359
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Hospital Initiative ComponentswwwcribsforkidsorgHospitalInitiativeToolkit INTRODUCTORY LETTER HOSPITAL INITIATIVE TOOL KIT
INSTRUCTIONS ORGANIZATIONAL CHART HOSPITAL POLICY ACKNOWLEDGMENT FORM (Engl amp
Span) SAFE SLEEP EDUCATIONAL FLIP CHART
NONCOMPLIANCE WAIVER (Engl amp Span)
NURSING EDUCATION MODULE
SAFE SLEEP POSTERS DOOR HANGERS (Engl amp Span) GRADUATION CERTIFICATE SAMPLE LETTER TO HOSPITALS SAMPLE LETTER TO PROVIDERS INFANT SAFE SLEEP BROCHURES
(Engl amp Span) PRESS KIT
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
All materials available on-lineo No major costs to the hospital
Easy on-line access for documentation
NO FEE FOR PARTICIPATION
wwwCribsforKidsorgHospitalInitiative
Tiffany Price (tpricecribsforkidsorg)
The National Safe Sleep Hospital Certification Program
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
TNmdash25 reduction in infant sleep-related deaths in 2 years
SDmdashOver 7915 Pack lsquon Plays distributed since 2012 Infant mortality rate decreased from 86 (2012) to 48 (2016)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
2009 to 2015 38 decrease in infant mortality Decreased from 135 to 84 per 1000 SUID decreased gt50 Decrease in racial disparityhttphealthybabiesbaltimorecomhome
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
And Finallyhellip
Health care providers should have open frank nonjudgmental conversations with families about their sleep practices
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Encouraging Parents to Take Action
According to the Social Learning Theory parents are more likely to recall and comply with instructions when
the health care provider
Uses a positive tone Provides adequate information Allows the parent to ask most of the questions
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Motivational Interviewing
ldquoa collaborative goal-oriented style of communication with particular attention to the language of changerdquo
o Strengthen personal motivation and commitment to a specific goal
o Explore onersquos reasons for change (barriers)o Patient generates own solutions
bull More likely to feel realisticbull Planting seeds of change
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Impact of Eliminating Sleep-Related Deaths
Every week we lose 70 children which is equivalent to 4 kindergarten classrooms
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Thank You
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Contact Information
mgoodsteinwellspanorg
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Visit Pediatric Care Online today for additional information on this and other topics
httppediatriccaresolutionsaaporgPediatric Care Online is a convenient electronic resource for immediate expert help with
virtually every pediatric clinical information need with must-have resources that are included in a comprehensive reference library and time-saving clinical tools
Donrsquot have a subscription to PCOThen take advantage of a free trial today
Call Mead Johnson Nutrition at 888363-2362 orfor more information go to
httppediatriccaresolutionsaaporgSSFree_Trialaspx
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
IMR over time Finland vs US
Slide Number 1
Disclaimer
Objectives for Todayrsquos Talk
Infant Mortality Rates for the Five Leading Causes of Infant Death in the United States 2005 and 2011
US Post-Neonatal Mortality 2015
FACT
What is SUID or SUDI
Some Causes of Deaths that Occur Suddenly and Unexpectedly during Infancy
What is SIDS
SIDS FACTS
SIDS FACTS
Triple Risk Model to Explain SIDS
Paterson DS Krous HF Kinney HC et al JAMA 2006
An Example of SIDS Pathogenesis
2016 AAP Recommendations Infant Sleep Safety
Strength of Recommendation
Recommendations Change as the Evidence Evolves
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
Correct Safe Sleep Environment
We Need to Move Beyond Back to Sleep
Sleep Position for Healthy Newborns
Sleep Position in Newborn Nursery
Sleep Position and Reflux
The Truth About Supine Sleep and Aspiration Ending the Fallacy
Title
Infant Sleep Location
Room-Share How Long Yoursquore Kidding Right
Supporting Data
More Recent Data
Why is Room-Sharing Protective
Room-Sharing and Sleep Quality
Insight Study (Paul 2017)
Insight Study (Paul 2017)
Insight Commentary (Hauck Moon)
Feeding the Baby at Night
Say NO to Couches Sofas and Cushioned Armchairs
High-Risk Bed Sharing Situations
Bedsharing in Low-Risk Breastfed Infants
Independent Review (Dr Robert Platt)
Bed Sharing
Bed Sharing
Bed Sharing with Overlay
Bed Sharing with Overlay
Bed Sharing with Overlay
Couch Sleeping
Couch Sleeping
Couch Sleeping
Unsafe Bedding NISP Trends 1993-2102
Why Use Soft Bedding
Soft Bedding for Older Infants
To Swaddle or Not to Swaddle That is the Question
Swaddling
SwaddlingmdashIs it Safe
SwaddlingmdashMore Questionshellip
wwwhealthychildrenorg
Pacifiers
Pacifiers and Breastfeeding
Baby Friendly USA Pacifiers
Addressing Sleep Deprivation
Overcoming Barriers to Change What Parents are Sayinghellip
Factors Associated With Choice of Infant Sleep Position
Slide Number 65
What is Working
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Infant Sleep Safety
Safe Sleep Nurse Modeling
Physician Advocacy
Healthcare Provider Advice to New Mothers Safe Sleep
Mason Clinical Peds 713
Bundled Intervention = Behavior Change
Hospital Unsafe Sleep Persists
Washington DC
TodaysBaby QI Safe Sleep Teaching
TodaysBaby QI Safe Sleep Teaching
Social Media and Risk-Reduction Training Study (SMART)
The National Safe Sleep Hospital Certification Program
Coordinated Education Efforts Work
Coordinated Education Efforts Work
And Finallyhellip
Encouraging Parents to Take Action
Motivational Interviewing
Impact of Eliminating Sleep-Related Deaths
Thank You
Contact Information
Slide Number 89
IMR over time Finland vs US
Column1
correct advice
55
incorrect advice
25
no advice
20
correct advice
incorrect advice
no advice
SIDS Rate
Percent Back Sleeping
1988
14
1989
139
1990
13
1991
13
1992
12
13
1993
117
17
1994
103
269
1995
087
386
1996
074
353
1997
077
531
1998
072
557
1999
067
644
2000
062
666
2001
056
716
2002
057
711
2003
053
728
2004
056
701
2005
055
722
2006
055
757
2007
057
703
2008
055
721
2009
054
741
2010
051
728
2011
048
2012
042
2013
04
2014
039
httpwwwcdcgovNCHSdatanvsrnvsr58nvsr58_19pdf
Xu JQ Kochanek KD Murphy SL Tejada-Vera B Deaths Final data for
2007
National vital statistics reports vol 58 no 19 Hyattsville MD
National Center for Health Statistics 2010
1988
1988
1989
1989
1990
1990
1991
1991
1992
1992
1993
1993
1994
1994
1995
1995
1996
1996
1997
1997
1998
1998
1999
1999
2000
2000
2001
2001
2002
2002
2003
2003
2004
2004
2005
2005
2006
2006
2007
2007
2008
2008
2009
2009
2010
2010
2011
2012
2013
2014
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Insight Study (Paul 2017)
At 9 monthso Longer sleep duration (40 minnight) o Better consolidation (100 min)
At 30 monthso Longer sleep duration (45 minnight)
Room-sharing 4 times more likely to transition to bed sharing overnight
Paul IM Hohman EE Loken E et al Mother-infant room-sharing and sleep outcomes in the INSIGHT study Pediatrics 2017140(1)e20170122
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Insight Commentary (Hauck Moon)
Late room-sharing mean 7 hours longest sleep Is early consolidation desirable Differences related to bedtime routines
o Early bedtimeo Number of night feedso Feeding back to sleep
Focus on the routine not early separation
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Feeding the Baby at Night Acknowledgment that parents may fall
asleep while feeding babyo Safer to feed on bed than on sofa
couch or armchair if you might fall asleep
o No pillows sheets blankets or other items that could obstruct infant breathing or cause overheating should be in bed
o Return infant back to separate sleep surface as soon as parent awakens
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Say NO to Couches Sofas and Cushioned Armchairs Never place a baby for sleep on these surfaces Never sleep with a baby on these surfaces One of the MOST dangerous places for an infant
(OR 51-669)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
High-Risk Bed Sharing Situations Age lt4 months Preterm or low birth weight Smoked during pregnancy Bed sharer is current smoker (even if not
smoking in bed) Bed sharer has usedis using meds or
substances that could impair alertness or arousal
Bed sharer is not parent (including other children)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bedsharing in Low-Risk Breastfed Infants
Blair et al AOR 16 (95 CI 096-27) o Age lt14 weekso Parents No cigarettes or alcoholo Independent of feeding method
Carpenter et al AOR 51 (95 CI 23-114) o Age lt3 months o Parents did not smokeo Mother No alcohol or drugso Breastfed infants
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Independent Review (Dr Robert Platt)
Very small numbers of low-risk babieso 24 in Blairrsquos studyo 12 in Carpenterrsquos study
Does not believe that data support definitive differences in 2 studies
Some evidence of increased risk in this group but cannot say how large the increased risk is
Cannot conclude that bed sharing in this group is safe
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Unsafe Bedding NISP Trends 1993-2102
Shapiro-Mendoza CK Colson ER Willinger M Rybin DV Camperlengo L Corwin MJ Trends in infant bedding use National Infant Sleep Position study 1993ndash2010 Pediatrics 2015135(1)10-17
Decrease from 86 to 55 Rate of decline decreases
2001-10 835 for teen mothers Predictors of adjusted OR
gt15
o Young motherso Non-white race
ethnicityo Less than college
education
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Why Use Soft Bedding
ComfortWarmtho Extrapolation of own feelingso Misinterpret firm with taut
bull Soft + taut ne firm
Safetyo Blankets pillows rolls to prevent falls
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Soft Bedding for Older Infants
Many parents recognize soft bedding is a risk Increased complacency as baby gets older Soft bedding is THE most important risk factor for
infants 4-12 months old (Colvin 2015) Infants roll into bedding and cannot extract
themselves
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
To Swaddle or Not to Swaddle That is the Question Pros
o Calms the infant promotes sleep decreases number of awakenings
o Encourages use of the supine position
Conso Increased respiratory rate and
reduced functional residual lung capacity
o Exacerbates hip dysplasia if the hips are kept in extension and adduction
o ldquoLooserdquo swaddling becomes loose bedding
o Overheating especially if the head is covered or the infant has infection
o Effects on arousability to an external stimulus remain unclear (conflicting data) There may be minimal effects of routine swaddling on arousal
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Swaddling
There is insufficient evidence to recommend routine swaddling as a strategy to reduce the incidence of SIDS
Swaddling must be correctly applied to avoid the possible hazards
Swaddling does not reduce the necessity to follow recommended safe sleep practices Ambrogio Lorenzettis Madonna and Child (1319)
Wikipedia
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
McDonnell E Moon RY Infant deaths and injuries associated with wearable blankets swaddle wraps and swaddling J Pediatr 20141641152-1156
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
SwaddlingmdashMore Questionshellip
Pease 2016 Pediatrics Pooled OR = 138
o Prone = 1299 o Side = 316o Supine = 193
Increased risk with age Limitations
o Heterogeneity definitions other risk factorsPease AS Fleming PJ Hauck FR et al Swaddling and the risk of sudden infant death syndrome a meta-analysis Pediatrics 2016137(6)e20153
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
wwwhealthychildrenorg
Swaddling (wrapping a light blanket snuggly around a baby) may help calm a crying baby If you swaddle your baby be sure to place him on his back to sleep Stop swaddling your baby when he starts to roll
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers
AAP recommendation Consider offering a pacifier at nap time and bedtime
Studies consistently demonstrate a protective effect of pacifiers on SIDS
Mechanism unknowno Dislodge within 15 to 60 minuteso Decreased arousal threshold
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers and Breastfeeding Well-designed trials
o 2 found no association among term infants
o 1 found no association among preterm infants
o 1 found slightly decreased breastfeeding duration at one month if pacifier introduced in first week of life but NO difference if pacifier introduced after one month
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Baby Friendly USA Pacifiers
Breastfeeding babies should not be given pacifiers by the staff of the facility with the exception of o Limited use to decrease pain during procedures when
the baby cannot safely be held or breastfed (pacifiers used should be discarded after these procedures)
o Babies who are being tube-fed in NICUo Other rare specific medical reasons
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Addressing Sleep Deprivation
Give parents tools to cope with fussy babies
Sleep-deprived parents may make poor judgments
Make use of tools o Swaddling side carrying
shushing swinging and sucking
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Overcoming Barriers to Change What Parents are Sayinghellip
Prone positioning fear of choking Baby sleeps ldquobetterrdquo on stomach Soft things are safer for the baby SIDS is ldquoGodrsquos willrdquo Why bother Recommendations keep changing
anyway Vigilance sleep with baby for protection
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Factors Associated With Choice of Infant Sleep Position 3300 mothers from 32 hospitals 77 usually use supine position 49 exclusive use supine position Most likely to use prone
o African-American motherso Mothers with lt high school educationo Lack of perceived controlo Personal attitudesocietal norms
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
A continuum starting in childhoodo Secondary school baby sitting classes
Pre-pregnancy Pregnancyprenatal education
o Prior to baby showerhellipldquowrong giftsrdquo In-hospital education and modeling
o Include family friends baby sitters Re-enforcement in the doctorrsquos office
o Especially between 1 to 4 months Grandparents They hold great power The general public (day cares religious leaders)
A Lifetime of Infant Sleep Safety
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Chart1
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
14
139
13
13
12
13
117
17
103
269
087
386
074
353
077
531
072
557
067
644
062
666
056
716
057
711
053
728
056
701
055
722
055
757
057
703
055
721
054
741
051
728
048
042
04
039
Sheet1
Sheet1
ampA
Page ampP
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
Sheet2
Pre-AAP recommendation Post-AAP RecommendationBack to SleepSafe to Sleep Campaign
Sheet3
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Infant Sleep Safety
Requires a consistent and repetitive message in the community to prevent accidental deaths
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Safe Sleep Nurse Modeling
People trust nurses Whatever the nurse does must
be correct and it will be imitated in the home
Fact supine positioning in the nursery can almost DOUBLE its use in the home
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Physician Advocacy
Srivatsa 1997 HCP education to new familieshellip34 reduction in prone sleeping
Eron 2009 Study of Central NY state physicianshellip30 identified incorrect safest sleep positionhellip30 do not discuss with families
Colson 2009 Only 13 mothers advised by MD to use supine positionhellip3 times more likely to position the baby properly
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Healthcare Provider Advice to New Mothers Safe Sleep
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Chart1
Column1
[]
[]
[]
55
25
20
Sheet1
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Mason Clinical Peds 713
Bundled interventiono Nursing education policy model behavior safe sleep
video posters in rooms declaration of safe sleep practice
Safe sleep environment uarr from 25 to 58 Intention in home 95 supine none ldquoco-sleepingrdquo
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bundled Intervention = Behavior Change
QUESTION GROUP p-value
ISS Study NISP
Behavior Questions n = 490 n = 1046
Baby routinely placed to sleep on back 925 73 lt 0001
Baby routinely sleeps in bassinetcrib 995 71 lt 00001
Baby sleeps under a thin sheet 992 86 lt 0001
Baby given a pacifier for sleep 741 84 lt 0001Goodstein MH Bell T Krugman SD Improving infant sleep safety through a comprehensive hospital-based program Clinical Pediatrics 201554(3)212-221
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
o Baseline Safe sleep 49 of 264 infants o Post 312 of 234 infants (P lt 001) o Extra blankets most common o Baseline 77 vs 44 post-intervention o Mean number of unsafe items reduced by 50 (P lt 001)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Washington DC
2 urban DC nurseries 26 did not believe or unsure that infant positioning
was associated with SIDS Top 3 factors influencing sleep position
o 56 PERSONAL PREFERENCE Why non-supine Clinical experience (25)
o Increase risk aspirationo Decrease sleep and comfort
Bartow KL Nursesrsquo knowledge and adherence to sudden infant death syndrome prevention guidelines Pediatr Nurs 201642(1)7-13
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
TodaysBaby QI Safe Sleep Teaching
QI intervention median = 160 days Mothers reported receiving information 72 to 95
(increase of 24-57) 94 babies observed supine (plus 24) 88 infants in safe sleep environment
o Increase of 33 Gains maintained up to 12 months
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Social Media and Risk-Reduction Training Study (SMART) Cluster randomization 4 groups Safe sleep or breast feeding education Nursing QI and social media (mobile health) N = 1600 1263 responses (79) Safe sleep NQI and MHealth
o Supine sleep 925 o Room-sharing 859o No soft bedding 819o Pacifier use 762
Moon RY Hauck FR Colson ER et al The effect of nursing quality improvement and mobile health interventions on infant sleep practices a randomized clinical trial JAMA 2017318(4)351-359
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Hospital Initiative ComponentswwwcribsforkidsorgHospitalInitiativeToolkit INTRODUCTORY LETTER HOSPITAL INITIATIVE TOOL KIT
INSTRUCTIONS ORGANIZATIONAL CHART HOSPITAL POLICY ACKNOWLEDGMENT FORM (Engl amp
Span) SAFE SLEEP EDUCATIONAL FLIP CHART
NONCOMPLIANCE WAIVER (Engl amp Span)
NURSING EDUCATION MODULE
SAFE SLEEP POSTERS DOOR HANGERS (Engl amp Span) GRADUATION CERTIFICATE SAMPLE LETTER TO HOSPITALS SAMPLE LETTER TO PROVIDERS INFANT SAFE SLEEP BROCHURES
(Engl amp Span) PRESS KIT
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
All materials available on-lineo No major costs to the hospital
Easy on-line access for documentation
NO FEE FOR PARTICIPATION
wwwCribsforKidsorgHospitalInitiative
Tiffany Price (tpricecribsforkidsorg)
The National Safe Sleep Hospital Certification Program
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
TNmdash25 reduction in infant sleep-related deaths in 2 years
SDmdashOver 7915 Pack lsquon Plays distributed since 2012 Infant mortality rate decreased from 86 (2012) to 48 (2016)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
2009 to 2015 38 decrease in infant mortality Decreased from 135 to 84 per 1000 SUID decreased gt50 Decrease in racial disparityhttphealthybabiesbaltimorecomhome
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
And Finallyhellip
Health care providers should have open frank nonjudgmental conversations with families about their sleep practices
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Encouraging Parents to Take Action
According to the Social Learning Theory parents are more likely to recall and comply with instructions when
the health care provider
Uses a positive tone Provides adequate information Allows the parent to ask most of the questions
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Motivational Interviewing
ldquoa collaborative goal-oriented style of communication with particular attention to the language of changerdquo
o Strengthen personal motivation and commitment to a specific goal
o Explore onersquos reasons for change (barriers)o Patient generates own solutions
bull More likely to feel realisticbull Planting seeds of change
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Impact of Eliminating Sleep-Related Deaths
Every week we lose 70 children which is equivalent to 4 kindergarten classrooms
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Thank You
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Contact Information
mgoodsteinwellspanorg
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Visit Pediatric Care Online today for additional information on this and other topics
httppediatriccaresolutionsaaporgPediatric Care Online is a convenient electronic resource for immediate expert help with
virtually every pediatric clinical information need with must-have resources that are included in a comprehensive reference library and time-saving clinical tools
Donrsquot have a subscription to PCOThen take advantage of a free trial today
Call Mead Johnson Nutrition at 888363-2362 orfor more information go to
httppediatriccaresolutionsaaporgSSFree_Trialaspx
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
IMR over time Finland vs US
Slide Number 1
Disclaimer
Objectives for Todayrsquos Talk
Infant Mortality Rates for the Five Leading Causes of Infant Death in the United States 2005 and 2011
US Post-Neonatal Mortality 2015
FACT
What is SUID or SUDI
Some Causes of Deaths that Occur Suddenly and Unexpectedly during Infancy
What is SIDS
SIDS FACTS
SIDS FACTS
Triple Risk Model to Explain SIDS
Paterson DS Krous HF Kinney HC et al JAMA 2006
An Example of SIDS Pathogenesis
2016 AAP Recommendations Infant Sleep Safety
Strength of Recommendation
Recommendations Change as the Evidence Evolves
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
Correct Safe Sleep Environment
We Need to Move Beyond Back to Sleep
Sleep Position for Healthy Newborns
Sleep Position in Newborn Nursery
Sleep Position and Reflux
The Truth About Supine Sleep and Aspiration Ending the Fallacy
Title
Infant Sleep Location
Room-Share How Long Yoursquore Kidding Right
Supporting Data
More Recent Data
Why is Room-Sharing Protective
Room-Sharing and Sleep Quality
Insight Study (Paul 2017)
Insight Study (Paul 2017)
Insight Commentary (Hauck Moon)
Feeding the Baby at Night
Say NO to Couches Sofas and Cushioned Armchairs
High-Risk Bed Sharing Situations
Bedsharing in Low-Risk Breastfed Infants
Independent Review (Dr Robert Platt)
Bed Sharing
Bed Sharing
Bed Sharing with Overlay
Bed Sharing with Overlay
Bed Sharing with Overlay
Couch Sleeping
Couch Sleeping
Couch Sleeping
Unsafe Bedding NISP Trends 1993-2102
Why Use Soft Bedding
Soft Bedding for Older Infants
To Swaddle or Not to Swaddle That is the Question
Swaddling
SwaddlingmdashIs it Safe
SwaddlingmdashMore Questionshellip
wwwhealthychildrenorg
Pacifiers
Pacifiers and Breastfeeding
Baby Friendly USA Pacifiers
Addressing Sleep Deprivation
Overcoming Barriers to Change What Parents are Sayinghellip
Factors Associated With Choice of Infant Sleep Position
Slide Number 65
What is Working
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Infant Sleep Safety
Safe Sleep Nurse Modeling
Physician Advocacy
Healthcare Provider Advice to New Mothers Safe Sleep
Mason Clinical Peds 713
Bundled Intervention = Behavior Change
Hospital Unsafe Sleep Persists
Washington DC
TodaysBaby QI Safe Sleep Teaching
TodaysBaby QI Safe Sleep Teaching
Social Media and Risk-Reduction Training Study (SMART)
The National Safe Sleep Hospital Certification Program
Coordinated Education Efforts Work
Coordinated Education Efforts Work
And Finallyhellip
Encouraging Parents to Take Action
Motivational Interviewing
Impact of Eliminating Sleep-Related Deaths
Thank You
Contact Information
Slide Number 89
IMR over time Finland vs US
Column1
correct advice
55
incorrect advice
25
no advice
20
correct advice
incorrect advice
no advice
SIDS Rate
Percent Back Sleeping
1988
14
1989
139
1990
13
1991
13
1992
12
13
1993
117
17
1994
103
269
1995
087
386
1996
074
353
1997
077
531
1998
072
557
1999
067
644
2000
062
666
2001
056
716
2002
057
711
2003
053
728
2004
056
701
2005
055
722
2006
055
757
2007
057
703
2008
055
721
2009
054
741
2010
051
728
2011
048
2012
042
2013
04
2014
039
httpwwwcdcgovNCHSdatanvsrnvsr58nvsr58_19pdf
Xu JQ Kochanek KD Murphy SL Tejada-Vera B Deaths Final data for
2007
National vital statistics reports vol 58 no 19 Hyattsville MD
National Center for Health Statistics 2010
1988
1988
1989
1989
1990
1990
1991
1991
1992
1992
1993
1993
1994
1994
1995
1995
1996
1996
1997
1997
1998
1998
1999
1999
2000
2000
2001
2001
2002
2002
2003
2003
2004
2004
2005
2005
2006
2006
2007
2007
2008
2008
2009
2009
2010
2010
2011
2012
2013
2014
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Insight Commentary (Hauck Moon)
Late room-sharing mean 7 hours longest sleep Is early consolidation desirable Differences related to bedtime routines
o Early bedtimeo Number of night feedso Feeding back to sleep
Focus on the routine not early separation
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Feeding the Baby at Night Acknowledgment that parents may fall
asleep while feeding babyo Safer to feed on bed than on sofa
couch or armchair if you might fall asleep
o No pillows sheets blankets or other items that could obstruct infant breathing or cause overheating should be in bed
o Return infant back to separate sleep surface as soon as parent awakens
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Say NO to Couches Sofas and Cushioned Armchairs Never place a baby for sleep on these surfaces Never sleep with a baby on these surfaces One of the MOST dangerous places for an infant
(OR 51-669)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
High-Risk Bed Sharing Situations Age lt4 months Preterm or low birth weight Smoked during pregnancy Bed sharer is current smoker (even if not
smoking in bed) Bed sharer has usedis using meds or
substances that could impair alertness or arousal
Bed sharer is not parent (including other children)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bedsharing in Low-Risk Breastfed Infants
Blair et al AOR 16 (95 CI 096-27) o Age lt14 weekso Parents No cigarettes or alcoholo Independent of feeding method
Carpenter et al AOR 51 (95 CI 23-114) o Age lt3 months o Parents did not smokeo Mother No alcohol or drugso Breastfed infants
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Independent Review (Dr Robert Platt)
Very small numbers of low-risk babieso 24 in Blairrsquos studyo 12 in Carpenterrsquos study
Does not believe that data support definitive differences in 2 studies
Some evidence of increased risk in this group but cannot say how large the increased risk is
Cannot conclude that bed sharing in this group is safe
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Unsafe Bedding NISP Trends 1993-2102
Shapiro-Mendoza CK Colson ER Willinger M Rybin DV Camperlengo L Corwin MJ Trends in infant bedding use National Infant Sleep Position study 1993ndash2010 Pediatrics 2015135(1)10-17
Decrease from 86 to 55 Rate of decline decreases
2001-10 835 for teen mothers Predictors of adjusted OR
gt15
o Young motherso Non-white race
ethnicityo Less than college
education
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Why Use Soft Bedding
ComfortWarmtho Extrapolation of own feelingso Misinterpret firm with taut
bull Soft + taut ne firm
Safetyo Blankets pillows rolls to prevent falls
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Soft Bedding for Older Infants
Many parents recognize soft bedding is a risk Increased complacency as baby gets older Soft bedding is THE most important risk factor for
infants 4-12 months old (Colvin 2015) Infants roll into bedding and cannot extract
themselves
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
To Swaddle or Not to Swaddle That is the Question Pros
o Calms the infant promotes sleep decreases number of awakenings
o Encourages use of the supine position
Conso Increased respiratory rate and
reduced functional residual lung capacity
o Exacerbates hip dysplasia if the hips are kept in extension and adduction
o ldquoLooserdquo swaddling becomes loose bedding
o Overheating especially if the head is covered or the infant has infection
o Effects on arousability to an external stimulus remain unclear (conflicting data) There may be minimal effects of routine swaddling on arousal
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Swaddling
There is insufficient evidence to recommend routine swaddling as a strategy to reduce the incidence of SIDS
Swaddling must be correctly applied to avoid the possible hazards
Swaddling does not reduce the necessity to follow recommended safe sleep practices Ambrogio Lorenzettis Madonna and Child (1319)
Wikipedia
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
McDonnell E Moon RY Infant deaths and injuries associated with wearable blankets swaddle wraps and swaddling J Pediatr 20141641152-1156
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
SwaddlingmdashMore Questionshellip
Pease 2016 Pediatrics Pooled OR = 138
o Prone = 1299 o Side = 316o Supine = 193
Increased risk with age Limitations
o Heterogeneity definitions other risk factorsPease AS Fleming PJ Hauck FR et al Swaddling and the risk of sudden infant death syndrome a meta-analysis Pediatrics 2016137(6)e20153
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
wwwhealthychildrenorg
Swaddling (wrapping a light blanket snuggly around a baby) may help calm a crying baby If you swaddle your baby be sure to place him on his back to sleep Stop swaddling your baby when he starts to roll
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers
AAP recommendation Consider offering a pacifier at nap time and bedtime
Studies consistently demonstrate a protective effect of pacifiers on SIDS
Mechanism unknowno Dislodge within 15 to 60 minuteso Decreased arousal threshold
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers and Breastfeeding Well-designed trials
o 2 found no association among term infants
o 1 found no association among preterm infants
o 1 found slightly decreased breastfeeding duration at one month if pacifier introduced in first week of life but NO difference if pacifier introduced after one month
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Baby Friendly USA Pacifiers
Breastfeeding babies should not be given pacifiers by the staff of the facility with the exception of o Limited use to decrease pain during procedures when
the baby cannot safely be held or breastfed (pacifiers used should be discarded after these procedures)
o Babies who are being tube-fed in NICUo Other rare specific medical reasons
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Addressing Sleep Deprivation
Give parents tools to cope with fussy babies
Sleep-deprived parents may make poor judgments
Make use of tools o Swaddling side carrying
shushing swinging and sucking
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Overcoming Barriers to Change What Parents are Sayinghellip
Prone positioning fear of choking Baby sleeps ldquobetterrdquo on stomach Soft things are safer for the baby SIDS is ldquoGodrsquos willrdquo Why bother Recommendations keep changing
anyway Vigilance sleep with baby for protection
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Factors Associated With Choice of Infant Sleep Position 3300 mothers from 32 hospitals 77 usually use supine position 49 exclusive use supine position Most likely to use prone
o African-American motherso Mothers with lt high school educationo Lack of perceived controlo Personal attitudesocietal norms
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
A continuum starting in childhoodo Secondary school baby sitting classes
Pre-pregnancy Pregnancyprenatal education
o Prior to baby showerhellipldquowrong giftsrdquo In-hospital education and modeling
o Include family friends baby sitters Re-enforcement in the doctorrsquos office
o Especially between 1 to 4 months Grandparents They hold great power The general public (day cares religious leaders)
A Lifetime of Infant Sleep Safety
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Chart1
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
14
139
13
13
12
13
117
17
103
269
087
386
074
353
077
531
072
557
067
644
062
666
056
716
057
711
053
728
056
701
055
722
055
757
057
703
055
721
054
741
051
728
048
042
04
039
Sheet1
Sheet1
ampA
Page ampP
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
Sheet2
Pre-AAP recommendation Post-AAP RecommendationBack to SleepSafe to Sleep Campaign
Sheet3
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Infant Sleep Safety
Requires a consistent and repetitive message in the community to prevent accidental deaths
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Safe Sleep Nurse Modeling
People trust nurses Whatever the nurse does must
be correct and it will be imitated in the home
Fact supine positioning in the nursery can almost DOUBLE its use in the home
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Physician Advocacy
Srivatsa 1997 HCP education to new familieshellip34 reduction in prone sleeping
Eron 2009 Study of Central NY state physicianshellip30 identified incorrect safest sleep positionhellip30 do not discuss with families
Colson 2009 Only 13 mothers advised by MD to use supine positionhellip3 times more likely to position the baby properly
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Healthcare Provider Advice to New Mothers Safe Sleep
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Chart1
Column1
[]
[]
[]
55
25
20
Sheet1
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Mason Clinical Peds 713
Bundled interventiono Nursing education policy model behavior safe sleep
video posters in rooms declaration of safe sleep practice
Safe sleep environment uarr from 25 to 58 Intention in home 95 supine none ldquoco-sleepingrdquo
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bundled Intervention = Behavior Change
QUESTION GROUP p-value
ISS Study NISP
Behavior Questions n = 490 n = 1046
Baby routinely placed to sleep on back 925 73 lt 0001
Baby routinely sleeps in bassinetcrib 995 71 lt 00001
Baby sleeps under a thin sheet 992 86 lt 0001
Baby given a pacifier for sleep 741 84 lt 0001Goodstein MH Bell T Krugman SD Improving infant sleep safety through a comprehensive hospital-based program Clinical Pediatrics 201554(3)212-221
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
o Baseline Safe sleep 49 of 264 infants o Post 312 of 234 infants (P lt 001) o Extra blankets most common o Baseline 77 vs 44 post-intervention o Mean number of unsafe items reduced by 50 (P lt 001)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Washington DC
2 urban DC nurseries 26 did not believe or unsure that infant positioning
was associated with SIDS Top 3 factors influencing sleep position
o 56 PERSONAL PREFERENCE Why non-supine Clinical experience (25)
o Increase risk aspirationo Decrease sleep and comfort
Bartow KL Nursesrsquo knowledge and adherence to sudden infant death syndrome prevention guidelines Pediatr Nurs 201642(1)7-13
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
TodaysBaby QI Safe Sleep Teaching
QI intervention median = 160 days Mothers reported receiving information 72 to 95
(increase of 24-57) 94 babies observed supine (plus 24) 88 infants in safe sleep environment
o Increase of 33 Gains maintained up to 12 months
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Social Media and Risk-Reduction Training Study (SMART) Cluster randomization 4 groups Safe sleep or breast feeding education Nursing QI and social media (mobile health) N = 1600 1263 responses (79) Safe sleep NQI and MHealth
o Supine sleep 925 o Room-sharing 859o No soft bedding 819o Pacifier use 762
Moon RY Hauck FR Colson ER et al The effect of nursing quality improvement and mobile health interventions on infant sleep practices a randomized clinical trial JAMA 2017318(4)351-359
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Hospital Initiative ComponentswwwcribsforkidsorgHospitalInitiativeToolkit INTRODUCTORY LETTER HOSPITAL INITIATIVE TOOL KIT
INSTRUCTIONS ORGANIZATIONAL CHART HOSPITAL POLICY ACKNOWLEDGMENT FORM (Engl amp
Span) SAFE SLEEP EDUCATIONAL FLIP CHART
NONCOMPLIANCE WAIVER (Engl amp Span)
NURSING EDUCATION MODULE
SAFE SLEEP POSTERS DOOR HANGERS (Engl amp Span) GRADUATION CERTIFICATE SAMPLE LETTER TO HOSPITALS SAMPLE LETTER TO PROVIDERS INFANT SAFE SLEEP BROCHURES
(Engl amp Span) PRESS KIT
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
All materials available on-lineo No major costs to the hospital
Easy on-line access for documentation
NO FEE FOR PARTICIPATION
wwwCribsforKidsorgHospitalInitiative
Tiffany Price (tpricecribsforkidsorg)
The National Safe Sleep Hospital Certification Program
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
TNmdash25 reduction in infant sleep-related deaths in 2 years
SDmdashOver 7915 Pack lsquon Plays distributed since 2012 Infant mortality rate decreased from 86 (2012) to 48 (2016)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
2009 to 2015 38 decrease in infant mortality Decreased from 135 to 84 per 1000 SUID decreased gt50 Decrease in racial disparityhttphealthybabiesbaltimorecomhome
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
And Finallyhellip
Health care providers should have open frank nonjudgmental conversations with families about their sleep practices
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Encouraging Parents to Take Action
According to the Social Learning Theory parents are more likely to recall and comply with instructions when
the health care provider
Uses a positive tone Provides adequate information Allows the parent to ask most of the questions
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Motivational Interviewing
ldquoa collaborative goal-oriented style of communication with particular attention to the language of changerdquo
o Strengthen personal motivation and commitment to a specific goal
o Explore onersquos reasons for change (barriers)o Patient generates own solutions
bull More likely to feel realisticbull Planting seeds of change
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Impact of Eliminating Sleep-Related Deaths
Every week we lose 70 children which is equivalent to 4 kindergarten classrooms
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Thank You
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Contact Information
mgoodsteinwellspanorg
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Visit Pediatric Care Online today for additional information on this and other topics
httppediatriccaresolutionsaaporgPediatric Care Online is a convenient electronic resource for immediate expert help with
virtually every pediatric clinical information need with must-have resources that are included in a comprehensive reference library and time-saving clinical tools
Donrsquot have a subscription to PCOThen take advantage of a free trial today
Call Mead Johnson Nutrition at 888363-2362 orfor more information go to
httppediatriccaresolutionsaaporgSSFree_Trialaspx
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
IMR over time Finland vs US
Slide Number 1
Disclaimer
Objectives for Todayrsquos Talk
Infant Mortality Rates for the Five Leading Causes of Infant Death in the United States 2005 and 2011
US Post-Neonatal Mortality 2015
FACT
What is SUID or SUDI
Some Causes of Deaths that Occur Suddenly and Unexpectedly during Infancy
What is SIDS
SIDS FACTS
SIDS FACTS
Triple Risk Model to Explain SIDS
Paterson DS Krous HF Kinney HC et al JAMA 2006
An Example of SIDS Pathogenesis
2016 AAP Recommendations Infant Sleep Safety
Strength of Recommendation
Recommendations Change as the Evidence Evolves
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
Correct Safe Sleep Environment
We Need to Move Beyond Back to Sleep
Sleep Position for Healthy Newborns
Sleep Position in Newborn Nursery
Sleep Position and Reflux
The Truth About Supine Sleep and Aspiration Ending the Fallacy
Title
Infant Sleep Location
Room-Share How Long Yoursquore Kidding Right
Supporting Data
More Recent Data
Why is Room-Sharing Protective
Room-Sharing and Sleep Quality
Insight Study (Paul 2017)
Insight Study (Paul 2017)
Insight Commentary (Hauck Moon)
Feeding the Baby at Night
Say NO to Couches Sofas and Cushioned Armchairs
High-Risk Bed Sharing Situations
Bedsharing in Low-Risk Breastfed Infants
Independent Review (Dr Robert Platt)
Bed Sharing
Bed Sharing
Bed Sharing with Overlay
Bed Sharing with Overlay
Bed Sharing with Overlay
Couch Sleeping
Couch Sleeping
Couch Sleeping
Unsafe Bedding NISP Trends 1993-2102
Why Use Soft Bedding
Soft Bedding for Older Infants
To Swaddle or Not to Swaddle That is the Question
Swaddling
SwaddlingmdashIs it Safe
SwaddlingmdashMore Questionshellip
wwwhealthychildrenorg
Pacifiers
Pacifiers and Breastfeeding
Baby Friendly USA Pacifiers
Addressing Sleep Deprivation
Overcoming Barriers to Change What Parents are Sayinghellip
Factors Associated With Choice of Infant Sleep Position
Slide Number 65
What is Working
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Infant Sleep Safety
Safe Sleep Nurse Modeling
Physician Advocacy
Healthcare Provider Advice to New Mothers Safe Sleep
Mason Clinical Peds 713
Bundled Intervention = Behavior Change
Hospital Unsafe Sleep Persists
Washington DC
TodaysBaby QI Safe Sleep Teaching
TodaysBaby QI Safe Sleep Teaching
Social Media and Risk-Reduction Training Study (SMART)
The National Safe Sleep Hospital Certification Program
Coordinated Education Efforts Work
Coordinated Education Efforts Work
And Finallyhellip
Encouraging Parents to Take Action
Motivational Interviewing
Impact of Eliminating Sleep-Related Deaths
Thank You
Contact Information
Slide Number 89
IMR over time Finland vs US
Column1
correct advice
55
incorrect advice
25
no advice
20
correct advice
incorrect advice
no advice
SIDS Rate
Percent Back Sleeping
1988
14
1989
139
1990
13
1991
13
1992
12
13
1993
117
17
1994
103
269
1995
087
386
1996
074
353
1997
077
531
1998
072
557
1999
067
644
2000
062
666
2001
056
716
2002
057
711
2003
053
728
2004
056
701
2005
055
722
2006
055
757
2007
057
703
2008
055
721
2009
054
741
2010
051
728
2011
048
2012
042
2013
04
2014
039
httpwwwcdcgovNCHSdatanvsrnvsr58nvsr58_19pdf
Xu JQ Kochanek KD Murphy SL Tejada-Vera B Deaths Final data for
2007
National vital statistics reports vol 58 no 19 Hyattsville MD
National Center for Health Statistics 2010
1988
1988
1989
1989
1990
1990
1991
1991
1992
1992
1993
1993
1994
1994
1995
1995
1996
1996
1997
1997
1998
1998
1999
1999
2000
2000
2001
2001
2002
2002
2003
2003
2004
2004
2005
2005
2006
2006
2007
2007
2008
2008
2009
2009
2010
2010
2011
2012
2013
2014
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Feeding the Baby at Night Acknowledgment that parents may fall
asleep while feeding babyo Safer to feed on bed than on sofa
couch or armchair if you might fall asleep
o No pillows sheets blankets or other items that could obstruct infant breathing or cause overheating should be in bed
o Return infant back to separate sleep surface as soon as parent awakens
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Say NO to Couches Sofas and Cushioned Armchairs Never place a baby for sleep on these surfaces Never sleep with a baby on these surfaces One of the MOST dangerous places for an infant
(OR 51-669)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
High-Risk Bed Sharing Situations Age lt4 months Preterm or low birth weight Smoked during pregnancy Bed sharer is current smoker (even if not
smoking in bed) Bed sharer has usedis using meds or
substances that could impair alertness or arousal
Bed sharer is not parent (including other children)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bedsharing in Low-Risk Breastfed Infants
Blair et al AOR 16 (95 CI 096-27) o Age lt14 weekso Parents No cigarettes or alcoholo Independent of feeding method
Carpenter et al AOR 51 (95 CI 23-114) o Age lt3 months o Parents did not smokeo Mother No alcohol or drugso Breastfed infants
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Independent Review (Dr Robert Platt)
Very small numbers of low-risk babieso 24 in Blairrsquos studyo 12 in Carpenterrsquos study
Does not believe that data support definitive differences in 2 studies
Some evidence of increased risk in this group but cannot say how large the increased risk is
Cannot conclude that bed sharing in this group is safe
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Unsafe Bedding NISP Trends 1993-2102
Shapiro-Mendoza CK Colson ER Willinger M Rybin DV Camperlengo L Corwin MJ Trends in infant bedding use National Infant Sleep Position study 1993ndash2010 Pediatrics 2015135(1)10-17
Decrease from 86 to 55 Rate of decline decreases
2001-10 835 for teen mothers Predictors of adjusted OR
gt15
o Young motherso Non-white race
ethnicityo Less than college
education
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Why Use Soft Bedding
ComfortWarmtho Extrapolation of own feelingso Misinterpret firm with taut
bull Soft + taut ne firm
Safetyo Blankets pillows rolls to prevent falls
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Soft Bedding for Older Infants
Many parents recognize soft bedding is a risk Increased complacency as baby gets older Soft bedding is THE most important risk factor for
infants 4-12 months old (Colvin 2015) Infants roll into bedding and cannot extract
themselves
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
To Swaddle or Not to Swaddle That is the Question Pros
o Calms the infant promotes sleep decreases number of awakenings
o Encourages use of the supine position
Conso Increased respiratory rate and
reduced functional residual lung capacity
o Exacerbates hip dysplasia if the hips are kept in extension and adduction
o ldquoLooserdquo swaddling becomes loose bedding
o Overheating especially if the head is covered or the infant has infection
o Effects on arousability to an external stimulus remain unclear (conflicting data) There may be minimal effects of routine swaddling on arousal
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Swaddling
There is insufficient evidence to recommend routine swaddling as a strategy to reduce the incidence of SIDS
Swaddling must be correctly applied to avoid the possible hazards
Swaddling does not reduce the necessity to follow recommended safe sleep practices Ambrogio Lorenzettis Madonna and Child (1319)
Wikipedia
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
McDonnell E Moon RY Infant deaths and injuries associated with wearable blankets swaddle wraps and swaddling J Pediatr 20141641152-1156
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
SwaddlingmdashMore Questionshellip
Pease 2016 Pediatrics Pooled OR = 138
o Prone = 1299 o Side = 316o Supine = 193
Increased risk with age Limitations
o Heterogeneity definitions other risk factorsPease AS Fleming PJ Hauck FR et al Swaddling and the risk of sudden infant death syndrome a meta-analysis Pediatrics 2016137(6)e20153
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
wwwhealthychildrenorg
Swaddling (wrapping a light blanket snuggly around a baby) may help calm a crying baby If you swaddle your baby be sure to place him on his back to sleep Stop swaddling your baby when he starts to roll
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers
AAP recommendation Consider offering a pacifier at nap time and bedtime
Studies consistently demonstrate a protective effect of pacifiers on SIDS
Mechanism unknowno Dislodge within 15 to 60 minuteso Decreased arousal threshold
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers and Breastfeeding Well-designed trials
o 2 found no association among term infants
o 1 found no association among preterm infants
o 1 found slightly decreased breastfeeding duration at one month if pacifier introduced in first week of life but NO difference if pacifier introduced after one month
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Baby Friendly USA Pacifiers
Breastfeeding babies should not be given pacifiers by the staff of the facility with the exception of o Limited use to decrease pain during procedures when
the baby cannot safely be held or breastfed (pacifiers used should be discarded after these procedures)
o Babies who are being tube-fed in NICUo Other rare specific medical reasons
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Addressing Sleep Deprivation
Give parents tools to cope with fussy babies
Sleep-deprived parents may make poor judgments
Make use of tools o Swaddling side carrying
shushing swinging and sucking
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Overcoming Barriers to Change What Parents are Sayinghellip
Prone positioning fear of choking Baby sleeps ldquobetterrdquo on stomach Soft things are safer for the baby SIDS is ldquoGodrsquos willrdquo Why bother Recommendations keep changing
anyway Vigilance sleep with baby for protection
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Factors Associated With Choice of Infant Sleep Position 3300 mothers from 32 hospitals 77 usually use supine position 49 exclusive use supine position Most likely to use prone
o African-American motherso Mothers with lt high school educationo Lack of perceived controlo Personal attitudesocietal norms
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
A continuum starting in childhoodo Secondary school baby sitting classes
Pre-pregnancy Pregnancyprenatal education
o Prior to baby showerhellipldquowrong giftsrdquo In-hospital education and modeling
o Include family friends baby sitters Re-enforcement in the doctorrsquos office
o Especially between 1 to 4 months Grandparents They hold great power The general public (day cares religious leaders)
A Lifetime of Infant Sleep Safety
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Chart1
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
14
139
13
13
12
13
117
17
103
269
087
386
074
353
077
531
072
557
067
644
062
666
056
716
057
711
053
728
056
701
055
722
055
757
057
703
055
721
054
741
051
728
048
042
04
039
Sheet1
Sheet1
ampA
Page ampP
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
Sheet2
Pre-AAP recommendation Post-AAP RecommendationBack to SleepSafe to Sleep Campaign
Sheet3
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Infant Sleep Safety
Requires a consistent and repetitive message in the community to prevent accidental deaths
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Safe Sleep Nurse Modeling
People trust nurses Whatever the nurse does must
be correct and it will be imitated in the home
Fact supine positioning in the nursery can almost DOUBLE its use in the home
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Physician Advocacy
Srivatsa 1997 HCP education to new familieshellip34 reduction in prone sleeping
Eron 2009 Study of Central NY state physicianshellip30 identified incorrect safest sleep positionhellip30 do not discuss with families
Colson 2009 Only 13 mothers advised by MD to use supine positionhellip3 times more likely to position the baby properly
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Healthcare Provider Advice to New Mothers Safe Sleep
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Chart1
Column1
[]
[]
[]
55
25
20
Sheet1
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Mason Clinical Peds 713
Bundled interventiono Nursing education policy model behavior safe sleep
video posters in rooms declaration of safe sleep practice
Safe sleep environment uarr from 25 to 58 Intention in home 95 supine none ldquoco-sleepingrdquo
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bundled Intervention = Behavior Change
QUESTION GROUP p-value
ISS Study NISP
Behavior Questions n = 490 n = 1046
Baby routinely placed to sleep on back 925 73 lt 0001
Baby routinely sleeps in bassinetcrib 995 71 lt 00001
Baby sleeps under a thin sheet 992 86 lt 0001
Baby given a pacifier for sleep 741 84 lt 0001Goodstein MH Bell T Krugman SD Improving infant sleep safety through a comprehensive hospital-based program Clinical Pediatrics 201554(3)212-221
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
o Baseline Safe sleep 49 of 264 infants o Post 312 of 234 infants (P lt 001) o Extra blankets most common o Baseline 77 vs 44 post-intervention o Mean number of unsafe items reduced by 50 (P lt 001)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Washington DC
2 urban DC nurseries 26 did not believe or unsure that infant positioning
was associated with SIDS Top 3 factors influencing sleep position
o 56 PERSONAL PREFERENCE Why non-supine Clinical experience (25)
o Increase risk aspirationo Decrease sleep and comfort
Bartow KL Nursesrsquo knowledge and adherence to sudden infant death syndrome prevention guidelines Pediatr Nurs 201642(1)7-13
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
TodaysBaby QI Safe Sleep Teaching
QI intervention median = 160 days Mothers reported receiving information 72 to 95
(increase of 24-57) 94 babies observed supine (plus 24) 88 infants in safe sleep environment
o Increase of 33 Gains maintained up to 12 months
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Social Media and Risk-Reduction Training Study (SMART) Cluster randomization 4 groups Safe sleep or breast feeding education Nursing QI and social media (mobile health) N = 1600 1263 responses (79) Safe sleep NQI and MHealth
o Supine sleep 925 o Room-sharing 859o No soft bedding 819o Pacifier use 762
Moon RY Hauck FR Colson ER et al The effect of nursing quality improvement and mobile health interventions on infant sleep practices a randomized clinical trial JAMA 2017318(4)351-359
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Hospital Initiative ComponentswwwcribsforkidsorgHospitalInitiativeToolkit INTRODUCTORY LETTER HOSPITAL INITIATIVE TOOL KIT
INSTRUCTIONS ORGANIZATIONAL CHART HOSPITAL POLICY ACKNOWLEDGMENT FORM (Engl amp
Span) SAFE SLEEP EDUCATIONAL FLIP CHART
NONCOMPLIANCE WAIVER (Engl amp Span)
NURSING EDUCATION MODULE
SAFE SLEEP POSTERS DOOR HANGERS (Engl amp Span) GRADUATION CERTIFICATE SAMPLE LETTER TO HOSPITALS SAMPLE LETTER TO PROVIDERS INFANT SAFE SLEEP BROCHURES
(Engl amp Span) PRESS KIT
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
All materials available on-lineo No major costs to the hospital
Easy on-line access for documentation
NO FEE FOR PARTICIPATION
wwwCribsforKidsorgHospitalInitiative
Tiffany Price (tpricecribsforkidsorg)
The National Safe Sleep Hospital Certification Program
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
TNmdash25 reduction in infant sleep-related deaths in 2 years
SDmdashOver 7915 Pack lsquon Plays distributed since 2012 Infant mortality rate decreased from 86 (2012) to 48 (2016)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
2009 to 2015 38 decrease in infant mortality Decreased from 135 to 84 per 1000 SUID decreased gt50 Decrease in racial disparityhttphealthybabiesbaltimorecomhome
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
And Finallyhellip
Health care providers should have open frank nonjudgmental conversations with families about their sleep practices
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Encouraging Parents to Take Action
According to the Social Learning Theory parents are more likely to recall and comply with instructions when
the health care provider
Uses a positive tone Provides adequate information Allows the parent to ask most of the questions
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Motivational Interviewing
ldquoa collaborative goal-oriented style of communication with particular attention to the language of changerdquo
o Strengthen personal motivation and commitment to a specific goal
o Explore onersquos reasons for change (barriers)o Patient generates own solutions
bull More likely to feel realisticbull Planting seeds of change
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Impact of Eliminating Sleep-Related Deaths
Every week we lose 70 children which is equivalent to 4 kindergarten classrooms
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Thank You
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Contact Information
mgoodsteinwellspanorg
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Visit Pediatric Care Online today for additional information on this and other topics
httppediatriccaresolutionsaaporgPediatric Care Online is a convenient electronic resource for immediate expert help with
virtually every pediatric clinical information need with must-have resources that are included in a comprehensive reference library and time-saving clinical tools
Donrsquot have a subscription to PCOThen take advantage of a free trial today
Call Mead Johnson Nutrition at 888363-2362 orfor more information go to
httppediatriccaresolutionsaaporgSSFree_Trialaspx
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
IMR over time Finland vs US
Slide Number 1
Disclaimer
Objectives for Todayrsquos Talk
Infant Mortality Rates for the Five Leading Causes of Infant Death in the United States 2005 and 2011
US Post-Neonatal Mortality 2015
FACT
What is SUID or SUDI
Some Causes of Deaths that Occur Suddenly and Unexpectedly during Infancy
What is SIDS
SIDS FACTS
SIDS FACTS
Triple Risk Model to Explain SIDS
Paterson DS Krous HF Kinney HC et al JAMA 2006
An Example of SIDS Pathogenesis
2016 AAP Recommendations Infant Sleep Safety
Strength of Recommendation
Recommendations Change as the Evidence Evolves
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
Correct Safe Sleep Environment
We Need to Move Beyond Back to Sleep
Sleep Position for Healthy Newborns
Sleep Position in Newborn Nursery
Sleep Position and Reflux
The Truth About Supine Sleep and Aspiration Ending the Fallacy
Title
Infant Sleep Location
Room-Share How Long Yoursquore Kidding Right
Supporting Data
More Recent Data
Why is Room-Sharing Protective
Room-Sharing and Sleep Quality
Insight Study (Paul 2017)
Insight Study (Paul 2017)
Insight Commentary (Hauck Moon)
Feeding the Baby at Night
Say NO to Couches Sofas and Cushioned Armchairs
High-Risk Bed Sharing Situations
Bedsharing in Low-Risk Breastfed Infants
Independent Review (Dr Robert Platt)
Bed Sharing
Bed Sharing
Bed Sharing with Overlay
Bed Sharing with Overlay
Bed Sharing with Overlay
Couch Sleeping
Couch Sleeping
Couch Sleeping
Unsafe Bedding NISP Trends 1993-2102
Why Use Soft Bedding
Soft Bedding for Older Infants
To Swaddle or Not to Swaddle That is the Question
Swaddling
SwaddlingmdashIs it Safe
SwaddlingmdashMore Questionshellip
wwwhealthychildrenorg
Pacifiers
Pacifiers and Breastfeeding
Baby Friendly USA Pacifiers
Addressing Sleep Deprivation
Overcoming Barriers to Change What Parents are Sayinghellip
Factors Associated With Choice of Infant Sleep Position
Slide Number 65
What is Working
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Infant Sleep Safety
Safe Sleep Nurse Modeling
Physician Advocacy
Healthcare Provider Advice to New Mothers Safe Sleep
Mason Clinical Peds 713
Bundled Intervention = Behavior Change
Hospital Unsafe Sleep Persists
Washington DC
TodaysBaby QI Safe Sleep Teaching
TodaysBaby QI Safe Sleep Teaching
Social Media and Risk-Reduction Training Study (SMART)
The National Safe Sleep Hospital Certification Program
Coordinated Education Efforts Work
Coordinated Education Efforts Work
And Finallyhellip
Encouraging Parents to Take Action
Motivational Interviewing
Impact of Eliminating Sleep-Related Deaths
Thank You
Contact Information
Slide Number 89
IMR over time Finland vs US
Column1
correct advice
55
incorrect advice
25
no advice
20
correct advice
incorrect advice
no advice
SIDS Rate
Percent Back Sleeping
1988
14
1989
139
1990
13
1991
13
1992
12
13
1993
117
17
1994
103
269
1995
087
386
1996
074
353
1997
077
531
1998
072
557
1999
067
644
2000
062
666
2001
056
716
2002
057
711
2003
053
728
2004
056
701
2005
055
722
2006
055
757
2007
057
703
2008
055
721
2009
054
741
2010
051
728
2011
048
2012
042
2013
04
2014
039
httpwwwcdcgovNCHSdatanvsrnvsr58nvsr58_19pdf
Xu JQ Kochanek KD Murphy SL Tejada-Vera B Deaths Final data for
2007
National vital statistics reports vol 58 no 19 Hyattsville MD
National Center for Health Statistics 2010
1988
1988
1989
1989
1990
1990
1991
1991
1992
1992
1993
1993
1994
1994
1995
1995
1996
1996
1997
1997
1998
1998
1999
1999
2000
2000
2001
2001
2002
2002
2003
2003
2004
2004
2005
2005
2006
2006
2007
2007
2008
2008
2009
2009
2010
2010
2011
2012
2013
2014
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Say NO to Couches Sofas and Cushioned Armchairs Never place a baby for sleep on these surfaces Never sleep with a baby on these surfaces One of the MOST dangerous places for an infant
(OR 51-669)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
High-Risk Bed Sharing Situations Age lt4 months Preterm or low birth weight Smoked during pregnancy Bed sharer is current smoker (even if not
smoking in bed) Bed sharer has usedis using meds or
substances that could impair alertness or arousal
Bed sharer is not parent (including other children)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bedsharing in Low-Risk Breastfed Infants
Blair et al AOR 16 (95 CI 096-27) o Age lt14 weekso Parents No cigarettes or alcoholo Independent of feeding method
Carpenter et al AOR 51 (95 CI 23-114) o Age lt3 months o Parents did not smokeo Mother No alcohol or drugso Breastfed infants
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Independent Review (Dr Robert Platt)
Very small numbers of low-risk babieso 24 in Blairrsquos studyo 12 in Carpenterrsquos study
Does not believe that data support definitive differences in 2 studies
Some evidence of increased risk in this group but cannot say how large the increased risk is
Cannot conclude that bed sharing in this group is safe
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Unsafe Bedding NISP Trends 1993-2102
Shapiro-Mendoza CK Colson ER Willinger M Rybin DV Camperlengo L Corwin MJ Trends in infant bedding use National Infant Sleep Position study 1993ndash2010 Pediatrics 2015135(1)10-17
Decrease from 86 to 55 Rate of decline decreases
2001-10 835 for teen mothers Predictors of adjusted OR
gt15
o Young motherso Non-white race
ethnicityo Less than college
education
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Why Use Soft Bedding
ComfortWarmtho Extrapolation of own feelingso Misinterpret firm with taut
bull Soft + taut ne firm
Safetyo Blankets pillows rolls to prevent falls
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Soft Bedding for Older Infants
Many parents recognize soft bedding is a risk Increased complacency as baby gets older Soft bedding is THE most important risk factor for
infants 4-12 months old (Colvin 2015) Infants roll into bedding and cannot extract
themselves
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
To Swaddle or Not to Swaddle That is the Question Pros
o Calms the infant promotes sleep decreases number of awakenings
o Encourages use of the supine position
Conso Increased respiratory rate and
reduced functional residual lung capacity
o Exacerbates hip dysplasia if the hips are kept in extension and adduction
o ldquoLooserdquo swaddling becomes loose bedding
o Overheating especially if the head is covered or the infant has infection
o Effects on arousability to an external stimulus remain unclear (conflicting data) There may be minimal effects of routine swaddling on arousal
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Swaddling
There is insufficient evidence to recommend routine swaddling as a strategy to reduce the incidence of SIDS
Swaddling must be correctly applied to avoid the possible hazards
Swaddling does not reduce the necessity to follow recommended safe sleep practices Ambrogio Lorenzettis Madonna and Child (1319)
Wikipedia
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
McDonnell E Moon RY Infant deaths and injuries associated with wearable blankets swaddle wraps and swaddling J Pediatr 20141641152-1156
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
SwaddlingmdashMore Questionshellip
Pease 2016 Pediatrics Pooled OR = 138
o Prone = 1299 o Side = 316o Supine = 193
Increased risk with age Limitations
o Heterogeneity definitions other risk factorsPease AS Fleming PJ Hauck FR et al Swaddling and the risk of sudden infant death syndrome a meta-analysis Pediatrics 2016137(6)e20153
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
wwwhealthychildrenorg
Swaddling (wrapping a light blanket snuggly around a baby) may help calm a crying baby If you swaddle your baby be sure to place him on his back to sleep Stop swaddling your baby when he starts to roll
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers
AAP recommendation Consider offering a pacifier at nap time and bedtime
Studies consistently demonstrate a protective effect of pacifiers on SIDS
Mechanism unknowno Dislodge within 15 to 60 minuteso Decreased arousal threshold
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers and Breastfeeding Well-designed trials
o 2 found no association among term infants
o 1 found no association among preterm infants
o 1 found slightly decreased breastfeeding duration at one month if pacifier introduced in first week of life but NO difference if pacifier introduced after one month
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Baby Friendly USA Pacifiers
Breastfeeding babies should not be given pacifiers by the staff of the facility with the exception of o Limited use to decrease pain during procedures when
the baby cannot safely be held or breastfed (pacifiers used should be discarded after these procedures)
o Babies who are being tube-fed in NICUo Other rare specific medical reasons
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Addressing Sleep Deprivation
Give parents tools to cope with fussy babies
Sleep-deprived parents may make poor judgments
Make use of tools o Swaddling side carrying
shushing swinging and sucking
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Overcoming Barriers to Change What Parents are Sayinghellip
Prone positioning fear of choking Baby sleeps ldquobetterrdquo on stomach Soft things are safer for the baby SIDS is ldquoGodrsquos willrdquo Why bother Recommendations keep changing
anyway Vigilance sleep with baby for protection
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Factors Associated With Choice of Infant Sleep Position 3300 mothers from 32 hospitals 77 usually use supine position 49 exclusive use supine position Most likely to use prone
o African-American motherso Mothers with lt high school educationo Lack of perceived controlo Personal attitudesocietal norms
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
A continuum starting in childhoodo Secondary school baby sitting classes
Pre-pregnancy Pregnancyprenatal education
o Prior to baby showerhellipldquowrong giftsrdquo In-hospital education and modeling
o Include family friends baby sitters Re-enforcement in the doctorrsquos office
o Especially between 1 to 4 months Grandparents They hold great power The general public (day cares religious leaders)
A Lifetime of Infant Sleep Safety
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Chart1
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
14
139
13
13
12
13
117
17
103
269
087
386
074
353
077
531
072
557
067
644
062
666
056
716
057
711
053
728
056
701
055
722
055
757
057
703
055
721
054
741
051
728
048
042
04
039
Sheet1
Sheet1
ampA
Page ampP
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
Sheet2
Pre-AAP recommendation Post-AAP RecommendationBack to SleepSafe to Sleep Campaign
Sheet3
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Infant Sleep Safety
Requires a consistent and repetitive message in the community to prevent accidental deaths
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Safe Sleep Nurse Modeling
People trust nurses Whatever the nurse does must
be correct and it will be imitated in the home
Fact supine positioning in the nursery can almost DOUBLE its use in the home
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Physician Advocacy
Srivatsa 1997 HCP education to new familieshellip34 reduction in prone sleeping
Eron 2009 Study of Central NY state physicianshellip30 identified incorrect safest sleep positionhellip30 do not discuss with families
Colson 2009 Only 13 mothers advised by MD to use supine positionhellip3 times more likely to position the baby properly
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Healthcare Provider Advice to New Mothers Safe Sleep
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Chart1
Column1
[]
[]
[]
55
25
20
Sheet1
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Mason Clinical Peds 713
Bundled interventiono Nursing education policy model behavior safe sleep
video posters in rooms declaration of safe sleep practice
Safe sleep environment uarr from 25 to 58 Intention in home 95 supine none ldquoco-sleepingrdquo
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bundled Intervention = Behavior Change
QUESTION GROUP p-value
ISS Study NISP
Behavior Questions n = 490 n = 1046
Baby routinely placed to sleep on back 925 73 lt 0001
Baby routinely sleeps in bassinetcrib 995 71 lt 00001
Baby sleeps under a thin sheet 992 86 lt 0001
Baby given a pacifier for sleep 741 84 lt 0001Goodstein MH Bell T Krugman SD Improving infant sleep safety through a comprehensive hospital-based program Clinical Pediatrics 201554(3)212-221
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
o Baseline Safe sleep 49 of 264 infants o Post 312 of 234 infants (P lt 001) o Extra blankets most common o Baseline 77 vs 44 post-intervention o Mean number of unsafe items reduced by 50 (P lt 001)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Washington DC
2 urban DC nurseries 26 did not believe or unsure that infant positioning
was associated with SIDS Top 3 factors influencing sleep position
o 56 PERSONAL PREFERENCE Why non-supine Clinical experience (25)
o Increase risk aspirationo Decrease sleep and comfort
Bartow KL Nursesrsquo knowledge and adherence to sudden infant death syndrome prevention guidelines Pediatr Nurs 201642(1)7-13
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
TodaysBaby QI Safe Sleep Teaching
QI intervention median = 160 days Mothers reported receiving information 72 to 95
(increase of 24-57) 94 babies observed supine (plus 24) 88 infants in safe sleep environment
o Increase of 33 Gains maintained up to 12 months
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Social Media and Risk-Reduction Training Study (SMART) Cluster randomization 4 groups Safe sleep or breast feeding education Nursing QI and social media (mobile health) N = 1600 1263 responses (79) Safe sleep NQI and MHealth
o Supine sleep 925 o Room-sharing 859o No soft bedding 819o Pacifier use 762
Moon RY Hauck FR Colson ER et al The effect of nursing quality improvement and mobile health interventions on infant sleep practices a randomized clinical trial JAMA 2017318(4)351-359
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Hospital Initiative ComponentswwwcribsforkidsorgHospitalInitiativeToolkit INTRODUCTORY LETTER HOSPITAL INITIATIVE TOOL KIT
INSTRUCTIONS ORGANIZATIONAL CHART HOSPITAL POLICY ACKNOWLEDGMENT FORM (Engl amp
Span) SAFE SLEEP EDUCATIONAL FLIP CHART
NONCOMPLIANCE WAIVER (Engl amp Span)
NURSING EDUCATION MODULE
SAFE SLEEP POSTERS DOOR HANGERS (Engl amp Span) GRADUATION CERTIFICATE SAMPLE LETTER TO HOSPITALS SAMPLE LETTER TO PROVIDERS INFANT SAFE SLEEP BROCHURES
(Engl amp Span) PRESS KIT
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
All materials available on-lineo No major costs to the hospital
Easy on-line access for documentation
NO FEE FOR PARTICIPATION
wwwCribsforKidsorgHospitalInitiative
Tiffany Price (tpricecribsforkidsorg)
The National Safe Sleep Hospital Certification Program
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
TNmdash25 reduction in infant sleep-related deaths in 2 years
SDmdashOver 7915 Pack lsquon Plays distributed since 2012 Infant mortality rate decreased from 86 (2012) to 48 (2016)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
2009 to 2015 38 decrease in infant mortality Decreased from 135 to 84 per 1000 SUID decreased gt50 Decrease in racial disparityhttphealthybabiesbaltimorecomhome
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
And Finallyhellip
Health care providers should have open frank nonjudgmental conversations with families about their sleep practices
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Encouraging Parents to Take Action
According to the Social Learning Theory parents are more likely to recall and comply with instructions when
the health care provider
Uses a positive tone Provides adequate information Allows the parent to ask most of the questions
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Motivational Interviewing
ldquoa collaborative goal-oriented style of communication with particular attention to the language of changerdquo
o Strengthen personal motivation and commitment to a specific goal
o Explore onersquos reasons for change (barriers)o Patient generates own solutions
bull More likely to feel realisticbull Planting seeds of change
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Impact of Eliminating Sleep-Related Deaths
Every week we lose 70 children which is equivalent to 4 kindergarten classrooms
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Thank You
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Contact Information
mgoodsteinwellspanorg
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Visit Pediatric Care Online today for additional information on this and other topics
httppediatriccaresolutionsaaporgPediatric Care Online is a convenient electronic resource for immediate expert help with
virtually every pediatric clinical information need with must-have resources that are included in a comprehensive reference library and time-saving clinical tools
Donrsquot have a subscription to PCOThen take advantage of a free trial today
Call Mead Johnson Nutrition at 888363-2362 orfor more information go to
httppediatriccaresolutionsaaporgSSFree_Trialaspx
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
IMR over time Finland vs US
Slide Number 1
Disclaimer
Objectives for Todayrsquos Talk
Infant Mortality Rates for the Five Leading Causes of Infant Death in the United States 2005 and 2011
US Post-Neonatal Mortality 2015
FACT
What is SUID or SUDI
Some Causes of Deaths that Occur Suddenly and Unexpectedly during Infancy
What is SIDS
SIDS FACTS
SIDS FACTS
Triple Risk Model to Explain SIDS
Paterson DS Krous HF Kinney HC et al JAMA 2006
An Example of SIDS Pathogenesis
2016 AAP Recommendations Infant Sleep Safety
Strength of Recommendation
Recommendations Change as the Evidence Evolves
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
Correct Safe Sleep Environment
We Need to Move Beyond Back to Sleep
Sleep Position for Healthy Newborns
Sleep Position in Newborn Nursery
Sleep Position and Reflux
The Truth About Supine Sleep and Aspiration Ending the Fallacy
Title
Infant Sleep Location
Room-Share How Long Yoursquore Kidding Right
Supporting Data
More Recent Data
Why is Room-Sharing Protective
Room-Sharing and Sleep Quality
Insight Study (Paul 2017)
Insight Study (Paul 2017)
Insight Commentary (Hauck Moon)
Feeding the Baby at Night
Say NO to Couches Sofas and Cushioned Armchairs
High-Risk Bed Sharing Situations
Bedsharing in Low-Risk Breastfed Infants
Independent Review (Dr Robert Platt)
Bed Sharing
Bed Sharing
Bed Sharing with Overlay
Bed Sharing with Overlay
Bed Sharing with Overlay
Couch Sleeping
Couch Sleeping
Couch Sleeping
Unsafe Bedding NISP Trends 1993-2102
Why Use Soft Bedding
Soft Bedding for Older Infants
To Swaddle or Not to Swaddle That is the Question
Swaddling
SwaddlingmdashIs it Safe
SwaddlingmdashMore Questionshellip
wwwhealthychildrenorg
Pacifiers
Pacifiers and Breastfeeding
Baby Friendly USA Pacifiers
Addressing Sleep Deprivation
Overcoming Barriers to Change What Parents are Sayinghellip
Factors Associated With Choice of Infant Sleep Position
Slide Number 65
What is Working
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Infant Sleep Safety
Safe Sleep Nurse Modeling
Physician Advocacy
Healthcare Provider Advice to New Mothers Safe Sleep
Mason Clinical Peds 713
Bundled Intervention = Behavior Change
Hospital Unsafe Sleep Persists
Washington DC
TodaysBaby QI Safe Sleep Teaching
TodaysBaby QI Safe Sleep Teaching
Social Media and Risk-Reduction Training Study (SMART)
The National Safe Sleep Hospital Certification Program
Coordinated Education Efforts Work
Coordinated Education Efforts Work
And Finallyhellip
Encouraging Parents to Take Action
Motivational Interviewing
Impact of Eliminating Sleep-Related Deaths
Thank You
Contact Information
Slide Number 89
IMR over time Finland vs US
Column1
correct advice
55
incorrect advice
25
no advice
20
correct advice
incorrect advice
no advice
SIDS Rate
Percent Back Sleeping
1988
14
1989
139
1990
13
1991
13
1992
12
13
1993
117
17
1994
103
269
1995
087
386
1996
074
353
1997
077
531
1998
072
557
1999
067
644
2000
062
666
2001
056
716
2002
057
711
2003
053
728
2004
056
701
2005
055
722
2006
055
757
2007
057
703
2008
055
721
2009
054
741
2010
051
728
2011
048
2012
042
2013
04
2014
039
httpwwwcdcgovNCHSdatanvsrnvsr58nvsr58_19pdf
Xu JQ Kochanek KD Murphy SL Tejada-Vera B Deaths Final data for
2007
National vital statistics reports vol 58 no 19 Hyattsville MD
National Center for Health Statistics 2010
1988
1988
1989
1989
1990
1990
1991
1991
1992
1992
1993
1993
1994
1994
1995
1995
1996
1996
1997
1997
1998
1998
1999
1999
2000
2000
2001
2001
2002
2002
2003
2003
2004
2004
2005
2005
2006
2006
2007
2007
2008
2008
2009
2009
2010
2010
2011
2012
2013
2014
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
High-Risk Bed Sharing Situations Age lt4 months Preterm or low birth weight Smoked during pregnancy Bed sharer is current smoker (even if not
smoking in bed) Bed sharer has usedis using meds or
substances that could impair alertness or arousal
Bed sharer is not parent (including other children)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bedsharing in Low-Risk Breastfed Infants
Blair et al AOR 16 (95 CI 096-27) o Age lt14 weekso Parents No cigarettes or alcoholo Independent of feeding method
Carpenter et al AOR 51 (95 CI 23-114) o Age lt3 months o Parents did not smokeo Mother No alcohol or drugso Breastfed infants
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Independent Review (Dr Robert Platt)
Very small numbers of low-risk babieso 24 in Blairrsquos studyo 12 in Carpenterrsquos study
Does not believe that data support definitive differences in 2 studies
Some evidence of increased risk in this group but cannot say how large the increased risk is
Cannot conclude that bed sharing in this group is safe
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Unsafe Bedding NISP Trends 1993-2102
Shapiro-Mendoza CK Colson ER Willinger M Rybin DV Camperlengo L Corwin MJ Trends in infant bedding use National Infant Sleep Position study 1993ndash2010 Pediatrics 2015135(1)10-17
Decrease from 86 to 55 Rate of decline decreases
2001-10 835 for teen mothers Predictors of adjusted OR
gt15
o Young motherso Non-white race
ethnicityo Less than college
education
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Why Use Soft Bedding
ComfortWarmtho Extrapolation of own feelingso Misinterpret firm with taut
bull Soft + taut ne firm
Safetyo Blankets pillows rolls to prevent falls
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Soft Bedding for Older Infants
Many parents recognize soft bedding is a risk Increased complacency as baby gets older Soft bedding is THE most important risk factor for
infants 4-12 months old (Colvin 2015) Infants roll into bedding and cannot extract
themselves
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
To Swaddle or Not to Swaddle That is the Question Pros
o Calms the infant promotes sleep decreases number of awakenings
o Encourages use of the supine position
Conso Increased respiratory rate and
reduced functional residual lung capacity
o Exacerbates hip dysplasia if the hips are kept in extension and adduction
o ldquoLooserdquo swaddling becomes loose bedding
o Overheating especially if the head is covered or the infant has infection
o Effects on arousability to an external stimulus remain unclear (conflicting data) There may be minimal effects of routine swaddling on arousal
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Swaddling
There is insufficient evidence to recommend routine swaddling as a strategy to reduce the incidence of SIDS
Swaddling must be correctly applied to avoid the possible hazards
Swaddling does not reduce the necessity to follow recommended safe sleep practices Ambrogio Lorenzettis Madonna and Child (1319)
Wikipedia
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
McDonnell E Moon RY Infant deaths and injuries associated with wearable blankets swaddle wraps and swaddling J Pediatr 20141641152-1156
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
SwaddlingmdashMore Questionshellip
Pease 2016 Pediatrics Pooled OR = 138
o Prone = 1299 o Side = 316o Supine = 193
Increased risk with age Limitations
o Heterogeneity definitions other risk factorsPease AS Fleming PJ Hauck FR et al Swaddling and the risk of sudden infant death syndrome a meta-analysis Pediatrics 2016137(6)e20153
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
wwwhealthychildrenorg
Swaddling (wrapping a light blanket snuggly around a baby) may help calm a crying baby If you swaddle your baby be sure to place him on his back to sleep Stop swaddling your baby when he starts to roll
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers
AAP recommendation Consider offering a pacifier at nap time and bedtime
Studies consistently demonstrate a protective effect of pacifiers on SIDS
Mechanism unknowno Dislodge within 15 to 60 minuteso Decreased arousal threshold
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers and Breastfeeding Well-designed trials
o 2 found no association among term infants
o 1 found no association among preterm infants
o 1 found slightly decreased breastfeeding duration at one month if pacifier introduced in first week of life but NO difference if pacifier introduced after one month
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Baby Friendly USA Pacifiers
Breastfeeding babies should not be given pacifiers by the staff of the facility with the exception of o Limited use to decrease pain during procedures when
the baby cannot safely be held or breastfed (pacifiers used should be discarded after these procedures)
o Babies who are being tube-fed in NICUo Other rare specific medical reasons
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Addressing Sleep Deprivation
Give parents tools to cope with fussy babies
Sleep-deprived parents may make poor judgments
Make use of tools o Swaddling side carrying
shushing swinging and sucking
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Overcoming Barriers to Change What Parents are Sayinghellip
Prone positioning fear of choking Baby sleeps ldquobetterrdquo on stomach Soft things are safer for the baby SIDS is ldquoGodrsquos willrdquo Why bother Recommendations keep changing
anyway Vigilance sleep with baby for protection
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Factors Associated With Choice of Infant Sleep Position 3300 mothers from 32 hospitals 77 usually use supine position 49 exclusive use supine position Most likely to use prone
o African-American motherso Mothers with lt high school educationo Lack of perceived controlo Personal attitudesocietal norms
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
A continuum starting in childhoodo Secondary school baby sitting classes
Pre-pregnancy Pregnancyprenatal education
o Prior to baby showerhellipldquowrong giftsrdquo In-hospital education and modeling
o Include family friends baby sitters Re-enforcement in the doctorrsquos office
o Especially between 1 to 4 months Grandparents They hold great power The general public (day cares religious leaders)
A Lifetime of Infant Sleep Safety
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Chart1
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
14
139
13
13
12
13
117
17
103
269
087
386
074
353
077
531
072
557
067
644
062
666
056
716
057
711
053
728
056
701
055
722
055
757
057
703
055
721
054
741
051
728
048
042
04
039
Sheet1
Sheet1
ampA
Page ampP
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
Sheet2
Pre-AAP recommendation Post-AAP RecommendationBack to SleepSafe to Sleep Campaign
Sheet3
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Infant Sleep Safety
Requires a consistent and repetitive message in the community to prevent accidental deaths
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Safe Sleep Nurse Modeling
People trust nurses Whatever the nurse does must
be correct and it will be imitated in the home
Fact supine positioning in the nursery can almost DOUBLE its use in the home
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Physician Advocacy
Srivatsa 1997 HCP education to new familieshellip34 reduction in prone sleeping
Eron 2009 Study of Central NY state physicianshellip30 identified incorrect safest sleep positionhellip30 do not discuss with families
Colson 2009 Only 13 mothers advised by MD to use supine positionhellip3 times more likely to position the baby properly
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Healthcare Provider Advice to New Mothers Safe Sleep
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Chart1
Column1
[]
[]
[]
55
25
20
Sheet1
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Mason Clinical Peds 713
Bundled interventiono Nursing education policy model behavior safe sleep
video posters in rooms declaration of safe sleep practice
Safe sleep environment uarr from 25 to 58 Intention in home 95 supine none ldquoco-sleepingrdquo
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bundled Intervention = Behavior Change
QUESTION GROUP p-value
ISS Study NISP
Behavior Questions n = 490 n = 1046
Baby routinely placed to sleep on back 925 73 lt 0001
Baby routinely sleeps in bassinetcrib 995 71 lt 00001
Baby sleeps under a thin sheet 992 86 lt 0001
Baby given a pacifier for sleep 741 84 lt 0001Goodstein MH Bell T Krugman SD Improving infant sleep safety through a comprehensive hospital-based program Clinical Pediatrics 201554(3)212-221
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
o Baseline Safe sleep 49 of 264 infants o Post 312 of 234 infants (P lt 001) o Extra blankets most common o Baseline 77 vs 44 post-intervention o Mean number of unsafe items reduced by 50 (P lt 001)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Washington DC
2 urban DC nurseries 26 did not believe or unsure that infant positioning
was associated with SIDS Top 3 factors influencing sleep position
o 56 PERSONAL PREFERENCE Why non-supine Clinical experience (25)
o Increase risk aspirationo Decrease sleep and comfort
Bartow KL Nursesrsquo knowledge and adherence to sudden infant death syndrome prevention guidelines Pediatr Nurs 201642(1)7-13
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
TodaysBaby QI Safe Sleep Teaching
QI intervention median = 160 days Mothers reported receiving information 72 to 95
(increase of 24-57) 94 babies observed supine (plus 24) 88 infants in safe sleep environment
o Increase of 33 Gains maintained up to 12 months
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Social Media and Risk-Reduction Training Study (SMART) Cluster randomization 4 groups Safe sleep or breast feeding education Nursing QI and social media (mobile health) N = 1600 1263 responses (79) Safe sleep NQI and MHealth
o Supine sleep 925 o Room-sharing 859o No soft bedding 819o Pacifier use 762
Moon RY Hauck FR Colson ER et al The effect of nursing quality improvement and mobile health interventions on infant sleep practices a randomized clinical trial JAMA 2017318(4)351-359
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Hospital Initiative ComponentswwwcribsforkidsorgHospitalInitiativeToolkit INTRODUCTORY LETTER HOSPITAL INITIATIVE TOOL KIT
INSTRUCTIONS ORGANIZATIONAL CHART HOSPITAL POLICY ACKNOWLEDGMENT FORM (Engl amp
Span) SAFE SLEEP EDUCATIONAL FLIP CHART
NONCOMPLIANCE WAIVER (Engl amp Span)
NURSING EDUCATION MODULE
SAFE SLEEP POSTERS DOOR HANGERS (Engl amp Span) GRADUATION CERTIFICATE SAMPLE LETTER TO HOSPITALS SAMPLE LETTER TO PROVIDERS INFANT SAFE SLEEP BROCHURES
(Engl amp Span) PRESS KIT
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
All materials available on-lineo No major costs to the hospital
Easy on-line access for documentation
NO FEE FOR PARTICIPATION
wwwCribsforKidsorgHospitalInitiative
Tiffany Price (tpricecribsforkidsorg)
The National Safe Sleep Hospital Certification Program
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
TNmdash25 reduction in infant sleep-related deaths in 2 years
SDmdashOver 7915 Pack lsquon Plays distributed since 2012 Infant mortality rate decreased from 86 (2012) to 48 (2016)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
2009 to 2015 38 decrease in infant mortality Decreased from 135 to 84 per 1000 SUID decreased gt50 Decrease in racial disparityhttphealthybabiesbaltimorecomhome
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
And Finallyhellip
Health care providers should have open frank nonjudgmental conversations with families about their sleep practices
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Encouraging Parents to Take Action
According to the Social Learning Theory parents are more likely to recall and comply with instructions when
the health care provider
Uses a positive tone Provides adequate information Allows the parent to ask most of the questions
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Motivational Interviewing
ldquoa collaborative goal-oriented style of communication with particular attention to the language of changerdquo
o Strengthen personal motivation and commitment to a specific goal
o Explore onersquos reasons for change (barriers)o Patient generates own solutions
bull More likely to feel realisticbull Planting seeds of change
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Impact of Eliminating Sleep-Related Deaths
Every week we lose 70 children which is equivalent to 4 kindergarten classrooms
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Thank You
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Contact Information
mgoodsteinwellspanorg
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Visit Pediatric Care Online today for additional information on this and other topics
httppediatriccaresolutionsaaporgPediatric Care Online is a convenient electronic resource for immediate expert help with
virtually every pediatric clinical information need with must-have resources that are included in a comprehensive reference library and time-saving clinical tools
Donrsquot have a subscription to PCOThen take advantage of a free trial today
Call Mead Johnson Nutrition at 888363-2362 orfor more information go to
httppediatriccaresolutionsaaporgSSFree_Trialaspx
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
IMR over time Finland vs US
Slide Number 1
Disclaimer
Objectives for Todayrsquos Talk
Infant Mortality Rates for the Five Leading Causes of Infant Death in the United States 2005 and 2011
US Post-Neonatal Mortality 2015
FACT
What is SUID or SUDI
Some Causes of Deaths that Occur Suddenly and Unexpectedly during Infancy
What is SIDS
SIDS FACTS
SIDS FACTS
Triple Risk Model to Explain SIDS
Paterson DS Krous HF Kinney HC et al JAMA 2006
An Example of SIDS Pathogenesis
2016 AAP Recommendations Infant Sleep Safety
Strength of Recommendation
Recommendations Change as the Evidence Evolves
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
Correct Safe Sleep Environment
We Need to Move Beyond Back to Sleep
Sleep Position for Healthy Newborns
Sleep Position in Newborn Nursery
Sleep Position and Reflux
The Truth About Supine Sleep and Aspiration Ending the Fallacy
Title
Infant Sleep Location
Room-Share How Long Yoursquore Kidding Right
Supporting Data
More Recent Data
Why is Room-Sharing Protective
Room-Sharing and Sleep Quality
Insight Study (Paul 2017)
Insight Study (Paul 2017)
Insight Commentary (Hauck Moon)
Feeding the Baby at Night
Say NO to Couches Sofas and Cushioned Armchairs
High-Risk Bed Sharing Situations
Bedsharing in Low-Risk Breastfed Infants
Independent Review (Dr Robert Platt)
Bed Sharing
Bed Sharing
Bed Sharing with Overlay
Bed Sharing with Overlay
Bed Sharing with Overlay
Couch Sleeping
Couch Sleeping
Couch Sleeping
Unsafe Bedding NISP Trends 1993-2102
Why Use Soft Bedding
Soft Bedding for Older Infants
To Swaddle or Not to Swaddle That is the Question
Swaddling
SwaddlingmdashIs it Safe
SwaddlingmdashMore Questionshellip
wwwhealthychildrenorg
Pacifiers
Pacifiers and Breastfeeding
Baby Friendly USA Pacifiers
Addressing Sleep Deprivation
Overcoming Barriers to Change What Parents are Sayinghellip
Factors Associated With Choice of Infant Sleep Position
Slide Number 65
What is Working
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Infant Sleep Safety
Safe Sleep Nurse Modeling
Physician Advocacy
Healthcare Provider Advice to New Mothers Safe Sleep
Mason Clinical Peds 713
Bundled Intervention = Behavior Change
Hospital Unsafe Sleep Persists
Washington DC
TodaysBaby QI Safe Sleep Teaching
TodaysBaby QI Safe Sleep Teaching
Social Media and Risk-Reduction Training Study (SMART)
The National Safe Sleep Hospital Certification Program
Coordinated Education Efforts Work
Coordinated Education Efforts Work
And Finallyhellip
Encouraging Parents to Take Action
Motivational Interviewing
Impact of Eliminating Sleep-Related Deaths
Thank You
Contact Information
Slide Number 89
IMR over time Finland vs US
Column1
correct advice
55
incorrect advice
25
no advice
20
correct advice
incorrect advice
no advice
SIDS Rate
Percent Back Sleeping
1988
14
1989
139
1990
13
1991
13
1992
12
13
1993
117
17
1994
103
269
1995
087
386
1996
074
353
1997
077
531
1998
072
557
1999
067
644
2000
062
666
2001
056
716
2002
057
711
2003
053
728
2004
056
701
2005
055
722
2006
055
757
2007
057
703
2008
055
721
2009
054
741
2010
051
728
2011
048
2012
042
2013
04
2014
039
httpwwwcdcgovNCHSdatanvsrnvsr58nvsr58_19pdf
Xu JQ Kochanek KD Murphy SL Tejada-Vera B Deaths Final data for
2007
National vital statistics reports vol 58 no 19 Hyattsville MD
National Center for Health Statistics 2010
1988
1988
1989
1989
1990
1990
1991
1991
1992
1992
1993
1993
1994
1994
1995
1995
1996
1996
1997
1997
1998
1998
1999
1999
2000
2000
2001
2001
2002
2002
2003
2003
2004
2004
2005
2005
2006
2006
2007
2007
2008
2008
2009
2009
2010
2010
2011
2012
2013
2014
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bedsharing in Low-Risk Breastfed Infants
Blair et al AOR 16 (95 CI 096-27) o Age lt14 weekso Parents No cigarettes or alcoholo Independent of feeding method
Carpenter et al AOR 51 (95 CI 23-114) o Age lt3 months o Parents did not smokeo Mother No alcohol or drugso Breastfed infants
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Independent Review (Dr Robert Platt)
Very small numbers of low-risk babieso 24 in Blairrsquos studyo 12 in Carpenterrsquos study
Does not believe that data support definitive differences in 2 studies
Some evidence of increased risk in this group but cannot say how large the increased risk is
Cannot conclude that bed sharing in this group is safe
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Unsafe Bedding NISP Trends 1993-2102
Shapiro-Mendoza CK Colson ER Willinger M Rybin DV Camperlengo L Corwin MJ Trends in infant bedding use National Infant Sleep Position study 1993ndash2010 Pediatrics 2015135(1)10-17
Decrease from 86 to 55 Rate of decline decreases
2001-10 835 for teen mothers Predictors of adjusted OR
gt15
o Young motherso Non-white race
ethnicityo Less than college
education
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Why Use Soft Bedding
ComfortWarmtho Extrapolation of own feelingso Misinterpret firm with taut
bull Soft + taut ne firm
Safetyo Blankets pillows rolls to prevent falls
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Soft Bedding for Older Infants
Many parents recognize soft bedding is a risk Increased complacency as baby gets older Soft bedding is THE most important risk factor for
infants 4-12 months old (Colvin 2015) Infants roll into bedding and cannot extract
themselves
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
To Swaddle or Not to Swaddle That is the Question Pros
o Calms the infant promotes sleep decreases number of awakenings
o Encourages use of the supine position
Conso Increased respiratory rate and
reduced functional residual lung capacity
o Exacerbates hip dysplasia if the hips are kept in extension and adduction
o ldquoLooserdquo swaddling becomes loose bedding
o Overheating especially if the head is covered or the infant has infection
o Effects on arousability to an external stimulus remain unclear (conflicting data) There may be minimal effects of routine swaddling on arousal
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Swaddling
There is insufficient evidence to recommend routine swaddling as a strategy to reduce the incidence of SIDS
Swaddling must be correctly applied to avoid the possible hazards
Swaddling does not reduce the necessity to follow recommended safe sleep practices Ambrogio Lorenzettis Madonna and Child (1319)
Wikipedia
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
McDonnell E Moon RY Infant deaths and injuries associated with wearable blankets swaddle wraps and swaddling J Pediatr 20141641152-1156
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
SwaddlingmdashMore Questionshellip
Pease 2016 Pediatrics Pooled OR = 138
o Prone = 1299 o Side = 316o Supine = 193
Increased risk with age Limitations
o Heterogeneity definitions other risk factorsPease AS Fleming PJ Hauck FR et al Swaddling and the risk of sudden infant death syndrome a meta-analysis Pediatrics 2016137(6)e20153
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
wwwhealthychildrenorg
Swaddling (wrapping a light blanket snuggly around a baby) may help calm a crying baby If you swaddle your baby be sure to place him on his back to sleep Stop swaddling your baby when he starts to roll
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers
AAP recommendation Consider offering a pacifier at nap time and bedtime
Studies consistently demonstrate a protective effect of pacifiers on SIDS
Mechanism unknowno Dislodge within 15 to 60 minuteso Decreased arousal threshold
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers and Breastfeeding Well-designed trials
o 2 found no association among term infants
o 1 found no association among preterm infants
o 1 found slightly decreased breastfeeding duration at one month if pacifier introduced in first week of life but NO difference if pacifier introduced after one month
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Baby Friendly USA Pacifiers
Breastfeeding babies should not be given pacifiers by the staff of the facility with the exception of o Limited use to decrease pain during procedures when
the baby cannot safely be held or breastfed (pacifiers used should be discarded after these procedures)
o Babies who are being tube-fed in NICUo Other rare specific medical reasons
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Addressing Sleep Deprivation
Give parents tools to cope with fussy babies
Sleep-deprived parents may make poor judgments
Make use of tools o Swaddling side carrying
shushing swinging and sucking
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Overcoming Barriers to Change What Parents are Sayinghellip
Prone positioning fear of choking Baby sleeps ldquobetterrdquo on stomach Soft things are safer for the baby SIDS is ldquoGodrsquos willrdquo Why bother Recommendations keep changing
anyway Vigilance sleep with baby for protection
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Factors Associated With Choice of Infant Sleep Position 3300 mothers from 32 hospitals 77 usually use supine position 49 exclusive use supine position Most likely to use prone
o African-American motherso Mothers with lt high school educationo Lack of perceived controlo Personal attitudesocietal norms
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
A continuum starting in childhoodo Secondary school baby sitting classes
Pre-pregnancy Pregnancyprenatal education
o Prior to baby showerhellipldquowrong giftsrdquo In-hospital education and modeling
o Include family friends baby sitters Re-enforcement in the doctorrsquos office
o Especially between 1 to 4 months Grandparents They hold great power The general public (day cares religious leaders)
A Lifetime of Infant Sleep Safety
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Chart1
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
14
139
13
13
12
13
117
17
103
269
087
386
074
353
077
531
072
557
067
644
062
666
056
716
057
711
053
728
056
701
055
722
055
757
057
703
055
721
054
741
051
728
048
042
04
039
Sheet1
Sheet1
ampA
Page ampP
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
Sheet2
Pre-AAP recommendation Post-AAP RecommendationBack to SleepSafe to Sleep Campaign
Sheet3
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Infant Sleep Safety
Requires a consistent and repetitive message in the community to prevent accidental deaths
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Safe Sleep Nurse Modeling
People trust nurses Whatever the nurse does must
be correct and it will be imitated in the home
Fact supine positioning in the nursery can almost DOUBLE its use in the home
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Physician Advocacy
Srivatsa 1997 HCP education to new familieshellip34 reduction in prone sleeping
Eron 2009 Study of Central NY state physicianshellip30 identified incorrect safest sleep positionhellip30 do not discuss with families
Colson 2009 Only 13 mothers advised by MD to use supine positionhellip3 times more likely to position the baby properly
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Healthcare Provider Advice to New Mothers Safe Sleep
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Chart1
Column1
[]
[]
[]
55
25
20
Sheet1
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Mason Clinical Peds 713
Bundled interventiono Nursing education policy model behavior safe sleep
video posters in rooms declaration of safe sleep practice
Safe sleep environment uarr from 25 to 58 Intention in home 95 supine none ldquoco-sleepingrdquo
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bundled Intervention = Behavior Change
QUESTION GROUP p-value
ISS Study NISP
Behavior Questions n = 490 n = 1046
Baby routinely placed to sleep on back 925 73 lt 0001
Baby routinely sleeps in bassinetcrib 995 71 lt 00001
Baby sleeps under a thin sheet 992 86 lt 0001
Baby given a pacifier for sleep 741 84 lt 0001Goodstein MH Bell T Krugman SD Improving infant sleep safety through a comprehensive hospital-based program Clinical Pediatrics 201554(3)212-221
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
o Baseline Safe sleep 49 of 264 infants o Post 312 of 234 infants (P lt 001) o Extra blankets most common o Baseline 77 vs 44 post-intervention o Mean number of unsafe items reduced by 50 (P lt 001)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Washington DC
2 urban DC nurseries 26 did not believe or unsure that infant positioning
was associated with SIDS Top 3 factors influencing sleep position
o 56 PERSONAL PREFERENCE Why non-supine Clinical experience (25)
o Increase risk aspirationo Decrease sleep and comfort
Bartow KL Nursesrsquo knowledge and adherence to sudden infant death syndrome prevention guidelines Pediatr Nurs 201642(1)7-13
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
TodaysBaby QI Safe Sleep Teaching
QI intervention median = 160 days Mothers reported receiving information 72 to 95
(increase of 24-57) 94 babies observed supine (plus 24) 88 infants in safe sleep environment
o Increase of 33 Gains maintained up to 12 months
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Social Media and Risk-Reduction Training Study (SMART) Cluster randomization 4 groups Safe sleep or breast feeding education Nursing QI and social media (mobile health) N = 1600 1263 responses (79) Safe sleep NQI and MHealth
o Supine sleep 925 o Room-sharing 859o No soft bedding 819o Pacifier use 762
Moon RY Hauck FR Colson ER et al The effect of nursing quality improvement and mobile health interventions on infant sleep practices a randomized clinical trial JAMA 2017318(4)351-359
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Hospital Initiative ComponentswwwcribsforkidsorgHospitalInitiativeToolkit INTRODUCTORY LETTER HOSPITAL INITIATIVE TOOL KIT
INSTRUCTIONS ORGANIZATIONAL CHART HOSPITAL POLICY ACKNOWLEDGMENT FORM (Engl amp
Span) SAFE SLEEP EDUCATIONAL FLIP CHART
NONCOMPLIANCE WAIVER (Engl amp Span)
NURSING EDUCATION MODULE
SAFE SLEEP POSTERS DOOR HANGERS (Engl amp Span) GRADUATION CERTIFICATE SAMPLE LETTER TO HOSPITALS SAMPLE LETTER TO PROVIDERS INFANT SAFE SLEEP BROCHURES
(Engl amp Span) PRESS KIT
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
All materials available on-lineo No major costs to the hospital
Easy on-line access for documentation
NO FEE FOR PARTICIPATION
wwwCribsforKidsorgHospitalInitiative
Tiffany Price (tpricecribsforkidsorg)
The National Safe Sleep Hospital Certification Program
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
TNmdash25 reduction in infant sleep-related deaths in 2 years
SDmdashOver 7915 Pack lsquon Plays distributed since 2012 Infant mortality rate decreased from 86 (2012) to 48 (2016)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
2009 to 2015 38 decrease in infant mortality Decreased from 135 to 84 per 1000 SUID decreased gt50 Decrease in racial disparityhttphealthybabiesbaltimorecomhome
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
And Finallyhellip
Health care providers should have open frank nonjudgmental conversations with families about their sleep practices
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Encouraging Parents to Take Action
According to the Social Learning Theory parents are more likely to recall and comply with instructions when
the health care provider
Uses a positive tone Provides adequate information Allows the parent to ask most of the questions
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Motivational Interviewing
ldquoa collaborative goal-oriented style of communication with particular attention to the language of changerdquo
o Strengthen personal motivation and commitment to a specific goal
o Explore onersquos reasons for change (barriers)o Patient generates own solutions
bull More likely to feel realisticbull Planting seeds of change
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Impact of Eliminating Sleep-Related Deaths
Every week we lose 70 children which is equivalent to 4 kindergarten classrooms
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Thank You
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Contact Information
mgoodsteinwellspanorg
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Visit Pediatric Care Online today for additional information on this and other topics
httppediatriccaresolutionsaaporgPediatric Care Online is a convenient electronic resource for immediate expert help with
virtually every pediatric clinical information need with must-have resources that are included in a comprehensive reference library and time-saving clinical tools
Donrsquot have a subscription to PCOThen take advantage of a free trial today
Call Mead Johnson Nutrition at 888363-2362 orfor more information go to
httppediatriccaresolutionsaaporgSSFree_Trialaspx
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
IMR over time Finland vs US
Slide Number 1
Disclaimer
Objectives for Todayrsquos Talk
Infant Mortality Rates for the Five Leading Causes of Infant Death in the United States 2005 and 2011
US Post-Neonatal Mortality 2015
FACT
What is SUID or SUDI
Some Causes of Deaths that Occur Suddenly and Unexpectedly during Infancy
What is SIDS
SIDS FACTS
SIDS FACTS
Triple Risk Model to Explain SIDS
Paterson DS Krous HF Kinney HC et al JAMA 2006
An Example of SIDS Pathogenesis
2016 AAP Recommendations Infant Sleep Safety
Strength of Recommendation
Recommendations Change as the Evidence Evolves
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
Correct Safe Sleep Environment
We Need to Move Beyond Back to Sleep
Sleep Position for Healthy Newborns
Sleep Position in Newborn Nursery
Sleep Position and Reflux
The Truth About Supine Sleep and Aspiration Ending the Fallacy
Title
Infant Sleep Location
Room-Share How Long Yoursquore Kidding Right
Supporting Data
More Recent Data
Why is Room-Sharing Protective
Room-Sharing and Sleep Quality
Insight Study (Paul 2017)
Insight Study (Paul 2017)
Insight Commentary (Hauck Moon)
Feeding the Baby at Night
Say NO to Couches Sofas and Cushioned Armchairs
High-Risk Bed Sharing Situations
Bedsharing in Low-Risk Breastfed Infants
Independent Review (Dr Robert Platt)
Bed Sharing
Bed Sharing
Bed Sharing with Overlay
Bed Sharing with Overlay
Bed Sharing with Overlay
Couch Sleeping
Couch Sleeping
Couch Sleeping
Unsafe Bedding NISP Trends 1993-2102
Why Use Soft Bedding
Soft Bedding for Older Infants
To Swaddle or Not to Swaddle That is the Question
Swaddling
SwaddlingmdashIs it Safe
SwaddlingmdashMore Questionshellip
wwwhealthychildrenorg
Pacifiers
Pacifiers and Breastfeeding
Baby Friendly USA Pacifiers
Addressing Sleep Deprivation
Overcoming Barriers to Change What Parents are Sayinghellip
Factors Associated With Choice of Infant Sleep Position
Slide Number 65
What is Working
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Infant Sleep Safety
Safe Sleep Nurse Modeling
Physician Advocacy
Healthcare Provider Advice to New Mothers Safe Sleep
Mason Clinical Peds 713
Bundled Intervention = Behavior Change
Hospital Unsafe Sleep Persists
Washington DC
TodaysBaby QI Safe Sleep Teaching
TodaysBaby QI Safe Sleep Teaching
Social Media and Risk-Reduction Training Study (SMART)
The National Safe Sleep Hospital Certification Program
Coordinated Education Efforts Work
Coordinated Education Efforts Work
And Finallyhellip
Encouraging Parents to Take Action
Motivational Interviewing
Impact of Eliminating Sleep-Related Deaths
Thank You
Contact Information
Slide Number 89
IMR over time Finland vs US
Column1
correct advice
55
incorrect advice
25
no advice
20
correct advice
incorrect advice
no advice
SIDS Rate
Percent Back Sleeping
1988
14
1989
139
1990
13
1991
13
1992
12
13
1993
117
17
1994
103
269
1995
087
386
1996
074
353
1997
077
531
1998
072
557
1999
067
644
2000
062
666
2001
056
716
2002
057
711
2003
053
728
2004
056
701
2005
055
722
2006
055
757
2007
057
703
2008
055
721
2009
054
741
2010
051
728
2011
048
2012
042
2013
04
2014
039
httpwwwcdcgovNCHSdatanvsrnvsr58nvsr58_19pdf
Xu JQ Kochanek KD Murphy SL Tejada-Vera B Deaths Final data for
2007
National vital statistics reports vol 58 no 19 Hyattsville MD
National Center for Health Statistics 2010
1988
1988
1989
1989
1990
1990
1991
1991
1992
1992
1993
1993
1994
1994
1995
1995
1996
1996
1997
1997
1998
1998
1999
1999
2000
2000
2001
2001
2002
2002
2003
2003
2004
2004
2005
2005
2006
2006
2007
2007
2008
2008
2009
2009
2010
2010
2011
2012
2013
2014
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Independent Review (Dr Robert Platt)
Very small numbers of low-risk babieso 24 in Blairrsquos studyo 12 in Carpenterrsquos study
Does not believe that data support definitive differences in 2 studies
Some evidence of increased risk in this group but cannot say how large the increased risk is
Cannot conclude that bed sharing in this group is safe
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Unsafe Bedding NISP Trends 1993-2102
Shapiro-Mendoza CK Colson ER Willinger M Rybin DV Camperlengo L Corwin MJ Trends in infant bedding use National Infant Sleep Position study 1993ndash2010 Pediatrics 2015135(1)10-17
Decrease from 86 to 55 Rate of decline decreases
2001-10 835 for teen mothers Predictors of adjusted OR
gt15
o Young motherso Non-white race
ethnicityo Less than college
education
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Why Use Soft Bedding
ComfortWarmtho Extrapolation of own feelingso Misinterpret firm with taut
bull Soft + taut ne firm
Safetyo Blankets pillows rolls to prevent falls
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Soft Bedding for Older Infants
Many parents recognize soft bedding is a risk Increased complacency as baby gets older Soft bedding is THE most important risk factor for
infants 4-12 months old (Colvin 2015) Infants roll into bedding and cannot extract
themselves
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
To Swaddle or Not to Swaddle That is the Question Pros
o Calms the infant promotes sleep decreases number of awakenings
o Encourages use of the supine position
Conso Increased respiratory rate and
reduced functional residual lung capacity
o Exacerbates hip dysplasia if the hips are kept in extension and adduction
o ldquoLooserdquo swaddling becomes loose bedding
o Overheating especially if the head is covered or the infant has infection
o Effects on arousability to an external stimulus remain unclear (conflicting data) There may be minimal effects of routine swaddling on arousal
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Swaddling
There is insufficient evidence to recommend routine swaddling as a strategy to reduce the incidence of SIDS
Swaddling must be correctly applied to avoid the possible hazards
Swaddling does not reduce the necessity to follow recommended safe sleep practices Ambrogio Lorenzettis Madonna and Child (1319)
Wikipedia
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
McDonnell E Moon RY Infant deaths and injuries associated with wearable blankets swaddle wraps and swaddling J Pediatr 20141641152-1156
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
SwaddlingmdashMore Questionshellip
Pease 2016 Pediatrics Pooled OR = 138
o Prone = 1299 o Side = 316o Supine = 193
Increased risk with age Limitations
o Heterogeneity definitions other risk factorsPease AS Fleming PJ Hauck FR et al Swaddling and the risk of sudden infant death syndrome a meta-analysis Pediatrics 2016137(6)e20153
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
wwwhealthychildrenorg
Swaddling (wrapping a light blanket snuggly around a baby) may help calm a crying baby If you swaddle your baby be sure to place him on his back to sleep Stop swaddling your baby when he starts to roll
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers
AAP recommendation Consider offering a pacifier at nap time and bedtime
Studies consistently demonstrate a protective effect of pacifiers on SIDS
Mechanism unknowno Dislodge within 15 to 60 minuteso Decreased arousal threshold
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers and Breastfeeding Well-designed trials
o 2 found no association among term infants
o 1 found no association among preterm infants
o 1 found slightly decreased breastfeeding duration at one month if pacifier introduced in first week of life but NO difference if pacifier introduced after one month
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Baby Friendly USA Pacifiers
Breastfeeding babies should not be given pacifiers by the staff of the facility with the exception of o Limited use to decrease pain during procedures when
the baby cannot safely be held or breastfed (pacifiers used should be discarded after these procedures)
o Babies who are being tube-fed in NICUo Other rare specific medical reasons
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Addressing Sleep Deprivation
Give parents tools to cope with fussy babies
Sleep-deprived parents may make poor judgments
Make use of tools o Swaddling side carrying
shushing swinging and sucking
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Overcoming Barriers to Change What Parents are Sayinghellip
Prone positioning fear of choking Baby sleeps ldquobetterrdquo on stomach Soft things are safer for the baby SIDS is ldquoGodrsquos willrdquo Why bother Recommendations keep changing
anyway Vigilance sleep with baby for protection
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Factors Associated With Choice of Infant Sleep Position 3300 mothers from 32 hospitals 77 usually use supine position 49 exclusive use supine position Most likely to use prone
o African-American motherso Mothers with lt high school educationo Lack of perceived controlo Personal attitudesocietal norms
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
A continuum starting in childhoodo Secondary school baby sitting classes
Pre-pregnancy Pregnancyprenatal education
o Prior to baby showerhellipldquowrong giftsrdquo In-hospital education and modeling
o Include family friends baby sitters Re-enforcement in the doctorrsquos office
o Especially between 1 to 4 months Grandparents They hold great power The general public (day cares religious leaders)
A Lifetime of Infant Sleep Safety
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Chart1
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
14
139
13
13
12
13
117
17
103
269
087
386
074
353
077
531
072
557
067
644
062
666
056
716
057
711
053
728
056
701
055
722
055
757
057
703
055
721
054
741
051
728
048
042
04
039
Sheet1
Sheet1
ampA
Page ampP
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
Sheet2
Pre-AAP recommendation Post-AAP RecommendationBack to SleepSafe to Sleep Campaign
Sheet3
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Infant Sleep Safety
Requires a consistent and repetitive message in the community to prevent accidental deaths
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Safe Sleep Nurse Modeling
People trust nurses Whatever the nurse does must
be correct and it will be imitated in the home
Fact supine positioning in the nursery can almost DOUBLE its use in the home
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Physician Advocacy
Srivatsa 1997 HCP education to new familieshellip34 reduction in prone sleeping
Eron 2009 Study of Central NY state physicianshellip30 identified incorrect safest sleep positionhellip30 do not discuss with families
Colson 2009 Only 13 mothers advised by MD to use supine positionhellip3 times more likely to position the baby properly
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Healthcare Provider Advice to New Mothers Safe Sleep
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Chart1
Column1
[]
[]
[]
55
25
20
Sheet1
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Mason Clinical Peds 713
Bundled interventiono Nursing education policy model behavior safe sleep
video posters in rooms declaration of safe sleep practice
Safe sleep environment uarr from 25 to 58 Intention in home 95 supine none ldquoco-sleepingrdquo
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bundled Intervention = Behavior Change
QUESTION GROUP p-value
ISS Study NISP
Behavior Questions n = 490 n = 1046
Baby routinely placed to sleep on back 925 73 lt 0001
Baby routinely sleeps in bassinetcrib 995 71 lt 00001
Baby sleeps under a thin sheet 992 86 lt 0001
Baby given a pacifier for sleep 741 84 lt 0001Goodstein MH Bell T Krugman SD Improving infant sleep safety through a comprehensive hospital-based program Clinical Pediatrics 201554(3)212-221
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
o Baseline Safe sleep 49 of 264 infants o Post 312 of 234 infants (P lt 001) o Extra blankets most common o Baseline 77 vs 44 post-intervention o Mean number of unsafe items reduced by 50 (P lt 001)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Washington DC
2 urban DC nurseries 26 did not believe or unsure that infant positioning
was associated with SIDS Top 3 factors influencing sleep position
o 56 PERSONAL PREFERENCE Why non-supine Clinical experience (25)
o Increase risk aspirationo Decrease sleep and comfort
Bartow KL Nursesrsquo knowledge and adherence to sudden infant death syndrome prevention guidelines Pediatr Nurs 201642(1)7-13
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
TodaysBaby QI Safe Sleep Teaching
QI intervention median = 160 days Mothers reported receiving information 72 to 95
(increase of 24-57) 94 babies observed supine (plus 24) 88 infants in safe sleep environment
o Increase of 33 Gains maintained up to 12 months
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Social Media and Risk-Reduction Training Study (SMART) Cluster randomization 4 groups Safe sleep or breast feeding education Nursing QI and social media (mobile health) N = 1600 1263 responses (79) Safe sleep NQI and MHealth
o Supine sleep 925 o Room-sharing 859o No soft bedding 819o Pacifier use 762
Moon RY Hauck FR Colson ER et al The effect of nursing quality improvement and mobile health interventions on infant sleep practices a randomized clinical trial JAMA 2017318(4)351-359
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Hospital Initiative ComponentswwwcribsforkidsorgHospitalInitiativeToolkit INTRODUCTORY LETTER HOSPITAL INITIATIVE TOOL KIT
INSTRUCTIONS ORGANIZATIONAL CHART HOSPITAL POLICY ACKNOWLEDGMENT FORM (Engl amp
Span) SAFE SLEEP EDUCATIONAL FLIP CHART
NONCOMPLIANCE WAIVER (Engl amp Span)
NURSING EDUCATION MODULE
SAFE SLEEP POSTERS DOOR HANGERS (Engl amp Span) GRADUATION CERTIFICATE SAMPLE LETTER TO HOSPITALS SAMPLE LETTER TO PROVIDERS INFANT SAFE SLEEP BROCHURES
(Engl amp Span) PRESS KIT
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
All materials available on-lineo No major costs to the hospital
Easy on-line access for documentation
NO FEE FOR PARTICIPATION
wwwCribsforKidsorgHospitalInitiative
Tiffany Price (tpricecribsforkidsorg)
The National Safe Sleep Hospital Certification Program
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
TNmdash25 reduction in infant sleep-related deaths in 2 years
SDmdashOver 7915 Pack lsquon Plays distributed since 2012 Infant mortality rate decreased from 86 (2012) to 48 (2016)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
2009 to 2015 38 decrease in infant mortality Decreased from 135 to 84 per 1000 SUID decreased gt50 Decrease in racial disparityhttphealthybabiesbaltimorecomhome
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
And Finallyhellip
Health care providers should have open frank nonjudgmental conversations with families about their sleep practices
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Encouraging Parents to Take Action
According to the Social Learning Theory parents are more likely to recall and comply with instructions when
the health care provider
Uses a positive tone Provides adequate information Allows the parent to ask most of the questions
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Motivational Interviewing
ldquoa collaborative goal-oriented style of communication with particular attention to the language of changerdquo
o Strengthen personal motivation and commitment to a specific goal
o Explore onersquos reasons for change (barriers)o Patient generates own solutions
bull More likely to feel realisticbull Planting seeds of change
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Impact of Eliminating Sleep-Related Deaths
Every week we lose 70 children which is equivalent to 4 kindergarten classrooms
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Thank You
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Contact Information
mgoodsteinwellspanorg
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Visit Pediatric Care Online today for additional information on this and other topics
httppediatriccaresolutionsaaporgPediatric Care Online is a convenient electronic resource for immediate expert help with
virtually every pediatric clinical information need with must-have resources that are included in a comprehensive reference library and time-saving clinical tools
Donrsquot have a subscription to PCOThen take advantage of a free trial today
Call Mead Johnson Nutrition at 888363-2362 orfor more information go to
httppediatriccaresolutionsaaporgSSFree_Trialaspx
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
IMR over time Finland vs US
Slide Number 1
Disclaimer
Objectives for Todayrsquos Talk
Infant Mortality Rates for the Five Leading Causes of Infant Death in the United States 2005 and 2011
US Post-Neonatal Mortality 2015
FACT
What is SUID or SUDI
Some Causes of Deaths that Occur Suddenly and Unexpectedly during Infancy
What is SIDS
SIDS FACTS
SIDS FACTS
Triple Risk Model to Explain SIDS
Paterson DS Krous HF Kinney HC et al JAMA 2006
An Example of SIDS Pathogenesis
2016 AAP Recommendations Infant Sleep Safety
Strength of Recommendation
Recommendations Change as the Evidence Evolves
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
Correct Safe Sleep Environment
We Need to Move Beyond Back to Sleep
Sleep Position for Healthy Newborns
Sleep Position in Newborn Nursery
Sleep Position and Reflux
The Truth About Supine Sleep and Aspiration Ending the Fallacy
Title
Infant Sleep Location
Room-Share How Long Yoursquore Kidding Right
Supporting Data
More Recent Data
Why is Room-Sharing Protective
Room-Sharing and Sleep Quality
Insight Study (Paul 2017)
Insight Study (Paul 2017)
Insight Commentary (Hauck Moon)
Feeding the Baby at Night
Say NO to Couches Sofas and Cushioned Armchairs
High-Risk Bed Sharing Situations
Bedsharing in Low-Risk Breastfed Infants
Independent Review (Dr Robert Platt)
Bed Sharing
Bed Sharing
Bed Sharing with Overlay
Bed Sharing with Overlay
Bed Sharing with Overlay
Couch Sleeping
Couch Sleeping
Couch Sleeping
Unsafe Bedding NISP Trends 1993-2102
Why Use Soft Bedding
Soft Bedding for Older Infants
To Swaddle or Not to Swaddle That is the Question
Swaddling
SwaddlingmdashIs it Safe
SwaddlingmdashMore Questionshellip
wwwhealthychildrenorg
Pacifiers
Pacifiers and Breastfeeding
Baby Friendly USA Pacifiers
Addressing Sleep Deprivation
Overcoming Barriers to Change What Parents are Sayinghellip
Factors Associated With Choice of Infant Sleep Position
Slide Number 65
What is Working
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Infant Sleep Safety
Safe Sleep Nurse Modeling
Physician Advocacy
Healthcare Provider Advice to New Mothers Safe Sleep
Mason Clinical Peds 713
Bundled Intervention = Behavior Change
Hospital Unsafe Sleep Persists
Washington DC
TodaysBaby QI Safe Sleep Teaching
TodaysBaby QI Safe Sleep Teaching
Social Media and Risk-Reduction Training Study (SMART)
The National Safe Sleep Hospital Certification Program
Coordinated Education Efforts Work
Coordinated Education Efforts Work
And Finallyhellip
Encouraging Parents to Take Action
Motivational Interviewing
Impact of Eliminating Sleep-Related Deaths
Thank You
Contact Information
Slide Number 89
IMR over time Finland vs US
Column1
correct advice
55
incorrect advice
25
no advice
20
correct advice
incorrect advice
no advice
SIDS Rate
Percent Back Sleeping
1988
14
1989
139
1990
13
1991
13
1992
12
13
1993
117
17
1994
103
269
1995
087
386
1996
074
353
1997
077
531
1998
072
557
1999
067
644
2000
062
666
2001
056
716
2002
057
711
2003
053
728
2004
056
701
2005
055
722
2006
055
757
2007
057
703
2008
055
721
2009
054
741
2010
051
728
2011
048
2012
042
2013
04
2014
039
httpwwwcdcgovNCHSdatanvsrnvsr58nvsr58_19pdf
Xu JQ Kochanek KD Murphy SL Tejada-Vera B Deaths Final data for
2007
National vital statistics reports vol 58 no 19 Hyattsville MD
National Center for Health Statistics 2010
1988
1988
1989
1989
1990
1990
1991
1991
1992
1992
1993
1993
1994
1994
1995
1995
1996
1996
1997
1997
1998
1998
1999
1999
2000
2000
2001
2001
2002
2002
2003
2003
2004
2004
2005
2005
2006
2006
2007
2007
2008
2008
2009
2009
2010
2010
2011
2012
2013
2014
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Unsafe Bedding NISP Trends 1993-2102
Shapiro-Mendoza CK Colson ER Willinger M Rybin DV Camperlengo L Corwin MJ Trends in infant bedding use National Infant Sleep Position study 1993ndash2010 Pediatrics 2015135(1)10-17
Decrease from 86 to 55 Rate of decline decreases
2001-10 835 for teen mothers Predictors of adjusted OR
gt15
o Young motherso Non-white race
ethnicityo Less than college
education
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Why Use Soft Bedding
ComfortWarmtho Extrapolation of own feelingso Misinterpret firm with taut
bull Soft + taut ne firm
Safetyo Blankets pillows rolls to prevent falls
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Soft Bedding for Older Infants
Many parents recognize soft bedding is a risk Increased complacency as baby gets older Soft bedding is THE most important risk factor for
infants 4-12 months old (Colvin 2015) Infants roll into bedding and cannot extract
themselves
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
To Swaddle or Not to Swaddle That is the Question Pros
o Calms the infant promotes sleep decreases number of awakenings
o Encourages use of the supine position
Conso Increased respiratory rate and
reduced functional residual lung capacity
o Exacerbates hip dysplasia if the hips are kept in extension and adduction
o ldquoLooserdquo swaddling becomes loose bedding
o Overheating especially if the head is covered or the infant has infection
o Effects on arousability to an external stimulus remain unclear (conflicting data) There may be minimal effects of routine swaddling on arousal
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Swaddling
There is insufficient evidence to recommend routine swaddling as a strategy to reduce the incidence of SIDS
Swaddling must be correctly applied to avoid the possible hazards
Swaddling does not reduce the necessity to follow recommended safe sleep practices Ambrogio Lorenzettis Madonna and Child (1319)
Wikipedia
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
McDonnell E Moon RY Infant deaths and injuries associated with wearable blankets swaddle wraps and swaddling J Pediatr 20141641152-1156
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
SwaddlingmdashMore Questionshellip
Pease 2016 Pediatrics Pooled OR = 138
o Prone = 1299 o Side = 316o Supine = 193
Increased risk with age Limitations
o Heterogeneity definitions other risk factorsPease AS Fleming PJ Hauck FR et al Swaddling and the risk of sudden infant death syndrome a meta-analysis Pediatrics 2016137(6)e20153
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
wwwhealthychildrenorg
Swaddling (wrapping a light blanket snuggly around a baby) may help calm a crying baby If you swaddle your baby be sure to place him on his back to sleep Stop swaddling your baby when he starts to roll
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers
AAP recommendation Consider offering a pacifier at nap time and bedtime
Studies consistently demonstrate a protective effect of pacifiers on SIDS
Mechanism unknowno Dislodge within 15 to 60 minuteso Decreased arousal threshold
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers and Breastfeeding Well-designed trials
o 2 found no association among term infants
o 1 found no association among preterm infants
o 1 found slightly decreased breastfeeding duration at one month if pacifier introduced in first week of life but NO difference if pacifier introduced after one month
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Baby Friendly USA Pacifiers
Breastfeeding babies should not be given pacifiers by the staff of the facility with the exception of o Limited use to decrease pain during procedures when
the baby cannot safely be held or breastfed (pacifiers used should be discarded after these procedures)
o Babies who are being tube-fed in NICUo Other rare specific medical reasons
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Addressing Sleep Deprivation
Give parents tools to cope with fussy babies
Sleep-deprived parents may make poor judgments
Make use of tools o Swaddling side carrying
shushing swinging and sucking
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Overcoming Barriers to Change What Parents are Sayinghellip
Prone positioning fear of choking Baby sleeps ldquobetterrdquo on stomach Soft things are safer for the baby SIDS is ldquoGodrsquos willrdquo Why bother Recommendations keep changing
anyway Vigilance sleep with baby for protection
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Factors Associated With Choice of Infant Sleep Position 3300 mothers from 32 hospitals 77 usually use supine position 49 exclusive use supine position Most likely to use prone
o African-American motherso Mothers with lt high school educationo Lack of perceived controlo Personal attitudesocietal norms
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
A continuum starting in childhoodo Secondary school baby sitting classes
Pre-pregnancy Pregnancyprenatal education
o Prior to baby showerhellipldquowrong giftsrdquo In-hospital education and modeling
o Include family friends baby sitters Re-enforcement in the doctorrsquos office
o Especially between 1 to 4 months Grandparents They hold great power The general public (day cares religious leaders)
A Lifetime of Infant Sleep Safety
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Chart1
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
14
139
13
13
12
13
117
17
103
269
087
386
074
353
077
531
072
557
067
644
062
666
056
716
057
711
053
728
056
701
055
722
055
757
057
703
055
721
054
741
051
728
048
042
04
039
Sheet1
Sheet1
ampA
Page ampP
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
Sheet2
Pre-AAP recommendation Post-AAP RecommendationBack to SleepSafe to Sleep Campaign
Sheet3
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Infant Sleep Safety
Requires a consistent and repetitive message in the community to prevent accidental deaths
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Safe Sleep Nurse Modeling
People trust nurses Whatever the nurse does must
be correct and it will be imitated in the home
Fact supine positioning in the nursery can almost DOUBLE its use in the home
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Physician Advocacy
Srivatsa 1997 HCP education to new familieshellip34 reduction in prone sleeping
Eron 2009 Study of Central NY state physicianshellip30 identified incorrect safest sleep positionhellip30 do not discuss with families
Colson 2009 Only 13 mothers advised by MD to use supine positionhellip3 times more likely to position the baby properly
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Healthcare Provider Advice to New Mothers Safe Sleep
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Chart1
Column1
[]
[]
[]
55
25
20
Sheet1
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Mason Clinical Peds 713
Bundled interventiono Nursing education policy model behavior safe sleep
video posters in rooms declaration of safe sleep practice
Safe sleep environment uarr from 25 to 58 Intention in home 95 supine none ldquoco-sleepingrdquo
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bundled Intervention = Behavior Change
QUESTION GROUP p-value
ISS Study NISP
Behavior Questions n = 490 n = 1046
Baby routinely placed to sleep on back 925 73 lt 0001
Baby routinely sleeps in bassinetcrib 995 71 lt 00001
Baby sleeps under a thin sheet 992 86 lt 0001
Baby given a pacifier for sleep 741 84 lt 0001Goodstein MH Bell T Krugman SD Improving infant sleep safety through a comprehensive hospital-based program Clinical Pediatrics 201554(3)212-221
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
o Baseline Safe sleep 49 of 264 infants o Post 312 of 234 infants (P lt 001) o Extra blankets most common o Baseline 77 vs 44 post-intervention o Mean number of unsafe items reduced by 50 (P lt 001)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Washington DC
2 urban DC nurseries 26 did not believe or unsure that infant positioning
was associated with SIDS Top 3 factors influencing sleep position
o 56 PERSONAL PREFERENCE Why non-supine Clinical experience (25)
o Increase risk aspirationo Decrease sleep and comfort
Bartow KL Nursesrsquo knowledge and adherence to sudden infant death syndrome prevention guidelines Pediatr Nurs 201642(1)7-13
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
TodaysBaby QI Safe Sleep Teaching
QI intervention median = 160 days Mothers reported receiving information 72 to 95
(increase of 24-57) 94 babies observed supine (plus 24) 88 infants in safe sleep environment
o Increase of 33 Gains maintained up to 12 months
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Social Media and Risk-Reduction Training Study (SMART) Cluster randomization 4 groups Safe sleep or breast feeding education Nursing QI and social media (mobile health) N = 1600 1263 responses (79) Safe sleep NQI and MHealth
o Supine sleep 925 o Room-sharing 859o No soft bedding 819o Pacifier use 762
Moon RY Hauck FR Colson ER et al The effect of nursing quality improvement and mobile health interventions on infant sleep practices a randomized clinical trial JAMA 2017318(4)351-359
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Hospital Initiative ComponentswwwcribsforkidsorgHospitalInitiativeToolkit INTRODUCTORY LETTER HOSPITAL INITIATIVE TOOL KIT
INSTRUCTIONS ORGANIZATIONAL CHART HOSPITAL POLICY ACKNOWLEDGMENT FORM (Engl amp
Span) SAFE SLEEP EDUCATIONAL FLIP CHART
NONCOMPLIANCE WAIVER (Engl amp Span)
NURSING EDUCATION MODULE
SAFE SLEEP POSTERS DOOR HANGERS (Engl amp Span) GRADUATION CERTIFICATE SAMPLE LETTER TO HOSPITALS SAMPLE LETTER TO PROVIDERS INFANT SAFE SLEEP BROCHURES
(Engl amp Span) PRESS KIT
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
All materials available on-lineo No major costs to the hospital
Easy on-line access for documentation
NO FEE FOR PARTICIPATION
wwwCribsforKidsorgHospitalInitiative
Tiffany Price (tpricecribsforkidsorg)
The National Safe Sleep Hospital Certification Program
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
TNmdash25 reduction in infant sleep-related deaths in 2 years
SDmdashOver 7915 Pack lsquon Plays distributed since 2012 Infant mortality rate decreased from 86 (2012) to 48 (2016)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
2009 to 2015 38 decrease in infant mortality Decreased from 135 to 84 per 1000 SUID decreased gt50 Decrease in racial disparityhttphealthybabiesbaltimorecomhome
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
And Finallyhellip
Health care providers should have open frank nonjudgmental conversations with families about their sleep practices
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Encouraging Parents to Take Action
According to the Social Learning Theory parents are more likely to recall and comply with instructions when
the health care provider
Uses a positive tone Provides adequate information Allows the parent to ask most of the questions
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Motivational Interviewing
ldquoa collaborative goal-oriented style of communication with particular attention to the language of changerdquo
o Strengthen personal motivation and commitment to a specific goal
o Explore onersquos reasons for change (barriers)o Patient generates own solutions
bull More likely to feel realisticbull Planting seeds of change
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Impact of Eliminating Sleep-Related Deaths
Every week we lose 70 children which is equivalent to 4 kindergarten classrooms
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Thank You
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Contact Information
mgoodsteinwellspanorg
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Visit Pediatric Care Online today for additional information on this and other topics
httppediatriccaresolutionsaaporgPediatric Care Online is a convenient electronic resource for immediate expert help with
virtually every pediatric clinical information need with must-have resources that are included in a comprehensive reference library and time-saving clinical tools
Donrsquot have a subscription to PCOThen take advantage of a free trial today
Call Mead Johnson Nutrition at 888363-2362 orfor more information go to
httppediatriccaresolutionsaaporgSSFree_Trialaspx
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
IMR over time Finland vs US
Slide Number 1
Disclaimer
Objectives for Todayrsquos Talk
Infant Mortality Rates for the Five Leading Causes of Infant Death in the United States 2005 and 2011
US Post-Neonatal Mortality 2015
FACT
What is SUID or SUDI
Some Causes of Deaths that Occur Suddenly and Unexpectedly during Infancy
What is SIDS
SIDS FACTS
SIDS FACTS
Triple Risk Model to Explain SIDS
Paterson DS Krous HF Kinney HC et al JAMA 2006
An Example of SIDS Pathogenesis
2016 AAP Recommendations Infant Sleep Safety
Strength of Recommendation
Recommendations Change as the Evidence Evolves
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
Correct Safe Sleep Environment
We Need to Move Beyond Back to Sleep
Sleep Position for Healthy Newborns
Sleep Position in Newborn Nursery
Sleep Position and Reflux
The Truth About Supine Sleep and Aspiration Ending the Fallacy
Title
Infant Sleep Location
Room-Share How Long Yoursquore Kidding Right
Supporting Data
More Recent Data
Why is Room-Sharing Protective
Room-Sharing and Sleep Quality
Insight Study (Paul 2017)
Insight Study (Paul 2017)
Insight Commentary (Hauck Moon)
Feeding the Baby at Night
Say NO to Couches Sofas and Cushioned Armchairs
High-Risk Bed Sharing Situations
Bedsharing in Low-Risk Breastfed Infants
Independent Review (Dr Robert Platt)
Bed Sharing
Bed Sharing
Bed Sharing with Overlay
Bed Sharing with Overlay
Bed Sharing with Overlay
Couch Sleeping
Couch Sleeping
Couch Sleeping
Unsafe Bedding NISP Trends 1993-2102
Why Use Soft Bedding
Soft Bedding for Older Infants
To Swaddle or Not to Swaddle That is the Question
Swaddling
SwaddlingmdashIs it Safe
SwaddlingmdashMore Questionshellip
wwwhealthychildrenorg
Pacifiers
Pacifiers and Breastfeeding
Baby Friendly USA Pacifiers
Addressing Sleep Deprivation
Overcoming Barriers to Change What Parents are Sayinghellip
Factors Associated With Choice of Infant Sleep Position
Slide Number 65
What is Working
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Infant Sleep Safety
Safe Sleep Nurse Modeling
Physician Advocacy
Healthcare Provider Advice to New Mothers Safe Sleep
Mason Clinical Peds 713
Bundled Intervention = Behavior Change
Hospital Unsafe Sleep Persists
Washington DC
TodaysBaby QI Safe Sleep Teaching
TodaysBaby QI Safe Sleep Teaching
Social Media and Risk-Reduction Training Study (SMART)
The National Safe Sleep Hospital Certification Program
Coordinated Education Efforts Work
Coordinated Education Efforts Work
And Finallyhellip
Encouraging Parents to Take Action
Motivational Interviewing
Impact of Eliminating Sleep-Related Deaths
Thank You
Contact Information
Slide Number 89
IMR over time Finland vs US
Column1
correct advice
55
incorrect advice
25
no advice
20
correct advice
incorrect advice
no advice
SIDS Rate
Percent Back Sleeping
1988
14
1989
139
1990
13
1991
13
1992
12
13
1993
117
17
1994
103
269
1995
087
386
1996
074
353
1997
077
531
1998
072
557
1999
067
644
2000
062
666
2001
056
716
2002
057
711
2003
053
728
2004
056
701
2005
055
722
2006
055
757
2007
057
703
2008
055
721
2009
054
741
2010
051
728
2011
048
2012
042
2013
04
2014
039
httpwwwcdcgovNCHSdatanvsrnvsr58nvsr58_19pdf
Xu JQ Kochanek KD Murphy SL Tejada-Vera B Deaths Final data for
2007
National vital statistics reports vol 58 no 19 Hyattsville MD
National Center for Health Statistics 2010
1988
1988
1989
1989
1990
1990
1991
1991
1992
1992
1993
1993
1994
1994
1995
1995
1996
1996
1997
1997
1998
1998
1999
1999
2000
2000
2001
2001
2002
2002
2003
2003
2004
2004
2005
2005
2006
2006
2007
2007
2008
2008
2009
2009
2010
2010
2011
2012
2013
2014
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Unsafe Bedding NISP Trends 1993-2102
Shapiro-Mendoza CK Colson ER Willinger M Rybin DV Camperlengo L Corwin MJ Trends in infant bedding use National Infant Sleep Position study 1993ndash2010 Pediatrics 2015135(1)10-17
Decrease from 86 to 55 Rate of decline decreases
2001-10 835 for teen mothers Predictors of adjusted OR
gt15
o Young motherso Non-white race
ethnicityo Less than college
education
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Why Use Soft Bedding
ComfortWarmtho Extrapolation of own feelingso Misinterpret firm with taut
bull Soft + taut ne firm
Safetyo Blankets pillows rolls to prevent falls
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Soft Bedding for Older Infants
Many parents recognize soft bedding is a risk Increased complacency as baby gets older Soft bedding is THE most important risk factor for
infants 4-12 months old (Colvin 2015) Infants roll into bedding and cannot extract
themselves
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
To Swaddle or Not to Swaddle That is the Question Pros
o Calms the infant promotes sleep decreases number of awakenings
o Encourages use of the supine position
Conso Increased respiratory rate and
reduced functional residual lung capacity
o Exacerbates hip dysplasia if the hips are kept in extension and adduction
o ldquoLooserdquo swaddling becomes loose bedding
o Overheating especially if the head is covered or the infant has infection
o Effects on arousability to an external stimulus remain unclear (conflicting data) There may be minimal effects of routine swaddling on arousal
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Swaddling
There is insufficient evidence to recommend routine swaddling as a strategy to reduce the incidence of SIDS
Swaddling must be correctly applied to avoid the possible hazards
Swaddling does not reduce the necessity to follow recommended safe sleep practices Ambrogio Lorenzettis Madonna and Child (1319)
Wikipedia
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
McDonnell E Moon RY Infant deaths and injuries associated with wearable blankets swaddle wraps and swaddling J Pediatr 20141641152-1156
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
SwaddlingmdashMore Questionshellip
Pease 2016 Pediatrics Pooled OR = 138
o Prone = 1299 o Side = 316o Supine = 193
Increased risk with age Limitations
o Heterogeneity definitions other risk factorsPease AS Fleming PJ Hauck FR et al Swaddling and the risk of sudden infant death syndrome a meta-analysis Pediatrics 2016137(6)e20153
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
wwwhealthychildrenorg
Swaddling (wrapping a light blanket snuggly around a baby) may help calm a crying baby If you swaddle your baby be sure to place him on his back to sleep Stop swaddling your baby when he starts to roll
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers
AAP recommendation Consider offering a pacifier at nap time and bedtime
Studies consistently demonstrate a protective effect of pacifiers on SIDS
Mechanism unknowno Dislodge within 15 to 60 minuteso Decreased arousal threshold
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers and Breastfeeding Well-designed trials
o 2 found no association among term infants
o 1 found no association among preterm infants
o 1 found slightly decreased breastfeeding duration at one month if pacifier introduced in first week of life but NO difference if pacifier introduced after one month
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Baby Friendly USA Pacifiers
Breastfeeding babies should not be given pacifiers by the staff of the facility with the exception of o Limited use to decrease pain during procedures when
the baby cannot safely be held or breastfed (pacifiers used should be discarded after these procedures)
o Babies who are being tube-fed in NICUo Other rare specific medical reasons
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Addressing Sleep Deprivation
Give parents tools to cope with fussy babies
Sleep-deprived parents may make poor judgments
Make use of tools o Swaddling side carrying
shushing swinging and sucking
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Overcoming Barriers to Change What Parents are Sayinghellip
Prone positioning fear of choking Baby sleeps ldquobetterrdquo on stomach Soft things are safer for the baby SIDS is ldquoGodrsquos willrdquo Why bother Recommendations keep changing
anyway Vigilance sleep with baby for protection
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Factors Associated With Choice of Infant Sleep Position 3300 mothers from 32 hospitals 77 usually use supine position 49 exclusive use supine position Most likely to use prone
o African-American motherso Mothers with lt high school educationo Lack of perceived controlo Personal attitudesocietal norms
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
A continuum starting in childhoodo Secondary school baby sitting classes
Pre-pregnancy Pregnancyprenatal education
o Prior to baby showerhellipldquowrong giftsrdquo In-hospital education and modeling
o Include family friends baby sitters Re-enforcement in the doctorrsquos office
o Especially between 1 to 4 months Grandparents They hold great power The general public (day cares religious leaders)
A Lifetime of Infant Sleep Safety
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Chart1
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
14
139
13
13
12
13
117
17
103
269
087
386
074
353
077
531
072
557
067
644
062
666
056
716
057
711
053
728
056
701
055
722
055
757
057
703
055
721
054
741
051
728
048
042
04
039
Sheet1
Sheet1
ampA
Page ampP
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
Sheet2
Pre-AAP recommendation Post-AAP RecommendationBack to SleepSafe to Sleep Campaign
Sheet3
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Infant Sleep Safety
Requires a consistent and repetitive message in the community to prevent accidental deaths
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Safe Sleep Nurse Modeling
People trust nurses Whatever the nurse does must
be correct and it will be imitated in the home
Fact supine positioning in the nursery can almost DOUBLE its use in the home
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Physician Advocacy
Srivatsa 1997 HCP education to new familieshellip34 reduction in prone sleeping
Eron 2009 Study of Central NY state physicianshellip30 identified incorrect safest sleep positionhellip30 do not discuss with families
Colson 2009 Only 13 mothers advised by MD to use supine positionhellip3 times more likely to position the baby properly
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Healthcare Provider Advice to New Mothers Safe Sleep
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Chart1
Column1
[]
[]
[]
55
25
20
Sheet1
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Mason Clinical Peds 713
Bundled interventiono Nursing education policy model behavior safe sleep
video posters in rooms declaration of safe sleep practice
Safe sleep environment uarr from 25 to 58 Intention in home 95 supine none ldquoco-sleepingrdquo
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bundled Intervention = Behavior Change
QUESTION GROUP p-value
ISS Study NISP
Behavior Questions n = 490 n = 1046
Baby routinely placed to sleep on back 925 73 lt 0001
Baby routinely sleeps in bassinetcrib 995 71 lt 00001
Baby sleeps under a thin sheet 992 86 lt 0001
Baby given a pacifier for sleep 741 84 lt 0001Goodstein MH Bell T Krugman SD Improving infant sleep safety through a comprehensive hospital-based program Clinical Pediatrics 201554(3)212-221
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
o Baseline Safe sleep 49 of 264 infants o Post 312 of 234 infants (P lt 001) o Extra blankets most common o Baseline 77 vs 44 post-intervention o Mean number of unsafe items reduced by 50 (P lt 001)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Washington DC
2 urban DC nurseries 26 did not believe or unsure that infant positioning
was associated with SIDS Top 3 factors influencing sleep position
o 56 PERSONAL PREFERENCE Why non-supine Clinical experience (25)
o Increase risk aspirationo Decrease sleep and comfort
Bartow KL Nursesrsquo knowledge and adherence to sudden infant death syndrome prevention guidelines Pediatr Nurs 201642(1)7-13
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
TodaysBaby QI Safe Sleep Teaching
QI intervention median = 160 days Mothers reported receiving information 72 to 95
(increase of 24-57) 94 babies observed supine (plus 24) 88 infants in safe sleep environment
o Increase of 33 Gains maintained up to 12 months
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Social Media and Risk-Reduction Training Study (SMART) Cluster randomization 4 groups Safe sleep or breast feeding education Nursing QI and social media (mobile health) N = 1600 1263 responses (79) Safe sleep NQI and MHealth
o Supine sleep 925 o Room-sharing 859o No soft bedding 819o Pacifier use 762
Moon RY Hauck FR Colson ER et al The effect of nursing quality improvement and mobile health interventions on infant sleep practices a randomized clinical trial JAMA 2017318(4)351-359
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Hospital Initiative ComponentswwwcribsforkidsorgHospitalInitiativeToolkit INTRODUCTORY LETTER HOSPITAL INITIATIVE TOOL KIT
INSTRUCTIONS ORGANIZATIONAL CHART HOSPITAL POLICY ACKNOWLEDGMENT FORM (Engl amp
Span) SAFE SLEEP EDUCATIONAL FLIP CHART
NONCOMPLIANCE WAIVER (Engl amp Span)
NURSING EDUCATION MODULE
SAFE SLEEP POSTERS DOOR HANGERS (Engl amp Span) GRADUATION CERTIFICATE SAMPLE LETTER TO HOSPITALS SAMPLE LETTER TO PROVIDERS INFANT SAFE SLEEP BROCHURES
(Engl amp Span) PRESS KIT
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
All materials available on-lineo No major costs to the hospital
Easy on-line access for documentation
NO FEE FOR PARTICIPATION
wwwCribsforKidsorgHospitalInitiative
Tiffany Price (tpricecribsforkidsorg)
The National Safe Sleep Hospital Certification Program
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
TNmdash25 reduction in infant sleep-related deaths in 2 years
SDmdashOver 7915 Pack lsquon Plays distributed since 2012 Infant mortality rate decreased from 86 (2012) to 48 (2016)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
2009 to 2015 38 decrease in infant mortality Decreased from 135 to 84 per 1000 SUID decreased gt50 Decrease in racial disparityhttphealthybabiesbaltimorecomhome
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
And Finallyhellip
Health care providers should have open frank nonjudgmental conversations with families about their sleep practices
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Encouraging Parents to Take Action
According to the Social Learning Theory parents are more likely to recall and comply with instructions when
the health care provider
Uses a positive tone Provides adequate information Allows the parent to ask most of the questions
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Motivational Interviewing
ldquoa collaborative goal-oriented style of communication with particular attention to the language of changerdquo
o Strengthen personal motivation and commitment to a specific goal
o Explore onersquos reasons for change (barriers)o Patient generates own solutions
bull More likely to feel realisticbull Planting seeds of change
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Impact of Eliminating Sleep-Related Deaths
Every week we lose 70 children which is equivalent to 4 kindergarten classrooms
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Thank You
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Contact Information
mgoodsteinwellspanorg
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Visit Pediatric Care Online today for additional information on this and other topics
httppediatriccaresolutionsaaporgPediatric Care Online is a convenient electronic resource for immediate expert help with
virtually every pediatric clinical information need with must-have resources that are included in a comprehensive reference library and time-saving clinical tools
Donrsquot have a subscription to PCOThen take advantage of a free trial today
Call Mead Johnson Nutrition at 888363-2362 orfor more information go to
httppediatriccaresolutionsaaporgSSFree_Trialaspx
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
IMR over time Finland vs US
Slide Number 1
Disclaimer
Objectives for Todayrsquos Talk
Infant Mortality Rates for the Five Leading Causes of Infant Death in the United States 2005 and 2011
US Post-Neonatal Mortality 2015
FACT
What is SUID or SUDI
Some Causes of Deaths that Occur Suddenly and Unexpectedly during Infancy
What is SIDS
SIDS FACTS
SIDS FACTS
Triple Risk Model to Explain SIDS
Paterson DS Krous HF Kinney HC et al JAMA 2006
An Example of SIDS Pathogenesis
2016 AAP Recommendations Infant Sleep Safety
Strength of Recommendation
Recommendations Change as the Evidence Evolves
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
Correct Safe Sleep Environment
We Need to Move Beyond Back to Sleep
Sleep Position for Healthy Newborns
Sleep Position in Newborn Nursery
Sleep Position and Reflux
The Truth About Supine Sleep and Aspiration Ending the Fallacy
Title
Infant Sleep Location
Room-Share How Long Yoursquore Kidding Right
Supporting Data
More Recent Data
Why is Room-Sharing Protective
Room-Sharing and Sleep Quality
Insight Study (Paul 2017)
Insight Study (Paul 2017)
Insight Commentary (Hauck Moon)
Feeding the Baby at Night
Say NO to Couches Sofas and Cushioned Armchairs
High-Risk Bed Sharing Situations
Bedsharing in Low-Risk Breastfed Infants
Independent Review (Dr Robert Platt)
Bed Sharing
Bed Sharing
Bed Sharing with Overlay
Bed Sharing with Overlay
Bed Sharing with Overlay
Couch Sleeping
Couch Sleeping
Couch Sleeping
Unsafe Bedding NISP Trends 1993-2102
Why Use Soft Bedding
Soft Bedding for Older Infants
To Swaddle or Not to Swaddle That is the Question
Swaddling
SwaddlingmdashIs it Safe
SwaddlingmdashMore Questionshellip
wwwhealthychildrenorg
Pacifiers
Pacifiers and Breastfeeding
Baby Friendly USA Pacifiers
Addressing Sleep Deprivation
Overcoming Barriers to Change What Parents are Sayinghellip
Factors Associated With Choice of Infant Sleep Position
Slide Number 65
What is Working
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Infant Sleep Safety
Safe Sleep Nurse Modeling
Physician Advocacy
Healthcare Provider Advice to New Mothers Safe Sleep
Mason Clinical Peds 713
Bundled Intervention = Behavior Change
Hospital Unsafe Sleep Persists
Washington DC
TodaysBaby QI Safe Sleep Teaching
TodaysBaby QI Safe Sleep Teaching
Social Media and Risk-Reduction Training Study (SMART)
The National Safe Sleep Hospital Certification Program
Coordinated Education Efforts Work
Coordinated Education Efforts Work
And Finallyhellip
Encouraging Parents to Take Action
Motivational Interviewing
Impact of Eliminating Sleep-Related Deaths
Thank You
Contact Information
Slide Number 89
IMR over time Finland vs US
Column1
correct advice
55
incorrect advice
25
no advice
20
correct advice
incorrect advice
no advice
SIDS Rate
Percent Back Sleeping
1988
14
1989
139
1990
13
1991
13
1992
12
13
1993
117
17
1994
103
269
1995
087
386
1996
074
353
1997
077
531
1998
072
557
1999
067
644
2000
062
666
2001
056
716
2002
057
711
2003
053
728
2004
056
701
2005
055
722
2006
055
757
2007
057
703
2008
055
721
2009
054
741
2010
051
728
2011
048
2012
042
2013
04
2014
039
httpwwwcdcgovNCHSdatanvsrnvsr58nvsr58_19pdf
Xu JQ Kochanek KD Murphy SL Tejada-Vera B Deaths Final data for
2007
National vital statistics reports vol 58 no 19 Hyattsville MD
National Center for Health Statistics 2010
1988
1988
1989
1989
1990
1990
1991
1991
1992
1992
1993
1993
1994
1994
1995
1995
1996
1996
1997
1997
1998
1998
1999
1999
2000
2000
2001
2001
2002
2002
2003
2003
2004
2004
2005
2005
2006
2006
2007
2007
2008
2008
2009
2009
2010
2010
2011
2012
2013
2014
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Unsafe Bedding NISP Trends 1993-2102
Shapiro-Mendoza CK Colson ER Willinger M Rybin DV Camperlengo L Corwin MJ Trends in infant bedding use National Infant Sleep Position study 1993ndash2010 Pediatrics 2015135(1)10-17
Decrease from 86 to 55 Rate of decline decreases
2001-10 835 for teen mothers Predictors of adjusted OR
gt15
o Young motherso Non-white race
ethnicityo Less than college
education
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Why Use Soft Bedding
ComfortWarmtho Extrapolation of own feelingso Misinterpret firm with taut
bull Soft + taut ne firm
Safetyo Blankets pillows rolls to prevent falls
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Soft Bedding for Older Infants
Many parents recognize soft bedding is a risk Increased complacency as baby gets older Soft bedding is THE most important risk factor for
infants 4-12 months old (Colvin 2015) Infants roll into bedding and cannot extract
themselves
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
To Swaddle or Not to Swaddle That is the Question Pros
o Calms the infant promotes sleep decreases number of awakenings
o Encourages use of the supine position
Conso Increased respiratory rate and
reduced functional residual lung capacity
o Exacerbates hip dysplasia if the hips are kept in extension and adduction
o ldquoLooserdquo swaddling becomes loose bedding
o Overheating especially if the head is covered or the infant has infection
o Effects on arousability to an external stimulus remain unclear (conflicting data) There may be minimal effects of routine swaddling on arousal
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Swaddling
There is insufficient evidence to recommend routine swaddling as a strategy to reduce the incidence of SIDS
Swaddling must be correctly applied to avoid the possible hazards
Swaddling does not reduce the necessity to follow recommended safe sleep practices Ambrogio Lorenzettis Madonna and Child (1319)
Wikipedia
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
McDonnell E Moon RY Infant deaths and injuries associated with wearable blankets swaddle wraps and swaddling J Pediatr 20141641152-1156
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
SwaddlingmdashMore Questionshellip
Pease 2016 Pediatrics Pooled OR = 138
o Prone = 1299 o Side = 316o Supine = 193
Increased risk with age Limitations
o Heterogeneity definitions other risk factorsPease AS Fleming PJ Hauck FR et al Swaddling and the risk of sudden infant death syndrome a meta-analysis Pediatrics 2016137(6)e20153
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
wwwhealthychildrenorg
Swaddling (wrapping a light blanket snuggly around a baby) may help calm a crying baby If you swaddle your baby be sure to place him on his back to sleep Stop swaddling your baby when he starts to roll
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers
AAP recommendation Consider offering a pacifier at nap time and bedtime
Studies consistently demonstrate a protective effect of pacifiers on SIDS
Mechanism unknowno Dislodge within 15 to 60 minuteso Decreased arousal threshold
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers and Breastfeeding Well-designed trials
o 2 found no association among term infants
o 1 found no association among preterm infants
o 1 found slightly decreased breastfeeding duration at one month if pacifier introduced in first week of life but NO difference if pacifier introduced after one month
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Baby Friendly USA Pacifiers
Breastfeeding babies should not be given pacifiers by the staff of the facility with the exception of o Limited use to decrease pain during procedures when
the baby cannot safely be held or breastfed (pacifiers used should be discarded after these procedures)
o Babies who are being tube-fed in NICUo Other rare specific medical reasons
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Addressing Sleep Deprivation
Give parents tools to cope with fussy babies
Sleep-deprived parents may make poor judgments
Make use of tools o Swaddling side carrying
shushing swinging and sucking
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Overcoming Barriers to Change What Parents are Sayinghellip
Prone positioning fear of choking Baby sleeps ldquobetterrdquo on stomach Soft things are safer for the baby SIDS is ldquoGodrsquos willrdquo Why bother Recommendations keep changing
anyway Vigilance sleep with baby for protection
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Factors Associated With Choice of Infant Sleep Position 3300 mothers from 32 hospitals 77 usually use supine position 49 exclusive use supine position Most likely to use prone
o African-American motherso Mothers with lt high school educationo Lack of perceived controlo Personal attitudesocietal norms
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
A continuum starting in childhoodo Secondary school baby sitting classes
Pre-pregnancy Pregnancyprenatal education
o Prior to baby showerhellipldquowrong giftsrdquo In-hospital education and modeling
o Include family friends baby sitters Re-enforcement in the doctorrsquos office
o Especially between 1 to 4 months Grandparents They hold great power The general public (day cares religious leaders)
A Lifetime of Infant Sleep Safety
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Chart1
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
14
139
13
13
12
13
117
17
103
269
087
386
074
353
077
531
072
557
067
644
062
666
056
716
057
711
053
728
056
701
055
722
055
757
057
703
055
721
054
741
051
728
048
042
04
039
Sheet1
Sheet1
ampA
Page ampP
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
Sheet2
Pre-AAP recommendation Post-AAP RecommendationBack to SleepSafe to Sleep Campaign
Sheet3
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Infant Sleep Safety
Requires a consistent and repetitive message in the community to prevent accidental deaths
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Safe Sleep Nurse Modeling
People trust nurses Whatever the nurse does must
be correct and it will be imitated in the home
Fact supine positioning in the nursery can almost DOUBLE its use in the home
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Physician Advocacy
Srivatsa 1997 HCP education to new familieshellip34 reduction in prone sleeping
Eron 2009 Study of Central NY state physicianshellip30 identified incorrect safest sleep positionhellip30 do not discuss with families
Colson 2009 Only 13 mothers advised by MD to use supine positionhellip3 times more likely to position the baby properly
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Healthcare Provider Advice to New Mothers Safe Sleep
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Chart1
Column1
[]
[]
[]
55
25
20
Sheet1
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Mason Clinical Peds 713
Bundled interventiono Nursing education policy model behavior safe sleep
video posters in rooms declaration of safe sleep practice
Safe sleep environment uarr from 25 to 58 Intention in home 95 supine none ldquoco-sleepingrdquo
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bundled Intervention = Behavior Change
QUESTION GROUP p-value
ISS Study NISP
Behavior Questions n = 490 n = 1046
Baby routinely placed to sleep on back 925 73 lt 0001
Baby routinely sleeps in bassinetcrib 995 71 lt 00001
Baby sleeps under a thin sheet 992 86 lt 0001
Baby given a pacifier for sleep 741 84 lt 0001Goodstein MH Bell T Krugman SD Improving infant sleep safety through a comprehensive hospital-based program Clinical Pediatrics 201554(3)212-221
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
o Baseline Safe sleep 49 of 264 infants o Post 312 of 234 infants (P lt 001) o Extra blankets most common o Baseline 77 vs 44 post-intervention o Mean number of unsafe items reduced by 50 (P lt 001)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Washington DC
2 urban DC nurseries 26 did not believe or unsure that infant positioning
was associated with SIDS Top 3 factors influencing sleep position
o 56 PERSONAL PREFERENCE Why non-supine Clinical experience (25)
o Increase risk aspirationo Decrease sleep and comfort
Bartow KL Nursesrsquo knowledge and adherence to sudden infant death syndrome prevention guidelines Pediatr Nurs 201642(1)7-13
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
TodaysBaby QI Safe Sleep Teaching
QI intervention median = 160 days Mothers reported receiving information 72 to 95
(increase of 24-57) 94 babies observed supine (plus 24) 88 infants in safe sleep environment
o Increase of 33 Gains maintained up to 12 months
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Social Media and Risk-Reduction Training Study (SMART) Cluster randomization 4 groups Safe sleep or breast feeding education Nursing QI and social media (mobile health) N = 1600 1263 responses (79) Safe sleep NQI and MHealth
o Supine sleep 925 o Room-sharing 859o No soft bedding 819o Pacifier use 762
Moon RY Hauck FR Colson ER et al The effect of nursing quality improvement and mobile health interventions on infant sleep practices a randomized clinical trial JAMA 2017318(4)351-359
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Hospital Initiative ComponentswwwcribsforkidsorgHospitalInitiativeToolkit INTRODUCTORY LETTER HOSPITAL INITIATIVE TOOL KIT
INSTRUCTIONS ORGANIZATIONAL CHART HOSPITAL POLICY ACKNOWLEDGMENT FORM (Engl amp
Span) SAFE SLEEP EDUCATIONAL FLIP CHART
NONCOMPLIANCE WAIVER (Engl amp Span)
NURSING EDUCATION MODULE
SAFE SLEEP POSTERS DOOR HANGERS (Engl amp Span) GRADUATION CERTIFICATE SAMPLE LETTER TO HOSPITALS SAMPLE LETTER TO PROVIDERS INFANT SAFE SLEEP BROCHURES
(Engl amp Span) PRESS KIT
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
All materials available on-lineo No major costs to the hospital
Easy on-line access for documentation
NO FEE FOR PARTICIPATION
wwwCribsforKidsorgHospitalInitiative
Tiffany Price (tpricecribsforkidsorg)
The National Safe Sleep Hospital Certification Program
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
TNmdash25 reduction in infant sleep-related deaths in 2 years
SDmdashOver 7915 Pack lsquon Plays distributed since 2012 Infant mortality rate decreased from 86 (2012) to 48 (2016)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
2009 to 2015 38 decrease in infant mortality Decreased from 135 to 84 per 1000 SUID decreased gt50 Decrease in racial disparityhttphealthybabiesbaltimorecomhome
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
And Finallyhellip
Health care providers should have open frank nonjudgmental conversations with families about their sleep practices
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Encouraging Parents to Take Action
According to the Social Learning Theory parents are more likely to recall and comply with instructions when
the health care provider
Uses a positive tone Provides adequate information Allows the parent to ask most of the questions
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Motivational Interviewing
ldquoa collaborative goal-oriented style of communication with particular attention to the language of changerdquo
o Strengthen personal motivation and commitment to a specific goal
o Explore onersquos reasons for change (barriers)o Patient generates own solutions
bull More likely to feel realisticbull Planting seeds of change
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Impact of Eliminating Sleep-Related Deaths
Every week we lose 70 children which is equivalent to 4 kindergarten classrooms
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Thank You
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Contact Information
mgoodsteinwellspanorg
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Visit Pediatric Care Online today for additional information on this and other topics
httppediatriccaresolutionsaaporgPediatric Care Online is a convenient electronic resource for immediate expert help with
virtually every pediatric clinical information need with must-have resources that are included in a comprehensive reference library and time-saving clinical tools
Donrsquot have a subscription to PCOThen take advantage of a free trial today
Call Mead Johnson Nutrition at 888363-2362 orfor more information go to
httppediatriccaresolutionsaaporgSSFree_Trialaspx
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
IMR over time Finland vs US
Slide Number 1
Disclaimer
Objectives for Todayrsquos Talk
Infant Mortality Rates for the Five Leading Causes of Infant Death in the United States 2005 and 2011
US Post-Neonatal Mortality 2015
FACT
What is SUID or SUDI
Some Causes of Deaths that Occur Suddenly and Unexpectedly during Infancy
What is SIDS
SIDS FACTS
SIDS FACTS
Triple Risk Model to Explain SIDS
Paterson DS Krous HF Kinney HC et al JAMA 2006
An Example of SIDS Pathogenesis
2016 AAP Recommendations Infant Sleep Safety
Strength of Recommendation
Recommendations Change as the Evidence Evolves
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
Correct Safe Sleep Environment
We Need to Move Beyond Back to Sleep
Sleep Position for Healthy Newborns
Sleep Position in Newborn Nursery
Sleep Position and Reflux
The Truth About Supine Sleep and Aspiration Ending the Fallacy
Title
Infant Sleep Location
Room-Share How Long Yoursquore Kidding Right
Supporting Data
More Recent Data
Why is Room-Sharing Protective
Room-Sharing and Sleep Quality
Insight Study (Paul 2017)
Insight Study (Paul 2017)
Insight Commentary (Hauck Moon)
Feeding the Baby at Night
Say NO to Couches Sofas and Cushioned Armchairs
High-Risk Bed Sharing Situations
Bedsharing in Low-Risk Breastfed Infants
Independent Review (Dr Robert Platt)
Bed Sharing
Bed Sharing
Bed Sharing with Overlay
Bed Sharing with Overlay
Bed Sharing with Overlay
Couch Sleeping
Couch Sleeping
Couch Sleeping
Unsafe Bedding NISP Trends 1993-2102
Why Use Soft Bedding
Soft Bedding for Older Infants
To Swaddle or Not to Swaddle That is the Question
Swaddling
SwaddlingmdashIs it Safe
SwaddlingmdashMore Questionshellip
wwwhealthychildrenorg
Pacifiers
Pacifiers and Breastfeeding
Baby Friendly USA Pacifiers
Addressing Sleep Deprivation
Overcoming Barriers to Change What Parents are Sayinghellip
Factors Associated With Choice of Infant Sleep Position
Slide Number 65
What is Working
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Infant Sleep Safety
Safe Sleep Nurse Modeling
Physician Advocacy
Healthcare Provider Advice to New Mothers Safe Sleep
Mason Clinical Peds 713
Bundled Intervention = Behavior Change
Hospital Unsafe Sleep Persists
Washington DC
TodaysBaby QI Safe Sleep Teaching
TodaysBaby QI Safe Sleep Teaching
Social Media and Risk-Reduction Training Study (SMART)
The National Safe Sleep Hospital Certification Program
Coordinated Education Efforts Work
Coordinated Education Efforts Work
And Finallyhellip
Encouraging Parents to Take Action
Motivational Interviewing
Impact of Eliminating Sleep-Related Deaths
Thank You
Contact Information
Slide Number 89
IMR over time Finland vs US
Column1
correct advice
55
incorrect advice
25
no advice
20
correct advice
incorrect advice
no advice
SIDS Rate
Percent Back Sleeping
1988
14
1989
139
1990
13
1991
13
1992
12
13
1993
117
17
1994
103
269
1995
087
386
1996
074
353
1997
077
531
1998
072
557
1999
067
644
2000
062
666
2001
056
716
2002
057
711
2003
053
728
2004
056
701
2005
055
722
2006
055
757
2007
057
703
2008
055
721
2009
054
741
2010
051
728
2011
048
2012
042
2013
04
2014
039
httpwwwcdcgovNCHSdatanvsrnvsr58nvsr58_19pdf
Xu JQ Kochanek KD Murphy SL Tejada-Vera B Deaths Final data for
2007
National vital statistics reports vol 58 no 19 Hyattsville MD
National Center for Health Statistics 2010
1988
1988
1989
1989
1990
1990
1991
1991
1992
1992
1993
1993
1994
1994
1995
1995
1996
1996
1997
1997
1998
1998
1999
1999
2000
2000
2001
2001
2002
2002
2003
2003
2004
2004
2005
2005
2006
2006
2007
2007
2008
2008
2009
2009
2010
2010
2011
2012
2013
2014
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Unsafe Bedding NISP Trends 1993-2102
Shapiro-Mendoza CK Colson ER Willinger M Rybin DV Camperlengo L Corwin MJ Trends in infant bedding use National Infant Sleep Position study 1993ndash2010 Pediatrics 2015135(1)10-17
Decrease from 86 to 55 Rate of decline decreases
2001-10 835 for teen mothers Predictors of adjusted OR
gt15
o Young motherso Non-white race
ethnicityo Less than college
education
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Why Use Soft Bedding
ComfortWarmtho Extrapolation of own feelingso Misinterpret firm with taut
bull Soft + taut ne firm
Safetyo Blankets pillows rolls to prevent falls
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Soft Bedding for Older Infants
Many parents recognize soft bedding is a risk Increased complacency as baby gets older Soft bedding is THE most important risk factor for
infants 4-12 months old (Colvin 2015) Infants roll into bedding and cannot extract
themselves
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
To Swaddle or Not to Swaddle That is the Question Pros
o Calms the infant promotes sleep decreases number of awakenings
o Encourages use of the supine position
Conso Increased respiratory rate and
reduced functional residual lung capacity
o Exacerbates hip dysplasia if the hips are kept in extension and adduction
o ldquoLooserdquo swaddling becomes loose bedding
o Overheating especially if the head is covered or the infant has infection
o Effects on arousability to an external stimulus remain unclear (conflicting data) There may be minimal effects of routine swaddling on arousal
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Swaddling
There is insufficient evidence to recommend routine swaddling as a strategy to reduce the incidence of SIDS
Swaddling must be correctly applied to avoid the possible hazards
Swaddling does not reduce the necessity to follow recommended safe sleep practices Ambrogio Lorenzettis Madonna and Child (1319)
Wikipedia
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
McDonnell E Moon RY Infant deaths and injuries associated with wearable blankets swaddle wraps and swaddling J Pediatr 20141641152-1156
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
SwaddlingmdashMore Questionshellip
Pease 2016 Pediatrics Pooled OR = 138
o Prone = 1299 o Side = 316o Supine = 193
Increased risk with age Limitations
o Heterogeneity definitions other risk factorsPease AS Fleming PJ Hauck FR et al Swaddling and the risk of sudden infant death syndrome a meta-analysis Pediatrics 2016137(6)e20153
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
wwwhealthychildrenorg
Swaddling (wrapping a light blanket snuggly around a baby) may help calm a crying baby If you swaddle your baby be sure to place him on his back to sleep Stop swaddling your baby when he starts to roll
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers
AAP recommendation Consider offering a pacifier at nap time and bedtime
Studies consistently demonstrate a protective effect of pacifiers on SIDS
Mechanism unknowno Dislodge within 15 to 60 minuteso Decreased arousal threshold
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers and Breastfeeding Well-designed trials
o 2 found no association among term infants
o 1 found no association among preterm infants
o 1 found slightly decreased breastfeeding duration at one month if pacifier introduced in first week of life but NO difference if pacifier introduced after one month
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Baby Friendly USA Pacifiers
Breastfeeding babies should not be given pacifiers by the staff of the facility with the exception of o Limited use to decrease pain during procedures when
the baby cannot safely be held or breastfed (pacifiers used should be discarded after these procedures)
o Babies who are being tube-fed in NICUo Other rare specific medical reasons
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Addressing Sleep Deprivation
Give parents tools to cope with fussy babies
Sleep-deprived parents may make poor judgments
Make use of tools o Swaddling side carrying
shushing swinging and sucking
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Overcoming Barriers to Change What Parents are Sayinghellip
Prone positioning fear of choking Baby sleeps ldquobetterrdquo on stomach Soft things are safer for the baby SIDS is ldquoGodrsquos willrdquo Why bother Recommendations keep changing
anyway Vigilance sleep with baby for protection
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Factors Associated With Choice of Infant Sleep Position 3300 mothers from 32 hospitals 77 usually use supine position 49 exclusive use supine position Most likely to use prone
o African-American motherso Mothers with lt high school educationo Lack of perceived controlo Personal attitudesocietal norms
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
A continuum starting in childhoodo Secondary school baby sitting classes
Pre-pregnancy Pregnancyprenatal education
o Prior to baby showerhellipldquowrong giftsrdquo In-hospital education and modeling
o Include family friends baby sitters Re-enforcement in the doctorrsquos office
o Especially between 1 to 4 months Grandparents They hold great power The general public (day cares religious leaders)
A Lifetime of Infant Sleep Safety
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Chart1
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
14
139
13
13
12
13
117
17
103
269
087
386
074
353
077
531
072
557
067
644
062
666
056
716
057
711
053
728
056
701
055
722
055
757
057
703
055
721
054
741
051
728
048
042
04
039
Sheet1
Sheet1
ampA
Page ampP
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
Sheet2
Pre-AAP recommendation Post-AAP RecommendationBack to SleepSafe to Sleep Campaign
Sheet3
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Infant Sleep Safety
Requires a consistent and repetitive message in the community to prevent accidental deaths
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Safe Sleep Nurse Modeling
People trust nurses Whatever the nurse does must
be correct and it will be imitated in the home
Fact supine positioning in the nursery can almost DOUBLE its use in the home
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Physician Advocacy
Srivatsa 1997 HCP education to new familieshellip34 reduction in prone sleeping
Eron 2009 Study of Central NY state physicianshellip30 identified incorrect safest sleep positionhellip30 do not discuss with families
Colson 2009 Only 13 mothers advised by MD to use supine positionhellip3 times more likely to position the baby properly
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Healthcare Provider Advice to New Mothers Safe Sleep
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Chart1
Column1
[]
[]
[]
55
25
20
Sheet1
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Mason Clinical Peds 713
Bundled interventiono Nursing education policy model behavior safe sleep
video posters in rooms declaration of safe sleep practice
Safe sleep environment uarr from 25 to 58 Intention in home 95 supine none ldquoco-sleepingrdquo
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bundled Intervention = Behavior Change
QUESTION GROUP p-value
ISS Study NISP
Behavior Questions n = 490 n = 1046
Baby routinely placed to sleep on back 925 73 lt 0001
Baby routinely sleeps in bassinetcrib 995 71 lt 00001
Baby sleeps under a thin sheet 992 86 lt 0001
Baby given a pacifier for sleep 741 84 lt 0001Goodstein MH Bell T Krugman SD Improving infant sleep safety through a comprehensive hospital-based program Clinical Pediatrics 201554(3)212-221
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
o Baseline Safe sleep 49 of 264 infants o Post 312 of 234 infants (P lt 001) o Extra blankets most common o Baseline 77 vs 44 post-intervention o Mean number of unsafe items reduced by 50 (P lt 001)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Washington DC
2 urban DC nurseries 26 did not believe or unsure that infant positioning
was associated with SIDS Top 3 factors influencing sleep position
o 56 PERSONAL PREFERENCE Why non-supine Clinical experience (25)
o Increase risk aspirationo Decrease sleep and comfort
Bartow KL Nursesrsquo knowledge and adherence to sudden infant death syndrome prevention guidelines Pediatr Nurs 201642(1)7-13
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
TodaysBaby QI Safe Sleep Teaching
QI intervention median = 160 days Mothers reported receiving information 72 to 95
(increase of 24-57) 94 babies observed supine (plus 24) 88 infants in safe sleep environment
o Increase of 33 Gains maintained up to 12 months
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Social Media and Risk-Reduction Training Study (SMART) Cluster randomization 4 groups Safe sleep or breast feeding education Nursing QI and social media (mobile health) N = 1600 1263 responses (79) Safe sleep NQI and MHealth
o Supine sleep 925 o Room-sharing 859o No soft bedding 819o Pacifier use 762
Moon RY Hauck FR Colson ER et al The effect of nursing quality improvement and mobile health interventions on infant sleep practices a randomized clinical trial JAMA 2017318(4)351-359
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Hospital Initiative ComponentswwwcribsforkidsorgHospitalInitiativeToolkit INTRODUCTORY LETTER HOSPITAL INITIATIVE TOOL KIT
INSTRUCTIONS ORGANIZATIONAL CHART HOSPITAL POLICY ACKNOWLEDGMENT FORM (Engl amp
Span) SAFE SLEEP EDUCATIONAL FLIP CHART
NONCOMPLIANCE WAIVER (Engl amp Span)
NURSING EDUCATION MODULE
SAFE SLEEP POSTERS DOOR HANGERS (Engl amp Span) GRADUATION CERTIFICATE SAMPLE LETTER TO HOSPITALS SAMPLE LETTER TO PROVIDERS INFANT SAFE SLEEP BROCHURES
(Engl amp Span) PRESS KIT
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
All materials available on-lineo No major costs to the hospital
Easy on-line access for documentation
NO FEE FOR PARTICIPATION
wwwCribsforKidsorgHospitalInitiative
Tiffany Price (tpricecribsforkidsorg)
The National Safe Sleep Hospital Certification Program
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
TNmdash25 reduction in infant sleep-related deaths in 2 years
SDmdashOver 7915 Pack lsquon Plays distributed since 2012 Infant mortality rate decreased from 86 (2012) to 48 (2016)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
2009 to 2015 38 decrease in infant mortality Decreased from 135 to 84 per 1000 SUID decreased gt50 Decrease in racial disparityhttphealthybabiesbaltimorecomhome
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
And Finallyhellip
Health care providers should have open frank nonjudgmental conversations with families about their sleep practices
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Encouraging Parents to Take Action
According to the Social Learning Theory parents are more likely to recall and comply with instructions when
the health care provider
Uses a positive tone Provides adequate information Allows the parent to ask most of the questions
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Motivational Interviewing
ldquoa collaborative goal-oriented style of communication with particular attention to the language of changerdquo
o Strengthen personal motivation and commitment to a specific goal
o Explore onersquos reasons for change (barriers)o Patient generates own solutions
bull More likely to feel realisticbull Planting seeds of change
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Impact of Eliminating Sleep-Related Deaths
Every week we lose 70 children which is equivalent to 4 kindergarten classrooms
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Thank You
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Contact Information
mgoodsteinwellspanorg
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Visit Pediatric Care Online today for additional information on this and other topics
httppediatriccaresolutionsaaporgPediatric Care Online is a convenient electronic resource for immediate expert help with
virtually every pediatric clinical information need with must-have resources that are included in a comprehensive reference library and time-saving clinical tools
Donrsquot have a subscription to PCOThen take advantage of a free trial today
Call Mead Johnson Nutrition at 888363-2362 orfor more information go to
httppediatriccaresolutionsaaporgSSFree_Trialaspx
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
IMR over time Finland vs US
Slide Number 1
Disclaimer
Objectives for Todayrsquos Talk
Infant Mortality Rates for the Five Leading Causes of Infant Death in the United States 2005 and 2011
US Post-Neonatal Mortality 2015
FACT
What is SUID or SUDI
Some Causes of Deaths that Occur Suddenly and Unexpectedly during Infancy
What is SIDS
SIDS FACTS
SIDS FACTS
Triple Risk Model to Explain SIDS
Paterson DS Krous HF Kinney HC et al JAMA 2006
An Example of SIDS Pathogenesis
2016 AAP Recommendations Infant Sleep Safety
Strength of Recommendation
Recommendations Change as the Evidence Evolves
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
Correct Safe Sleep Environment
We Need to Move Beyond Back to Sleep
Sleep Position for Healthy Newborns
Sleep Position in Newborn Nursery
Sleep Position and Reflux
The Truth About Supine Sleep and Aspiration Ending the Fallacy
Title
Infant Sleep Location
Room-Share How Long Yoursquore Kidding Right
Supporting Data
More Recent Data
Why is Room-Sharing Protective
Room-Sharing and Sleep Quality
Insight Study (Paul 2017)
Insight Study (Paul 2017)
Insight Commentary (Hauck Moon)
Feeding the Baby at Night
Say NO to Couches Sofas and Cushioned Armchairs
High-Risk Bed Sharing Situations
Bedsharing in Low-Risk Breastfed Infants
Independent Review (Dr Robert Platt)
Bed Sharing
Bed Sharing
Bed Sharing with Overlay
Bed Sharing with Overlay
Bed Sharing with Overlay
Couch Sleeping
Couch Sleeping
Couch Sleeping
Unsafe Bedding NISP Trends 1993-2102
Why Use Soft Bedding
Soft Bedding for Older Infants
To Swaddle or Not to Swaddle That is the Question
Swaddling
SwaddlingmdashIs it Safe
SwaddlingmdashMore Questionshellip
wwwhealthychildrenorg
Pacifiers
Pacifiers and Breastfeeding
Baby Friendly USA Pacifiers
Addressing Sleep Deprivation
Overcoming Barriers to Change What Parents are Sayinghellip
Factors Associated With Choice of Infant Sleep Position
Slide Number 65
What is Working
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Infant Sleep Safety
Safe Sleep Nurse Modeling
Physician Advocacy
Healthcare Provider Advice to New Mothers Safe Sleep
Mason Clinical Peds 713
Bundled Intervention = Behavior Change
Hospital Unsafe Sleep Persists
Washington DC
TodaysBaby QI Safe Sleep Teaching
TodaysBaby QI Safe Sleep Teaching
Social Media and Risk-Reduction Training Study (SMART)
The National Safe Sleep Hospital Certification Program
Coordinated Education Efforts Work
Coordinated Education Efforts Work
And Finallyhellip
Encouraging Parents to Take Action
Motivational Interviewing
Impact of Eliminating Sleep-Related Deaths
Thank You
Contact Information
Slide Number 89
IMR over time Finland vs US
Column1
correct advice
55
incorrect advice
25
no advice
20
correct advice
incorrect advice
no advice
SIDS Rate
Percent Back Sleeping
1988
14
1989
139
1990
13
1991
13
1992
12
13
1993
117
17
1994
103
269
1995
087
386
1996
074
353
1997
077
531
1998
072
557
1999
067
644
2000
062
666
2001
056
716
2002
057
711
2003
053
728
2004
056
701
2005
055
722
2006
055
757
2007
057
703
2008
055
721
2009
054
741
2010
051
728
2011
048
2012
042
2013
04
2014
039
httpwwwcdcgovNCHSdatanvsrnvsr58nvsr58_19pdf
Xu JQ Kochanek KD Murphy SL Tejada-Vera B Deaths Final data for
2007
National vital statistics reports vol 58 no 19 Hyattsville MD
National Center for Health Statistics 2010
1988
1988
1989
1989
1990
1990
1991
1991
1992
1992
1993
1993
1994
1994
1995
1995
1996
1996
1997
1997
1998
1998
1999
1999
2000
2000
2001
2001
2002
2002
2003
2003
2004
2004
2005
2005
2006
2006
2007
2007
2008
2008
2009
2009
2010
2010
2011
2012
2013
2014
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bed Sharing with Overlay
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Unsafe Bedding NISP Trends 1993-2102
Shapiro-Mendoza CK Colson ER Willinger M Rybin DV Camperlengo L Corwin MJ Trends in infant bedding use National Infant Sleep Position study 1993ndash2010 Pediatrics 2015135(1)10-17
Decrease from 86 to 55 Rate of decline decreases
2001-10 835 for teen mothers Predictors of adjusted OR
gt15
o Young motherso Non-white race
ethnicityo Less than college
education
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Why Use Soft Bedding
ComfortWarmtho Extrapolation of own feelingso Misinterpret firm with taut
bull Soft + taut ne firm
Safetyo Blankets pillows rolls to prevent falls
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Soft Bedding for Older Infants
Many parents recognize soft bedding is a risk Increased complacency as baby gets older Soft bedding is THE most important risk factor for
infants 4-12 months old (Colvin 2015) Infants roll into bedding and cannot extract
themselves
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
To Swaddle or Not to Swaddle That is the Question Pros
o Calms the infant promotes sleep decreases number of awakenings
o Encourages use of the supine position
Conso Increased respiratory rate and
reduced functional residual lung capacity
o Exacerbates hip dysplasia if the hips are kept in extension and adduction
o ldquoLooserdquo swaddling becomes loose bedding
o Overheating especially if the head is covered or the infant has infection
o Effects on arousability to an external stimulus remain unclear (conflicting data) There may be minimal effects of routine swaddling on arousal
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Swaddling
There is insufficient evidence to recommend routine swaddling as a strategy to reduce the incidence of SIDS
Swaddling must be correctly applied to avoid the possible hazards
Swaddling does not reduce the necessity to follow recommended safe sleep practices Ambrogio Lorenzettis Madonna and Child (1319)
Wikipedia
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
McDonnell E Moon RY Infant deaths and injuries associated with wearable blankets swaddle wraps and swaddling J Pediatr 20141641152-1156
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
SwaddlingmdashMore Questionshellip
Pease 2016 Pediatrics Pooled OR = 138
o Prone = 1299 o Side = 316o Supine = 193
Increased risk with age Limitations
o Heterogeneity definitions other risk factorsPease AS Fleming PJ Hauck FR et al Swaddling and the risk of sudden infant death syndrome a meta-analysis Pediatrics 2016137(6)e20153
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
wwwhealthychildrenorg
Swaddling (wrapping a light blanket snuggly around a baby) may help calm a crying baby If you swaddle your baby be sure to place him on his back to sleep Stop swaddling your baby when he starts to roll
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers
AAP recommendation Consider offering a pacifier at nap time and bedtime
Studies consistently demonstrate a protective effect of pacifiers on SIDS
Mechanism unknowno Dislodge within 15 to 60 minuteso Decreased arousal threshold
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers and Breastfeeding Well-designed trials
o 2 found no association among term infants
o 1 found no association among preterm infants
o 1 found slightly decreased breastfeeding duration at one month if pacifier introduced in first week of life but NO difference if pacifier introduced after one month
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Baby Friendly USA Pacifiers
Breastfeeding babies should not be given pacifiers by the staff of the facility with the exception of o Limited use to decrease pain during procedures when
the baby cannot safely be held or breastfed (pacifiers used should be discarded after these procedures)
o Babies who are being tube-fed in NICUo Other rare specific medical reasons
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Addressing Sleep Deprivation
Give parents tools to cope with fussy babies
Sleep-deprived parents may make poor judgments
Make use of tools o Swaddling side carrying
shushing swinging and sucking
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Overcoming Barriers to Change What Parents are Sayinghellip
Prone positioning fear of choking Baby sleeps ldquobetterrdquo on stomach Soft things are safer for the baby SIDS is ldquoGodrsquos willrdquo Why bother Recommendations keep changing
anyway Vigilance sleep with baby for protection
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Factors Associated With Choice of Infant Sleep Position 3300 mothers from 32 hospitals 77 usually use supine position 49 exclusive use supine position Most likely to use prone
o African-American motherso Mothers with lt high school educationo Lack of perceived controlo Personal attitudesocietal norms
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
A continuum starting in childhoodo Secondary school baby sitting classes
Pre-pregnancy Pregnancyprenatal education
o Prior to baby showerhellipldquowrong giftsrdquo In-hospital education and modeling
o Include family friends baby sitters Re-enforcement in the doctorrsquos office
o Especially between 1 to 4 months Grandparents They hold great power The general public (day cares religious leaders)
A Lifetime of Infant Sleep Safety
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Chart1
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
14
139
13
13
12
13
117
17
103
269
087
386
074
353
077
531
072
557
067
644
062
666
056
716
057
711
053
728
056
701
055
722
055
757
057
703
055
721
054
741
051
728
048
042
04
039
Sheet1
Sheet1
ampA
Page ampP
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
Sheet2
Pre-AAP recommendation Post-AAP RecommendationBack to SleepSafe to Sleep Campaign
Sheet3
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Infant Sleep Safety
Requires a consistent and repetitive message in the community to prevent accidental deaths
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Safe Sleep Nurse Modeling
People trust nurses Whatever the nurse does must
be correct and it will be imitated in the home
Fact supine positioning in the nursery can almost DOUBLE its use in the home
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Physician Advocacy
Srivatsa 1997 HCP education to new familieshellip34 reduction in prone sleeping
Eron 2009 Study of Central NY state physicianshellip30 identified incorrect safest sleep positionhellip30 do not discuss with families
Colson 2009 Only 13 mothers advised by MD to use supine positionhellip3 times more likely to position the baby properly
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Healthcare Provider Advice to New Mothers Safe Sleep
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Chart1
Column1
[]
[]
[]
55
25
20
Sheet1
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Mason Clinical Peds 713
Bundled interventiono Nursing education policy model behavior safe sleep
video posters in rooms declaration of safe sleep practice
Safe sleep environment uarr from 25 to 58 Intention in home 95 supine none ldquoco-sleepingrdquo
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bundled Intervention = Behavior Change
QUESTION GROUP p-value
ISS Study NISP
Behavior Questions n = 490 n = 1046
Baby routinely placed to sleep on back 925 73 lt 0001
Baby routinely sleeps in bassinetcrib 995 71 lt 00001
Baby sleeps under a thin sheet 992 86 lt 0001
Baby given a pacifier for sleep 741 84 lt 0001Goodstein MH Bell T Krugman SD Improving infant sleep safety through a comprehensive hospital-based program Clinical Pediatrics 201554(3)212-221
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
o Baseline Safe sleep 49 of 264 infants o Post 312 of 234 infants (P lt 001) o Extra blankets most common o Baseline 77 vs 44 post-intervention o Mean number of unsafe items reduced by 50 (P lt 001)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Washington DC
2 urban DC nurseries 26 did not believe or unsure that infant positioning
was associated with SIDS Top 3 factors influencing sleep position
o 56 PERSONAL PREFERENCE Why non-supine Clinical experience (25)
o Increase risk aspirationo Decrease sleep and comfort
Bartow KL Nursesrsquo knowledge and adherence to sudden infant death syndrome prevention guidelines Pediatr Nurs 201642(1)7-13
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
TodaysBaby QI Safe Sleep Teaching
QI intervention median = 160 days Mothers reported receiving information 72 to 95
(increase of 24-57) 94 babies observed supine (plus 24) 88 infants in safe sleep environment
o Increase of 33 Gains maintained up to 12 months
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Social Media and Risk-Reduction Training Study (SMART) Cluster randomization 4 groups Safe sleep or breast feeding education Nursing QI and social media (mobile health) N = 1600 1263 responses (79) Safe sleep NQI and MHealth
o Supine sleep 925 o Room-sharing 859o No soft bedding 819o Pacifier use 762
Moon RY Hauck FR Colson ER et al The effect of nursing quality improvement and mobile health interventions on infant sleep practices a randomized clinical trial JAMA 2017318(4)351-359
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Hospital Initiative ComponentswwwcribsforkidsorgHospitalInitiativeToolkit INTRODUCTORY LETTER HOSPITAL INITIATIVE TOOL KIT
INSTRUCTIONS ORGANIZATIONAL CHART HOSPITAL POLICY ACKNOWLEDGMENT FORM (Engl amp
Span) SAFE SLEEP EDUCATIONAL FLIP CHART
NONCOMPLIANCE WAIVER (Engl amp Span)
NURSING EDUCATION MODULE
SAFE SLEEP POSTERS DOOR HANGERS (Engl amp Span) GRADUATION CERTIFICATE SAMPLE LETTER TO HOSPITALS SAMPLE LETTER TO PROVIDERS INFANT SAFE SLEEP BROCHURES
(Engl amp Span) PRESS KIT
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
All materials available on-lineo No major costs to the hospital
Easy on-line access for documentation
NO FEE FOR PARTICIPATION
wwwCribsforKidsorgHospitalInitiative
Tiffany Price (tpricecribsforkidsorg)
The National Safe Sleep Hospital Certification Program
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
TNmdash25 reduction in infant sleep-related deaths in 2 years
SDmdashOver 7915 Pack lsquon Plays distributed since 2012 Infant mortality rate decreased from 86 (2012) to 48 (2016)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
2009 to 2015 38 decrease in infant mortality Decreased from 135 to 84 per 1000 SUID decreased gt50 Decrease in racial disparityhttphealthybabiesbaltimorecomhome
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
And Finallyhellip
Health care providers should have open frank nonjudgmental conversations with families about their sleep practices
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Encouraging Parents to Take Action
According to the Social Learning Theory parents are more likely to recall and comply with instructions when
the health care provider
Uses a positive tone Provides adequate information Allows the parent to ask most of the questions
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Motivational Interviewing
ldquoa collaborative goal-oriented style of communication with particular attention to the language of changerdquo
o Strengthen personal motivation and commitment to a specific goal
o Explore onersquos reasons for change (barriers)o Patient generates own solutions
bull More likely to feel realisticbull Planting seeds of change
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Impact of Eliminating Sleep-Related Deaths
Every week we lose 70 children which is equivalent to 4 kindergarten classrooms
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Thank You
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Contact Information
mgoodsteinwellspanorg
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Visit Pediatric Care Online today for additional information on this and other topics
httppediatriccaresolutionsaaporgPediatric Care Online is a convenient electronic resource for immediate expert help with
virtually every pediatric clinical information need with must-have resources that are included in a comprehensive reference library and time-saving clinical tools
Donrsquot have a subscription to PCOThen take advantage of a free trial today
Call Mead Johnson Nutrition at 888363-2362 orfor more information go to
httppediatriccaresolutionsaaporgSSFree_Trialaspx
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
IMR over time Finland vs US
Slide Number 1
Disclaimer
Objectives for Todayrsquos Talk
Infant Mortality Rates for the Five Leading Causes of Infant Death in the United States 2005 and 2011
US Post-Neonatal Mortality 2015
FACT
What is SUID or SUDI
Some Causes of Deaths that Occur Suddenly and Unexpectedly during Infancy
What is SIDS
SIDS FACTS
SIDS FACTS
Triple Risk Model to Explain SIDS
Paterson DS Krous HF Kinney HC et al JAMA 2006
An Example of SIDS Pathogenesis
2016 AAP Recommendations Infant Sleep Safety
Strength of Recommendation
Recommendations Change as the Evidence Evolves
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
Correct Safe Sleep Environment
We Need to Move Beyond Back to Sleep
Sleep Position for Healthy Newborns
Sleep Position in Newborn Nursery
Sleep Position and Reflux
The Truth About Supine Sleep and Aspiration Ending the Fallacy
Title
Infant Sleep Location
Room-Share How Long Yoursquore Kidding Right
Supporting Data
More Recent Data
Why is Room-Sharing Protective
Room-Sharing and Sleep Quality
Insight Study (Paul 2017)
Insight Study (Paul 2017)
Insight Commentary (Hauck Moon)
Feeding the Baby at Night
Say NO to Couches Sofas and Cushioned Armchairs
High-Risk Bed Sharing Situations
Bedsharing in Low-Risk Breastfed Infants
Independent Review (Dr Robert Platt)
Bed Sharing
Bed Sharing
Bed Sharing with Overlay
Bed Sharing with Overlay
Bed Sharing with Overlay
Couch Sleeping
Couch Sleeping
Couch Sleeping
Unsafe Bedding NISP Trends 1993-2102
Why Use Soft Bedding
Soft Bedding for Older Infants
To Swaddle or Not to Swaddle That is the Question
Swaddling
SwaddlingmdashIs it Safe
SwaddlingmdashMore Questionshellip
wwwhealthychildrenorg
Pacifiers
Pacifiers and Breastfeeding
Baby Friendly USA Pacifiers
Addressing Sleep Deprivation
Overcoming Barriers to Change What Parents are Sayinghellip
Factors Associated With Choice of Infant Sleep Position
Slide Number 65
What is Working
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Infant Sleep Safety
Safe Sleep Nurse Modeling
Physician Advocacy
Healthcare Provider Advice to New Mothers Safe Sleep
Mason Clinical Peds 713
Bundled Intervention = Behavior Change
Hospital Unsafe Sleep Persists
Washington DC
TodaysBaby QI Safe Sleep Teaching
TodaysBaby QI Safe Sleep Teaching
Social Media and Risk-Reduction Training Study (SMART)
The National Safe Sleep Hospital Certification Program
Coordinated Education Efforts Work
Coordinated Education Efforts Work
And Finallyhellip
Encouraging Parents to Take Action
Motivational Interviewing
Impact of Eliminating Sleep-Related Deaths
Thank You
Contact Information
Slide Number 89
IMR over time Finland vs US
Column1
correct advice
55
incorrect advice
25
no advice
20
correct advice
incorrect advice
no advice
SIDS Rate
Percent Back Sleeping
1988
14
1989
139
1990
13
1991
13
1992
12
13
1993
117
17
1994
103
269
1995
087
386
1996
074
353
1997
077
531
1998
072
557
1999
067
644
2000
062
666
2001
056
716
2002
057
711
2003
053
728
2004
056
701
2005
055
722
2006
055
757
2007
057
703
2008
055
721
2009
054
741
2010
051
728
2011
048
2012
042
2013
04
2014
039
httpwwwcdcgovNCHSdatanvsrnvsr58nvsr58_19pdf
Xu JQ Kochanek KD Murphy SL Tejada-Vera B Deaths Final data for
2007
National vital statistics reports vol 58 no 19 Hyattsville MD
National Center for Health Statistics 2010
1988
1988
1989
1989
1990
1990
1991
1991
1992
1992
1993
1993
1994
1994
1995
1995
1996
1996
1997
1997
1998
1998
1999
1999
2000
2000
2001
2001
2002
2002
2003
2003
2004
2004
2005
2005
2006
2006
2007
2007
2008
2008
2009
2009
2010
2010
2011
2012
2013
2014
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Unsafe Bedding NISP Trends 1993-2102
Shapiro-Mendoza CK Colson ER Willinger M Rybin DV Camperlengo L Corwin MJ Trends in infant bedding use National Infant Sleep Position study 1993ndash2010 Pediatrics 2015135(1)10-17
Decrease from 86 to 55 Rate of decline decreases
2001-10 835 for teen mothers Predictors of adjusted OR
gt15
o Young motherso Non-white race
ethnicityo Less than college
education
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Why Use Soft Bedding
ComfortWarmtho Extrapolation of own feelingso Misinterpret firm with taut
bull Soft + taut ne firm
Safetyo Blankets pillows rolls to prevent falls
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Soft Bedding for Older Infants
Many parents recognize soft bedding is a risk Increased complacency as baby gets older Soft bedding is THE most important risk factor for
infants 4-12 months old (Colvin 2015) Infants roll into bedding and cannot extract
themselves
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
To Swaddle or Not to Swaddle That is the Question Pros
o Calms the infant promotes sleep decreases number of awakenings
o Encourages use of the supine position
Conso Increased respiratory rate and
reduced functional residual lung capacity
o Exacerbates hip dysplasia if the hips are kept in extension and adduction
o ldquoLooserdquo swaddling becomes loose bedding
o Overheating especially if the head is covered or the infant has infection
o Effects on arousability to an external stimulus remain unclear (conflicting data) There may be minimal effects of routine swaddling on arousal
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Swaddling
There is insufficient evidence to recommend routine swaddling as a strategy to reduce the incidence of SIDS
Swaddling must be correctly applied to avoid the possible hazards
Swaddling does not reduce the necessity to follow recommended safe sleep practices Ambrogio Lorenzettis Madonna and Child (1319)
Wikipedia
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
McDonnell E Moon RY Infant deaths and injuries associated with wearable blankets swaddle wraps and swaddling J Pediatr 20141641152-1156
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
SwaddlingmdashMore Questionshellip
Pease 2016 Pediatrics Pooled OR = 138
o Prone = 1299 o Side = 316o Supine = 193
Increased risk with age Limitations
o Heterogeneity definitions other risk factorsPease AS Fleming PJ Hauck FR et al Swaddling and the risk of sudden infant death syndrome a meta-analysis Pediatrics 2016137(6)e20153
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
wwwhealthychildrenorg
Swaddling (wrapping a light blanket snuggly around a baby) may help calm a crying baby If you swaddle your baby be sure to place him on his back to sleep Stop swaddling your baby when he starts to roll
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers
AAP recommendation Consider offering a pacifier at nap time and bedtime
Studies consistently demonstrate a protective effect of pacifiers on SIDS
Mechanism unknowno Dislodge within 15 to 60 minuteso Decreased arousal threshold
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers and Breastfeeding Well-designed trials
o 2 found no association among term infants
o 1 found no association among preterm infants
o 1 found slightly decreased breastfeeding duration at one month if pacifier introduced in first week of life but NO difference if pacifier introduced after one month
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Baby Friendly USA Pacifiers
Breastfeeding babies should not be given pacifiers by the staff of the facility with the exception of o Limited use to decrease pain during procedures when
the baby cannot safely be held or breastfed (pacifiers used should be discarded after these procedures)
o Babies who are being tube-fed in NICUo Other rare specific medical reasons
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Addressing Sleep Deprivation
Give parents tools to cope with fussy babies
Sleep-deprived parents may make poor judgments
Make use of tools o Swaddling side carrying
shushing swinging and sucking
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Overcoming Barriers to Change What Parents are Sayinghellip
Prone positioning fear of choking Baby sleeps ldquobetterrdquo on stomach Soft things are safer for the baby SIDS is ldquoGodrsquos willrdquo Why bother Recommendations keep changing
anyway Vigilance sleep with baby for protection
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Factors Associated With Choice of Infant Sleep Position 3300 mothers from 32 hospitals 77 usually use supine position 49 exclusive use supine position Most likely to use prone
o African-American motherso Mothers with lt high school educationo Lack of perceived controlo Personal attitudesocietal norms
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
A continuum starting in childhoodo Secondary school baby sitting classes
Pre-pregnancy Pregnancyprenatal education
o Prior to baby showerhellipldquowrong giftsrdquo In-hospital education and modeling
o Include family friends baby sitters Re-enforcement in the doctorrsquos office
o Especially between 1 to 4 months Grandparents They hold great power The general public (day cares religious leaders)
A Lifetime of Infant Sleep Safety
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Chart1
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
14
139
13
13
12
13
117
17
103
269
087
386
074
353
077
531
072
557
067
644
062
666
056
716
057
711
053
728
056
701
055
722
055
757
057
703
055
721
054
741
051
728
048
042
04
039
Sheet1
Sheet1
ampA
Page ampP
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
Sheet2
Pre-AAP recommendation Post-AAP RecommendationBack to SleepSafe to Sleep Campaign
Sheet3
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Infant Sleep Safety
Requires a consistent and repetitive message in the community to prevent accidental deaths
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Safe Sleep Nurse Modeling
People trust nurses Whatever the nurse does must
be correct and it will be imitated in the home
Fact supine positioning in the nursery can almost DOUBLE its use in the home
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Physician Advocacy
Srivatsa 1997 HCP education to new familieshellip34 reduction in prone sleeping
Eron 2009 Study of Central NY state physicianshellip30 identified incorrect safest sleep positionhellip30 do not discuss with families
Colson 2009 Only 13 mothers advised by MD to use supine positionhellip3 times more likely to position the baby properly
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Healthcare Provider Advice to New Mothers Safe Sleep
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Chart1
Column1
[]
[]
[]
55
25
20
Sheet1
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Mason Clinical Peds 713
Bundled interventiono Nursing education policy model behavior safe sleep
video posters in rooms declaration of safe sleep practice
Safe sleep environment uarr from 25 to 58 Intention in home 95 supine none ldquoco-sleepingrdquo
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bundled Intervention = Behavior Change
QUESTION GROUP p-value
ISS Study NISP
Behavior Questions n = 490 n = 1046
Baby routinely placed to sleep on back 925 73 lt 0001
Baby routinely sleeps in bassinetcrib 995 71 lt 00001
Baby sleeps under a thin sheet 992 86 lt 0001
Baby given a pacifier for sleep 741 84 lt 0001Goodstein MH Bell T Krugman SD Improving infant sleep safety through a comprehensive hospital-based program Clinical Pediatrics 201554(3)212-221
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
o Baseline Safe sleep 49 of 264 infants o Post 312 of 234 infants (P lt 001) o Extra blankets most common o Baseline 77 vs 44 post-intervention o Mean number of unsafe items reduced by 50 (P lt 001)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Washington DC
2 urban DC nurseries 26 did not believe or unsure that infant positioning
was associated with SIDS Top 3 factors influencing sleep position
o 56 PERSONAL PREFERENCE Why non-supine Clinical experience (25)
o Increase risk aspirationo Decrease sleep and comfort
Bartow KL Nursesrsquo knowledge and adherence to sudden infant death syndrome prevention guidelines Pediatr Nurs 201642(1)7-13
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
TodaysBaby QI Safe Sleep Teaching
QI intervention median = 160 days Mothers reported receiving information 72 to 95
(increase of 24-57) 94 babies observed supine (plus 24) 88 infants in safe sleep environment
o Increase of 33 Gains maintained up to 12 months
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Social Media and Risk-Reduction Training Study (SMART) Cluster randomization 4 groups Safe sleep or breast feeding education Nursing QI and social media (mobile health) N = 1600 1263 responses (79) Safe sleep NQI and MHealth
o Supine sleep 925 o Room-sharing 859o No soft bedding 819o Pacifier use 762
Moon RY Hauck FR Colson ER et al The effect of nursing quality improvement and mobile health interventions on infant sleep practices a randomized clinical trial JAMA 2017318(4)351-359
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Hospital Initiative ComponentswwwcribsforkidsorgHospitalInitiativeToolkit INTRODUCTORY LETTER HOSPITAL INITIATIVE TOOL KIT
INSTRUCTIONS ORGANIZATIONAL CHART HOSPITAL POLICY ACKNOWLEDGMENT FORM (Engl amp
Span) SAFE SLEEP EDUCATIONAL FLIP CHART
NONCOMPLIANCE WAIVER (Engl amp Span)
NURSING EDUCATION MODULE
SAFE SLEEP POSTERS DOOR HANGERS (Engl amp Span) GRADUATION CERTIFICATE SAMPLE LETTER TO HOSPITALS SAMPLE LETTER TO PROVIDERS INFANT SAFE SLEEP BROCHURES
(Engl amp Span) PRESS KIT
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
All materials available on-lineo No major costs to the hospital
Easy on-line access for documentation
NO FEE FOR PARTICIPATION
wwwCribsforKidsorgHospitalInitiative
Tiffany Price (tpricecribsforkidsorg)
The National Safe Sleep Hospital Certification Program
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
TNmdash25 reduction in infant sleep-related deaths in 2 years
SDmdashOver 7915 Pack lsquon Plays distributed since 2012 Infant mortality rate decreased from 86 (2012) to 48 (2016)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
2009 to 2015 38 decrease in infant mortality Decreased from 135 to 84 per 1000 SUID decreased gt50 Decrease in racial disparityhttphealthybabiesbaltimorecomhome
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
And Finallyhellip
Health care providers should have open frank nonjudgmental conversations with families about their sleep practices
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Encouraging Parents to Take Action
According to the Social Learning Theory parents are more likely to recall and comply with instructions when
the health care provider
Uses a positive tone Provides adequate information Allows the parent to ask most of the questions
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Motivational Interviewing
ldquoa collaborative goal-oriented style of communication with particular attention to the language of changerdquo
o Strengthen personal motivation and commitment to a specific goal
o Explore onersquos reasons for change (barriers)o Patient generates own solutions
bull More likely to feel realisticbull Planting seeds of change
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Impact of Eliminating Sleep-Related Deaths
Every week we lose 70 children which is equivalent to 4 kindergarten classrooms
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Thank You
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Contact Information
mgoodsteinwellspanorg
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Visit Pediatric Care Online today for additional information on this and other topics
httppediatriccaresolutionsaaporgPediatric Care Online is a convenient electronic resource for immediate expert help with
virtually every pediatric clinical information need with must-have resources that are included in a comprehensive reference library and time-saving clinical tools
Donrsquot have a subscription to PCOThen take advantage of a free trial today
Call Mead Johnson Nutrition at 888363-2362 orfor more information go to
httppediatriccaresolutionsaaporgSSFree_Trialaspx
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
IMR over time Finland vs US
Slide Number 1
Disclaimer
Objectives for Todayrsquos Talk
Infant Mortality Rates for the Five Leading Causes of Infant Death in the United States 2005 and 2011
US Post-Neonatal Mortality 2015
FACT
What is SUID or SUDI
Some Causes of Deaths that Occur Suddenly and Unexpectedly during Infancy
What is SIDS
SIDS FACTS
SIDS FACTS
Triple Risk Model to Explain SIDS
Paterson DS Krous HF Kinney HC et al JAMA 2006
An Example of SIDS Pathogenesis
2016 AAP Recommendations Infant Sleep Safety
Strength of Recommendation
Recommendations Change as the Evidence Evolves
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
Correct Safe Sleep Environment
We Need to Move Beyond Back to Sleep
Sleep Position for Healthy Newborns
Sleep Position in Newborn Nursery
Sleep Position and Reflux
The Truth About Supine Sleep and Aspiration Ending the Fallacy
Title
Infant Sleep Location
Room-Share How Long Yoursquore Kidding Right
Supporting Data
More Recent Data
Why is Room-Sharing Protective
Room-Sharing and Sleep Quality
Insight Study (Paul 2017)
Insight Study (Paul 2017)
Insight Commentary (Hauck Moon)
Feeding the Baby at Night
Say NO to Couches Sofas and Cushioned Armchairs
High-Risk Bed Sharing Situations
Bedsharing in Low-Risk Breastfed Infants
Independent Review (Dr Robert Platt)
Bed Sharing
Bed Sharing
Bed Sharing with Overlay
Bed Sharing with Overlay
Bed Sharing with Overlay
Couch Sleeping
Couch Sleeping
Couch Sleeping
Unsafe Bedding NISP Trends 1993-2102
Why Use Soft Bedding
Soft Bedding for Older Infants
To Swaddle or Not to Swaddle That is the Question
Swaddling
SwaddlingmdashIs it Safe
SwaddlingmdashMore Questionshellip
wwwhealthychildrenorg
Pacifiers
Pacifiers and Breastfeeding
Baby Friendly USA Pacifiers
Addressing Sleep Deprivation
Overcoming Barriers to Change What Parents are Sayinghellip
Factors Associated With Choice of Infant Sleep Position
Slide Number 65
What is Working
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Infant Sleep Safety
Safe Sleep Nurse Modeling
Physician Advocacy
Healthcare Provider Advice to New Mothers Safe Sleep
Mason Clinical Peds 713
Bundled Intervention = Behavior Change
Hospital Unsafe Sleep Persists
Washington DC
TodaysBaby QI Safe Sleep Teaching
TodaysBaby QI Safe Sleep Teaching
Social Media and Risk-Reduction Training Study (SMART)
The National Safe Sleep Hospital Certification Program
Coordinated Education Efforts Work
Coordinated Education Efforts Work
And Finallyhellip
Encouraging Parents to Take Action
Motivational Interviewing
Impact of Eliminating Sleep-Related Deaths
Thank You
Contact Information
Slide Number 89
IMR over time Finland vs US
Column1
correct advice
55
incorrect advice
25
no advice
20
correct advice
incorrect advice
no advice
SIDS Rate
Percent Back Sleeping
1988
14
1989
139
1990
13
1991
13
1992
12
13
1993
117
17
1994
103
269
1995
087
386
1996
074
353
1997
077
531
1998
072
557
1999
067
644
2000
062
666
2001
056
716
2002
057
711
2003
053
728
2004
056
701
2005
055
722
2006
055
757
2007
057
703
2008
055
721
2009
054
741
2010
051
728
2011
048
2012
042
2013
04
2014
039
httpwwwcdcgovNCHSdatanvsrnvsr58nvsr58_19pdf
Xu JQ Kochanek KD Murphy SL Tejada-Vera B Deaths Final data for
2007
National vital statistics reports vol 58 no 19 Hyattsville MD
National Center for Health Statistics 2010
1988
1988
1989
1989
1990
1990
1991
1991
1992
1992
1993
1993
1994
1994
1995
1995
1996
1996
1997
1997
1998
1998
1999
1999
2000
2000
2001
2001
2002
2002
2003
2003
2004
2004
2005
2005
2006
2006
2007
2007
2008
2008
2009
2009
2010
2010
2011
2012
2013
2014
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Unsafe Bedding NISP Trends 1993-2102
Shapiro-Mendoza CK Colson ER Willinger M Rybin DV Camperlengo L Corwin MJ Trends in infant bedding use National Infant Sleep Position study 1993ndash2010 Pediatrics 2015135(1)10-17
Decrease from 86 to 55 Rate of decline decreases
2001-10 835 for teen mothers Predictors of adjusted OR
gt15
o Young motherso Non-white race
ethnicityo Less than college
education
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Why Use Soft Bedding
ComfortWarmtho Extrapolation of own feelingso Misinterpret firm with taut
bull Soft + taut ne firm
Safetyo Blankets pillows rolls to prevent falls
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Soft Bedding for Older Infants
Many parents recognize soft bedding is a risk Increased complacency as baby gets older Soft bedding is THE most important risk factor for
infants 4-12 months old (Colvin 2015) Infants roll into bedding and cannot extract
themselves
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
To Swaddle or Not to Swaddle That is the Question Pros
o Calms the infant promotes sleep decreases number of awakenings
o Encourages use of the supine position
Conso Increased respiratory rate and
reduced functional residual lung capacity
o Exacerbates hip dysplasia if the hips are kept in extension and adduction
o ldquoLooserdquo swaddling becomes loose bedding
o Overheating especially if the head is covered or the infant has infection
o Effects on arousability to an external stimulus remain unclear (conflicting data) There may be minimal effects of routine swaddling on arousal
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Swaddling
There is insufficient evidence to recommend routine swaddling as a strategy to reduce the incidence of SIDS
Swaddling must be correctly applied to avoid the possible hazards
Swaddling does not reduce the necessity to follow recommended safe sleep practices Ambrogio Lorenzettis Madonna and Child (1319)
Wikipedia
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
McDonnell E Moon RY Infant deaths and injuries associated with wearable blankets swaddle wraps and swaddling J Pediatr 20141641152-1156
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
SwaddlingmdashMore Questionshellip
Pease 2016 Pediatrics Pooled OR = 138
o Prone = 1299 o Side = 316o Supine = 193
Increased risk with age Limitations
o Heterogeneity definitions other risk factorsPease AS Fleming PJ Hauck FR et al Swaddling and the risk of sudden infant death syndrome a meta-analysis Pediatrics 2016137(6)e20153
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
wwwhealthychildrenorg
Swaddling (wrapping a light blanket snuggly around a baby) may help calm a crying baby If you swaddle your baby be sure to place him on his back to sleep Stop swaddling your baby when he starts to roll
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers
AAP recommendation Consider offering a pacifier at nap time and bedtime
Studies consistently demonstrate a protective effect of pacifiers on SIDS
Mechanism unknowno Dislodge within 15 to 60 minuteso Decreased arousal threshold
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers and Breastfeeding Well-designed trials
o 2 found no association among term infants
o 1 found no association among preterm infants
o 1 found slightly decreased breastfeeding duration at one month if pacifier introduced in first week of life but NO difference if pacifier introduced after one month
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Baby Friendly USA Pacifiers
Breastfeeding babies should not be given pacifiers by the staff of the facility with the exception of o Limited use to decrease pain during procedures when
the baby cannot safely be held or breastfed (pacifiers used should be discarded after these procedures)
o Babies who are being tube-fed in NICUo Other rare specific medical reasons
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Addressing Sleep Deprivation
Give parents tools to cope with fussy babies
Sleep-deprived parents may make poor judgments
Make use of tools o Swaddling side carrying
shushing swinging and sucking
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Overcoming Barriers to Change What Parents are Sayinghellip
Prone positioning fear of choking Baby sleeps ldquobetterrdquo on stomach Soft things are safer for the baby SIDS is ldquoGodrsquos willrdquo Why bother Recommendations keep changing
anyway Vigilance sleep with baby for protection
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Factors Associated With Choice of Infant Sleep Position 3300 mothers from 32 hospitals 77 usually use supine position 49 exclusive use supine position Most likely to use prone
o African-American motherso Mothers with lt high school educationo Lack of perceived controlo Personal attitudesocietal norms
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
A continuum starting in childhoodo Secondary school baby sitting classes
Pre-pregnancy Pregnancyprenatal education
o Prior to baby showerhellipldquowrong giftsrdquo In-hospital education and modeling
o Include family friends baby sitters Re-enforcement in the doctorrsquos office
o Especially between 1 to 4 months Grandparents They hold great power The general public (day cares religious leaders)
A Lifetime of Infant Sleep Safety
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Chart1
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
14
139
13
13
12
13
117
17
103
269
087
386
074
353
077
531
072
557
067
644
062
666
056
716
057
711
053
728
056
701
055
722
055
757
057
703
055
721
054
741
051
728
048
042
04
039
Sheet1
Sheet1
ampA
Page ampP
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
Sheet2
Pre-AAP recommendation Post-AAP RecommendationBack to SleepSafe to Sleep Campaign
Sheet3
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Infant Sleep Safety
Requires a consistent and repetitive message in the community to prevent accidental deaths
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Safe Sleep Nurse Modeling
People trust nurses Whatever the nurse does must
be correct and it will be imitated in the home
Fact supine positioning in the nursery can almost DOUBLE its use in the home
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Physician Advocacy
Srivatsa 1997 HCP education to new familieshellip34 reduction in prone sleeping
Eron 2009 Study of Central NY state physicianshellip30 identified incorrect safest sleep positionhellip30 do not discuss with families
Colson 2009 Only 13 mothers advised by MD to use supine positionhellip3 times more likely to position the baby properly
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Healthcare Provider Advice to New Mothers Safe Sleep
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Chart1
Column1
[]
[]
[]
55
25
20
Sheet1
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Mason Clinical Peds 713
Bundled interventiono Nursing education policy model behavior safe sleep
video posters in rooms declaration of safe sleep practice
Safe sleep environment uarr from 25 to 58 Intention in home 95 supine none ldquoco-sleepingrdquo
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bundled Intervention = Behavior Change
QUESTION GROUP p-value
ISS Study NISP
Behavior Questions n = 490 n = 1046
Baby routinely placed to sleep on back 925 73 lt 0001
Baby routinely sleeps in bassinetcrib 995 71 lt 00001
Baby sleeps under a thin sheet 992 86 lt 0001
Baby given a pacifier for sleep 741 84 lt 0001Goodstein MH Bell T Krugman SD Improving infant sleep safety through a comprehensive hospital-based program Clinical Pediatrics 201554(3)212-221
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
o Baseline Safe sleep 49 of 264 infants o Post 312 of 234 infants (P lt 001) o Extra blankets most common o Baseline 77 vs 44 post-intervention o Mean number of unsafe items reduced by 50 (P lt 001)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Washington DC
2 urban DC nurseries 26 did not believe or unsure that infant positioning
was associated with SIDS Top 3 factors influencing sleep position
o 56 PERSONAL PREFERENCE Why non-supine Clinical experience (25)
o Increase risk aspirationo Decrease sleep and comfort
Bartow KL Nursesrsquo knowledge and adherence to sudden infant death syndrome prevention guidelines Pediatr Nurs 201642(1)7-13
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
TodaysBaby QI Safe Sleep Teaching
QI intervention median = 160 days Mothers reported receiving information 72 to 95
(increase of 24-57) 94 babies observed supine (plus 24) 88 infants in safe sleep environment
o Increase of 33 Gains maintained up to 12 months
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Social Media and Risk-Reduction Training Study (SMART) Cluster randomization 4 groups Safe sleep or breast feeding education Nursing QI and social media (mobile health) N = 1600 1263 responses (79) Safe sleep NQI and MHealth
o Supine sleep 925 o Room-sharing 859o No soft bedding 819o Pacifier use 762
Moon RY Hauck FR Colson ER et al The effect of nursing quality improvement and mobile health interventions on infant sleep practices a randomized clinical trial JAMA 2017318(4)351-359
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Hospital Initiative ComponentswwwcribsforkidsorgHospitalInitiativeToolkit INTRODUCTORY LETTER HOSPITAL INITIATIVE TOOL KIT
INSTRUCTIONS ORGANIZATIONAL CHART HOSPITAL POLICY ACKNOWLEDGMENT FORM (Engl amp
Span) SAFE SLEEP EDUCATIONAL FLIP CHART
NONCOMPLIANCE WAIVER (Engl amp Span)
NURSING EDUCATION MODULE
SAFE SLEEP POSTERS DOOR HANGERS (Engl amp Span) GRADUATION CERTIFICATE SAMPLE LETTER TO HOSPITALS SAMPLE LETTER TO PROVIDERS INFANT SAFE SLEEP BROCHURES
(Engl amp Span) PRESS KIT
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
All materials available on-lineo No major costs to the hospital
Easy on-line access for documentation
NO FEE FOR PARTICIPATION
wwwCribsforKidsorgHospitalInitiative
Tiffany Price (tpricecribsforkidsorg)
The National Safe Sleep Hospital Certification Program
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
TNmdash25 reduction in infant sleep-related deaths in 2 years
SDmdashOver 7915 Pack lsquon Plays distributed since 2012 Infant mortality rate decreased from 86 (2012) to 48 (2016)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
2009 to 2015 38 decrease in infant mortality Decreased from 135 to 84 per 1000 SUID decreased gt50 Decrease in racial disparityhttphealthybabiesbaltimorecomhome
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
And Finallyhellip
Health care providers should have open frank nonjudgmental conversations with families about their sleep practices
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Encouraging Parents to Take Action
According to the Social Learning Theory parents are more likely to recall and comply with instructions when
the health care provider
Uses a positive tone Provides adequate information Allows the parent to ask most of the questions
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Motivational Interviewing
ldquoa collaborative goal-oriented style of communication with particular attention to the language of changerdquo
o Strengthen personal motivation and commitment to a specific goal
o Explore onersquos reasons for change (barriers)o Patient generates own solutions
bull More likely to feel realisticbull Planting seeds of change
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Impact of Eliminating Sleep-Related Deaths
Every week we lose 70 children which is equivalent to 4 kindergarten classrooms
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Thank You
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Contact Information
mgoodsteinwellspanorg
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Visit Pediatric Care Online today for additional information on this and other topics
httppediatriccaresolutionsaaporgPediatric Care Online is a convenient electronic resource for immediate expert help with
virtually every pediatric clinical information need with must-have resources that are included in a comprehensive reference library and time-saving clinical tools
Donrsquot have a subscription to PCOThen take advantage of a free trial today
Call Mead Johnson Nutrition at 888363-2362 orfor more information go to
httppediatriccaresolutionsaaporgSSFree_Trialaspx
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
IMR over time Finland vs US
Slide Number 1
Disclaimer
Objectives for Todayrsquos Talk
Infant Mortality Rates for the Five Leading Causes of Infant Death in the United States 2005 and 2011
US Post-Neonatal Mortality 2015
FACT
What is SUID or SUDI
Some Causes of Deaths that Occur Suddenly and Unexpectedly during Infancy
What is SIDS
SIDS FACTS
SIDS FACTS
Triple Risk Model to Explain SIDS
Paterson DS Krous HF Kinney HC et al JAMA 2006
An Example of SIDS Pathogenesis
2016 AAP Recommendations Infant Sleep Safety
Strength of Recommendation
Recommendations Change as the Evidence Evolves
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
Correct Safe Sleep Environment
We Need to Move Beyond Back to Sleep
Sleep Position for Healthy Newborns
Sleep Position in Newborn Nursery
Sleep Position and Reflux
The Truth About Supine Sleep and Aspiration Ending the Fallacy
Title
Infant Sleep Location
Room-Share How Long Yoursquore Kidding Right
Supporting Data
More Recent Data
Why is Room-Sharing Protective
Room-Sharing and Sleep Quality
Insight Study (Paul 2017)
Insight Study (Paul 2017)
Insight Commentary (Hauck Moon)
Feeding the Baby at Night
Say NO to Couches Sofas and Cushioned Armchairs
High-Risk Bed Sharing Situations
Bedsharing in Low-Risk Breastfed Infants
Independent Review (Dr Robert Platt)
Bed Sharing
Bed Sharing
Bed Sharing with Overlay
Bed Sharing with Overlay
Bed Sharing with Overlay
Couch Sleeping
Couch Sleeping
Couch Sleeping
Unsafe Bedding NISP Trends 1993-2102
Why Use Soft Bedding
Soft Bedding for Older Infants
To Swaddle or Not to Swaddle That is the Question
Swaddling
SwaddlingmdashIs it Safe
SwaddlingmdashMore Questionshellip
wwwhealthychildrenorg
Pacifiers
Pacifiers and Breastfeeding
Baby Friendly USA Pacifiers
Addressing Sleep Deprivation
Overcoming Barriers to Change What Parents are Sayinghellip
Factors Associated With Choice of Infant Sleep Position
Slide Number 65
What is Working
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Infant Sleep Safety
Safe Sleep Nurse Modeling
Physician Advocacy
Healthcare Provider Advice to New Mothers Safe Sleep
Mason Clinical Peds 713
Bundled Intervention = Behavior Change
Hospital Unsafe Sleep Persists
Washington DC
TodaysBaby QI Safe Sleep Teaching
TodaysBaby QI Safe Sleep Teaching
Social Media and Risk-Reduction Training Study (SMART)
The National Safe Sleep Hospital Certification Program
Coordinated Education Efforts Work
Coordinated Education Efforts Work
And Finallyhellip
Encouraging Parents to Take Action
Motivational Interviewing
Impact of Eliminating Sleep-Related Deaths
Thank You
Contact Information
Slide Number 89
IMR over time Finland vs US
Column1
correct advice
55
incorrect advice
25
no advice
20
correct advice
incorrect advice
no advice
SIDS Rate
Percent Back Sleeping
1988
14
1989
139
1990
13
1991
13
1992
12
13
1993
117
17
1994
103
269
1995
087
386
1996
074
353
1997
077
531
1998
072
557
1999
067
644
2000
062
666
2001
056
716
2002
057
711
2003
053
728
2004
056
701
2005
055
722
2006
055
757
2007
057
703
2008
055
721
2009
054
741
2010
051
728
2011
048
2012
042
2013
04
2014
039
httpwwwcdcgovNCHSdatanvsrnvsr58nvsr58_19pdf
Xu JQ Kochanek KD Murphy SL Tejada-Vera B Deaths Final data for
2007
National vital statistics reports vol 58 no 19 Hyattsville MD
National Center for Health Statistics 2010
1988
1988
1989
1989
1990
1990
1991
1991
1992
1992
1993
1993
1994
1994
1995
1995
1996
1996
1997
1997
1998
1998
1999
1999
2000
2000
2001
2001
2002
2002
2003
2003
2004
2004
2005
2005
2006
2006
2007
2007
2008
2008
2009
2009
2010
2010
2011
2012
2013
2014
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Couch Sleeping
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Unsafe Bedding NISP Trends 1993-2102
Shapiro-Mendoza CK Colson ER Willinger M Rybin DV Camperlengo L Corwin MJ Trends in infant bedding use National Infant Sleep Position study 1993ndash2010 Pediatrics 2015135(1)10-17
Decrease from 86 to 55 Rate of decline decreases
2001-10 835 for teen mothers Predictors of adjusted OR
gt15
o Young motherso Non-white race
ethnicityo Less than college
education
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Why Use Soft Bedding
ComfortWarmtho Extrapolation of own feelingso Misinterpret firm with taut
bull Soft + taut ne firm
Safetyo Blankets pillows rolls to prevent falls
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Soft Bedding for Older Infants
Many parents recognize soft bedding is a risk Increased complacency as baby gets older Soft bedding is THE most important risk factor for
infants 4-12 months old (Colvin 2015) Infants roll into bedding and cannot extract
themselves
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
To Swaddle or Not to Swaddle That is the Question Pros
o Calms the infant promotes sleep decreases number of awakenings
o Encourages use of the supine position
Conso Increased respiratory rate and
reduced functional residual lung capacity
o Exacerbates hip dysplasia if the hips are kept in extension and adduction
o ldquoLooserdquo swaddling becomes loose bedding
o Overheating especially if the head is covered or the infant has infection
o Effects on arousability to an external stimulus remain unclear (conflicting data) There may be minimal effects of routine swaddling on arousal
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Swaddling
There is insufficient evidence to recommend routine swaddling as a strategy to reduce the incidence of SIDS
Swaddling must be correctly applied to avoid the possible hazards
Swaddling does not reduce the necessity to follow recommended safe sleep practices Ambrogio Lorenzettis Madonna and Child (1319)
Wikipedia
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
McDonnell E Moon RY Infant deaths and injuries associated with wearable blankets swaddle wraps and swaddling J Pediatr 20141641152-1156
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
SwaddlingmdashMore Questionshellip
Pease 2016 Pediatrics Pooled OR = 138
o Prone = 1299 o Side = 316o Supine = 193
Increased risk with age Limitations
o Heterogeneity definitions other risk factorsPease AS Fleming PJ Hauck FR et al Swaddling and the risk of sudden infant death syndrome a meta-analysis Pediatrics 2016137(6)e20153
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
wwwhealthychildrenorg
Swaddling (wrapping a light blanket snuggly around a baby) may help calm a crying baby If you swaddle your baby be sure to place him on his back to sleep Stop swaddling your baby when he starts to roll
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers
AAP recommendation Consider offering a pacifier at nap time and bedtime
Studies consistently demonstrate a protective effect of pacifiers on SIDS
Mechanism unknowno Dislodge within 15 to 60 minuteso Decreased arousal threshold
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers and Breastfeeding Well-designed trials
o 2 found no association among term infants
o 1 found no association among preterm infants
o 1 found slightly decreased breastfeeding duration at one month if pacifier introduced in first week of life but NO difference if pacifier introduced after one month
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Baby Friendly USA Pacifiers
Breastfeeding babies should not be given pacifiers by the staff of the facility with the exception of o Limited use to decrease pain during procedures when
the baby cannot safely be held or breastfed (pacifiers used should be discarded after these procedures)
o Babies who are being tube-fed in NICUo Other rare specific medical reasons
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Addressing Sleep Deprivation
Give parents tools to cope with fussy babies
Sleep-deprived parents may make poor judgments
Make use of tools o Swaddling side carrying
shushing swinging and sucking
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Overcoming Barriers to Change What Parents are Sayinghellip
Prone positioning fear of choking Baby sleeps ldquobetterrdquo on stomach Soft things are safer for the baby SIDS is ldquoGodrsquos willrdquo Why bother Recommendations keep changing
anyway Vigilance sleep with baby for protection
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Factors Associated With Choice of Infant Sleep Position 3300 mothers from 32 hospitals 77 usually use supine position 49 exclusive use supine position Most likely to use prone
o African-American motherso Mothers with lt high school educationo Lack of perceived controlo Personal attitudesocietal norms
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
A continuum starting in childhoodo Secondary school baby sitting classes
Pre-pregnancy Pregnancyprenatal education
o Prior to baby showerhellipldquowrong giftsrdquo In-hospital education and modeling
o Include family friends baby sitters Re-enforcement in the doctorrsquos office
o Especially between 1 to 4 months Grandparents They hold great power The general public (day cares religious leaders)
A Lifetime of Infant Sleep Safety
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Chart1
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
14
139
13
13
12
13
117
17
103
269
087
386
074
353
077
531
072
557
067
644
062
666
056
716
057
711
053
728
056
701
055
722
055
757
057
703
055
721
054
741
051
728
048
042
04
039
Sheet1
Sheet1
ampA
Page ampP
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
Sheet2
Pre-AAP recommendation Post-AAP RecommendationBack to SleepSafe to Sleep Campaign
Sheet3
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Infant Sleep Safety
Requires a consistent and repetitive message in the community to prevent accidental deaths
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Safe Sleep Nurse Modeling
People trust nurses Whatever the nurse does must
be correct and it will be imitated in the home
Fact supine positioning in the nursery can almost DOUBLE its use in the home
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Physician Advocacy
Srivatsa 1997 HCP education to new familieshellip34 reduction in prone sleeping
Eron 2009 Study of Central NY state physicianshellip30 identified incorrect safest sleep positionhellip30 do not discuss with families
Colson 2009 Only 13 mothers advised by MD to use supine positionhellip3 times more likely to position the baby properly
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Healthcare Provider Advice to New Mothers Safe Sleep
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Chart1
Column1
[]
[]
[]
55
25
20
Sheet1
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Mason Clinical Peds 713
Bundled interventiono Nursing education policy model behavior safe sleep
video posters in rooms declaration of safe sleep practice
Safe sleep environment uarr from 25 to 58 Intention in home 95 supine none ldquoco-sleepingrdquo
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bundled Intervention = Behavior Change
QUESTION GROUP p-value
ISS Study NISP
Behavior Questions n = 490 n = 1046
Baby routinely placed to sleep on back 925 73 lt 0001
Baby routinely sleeps in bassinetcrib 995 71 lt 00001
Baby sleeps under a thin sheet 992 86 lt 0001
Baby given a pacifier for sleep 741 84 lt 0001Goodstein MH Bell T Krugman SD Improving infant sleep safety through a comprehensive hospital-based program Clinical Pediatrics 201554(3)212-221
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
o Baseline Safe sleep 49 of 264 infants o Post 312 of 234 infants (P lt 001) o Extra blankets most common o Baseline 77 vs 44 post-intervention o Mean number of unsafe items reduced by 50 (P lt 001)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Washington DC
2 urban DC nurseries 26 did not believe or unsure that infant positioning
was associated with SIDS Top 3 factors influencing sleep position
o 56 PERSONAL PREFERENCE Why non-supine Clinical experience (25)
o Increase risk aspirationo Decrease sleep and comfort
Bartow KL Nursesrsquo knowledge and adherence to sudden infant death syndrome prevention guidelines Pediatr Nurs 201642(1)7-13
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
TodaysBaby QI Safe Sleep Teaching
QI intervention median = 160 days Mothers reported receiving information 72 to 95
(increase of 24-57) 94 babies observed supine (plus 24) 88 infants in safe sleep environment
o Increase of 33 Gains maintained up to 12 months
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Social Media and Risk-Reduction Training Study (SMART) Cluster randomization 4 groups Safe sleep or breast feeding education Nursing QI and social media (mobile health) N = 1600 1263 responses (79) Safe sleep NQI and MHealth
o Supine sleep 925 o Room-sharing 859o No soft bedding 819o Pacifier use 762
Moon RY Hauck FR Colson ER et al The effect of nursing quality improvement and mobile health interventions on infant sleep practices a randomized clinical trial JAMA 2017318(4)351-359
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Hospital Initiative ComponentswwwcribsforkidsorgHospitalInitiativeToolkit INTRODUCTORY LETTER HOSPITAL INITIATIVE TOOL KIT
INSTRUCTIONS ORGANIZATIONAL CHART HOSPITAL POLICY ACKNOWLEDGMENT FORM (Engl amp
Span) SAFE SLEEP EDUCATIONAL FLIP CHART
NONCOMPLIANCE WAIVER (Engl amp Span)
NURSING EDUCATION MODULE
SAFE SLEEP POSTERS DOOR HANGERS (Engl amp Span) GRADUATION CERTIFICATE SAMPLE LETTER TO HOSPITALS SAMPLE LETTER TO PROVIDERS INFANT SAFE SLEEP BROCHURES
(Engl amp Span) PRESS KIT
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
All materials available on-lineo No major costs to the hospital
Easy on-line access for documentation
NO FEE FOR PARTICIPATION
wwwCribsforKidsorgHospitalInitiative
Tiffany Price (tpricecribsforkidsorg)
The National Safe Sleep Hospital Certification Program
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
TNmdash25 reduction in infant sleep-related deaths in 2 years
SDmdashOver 7915 Pack lsquon Plays distributed since 2012 Infant mortality rate decreased from 86 (2012) to 48 (2016)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
2009 to 2015 38 decrease in infant mortality Decreased from 135 to 84 per 1000 SUID decreased gt50 Decrease in racial disparityhttphealthybabiesbaltimorecomhome
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
And Finallyhellip
Health care providers should have open frank nonjudgmental conversations with families about their sleep practices
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Encouraging Parents to Take Action
According to the Social Learning Theory parents are more likely to recall and comply with instructions when
the health care provider
Uses a positive tone Provides adequate information Allows the parent to ask most of the questions
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Motivational Interviewing
ldquoa collaborative goal-oriented style of communication with particular attention to the language of changerdquo
o Strengthen personal motivation and commitment to a specific goal
o Explore onersquos reasons for change (barriers)o Patient generates own solutions
bull More likely to feel realisticbull Planting seeds of change
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Impact of Eliminating Sleep-Related Deaths
Every week we lose 70 children which is equivalent to 4 kindergarten classrooms
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Thank You
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Contact Information
mgoodsteinwellspanorg
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Visit Pediatric Care Online today for additional information on this and other topics
httppediatriccaresolutionsaaporgPediatric Care Online is a convenient electronic resource for immediate expert help with
virtually every pediatric clinical information need with must-have resources that are included in a comprehensive reference library and time-saving clinical tools
Donrsquot have a subscription to PCOThen take advantage of a free trial today
Call Mead Johnson Nutrition at 888363-2362 orfor more information go to
httppediatriccaresolutionsaaporgSSFree_Trialaspx
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
IMR over time Finland vs US
Slide Number 1
Disclaimer
Objectives for Todayrsquos Talk
Infant Mortality Rates for the Five Leading Causes of Infant Death in the United States 2005 and 2011
US Post-Neonatal Mortality 2015
FACT
What is SUID or SUDI
Some Causes of Deaths that Occur Suddenly and Unexpectedly during Infancy
What is SIDS
SIDS FACTS
SIDS FACTS
Triple Risk Model to Explain SIDS
Paterson DS Krous HF Kinney HC et al JAMA 2006
An Example of SIDS Pathogenesis
2016 AAP Recommendations Infant Sleep Safety
Strength of Recommendation
Recommendations Change as the Evidence Evolves
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
Correct Safe Sleep Environment
We Need to Move Beyond Back to Sleep
Sleep Position for Healthy Newborns
Sleep Position in Newborn Nursery
Sleep Position and Reflux
The Truth About Supine Sleep and Aspiration Ending the Fallacy
Title
Infant Sleep Location
Room-Share How Long Yoursquore Kidding Right
Supporting Data
More Recent Data
Why is Room-Sharing Protective
Room-Sharing and Sleep Quality
Insight Study (Paul 2017)
Insight Study (Paul 2017)
Insight Commentary (Hauck Moon)
Feeding the Baby at Night
Say NO to Couches Sofas and Cushioned Armchairs
High-Risk Bed Sharing Situations
Bedsharing in Low-Risk Breastfed Infants
Independent Review (Dr Robert Platt)
Bed Sharing
Bed Sharing
Bed Sharing with Overlay
Bed Sharing with Overlay
Bed Sharing with Overlay
Couch Sleeping
Couch Sleeping
Couch Sleeping
Unsafe Bedding NISP Trends 1993-2102
Why Use Soft Bedding
Soft Bedding for Older Infants
To Swaddle or Not to Swaddle That is the Question
Swaddling
SwaddlingmdashIs it Safe
SwaddlingmdashMore Questionshellip
wwwhealthychildrenorg
Pacifiers
Pacifiers and Breastfeeding
Baby Friendly USA Pacifiers
Addressing Sleep Deprivation
Overcoming Barriers to Change What Parents are Sayinghellip
Factors Associated With Choice of Infant Sleep Position
Slide Number 65
What is Working
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Infant Sleep Safety
Safe Sleep Nurse Modeling
Physician Advocacy
Healthcare Provider Advice to New Mothers Safe Sleep
Mason Clinical Peds 713
Bundled Intervention = Behavior Change
Hospital Unsafe Sleep Persists
Washington DC
TodaysBaby QI Safe Sleep Teaching
TodaysBaby QI Safe Sleep Teaching
Social Media and Risk-Reduction Training Study (SMART)
The National Safe Sleep Hospital Certification Program
Coordinated Education Efforts Work
Coordinated Education Efforts Work
And Finallyhellip
Encouraging Parents to Take Action
Motivational Interviewing
Impact of Eliminating Sleep-Related Deaths
Thank You
Contact Information
Slide Number 89
IMR over time Finland vs US
Column1
correct advice
55
incorrect advice
25
no advice
20
correct advice
incorrect advice
no advice
SIDS Rate
Percent Back Sleeping
1988
14
1989
139
1990
13
1991
13
1992
12
13
1993
117
17
1994
103
269
1995
087
386
1996
074
353
1997
077
531
1998
072
557
1999
067
644
2000
062
666
2001
056
716
2002
057
711
2003
053
728
2004
056
701
2005
055
722
2006
055
757
2007
057
703
2008
055
721
2009
054
741
2010
051
728
2011
048
2012
042
2013
04
2014
039
httpwwwcdcgovNCHSdatanvsrnvsr58nvsr58_19pdf
Xu JQ Kochanek KD Murphy SL Tejada-Vera B Deaths Final data for
2007
National vital statistics reports vol 58 no 19 Hyattsville MD
National Center for Health Statistics 2010
1988
1988
1989
1989
1990
1990
1991
1991
1992
1992
1993
1993
1994
1994
1995
1995
1996
1996
1997
1997
1998
1998
1999
1999
2000
2000
2001
2001
2002
2002
2003
2003
2004
2004
2005
2005
2006
2006
2007
2007
2008
2008
2009
2009
2010
2010
2011
2012
2013
2014
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Unsafe Bedding NISP Trends 1993-2102
Shapiro-Mendoza CK Colson ER Willinger M Rybin DV Camperlengo L Corwin MJ Trends in infant bedding use National Infant Sleep Position study 1993ndash2010 Pediatrics 2015135(1)10-17
Decrease from 86 to 55 Rate of decline decreases
2001-10 835 for teen mothers Predictors of adjusted OR
gt15
o Young motherso Non-white race
ethnicityo Less than college
education
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Why Use Soft Bedding
ComfortWarmtho Extrapolation of own feelingso Misinterpret firm with taut
bull Soft + taut ne firm
Safetyo Blankets pillows rolls to prevent falls
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Soft Bedding for Older Infants
Many parents recognize soft bedding is a risk Increased complacency as baby gets older Soft bedding is THE most important risk factor for
infants 4-12 months old (Colvin 2015) Infants roll into bedding and cannot extract
themselves
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
To Swaddle or Not to Swaddle That is the Question Pros
o Calms the infant promotes sleep decreases number of awakenings
o Encourages use of the supine position
Conso Increased respiratory rate and
reduced functional residual lung capacity
o Exacerbates hip dysplasia if the hips are kept in extension and adduction
o ldquoLooserdquo swaddling becomes loose bedding
o Overheating especially if the head is covered or the infant has infection
o Effects on arousability to an external stimulus remain unclear (conflicting data) There may be minimal effects of routine swaddling on arousal
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Swaddling
There is insufficient evidence to recommend routine swaddling as a strategy to reduce the incidence of SIDS
Swaddling must be correctly applied to avoid the possible hazards
Swaddling does not reduce the necessity to follow recommended safe sleep practices Ambrogio Lorenzettis Madonna and Child (1319)
Wikipedia
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
McDonnell E Moon RY Infant deaths and injuries associated with wearable blankets swaddle wraps and swaddling J Pediatr 20141641152-1156
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
SwaddlingmdashMore Questionshellip
Pease 2016 Pediatrics Pooled OR = 138
o Prone = 1299 o Side = 316o Supine = 193
Increased risk with age Limitations
o Heterogeneity definitions other risk factorsPease AS Fleming PJ Hauck FR et al Swaddling and the risk of sudden infant death syndrome a meta-analysis Pediatrics 2016137(6)e20153
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
wwwhealthychildrenorg
Swaddling (wrapping a light blanket snuggly around a baby) may help calm a crying baby If you swaddle your baby be sure to place him on his back to sleep Stop swaddling your baby when he starts to roll
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers
AAP recommendation Consider offering a pacifier at nap time and bedtime
Studies consistently demonstrate a protective effect of pacifiers on SIDS
Mechanism unknowno Dislodge within 15 to 60 minuteso Decreased arousal threshold
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers and Breastfeeding Well-designed trials
o 2 found no association among term infants
o 1 found no association among preterm infants
o 1 found slightly decreased breastfeeding duration at one month if pacifier introduced in first week of life but NO difference if pacifier introduced after one month
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Baby Friendly USA Pacifiers
Breastfeeding babies should not be given pacifiers by the staff of the facility with the exception of o Limited use to decrease pain during procedures when
the baby cannot safely be held or breastfed (pacifiers used should be discarded after these procedures)
o Babies who are being tube-fed in NICUo Other rare specific medical reasons
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Addressing Sleep Deprivation
Give parents tools to cope with fussy babies
Sleep-deprived parents may make poor judgments
Make use of tools o Swaddling side carrying
shushing swinging and sucking
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Overcoming Barriers to Change What Parents are Sayinghellip
Prone positioning fear of choking Baby sleeps ldquobetterrdquo on stomach Soft things are safer for the baby SIDS is ldquoGodrsquos willrdquo Why bother Recommendations keep changing
anyway Vigilance sleep with baby for protection
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Factors Associated With Choice of Infant Sleep Position 3300 mothers from 32 hospitals 77 usually use supine position 49 exclusive use supine position Most likely to use prone
o African-American motherso Mothers with lt high school educationo Lack of perceived controlo Personal attitudesocietal norms
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
A continuum starting in childhoodo Secondary school baby sitting classes
Pre-pregnancy Pregnancyprenatal education
o Prior to baby showerhellipldquowrong giftsrdquo In-hospital education and modeling
o Include family friends baby sitters Re-enforcement in the doctorrsquos office
o Especially between 1 to 4 months Grandparents They hold great power The general public (day cares religious leaders)
A Lifetime of Infant Sleep Safety
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Chart1
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
14
139
13
13
12
13
117
17
103
269
087
386
074
353
077
531
072
557
067
644
062
666
056
716
057
711
053
728
056
701
055
722
055
757
057
703
055
721
054
741
051
728
048
042
04
039
Sheet1
Sheet1
ampA
Page ampP
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
Sheet2
Pre-AAP recommendation Post-AAP RecommendationBack to SleepSafe to Sleep Campaign
Sheet3
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Infant Sleep Safety
Requires a consistent and repetitive message in the community to prevent accidental deaths
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Safe Sleep Nurse Modeling
People trust nurses Whatever the nurse does must
be correct and it will be imitated in the home
Fact supine positioning in the nursery can almost DOUBLE its use in the home
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Physician Advocacy
Srivatsa 1997 HCP education to new familieshellip34 reduction in prone sleeping
Eron 2009 Study of Central NY state physicianshellip30 identified incorrect safest sleep positionhellip30 do not discuss with families
Colson 2009 Only 13 mothers advised by MD to use supine positionhellip3 times more likely to position the baby properly
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Healthcare Provider Advice to New Mothers Safe Sleep
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Chart1
Column1
[]
[]
[]
55
25
20
Sheet1
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Mason Clinical Peds 713
Bundled interventiono Nursing education policy model behavior safe sleep
video posters in rooms declaration of safe sleep practice
Safe sleep environment uarr from 25 to 58 Intention in home 95 supine none ldquoco-sleepingrdquo
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bundled Intervention = Behavior Change
QUESTION GROUP p-value
ISS Study NISP
Behavior Questions n = 490 n = 1046
Baby routinely placed to sleep on back 925 73 lt 0001
Baby routinely sleeps in bassinetcrib 995 71 lt 00001
Baby sleeps under a thin sheet 992 86 lt 0001
Baby given a pacifier for sleep 741 84 lt 0001Goodstein MH Bell T Krugman SD Improving infant sleep safety through a comprehensive hospital-based program Clinical Pediatrics 201554(3)212-221
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
o Baseline Safe sleep 49 of 264 infants o Post 312 of 234 infants (P lt 001) o Extra blankets most common o Baseline 77 vs 44 post-intervention o Mean number of unsafe items reduced by 50 (P lt 001)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Washington DC
2 urban DC nurseries 26 did not believe or unsure that infant positioning
was associated with SIDS Top 3 factors influencing sleep position
o 56 PERSONAL PREFERENCE Why non-supine Clinical experience (25)
o Increase risk aspirationo Decrease sleep and comfort
Bartow KL Nursesrsquo knowledge and adherence to sudden infant death syndrome prevention guidelines Pediatr Nurs 201642(1)7-13
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
TodaysBaby QI Safe Sleep Teaching
QI intervention median = 160 days Mothers reported receiving information 72 to 95
(increase of 24-57) 94 babies observed supine (plus 24) 88 infants in safe sleep environment
o Increase of 33 Gains maintained up to 12 months
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Social Media and Risk-Reduction Training Study (SMART) Cluster randomization 4 groups Safe sleep or breast feeding education Nursing QI and social media (mobile health) N = 1600 1263 responses (79) Safe sleep NQI and MHealth
o Supine sleep 925 o Room-sharing 859o No soft bedding 819o Pacifier use 762
Moon RY Hauck FR Colson ER et al The effect of nursing quality improvement and mobile health interventions on infant sleep practices a randomized clinical trial JAMA 2017318(4)351-359
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Hospital Initiative ComponentswwwcribsforkidsorgHospitalInitiativeToolkit INTRODUCTORY LETTER HOSPITAL INITIATIVE TOOL KIT
INSTRUCTIONS ORGANIZATIONAL CHART HOSPITAL POLICY ACKNOWLEDGMENT FORM (Engl amp
Span) SAFE SLEEP EDUCATIONAL FLIP CHART
NONCOMPLIANCE WAIVER (Engl amp Span)
NURSING EDUCATION MODULE
SAFE SLEEP POSTERS DOOR HANGERS (Engl amp Span) GRADUATION CERTIFICATE SAMPLE LETTER TO HOSPITALS SAMPLE LETTER TO PROVIDERS INFANT SAFE SLEEP BROCHURES
(Engl amp Span) PRESS KIT
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
All materials available on-lineo No major costs to the hospital
Easy on-line access for documentation
NO FEE FOR PARTICIPATION
wwwCribsforKidsorgHospitalInitiative
Tiffany Price (tpricecribsforkidsorg)
The National Safe Sleep Hospital Certification Program
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
TNmdash25 reduction in infant sleep-related deaths in 2 years
SDmdashOver 7915 Pack lsquon Plays distributed since 2012 Infant mortality rate decreased from 86 (2012) to 48 (2016)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
2009 to 2015 38 decrease in infant mortality Decreased from 135 to 84 per 1000 SUID decreased gt50 Decrease in racial disparityhttphealthybabiesbaltimorecomhome
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
And Finallyhellip
Health care providers should have open frank nonjudgmental conversations with families about their sleep practices
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Encouraging Parents to Take Action
According to the Social Learning Theory parents are more likely to recall and comply with instructions when
the health care provider
Uses a positive tone Provides adequate information Allows the parent to ask most of the questions
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Motivational Interviewing
ldquoa collaborative goal-oriented style of communication with particular attention to the language of changerdquo
o Strengthen personal motivation and commitment to a specific goal
o Explore onersquos reasons for change (barriers)o Patient generates own solutions
bull More likely to feel realisticbull Planting seeds of change
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Impact of Eliminating Sleep-Related Deaths
Every week we lose 70 children which is equivalent to 4 kindergarten classrooms
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Thank You
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Contact Information
mgoodsteinwellspanorg
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Visit Pediatric Care Online today for additional information on this and other topics
httppediatriccaresolutionsaaporgPediatric Care Online is a convenient electronic resource for immediate expert help with
virtually every pediatric clinical information need with must-have resources that are included in a comprehensive reference library and time-saving clinical tools
Donrsquot have a subscription to PCOThen take advantage of a free trial today
Call Mead Johnson Nutrition at 888363-2362 orfor more information go to
httppediatriccaresolutionsaaporgSSFree_Trialaspx
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
IMR over time Finland vs US
Slide Number 1
Disclaimer
Objectives for Todayrsquos Talk
Infant Mortality Rates for the Five Leading Causes of Infant Death in the United States 2005 and 2011
US Post-Neonatal Mortality 2015
FACT
What is SUID or SUDI
Some Causes of Deaths that Occur Suddenly and Unexpectedly during Infancy
What is SIDS
SIDS FACTS
SIDS FACTS
Triple Risk Model to Explain SIDS
Paterson DS Krous HF Kinney HC et al JAMA 2006
An Example of SIDS Pathogenesis
2016 AAP Recommendations Infant Sleep Safety
Strength of Recommendation
Recommendations Change as the Evidence Evolves
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
Correct Safe Sleep Environment
We Need to Move Beyond Back to Sleep
Sleep Position for Healthy Newborns
Sleep Position in Newborn Nursery
Sleep Position and Reflux
The Truth About Supine Sleep and Aspiration Ending the Fallacy
Title
Infant Sleep Location
Room-Share How Long Yoursquore Kidding Right
Supporting Data
More Recent Data
Why is Room-Sharing Protective
Room-Sharing and Sleep Quality
Insight Study (Paul 2017)
Insight Study (Paul 2017)
Insight Commentary (Hauck Moon)
Feeding the Baby at Night
Say NO to Couches Sofas and Cushioned Armchairs
High-Risk Bed Sharing Situations
Bedsharing in Low-Risk Breastfed Infants
Independent Review (Dr Robert Platt)
Bed Sharing
Bed Sharing
Bed Sharing with Overlay
Bed Sharing with Overlay
Bed Sharing with Overlay
Couch Sleeping
Couch Sleeping
Couch Sleeping
Unsafe Bedding NISP Trends 1993-2102
Why Use Soft Bedding
Soft Bedding for Older Infants
To Swaddle or Not to Swaddle That is the Question
Swaddling
SwaddlingmdashIs it Safe
SwaddlingmdashMore Questionshellip
wwwhealthychildrenorg
Pacifiers
Pacifiers and Breastfeeding
Baby Friendly USA Pacifiers
Addressing Sleep Deprivation
Overcoming Barriers to Change What Parents are Sayinghellip
Factors Associated With Choice of Infant Sleep Position
Slide Number 65
What is Working
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Infant Sleep Safety
Safe Sleep Nurse Modeling
Physician Advocacy
Healthcare Provider Advice to New Mothers Safe Sleep
Mason Clinical Peds 713
Bundled Intervention = Behavior Change
Hospital Unsafe Sleep Persists
Washington DC
TodaysBaby QI Safe Sleep Teaching
TodaysBaby QI Safe Sleep Teaching
Social Media and Risk-Reduction Training Study (SMART)
The National Safe Sleep Hospital Certification Program
Coordinated Education Efforts Work
Coordinated Education Efforts Work
And Finallyhellip
Encouraging Parents to Take Action
Motivational Interviewing
Impact of Eliminating Sleep-Related Deaths
Thank You
Contact Information
Slide Number 89
IMR over time Finland vs US
Column1
correct advice
55
incorrect advice
25
no advice
20
correct advice
incorrect advice
no advice
SIDS Rate
Percent Back Sleeping
1988
14
1989
139
1990
13
1991
13
1992
12
13
1993
117
17
1994
103
269
1995
087
386
1996
074
353
1997
077
531
1998
072
557
1999
067
644
2000
062
666
2001
056
716
2002
057
711
2003
053
728
2004
056
701
2005
055
722
2006
055
757
2007
057
703
2008
055
721
2009
054
741
2010
051
728
2011
048
2012
042
2013
04
2014
039
httpwwwcdcgovNCHSdatanvsrnvsr58nvsr58_19pdf
Xu JQ Kochanek KD Murphy SL Tejada-Vera B Deaths Final data for
2007
National vital statistics reports vol 58 no 19 Hyattsville MD
National Center for Health Statistics 2010
1988
1988
1989
1989
1990
1990
1991
1991
1992
1992
1993
1993
1994
1994
1995
1995
1996
1996
1997
1997
1998
1998
1999
1999
2000
2000
2001
2001
2002
2002
2003
2003
2004
2004
2005
2005
2006
2006
2007
2007
2008
2008
2009
2009
2010
2010
2011
2012
2013
2014
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Why Use Soft Bedding
ComfortWarmtho Extrapolation of own feelingso Misinterpret firm with taut
bull Soft + taut ne firm
Safetyo Blankets pillows rolls to prevent falls
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Soft Bedding for Older Infants
Many parents recognize soft bedding is a risk Increased complacency as baby gets older Soft bedding is THE most important risk factor for
infants 4-12 months old (Colvin 2015) Infants roll into bedding and cannot extract
themselves
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
To Swaddle or Not to Swaddle That is the Question Pros
o Calms the infant promotes sleep decreases number of awakenings
o Encourages use of the supine position
Conso Increased respiratory rate and
reduced functional residual lung capacity
o Exacerbates hip dysplasia if the hips are kept in extension and adduction
o ldquoLooserdquo swaddling becomes loose bedding
o Overheating especially if the head is covered or the infant has infection
o Effects on arousability to an external stimulus remain unclear (conflicting data) There may be minimal effects of routine swaddling on arousal
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Swaddling
There is insufficient evidence to recommend routine swaddling as a strategy to reduce the incidence of SIDS
Swaddling must be correctly applied to avoid the possible hazards
Swaddling does not reduce the necessity to follow recommended safe sleep practices Ambrogio Lorenzettis Madonna and Child (1319)
Wikipedia
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
McDonnell E Moon RY Infant deaths and injuries associated with wearable blankets swaddle wraps and swaddling J Pediatr 20141641152-1156
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
SwaddlingmdashMore Questionshellip
Pease 2016 Pediatrics Pooled OR = 138
o Prone = 1299 o Side = 316o Supine = 193
Increased risk with age Limitations
o Heterogeneity definitions other risk factorsPease AS Fleming PJ Hauck FR et al Swaddling and the risk of sudden infant death syndrome a meta-analysis Pediatrics 2016137(6)e20153
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
wwwhealthychildrenorg
Swaddling (wrapping a light blanket snuggly around a baby) may help calm a crying baby If you swaddle your baby be sure to place him on his back to sleep Stop swaddling your baby when he starts to roll
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers
AAP recommendation Consider offering a pacifier at nap time and bedtime
Studies consistently demonstrate a protective effect of pacifiers on SIDS
Mechanism unknowno Dislodge within 15 to 60 minuteso Decreased arousal threshold
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers and Breastfeeding Well-designed trials
o 2 found no association among term infants
o 1 found no association among preterm infants
o 1 found slightly decreased breastfeeding duration at one month if pacifier introduced in first week of life but NO difference if pacifier introduced after one month
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Baby Friendly USA Pacifiers
Breastfeeding babies should not be given pacifiers by the staff of the facility with the exception of o Limited use to decrease pain during procedures when
the baby cannot safely be held or breastfed (pacifiers used should be discarded after these procedures)
o Babies who are being tube-fed in NICUo Other rare specific medical reasons
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Addressing Sleep Deprivation
Give parents tools to cope with fussy babies
Sleep-deprived parents may make poor judgments
Make use of tools o Swaddling side carrying
shushing swinging and sucking
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Overcoming Barriers to Change What Parents are Sayinghellip
Prone positioning fear of choking Baby sleeps ldquobetterrdquo on stomach Soft things are safer for the baby SIDS is ldquoGodrsquos willrdquo Why bother Recommendations keep changing
anyway Vigilance sleep with baby for protection
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Factors Associated With Choice of Infant Sleep Position 3300 mothers from 32 hospitals 77 usually use supine position 49 exclusive use supine position Most likely to use prone
o African-American motherso Mothers with lt high school educationo Lack of perceived controlo Personal attitudesocietal norms
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
A continuum starting in childhoodo Secondary school baby sitting classes
Pre-pregnancy Pregnancyprenatal education
o Prior to baby showerhellipldquowrong giftsrdquo In-hospital education and modeling
o Include family friends baby sitters Re-enforcement in the doctorrsquos office
o Especially between 1 to 4 months Grandparents They hold great power The general public (day cares religious leaders)
A Lifetime of Infant Sleep Safety
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Chart1
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
14
139
13
13
12
13
117
17
103
269
087
386
074
353
077
531
072
557
067
644
062
666
056
716
057
711
053
728
056
701
055
722
055
757
057
703
055
721
054
741
051
728
048
042
04
039
Sheet1
Sheet1
ampA
Page ampP
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
Sheet2
Pre-AAP recommendation Post-AAP RecommendationBack to SleepSafe to Sleep Campaign
Sheet3
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Infant Sleep Safety
Requires a consistent and repetitive message in the community to prevent accidental deaths
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Safe Sleep Nurse Modeling
People trust nurses Whatever the nurse does must
be correct and it will be imitated in the home
Fact supine positioning in the nursery can almost DOUBLE its use in the home
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Physician Advocacy
Srivatsa 1997 HCP education to new familieshellip34 reduction in prone sleeping
Eron 2009 Study of Central NY state physicianshellip30 identified incorrect safest sleep positionhellip30 do not discuss with families
Colson 2009 Only 13 mothers advised by MD to use supine positionhellip3 times more likely to position the baby properly
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Healthcare Provider Advice to New Mothers Safe Sleep
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Chart1
Column1
[]
[]
[]
55
25
20
Sheet1
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Mason Clinical Peds 713
Bundled interventiono Nursing education policy model behavior safe sleep
video posters in rooms declaration of safe sleep practice
Safe sleep environment uarr from 25 to 58 Intention in home 95 supine none ldquoco-sleepingrdquo
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bundled Intervention = Behavior Change
QUESTION GROUP p-value
ISS Study NISP
Behavior Questions n = 490 n = 1046
Baby routinely placed to sleep on back 925 73 lt 0001
Baby routinely sleeps in bassinetcrib 995 71 lt 00001
Baby sleeps under a thin sheet 992 86 lt 0001
Baby given a pacifier for sleep 741 84 lt 0001Goodstein MH Bell T Krugman SD Improving infant sleep safety through a comprehensive hospital-based program Clinical Pediatrics 201554(3)212-221
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
o Baseline Safe sleep 49 of 264 infants o Post 312 of 234 infants (P lt 001) o Extra blankets most common o Baseline 77 vs 44 post-intervention o Mean number of unsafe items reduced by 50 (P lt 001)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Washington DC
2 urban DC nurseries 26 did not believe or unsure that infant positioning
was associated with SIDS Top 3 factors influencing sleep position
o 56 PERSONAL PREFERENCE Why non-supine Clinical experience (25)
o Increase risk aspirationo Decrease sleep and comfort
Bartow KL Nursesrsquo knowledge and adherence to sudden infant death syndrome prevention guidelines Pediatr Nurs 201642(1)7-13
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
TodaysBaby QI Safe Sleep Teaching
QI intervention median = 160 days Mothers reported receiving information 72 to 95
(increase of 24-57) 94 babies observed supine (plus 24) 88 infants in safe sleep environment
o Increase of 33 Gains maintained up to 12 months
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Social Media and Risk-Reduction Training Study (SMART) Cluster randomization 4 groups Safe sleep or breast feeding education Nursing QI and social media (mobile health) N = 1600 1263 responses (79) Safe sleep NQI and MHealth
o Supine sleep 925 o Room-sharing 859o No soft bedding 819o Pacifier use 762
Moon RY Hauck FR Colson ER et al The effect of nursing quality improvement and mobile health interventions on infant sleep practices a randomized clinical trial JAMA 2017318(4)351-359
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Hospital Initiative ComponentswwwcribsforkidsorgHospitalInitiativeToolkit INTRODUCTORY LETTER HOSPITAL INITIATIVE TOOL KIT
INSTRUCTIONS ORGANIZATIONAL CHART HOSPITAL POLICY ACKNOWLEDGMENT FORM (Engl amp
Span) SAFE SLEEP EDUCATIONAL FLIP CHART
NONCOMPLIANCE WAIVER (Engl amp Span)
NURSING EDUCATION MODULE
SAFE SLEEP POSTERS DOOR HANGERS (Engl amp Span) GRADUATION CERTIFICATE SAMPLE LETTER TO HOSPITALS SAMPLE LETTER TO PROVIDERS INFANT SAFE SLEEP BROCHURES
(Engl amp Span) PRESS KIT
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
All materials available on-lineo No major costs to the hospital
Easy on-line access for documentation
NO FEE FOR PARTICIPATION
wwwCribsforKidsorgHospitalInitiative
Tiffany Price (tpricecribsforkidsorg)
The National Safe Sleep Hospital Certification Program
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
TNmdash25 reduction in infant sleep-related deaths in 2 years
SDmdashOver 7915 Pack lsquon Plays distributed since 2012 Infant mortality rate decreased from 86 (2012) to 48 (2016)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
2009 to 2015 38 decrease in infant mortality Decreased from 135 to 84 per 1000 SUID decreased gt50 Decrease in racial disparityhttphealthybabiesbaltimorecomhome
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
And Finallyhellip
Health care providers should have open frank nonjudgmental conversations with families about their sleep practices
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Encouraging Parents to Take Action
According to the Social Learning Theory parents are more likely to recall and comply with instructions when
the health care provider
Uses a positive tone Provides adequate information Allows the parent to ask most of the questions
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Motivational Interviewing
ldquoa collaborative goal-oriented style of communication with particular attention to the language of changerdquo
o Strengthen personal motivation and commitment to a specific goal
o Explore onersquos reasons for change (barriers)o Patient generates own solutions
bull More likely to feel realisticbull Planting seeds of change
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Impact of Eliminating Sleep-Related Deaths
Every week we lose 70 children which is equivalent to 4 kindergarten classrooms
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Thank You
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Contact Information
mgoodsteinwellspanorg
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Visit Pediatric Care Online today for additional information on this and other topics
httppediatriccaresolutionsaaporgPediatric Care Online is a convenient electronic resource for immediate expert help with
virtually every pediatric clinical information need with must-have resources that are included in a comprehensive reference library and time-saving clinical tools
Donrsquot have a subscription to PCOThen take advantage of a free trial today
Call Mead Johnson Nutrition at 888363-2362 orfor more information go to
httppediatriccaresolutionsaaporgSSFree_Trialaspx
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
IMR over time Finland vs US
Slide Number 1
Disclaimer
Objectives for Todayrsquos Talk
Infant Mortality Rates for the Five Leading Causes of Infant Death in the United States 2005 and 2011
US Post-Neonatal Mortality 2015
FACT
What is SUID or SUDI
Some Causes of Deaths that Occur Suddenly and Unexpectedly during Infancy
What is SIDS
SIDS FACTS
SIDS FACTS
Triple Risk Model to Explain SIDS
Paterson DS Krous HF Kinney HC et al JAMA 2006
An Example of SIDS Pathogenesis
2016 AAP Recommendations Infant Sleep Safety
Strength of Recommendation
Recommendations Change as the Evidence Evolves
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
Correct Safe Sleep Environment
We Need to Move Beyond Back to Sleep
Sleep Position for Healthy Newborns
Sleep Position in Newborn Nursery
Sleep Position and Reflux
The Truth About Supine Sleep and Aspiration Ending the Fallacy
Title
Infant Sleep Location
Room-Share How Long Yoursquore Kidding Right
Supporting Data
More Recent Data
Why is Room-Sharing Protective
Room-Sharing and Sleep Quality
Insight Study (Paul 2017)
Insight Study (Paul 2017)
Insight Commentary (Hauck Moon)
Feeding the Baby at Night
Say NO to Couches Sofas and Cushioned Armchairs
High-Risk Bed Sharing Situations
Bedsharing in Low-Risk Breastfed Infants
Independent Review (Dr Robert Platt)
Bed Sharing
Bed Sharing
Bed Sharing with Overlay
Bed Sharing with Overlay
Bed Sharing with Overlay
Couch Sleeping
Couch Sleeping
Couch Sleeping
Unsafe Bedding NISP Trends 1993-2102
Why Use Soft Bedding
Soft Bedding for Older Infants
To Swaddle or Not to Swaddle That is the Question
Swaddling
SwaddlingmdashIs it Safe
SwaddlingmdashMore Questionshellip
wwwhealthychildrenorg
Pacifiers
Pacifiers and Breastfeeding
Baby Friendly USA Pacifiers
Addressing Sleep Deprivation
Overcoming Barriers to Change What Parents are Sayinghellip
Factors Associated With Choice of Infant Sleep Position
Slide Number 65
What is Working
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Infant Sleep Safety
Safe Sleep Nurse Modeling
Physician Advocacy
Healthcare Provider Advice to New Mothers Safe Sleep
Mason Clinical Peds 713
Bundled Intervention = Behavior Change
Hospital Unsafe Sleep Persists
Washington DC
TodaysBaby QI Safe Sleep Teaching
TodaysBaby QI Safe Sleep Teaching
Social Media and Risk-Reduction Training Study (SMART)
The National Safe Sleep Hospital Certification Program
Coordinated Education Efforts Work
Coordinated Education Efforts Work
And Finallyhellip
Encouraging Parents to Take Action
Motivational Interviewing
Impact of Eliminating Sleep-Related Deaths
Thank You
Contact Information
Slide Number 89
IMR over time Finland vs US
Column1
correct advice
55
incorrect advice
25
no advice
20
correct advice
incorrect advice
no advice
SIDS Rate
Percent Back Sleeping
1988
14
1989
139
1990
13
1991
13
1992
12
13
1993
117
17
1994
103
269
1995
087
386
1996
074
353
1997
077
531
1998
072
557
1999
067
644
2000
062
666
2001
056
716
2002
057
711
2003
053
728
2004
056
701
2005
055
722
2006
055
757
2007
057
703
2008
055
721
2009
054
741
2010
051
728
2011
048
2012
042
2013
04
2014
039
httpwwwcdcgovNCHSdatanvsrnvsr58nvsr58_19pdf
Xu JQ Kochanek KD Murphy SL Tejada-Vera B Deaths Final data for
2007
National vital statistics reports vol 58 no 19 Hyattsville MD
National Center for Health Statistics 2010
1988
1988
1989
1989
1990
1990
1991
1991
1992
1992
1993
1993
1994
1994
1995
1995
1996
1996
1997
1997
1998
1998
1999
1999
2000
2000
2001
2001
2002
2002
2003
2003
2004
2004
2005
2005
2006
2006
2007
2007
2008
2008
2009
2009
2010
2010
2011
2012
2013
2014
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Soft Bedding for Older Infants
Many parents recognize soft bedding is a risk Increased complacency as baby gets older Soft bedding is THE most important risk factor for
infants 4-12 months old (Colvin 2015) Infants roll into bedding and cannot extract
themselves
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
To Swaddle or Not to Swaddle That is the Question Pros
o Calms the infant promotes sleep decreases number of awakenings
o Encourages use of the supine position
Conso Increased respiratory rate and
reduced functional residual lung capacity
o Exacerbates hip dysplasia if the hips are kept in extension and adduction
o ldquoLooserdquo swaddling becomes loose bedding
o Overheating especially if the head is covered or the infant has infection
o Effects on arousability to an external stimulus remain unclear (conflicting data) There may be minimal effects of routine swaddling on arousal
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Swaddling
There is insufficient evidence to recommend routine swaddling as a strategy to reduce the incidence of SIDS
Swaddling must be correctly applied to avoid the possible hazards
Swaddling does not reduce the necessity to follow recommended safe sleep practices Ambrogio Lorenzettis Madonna and Child (1319)
Wikipedia
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
McDonnell E Moon RY Infant deaths and injuries associated with wearable blankets swaddle wraps and swaddling J Pediatr 20141641152-1156
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
SwaddlingmdashMore Questionshellip
Pease 2016 Pediatrics Pooled OR = 138
o Prone = 1299 o Side = 316o Supine = 193
Increased risk with age Limitations
o Heterogeneity definitions other risk factorsPease AS Fleming PJ Hauck FR et al Swaddling and the risk of sudden infant death syndrome a meta-analysis Pediatrics 2016137(6)e20153
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
wwwhealthychildrenorg
Swaddling (wrapping a light blanket snuggly around a baby) may help calm a crying baby If you swaddle your baby be sure to place him on his back to sleep Stop swaddling your baby when he starts to roll
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers
AAP recommendation Consider offering a pacifier at nap time and bedtime
Studies consistently demonstrate a protective effect of pacifiers on SIDS
Mechanism unknowno Dislodge within 15 to 60 minuteso Decreased arousal threshold
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers and Breastfeeding Well-designed trials
o 2 found no association among term infants
o 1 found no association among preterm infants
o 1 found slightly decreased breastfeeding duration at one month if pacifier introduced in first week of life but NO difference if pacifier introduced after one month
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Baby Friendly USA Pacifiers
Breastfeeding babies should not be given pacifiers by the staff of the facility with the exception of o Limited use to decrease pain during procedures when
the baby cannot safely be held or breastfed (pacifiers used should be discarded after these procedures)
o Babies who are being tube-fed in NICUo Other rare specific medical reasons
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Addressing Sleep Deprivation
Give parents tools to cope with fussy babies
Sleep-deprived parents may make poor judgments
Make use of tools o Swaddling side carrying
shushing swinging and sucking
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Overcoming Barriers to Change What Parents are Sayinghellip
Prone positioning fear of choking Baby sleeps ldquobetterrdquo on stomach Soft things are safer for the baby SIDS is ldquoGodrsquos willrdquo Why bother Recommendations keep changing
anyway Vigilance sleep with baby for protection
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Factors Associated With Choice of Infant Sleep Position 3300 mothers from 32 hospitals 77 usually use supine position 49 exclusive use supine position Most likely to use prone
o African-American motherso Mothers with lt high school educationo Lack of perceived controlo Personal attitudesocietal norms
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
A continuum starting in childhoodo Secondary school baby sitting classes
Pre-pregnancy Pregnancyprenatal education
o Prior to baby showerhellipldquowrong giftsrdquo In-hospital education and modeling
o Include family friends baby sitters Re-enforcement in the doctorrsquos office
o Especially between 1 to 4 months Grandparents They hold great power The general public (day cares religious leaders)
A Lifetime of Infant Sleep Safety
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Chart1
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
14
139
13
13
12
13
117
17
103
269
087
386
074
353
077
531
072
557
067
644
062
666
056
716
057
711
053
728
056
701
055
722
055
757
057
703
055
721
054
741
051
728
048
042
04
039
Sheet1
Sheet1
ampA
Page ampP
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
Sheet2
Pre-AAP recommendation Post-AAP RecommendationBack to SleepSafe to Sleep Campaign
Sheet3
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Infant Sleep Safety
Requires a consistent and repetitive message in the community to prevent accidental deaths
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Safe Sleep Nurse Modeling
People trust nurses Whatever the nurse does must
be correct and it will be imitated in the home
Fact supine positioning in the nursery can almost DOUBLE its use in the home
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Physician Advocacy
Srivatsa 1997 HCP education to new familieshellip34 reduction in prone sleeping
Eron 2009 Study of Central NY state physicianshellip30 identified incorrect safest sleep positionhellip30 do not discuss with families
Colson 2009 Only 13 mothers advised by MD to use supine positionhellip3 times more likely to position the baby properly
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Healthcare Provider Advice to New Mothers Safe Sleep
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Chart1
Column1
[]
[]
[]
55
25
20
Sheet1
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Mason Clinical Peds 713
Bundled interventiono Nursing education policy model behavior safe sleep
video posters in rooms declaration of safe sleep practice
Safe sleep environment uarr from 25 to 58 Intention in home 95 supine none ldquoco-sleepingrdquo
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bundled Intervention = Behavior Change
QUESTION GROUP p-value
ISS Study NISP
Behavior Questions n = 490 n = 1046
Baby routinely placed to sleep on back 925 73 lt 0001
Baby routinely sleeps in bassinetcrib 995 71 lt 00001
Baby sleeps under a thin sheet 992 86 lt 0001
Baby given a pacifier for sleep 741 84 lt 0001Goodstein MH Bell T Krugman SD Improving infant sleep safety through a comprehensive hospital-based program Clinical Pediatrics 201554(3)212-221
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
o Baseline Safe sleep 49 of 264 infants o Post 312 of 234 infants (P lt 001) o Extra blankets most common o Baseline 77 vs 44 post-intervention o Mean number of unsafe items reduced by 50 (P lt 001)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Washington DC
2 urban DC nurseries 26 did not believe or unsure that infant positioning
was associated with SIDS Top 3 factors influencing sleep position
o 56 PERSONAL PREFERENCE Why non-supine Clinical experience (25)
o Increase risk aspirationo Decrease sleep and comfort
Bartow KL Nursesrsquo knowledge and adherence to sudden infant death syndrome prevention guidelines Pediatr Nurs 201642(1)7-13
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
TodaysBaby QI Safe Sleep Teaching
QI intervention median = 160 days Mothers reported receiving information 72 to 95
(increase of 24-57) 94 babies observed supine (plus 24) 88 infants in safe sleep environment
o Increase of 33 Gains maintained up to 12 months
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Social Media and Risk-Reduction Training Study (SMART) Cluster randomization 4 groups Safe sleep or breast feeding education Nursing QI and social media (mobile health) N = 1600 1263 responses (79) Safe sleep NQI and MHealth
o Supine sleep 925 o Room-sharing 859o No soft bedding 819o Pacifier use 762
Moon RY Hauck FR Colson ER et al The effect of nursing quality improvement and mobile health interventions on infant sleep practices a randomized clinical trial JAMA 2017318(4)351-359
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Hospital Initiative ComponentswwwcribsforkidsorgHospitalInitiativeToolkit INTRODUCTORY LETTER HOSPITAL INITIATIVE TOOL KIT
INSTRUCTIONS ORGANIZATIONAL CHART HOSPITAL POLICY ACKNOWLEDGMENT FORM (Engl amp
Span) SAFE SLEEP EDUCATIONAL FLIP CHART
NONCOMPLIANCE WAIVER (Engl amp Span)
NURSING EDUCATION MODULE
SAFE SLEEP POSTERS DOOR HANGERS (Engl amp Span) GRADUATION CERTIFICATE SAMPLE LETTER TO HOSPITALS SAMPLE LETTER TO PROVIDERS INFANT SAFE SLEEP BROCHURES
(Engl amp Span) PRESS KIT
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
All materials available on-lineo No major costs to the hospital
Easy on-line access for documentation
NO FEE FOR PARTICIPATION
wwwCribsforKidsorgHospitalInitiative
Tiffany Price (tpricecribsforkidsorg)
The National Safe Sleep Hospital Certification Program
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
TNmdash25 reduction in infant sleep-related deaths in 2 years
SDmdashOver 7915 Pack lsquon Plays distributed since 2012 Infant mortality rate decreased from 86 (2012) to 48 (2016)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
2009 to 2015 38 decrease in infant mortality Decreased from 135 to 84 per 1000 SUID decreased gt50 Decrease in racial disparityhttphealthybabiesbaltimorecomhome
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
And Finallyhellip
Health care providers should have open frank nonjudgmental conversations with families about their sleep practices
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Encouraging Parents to Take Action
According to the Social Learning Theory parents are more likely to recall and comply with instructions when
the health care provider
Uses a positive tone Provides adequate information Allows the parent to ask most of the questions
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Motivational Interviewing
ldquoa collaborative goal-oriented style of communication with particular attention to the language of changerdquo
o Strengthen personal motivation and commitment to a specific goal
o Explore onersquos reasons for change (barriers)o Patient generates own solutions
bull More likely to feel realisticbull Planting seeds of change
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Impact of Eliminating Sleep-Related Deaths
Every week we lose 70 children which is equivalent to 4 kindergarten classrooms
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Thank You
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Contact Information
mgoodsteinwellspanorg
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Visit Pediatric Care Online today for additional information on this and other topics
httppediatriccaresolutionsaaporgPediatric Care Online is a convenient electronic resource for immediate expert help with
virtually every pediatric clinical information need with must-have resources that are included in a comprehensive reference library and time-saving clinical tools
Donrsquot have a subscription to PCOThen take advantage of a free trial today
Call Mead Johnson Nutrition at 888363-2362 orfor more information go to
httppediatriccaresolutionsaaporgSSFree_Trialaspx
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
IMR over time Finland vs US
Slide Number 1
Disclaimer
Objectives for Todayrsquos Talk
Infant Mortality Rates for the Five Leading Causes of Infant Death in the United States 2005 and 2011
US Post-Neonatal Mortality 2015
FACT
What is SUID or SUDI
Some Causes of Deaths that Occur Suddenly and Unexpectedly during Infancy
What is SIDS
SIDS FACTS
SIDS FACTS
Triple Risk Model to Explain SIDS
Paterson DS Krous HF Kinney HC et al JAMA 2006
An Example of SIDS Pathogenesis
2016 AAP Recommendations Infant Sleep Safety
Strength of Recommendation
Recommendations Change as the Evidence Evolves
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
Correct Safe Sleep Environment
We Need to Move Beyond Back to Sleep
Sleep Position for Healthy Newborns
Sleep Position in Newborn Nursery
Sleep Position and Reflux
The Truth About Supine Sleep and Aspiration Ending the Fallacy
Title
Infant Sleep Location
Room-Share How Long Yoursquore Kidding Right
Supporting Data
More Recent Data
Why is Room-Sharing Protective
Room-Sharing and Sleep Quality
Insight Study (Paul 2017)
Insight Study (Paul 2017)
Insight Commentary (Hauck Moon)
Feeding the Baby at Night
Say NO to Couches Sofas and Cushioned Armchairs
High-Risk Bed Sharing Situations
Bedsharing in Low-Risk Breastfed Infants
Independent Review (Dr Robert Platt)
Bed Sharing
Bed Sharing
Bed Sharing with Overlay
Bed Sharing with Overlay
Bed Sharing with Overlay
Couch Sleeping
Couch Sleeping
Couch Sleeping
Unsafe Bedding NISP Trends 1993-2102
Why Use Soft Bedding
Soft Bedding for Older Infants
To Swaddle or Not to Swaddle That is the Question
Swaddling
SwaddlingmdashIs it Safe
SwaddlingmdashMore Questionshellip
wwwhealthychildrenorg
Pacifiers
Pacifiers and Breastfeeding
Baby Friendly USA Pacifiers
Addressing Sleep Deprivation
Overcoming Barriers to Change What Parents are Sayinghellip
Factors Associated With Choice of Infant Sleep Position
Slide Number 65
What is Working
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Infant Sleep Safety
Safe Sleep Nurse Modeling
Physician Advocacy
Healthcare Provider Advice to New Mothers Safe Sleep
Mason Clinical Peds 713
Bundled Intervention = Behavior Change
Hospital Unsafe Sleep Persists
Washington DC
TodaysBaby QI Safe Sleep Teaching
TodaysBaby QI Safe Sleep Teaching
Social Media and Risk-Reduction Training Study (SMART)
The National Safe Sleep Hospital Certification Program
Coordinated Education Efforts Work
Coordinated Education Efforts Work
And Finallyhellip
Encouraging Parents to Take Action
Motivational Interviewing
Impact of Eliminating Sleep-Related Deaths
Thank You
Contact Information
Slide Number 89
IMR over time Finland vs US
Column1
correct advice
55
incorrect advice
25
no advice
20
correct advice
incorrect advice
no advice
SIDS Rate
Percent Back Sleeping
1988
14
1989
139
1990
13
1991
13
1992
12
13
1993
117
17
1994
103
269
1995
087
386
1996
074
353
1997
077
531
1998
072
557
1999
067
644
2000
062
666
2001
056
716
2002
057
711
2003
053
728
2004
056
701
2005
055
722
2006
055
757
2007
057
703
2008
055
721
2009
054
741
2010
051
728
2011
048
2012
042
2013
04
2014
039
httpwwwcdcgovNCHSdatanvsrnvsr58nvsr58_19pdf
Xu JQ Kochanek KD Murphy SL Tejada-Vera B Deaths Final data for
2007
National vital statistics reports vol 58 no 19 Hyattsville MD
National Center for Health Statistics 2010
1988
1988
1989
1989
1990
1990
1991
1991
1992
1992
1993
1993
1994
1994
1995
1995
1996
1996
1997
1997
1998
1998
1999
1999
2000
2000
2001
2001
2002
2002
2003
2003
2004
2004
2005
2005
2006
2006
2007
2007
2008
2008
2009
2009
2010
2010
2011
2012
2013
2014
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
To Swaddle or Not to Swaddle That is the Question Pros
o Calms the infant promotes sleep decreases number of awakenings
o Encourages use of the supine position
Conso Increased respiratory rate and
reduced functional residual lung capacity
o Exacerbates hip dysplasia if the hips are kept in extension and adduction
o ldquoLooserdquo swaddling becomes loose bedding
o Overheating especially if the head is covered or the infant has infection
o Effects on arousability to an external stimulus remain unclear (conflicting data) There may be minimal effects of routine swaddling on arousal
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Swaddling
There is insufficient evidence to recommend routine swaddling as a strategy to reduce the incidence of SIDS
Swaddling must be correctly applied to avoid the possible hazards
Swaddling does not reduce the necessity to follow recommended safe sleep practices Ambrogio Lorenzettis Madonna and Child (1319)
Wikipedia
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
McDonnell E Moon RY Infant deaths and injuries associated with wearable blankets swaddle wraps and swaddling J Pediatr 20141641152-1156
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
SwaddlingmdashMore Questionshellip
Pease 2016 Pediatrics Pooled OR = 138
o Prone = 1299 o Side = 316o Supine = 193
Increased risk with age Limitations
o Heterogeneity definitions other risk factorsPease AS Fleming PJ Hauck FR et al Swaddling and the risk of sudden infant death syndrome a meta-analysis Pediatrics 2016137(6)e20153
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
wwwhealthychildrenorg
Swaddling (wrapping a light blanket snuggly around a baby) may help calm a crying baby If you swaddle your baby be sure to place him on his back to sleep Stop swaddling your baby when he starts to roll
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers
AAP recommendation Consider offering a pacifier at nap time and bedtime
Studies consistently demonstrate a protective effect of pacifiers on SIDS
Mechanism unknowno Dislodge within 15 to 60 minuteso Decreased arousal threshold
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers and Breastfeeding Well-designed trials
o 2 found no association among term infants
o 1 found no association among preterm infants
o 1 found slightly decreased breastfeeding duration at one month if pacifier introduced in first week of life but NO difference if pacifier introduced after one month
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Baby Friendly USA Pacifiers
Breastfeeding babies should not be given pacifiers by the staff of the facility with the exception of o Limited use to decrease pain during procedures when
the baby cannot safely be held or breastfed (pacifiers used should be discarded after these procedures)
o Babies who are being tube-fed in NICUo Other rare specific medical reasons
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Addressing Sleep Deprivation
Give parents tools to cope with fussy babies
Sleep-deprived parents may make poor judgments
Make use of tools o Swaddling side carrying
shushing swinging and sucking
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Overcoming Barriers to Change What Parents are Sayinghellip
Prone positioning fear of choking Baby sleeps ldquobetterrdquo on stomach Soft things are safer for the baby SIDS is ldquoGodrsquos willrdquo Why bother Recommendations keep changing
anyway Vigilance sleep with baby for protection
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Factors Associated With Choice of Infant Sleep Position 3300 mothers from 32 hospitals 77 usually use supine position 49 exclusive use supine position Most likely to use prone
o African-American motherso Mothers with lt high school educationo Lack of perceived controlo Personal attitudesocietal norms
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
A continuum starting in childhoodo Secondary school baby sitting classes
Pre-pregnancy Pregnancyprenatal education
o Prior to baby showerhellipldquowrong giftsrdquo In-hospital education and modeling
o Include family friends baby sitters Re-enforcement in the doctorrsquos office
o Especially between 1 to 4 months Grandparents They hold great power The general public (day cares religious leaders)
A Lifetime of Infant Sleep Safety
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Chart1
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
14
139
13
13
12
13
117
17
103
269
087
386
074
353
077
531
072
557
067
644
062
666
056
716
057
711
053
728
056
701
055
722
055
757
057
703
055
721
054
741
051
728
048
042
04
039
Sheet1
Sheet1
ampA
Page ampP
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
Sheet2
Pre-AAP recommendation Post-AAP RecommendationBack to SleepSafe to Sleep Campaign
Sheet3
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Infant Sleep Safety
Requires a consistent and repetitive message in the community to prevent accidental deaths
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Safe Sleep Nurse Modeling
People trust nurses Whatever the nurse does must
be correct and it will be imitated in the home
Fact supine positioning in the nursery can almost DOUBLE its use in the home
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Physician Advocacy
Srivatsa 1997 HCP education to new familieshellip34 reduction in prone sleeping
Eron 2009 Study of Central NY state physicianshellip30 identified incorrect safest sleep positionhellip30 do not discuss with families
Colson 2009 Only 13 mothers advised by MD to use supine positionhellip3 times more likely to position the baby properly
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Healthcare Provider Advice to New Mothers Safe Sleep
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Chart1
Column1
[]
[]
[]
55
25
20
Sheet1
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Mason Clinical Peds 713
Bundled interventiono Nursing education policy model behavior safe sleep
video posters in rooms declaration of safe sleep practice
Safe sleep environment uarr from 25 to 58 Intention in home 95 supine none ldquoco-sleepingrdquo
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bundled Intervention = Behavior Change
QUESTION GROUP p-value
ISS Study NISP
Behavior Questions n = 490 n = 1046
Baby routinely placed to sleep on back 925 73 lt 0001
Baby routinely sleeps in bassinetcrib 995 71 lt 00001
Baby sleeps under a thin sheet 992 86 lt 0001
Baby given a pacifier for sleep 741 84 lt 0001Goodstein MH Bell T Krugman SD Improving infant sleep safety through a comprehensive hospital-based program Clinical Pediatrics 201554(3)212-221
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
o Baseline Safe sleep 49 of 264 infants o Post 312 of 234 infants (P lt 001) o Extra blankets most common o Baseline 77 vs 44 post-intervention o Mean number of unsafe items reduced by 50 (P lt 001)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Washington DC
2 urban DC nurseries 26 did not believe or unsure that infant positioning
was associated with SIDS Top 3 factors influencing sleep position
o 56 PERSONAL PREFERENCE Why non-supine Clinical experience (25)
o Increase risk aspirationo Decrease sleep and comfort
Bartow KL Nursesrsquo knowledge and adherence to sudden infant death syndrome prevention guidelines Pediatr Nurs 201642(1)7-13
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
TodaysBaby QI Safe Sleep Teaching
QI intervention median = 160 days Mothers reported receiving information 72 to 95
(increase of 24-57) 94 babies observed supine (plus 24) 88 infants in safe sleep environment
o Increase of 33 Gains maintained up to 12 months
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Social Media and Risk-Reduction Training Study (SMART) Cluster randomization 4 groups Safe sleep or breast feeding education Nursing QI and social media (mobile health) N = 1600 1263 responses (79) Safe sleep NQI and MHealth
o Supine sleep 925 o Room-sharing 859o No soft bedding 819o Pacifier use 762
Moon RY Hauck FR Colson ER et al The effect of nursing quality improvement and mobile health interventions on infant sleep practices a randomized clinical trial JAMA 2017318(4)351-359
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Hospital Initiative ComponentswwwcribsforkidsorgHospitalInitiativeToolkit INTRODUCTORY LETTER HOSPITAL INITIATIVE TOOL KIT
INSTRUCTIONS ORGANIZATIONAL CHART HOSPITAL POLICY ACKNOWLEDGMENT FORM (Engl amp
Span) SAFE SLEEP EDUCATIONAL FLIP CHART
NONCOMPLIANCE WAIVER (Engl amp Span)
NURSING EDUCATION MODULE
SAFE SLEEP POSTERS DOOR HANGERS (Engl amp Span) GRADUATION CERTIFICATE SAMPLE LETTER TO HOSPITALS SAMPLE LETTER TO PROVIDERS INFANT SAFE SLEEP BROCHURES
(Engl amp Span) PRESS KIT
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
All materials available on-lineo No major costs to the hospital
Easy on-line access for documentation
NO FEE FOR PARTICIPATION
wwwCribsforKidsorgHospitalInitiative
Tiffany Price (tpricecribsforkidsorg)
The National Safe Sleep Hospital Certification Program
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
TNmdash25 reduction in infant sleep-related deaths in 2 years
SDmdashOver 7915 Pack lsquon Plays distributed since 2012 Infant mortality rate decreased from 86 (2012) to 48 (2016)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
2009 to 2015 38 decrease in infant mortality Decreased from 135 to 84 per 1000 SUID decreased gt50 Decrease in racial disparityhttphealthybabiesbaltimorecomhome
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
And Finallyhellip
Health care providers should have open frank nonjudgmental conversations with families about their sleep practices
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Encouraging Parents to Take Action
According to the Social Learning Theory parents are more likely to recall and comply with instructions when
the health care provider
Uses a positive tone Provides adequate information Allows the parent to ask most of the questions
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Motivational Interviewing
ldquoa collaborative goal-oriented style of communication with particular attention to the language of changerdquo
o Strengthen personal motivation and commitment to a specific goal
o Explore onersquos reasons for change (barriers)o Patient generates own solutions
bull More likely to feel realisticbull Planting seeds of change
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Impact of Eliminating Sleep-Related Deaths
Every week we lose 70 children which is equivalent to 4 kindergarten classrooms
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Thank You
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Contact Information
mgoodsteinwellspanorg
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Visit Pediatric Care Online today for additional information on this and other topics
httppediatriccaresolutionsaaporgPediatric Care Online is a convenient electronic resource for immediate expert help with
virtually every pediatric clinical information need with must-have resources that are included in a comprehensive reference library and time-saving clinical tools
Donrsquot have a subscription to PCOThen take advantage of a free trial today
Call Mead Johnson Nutrition at 888363-2362 orfor more information go to
httppediatriccaresolutionsaaporgSSFree_Trialaspx
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
IMR over time Finland vs US
Slide Number 1
Disclaimer
Objectives for Todayrsquos Talk
Infant Mortality Rates for the Five Leading Causes of Infant Death in the United States 2005 and 2011
US Post-Neonatal Mortality 2015
FACT
What is SUID or SUDI
Some Causes of Deaths that Occur Suddenly and Unexpectedly during Infancy
What is SIDS
SIDS FACTS
SIDS FACTS
Triple Risk Model to Explain SIDS
Paterson DS Krous HF Kinney HC et al JAMA 2006
An Example of SIDS Pathogenesis
2016 AAP Recommendations Infant Sleep Safety
Strength of Recommendation
Recommendations Change as the Evidence Evolves
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
Correct Safe Sleep Environment
We Need to Move Beyond Back to Sleep
Sleep Position for Healthy Newborns
Sleep Position in Newborn Nursery
Sleep Position and Reflux
The Truth About Supine Sleep and Aspiration Ending the Fallacy
Title
Infant Sleep Location
Room-Share How Long Yoursquore Kidding Right
Supporting Data
More Recent Data
Why is Room-Sharing Protective
Room-Sharing and Sleep Quality
Insight Study (Paul 2017)
Insight Study (Paul 2017)
Insight Commentary (Hauck Moon)
Feeding the Baby at Night
Say NO to Couches Sofas and Cushioned Armchairs
High-Risk Bed Sharing Situations
Bedsharing in Low-Risk Breastfed Infants
Independent Review (Dr Robert Platt)
Bed Sharing
Bed Sharing
Bed Sharing with Overlay
Bed Sharing with Overlay
Bed Sharing with Overlay
Couch Sleeping
Couch Sleeping
Couch Sleeping
Unsafe Bedding NISP Trends 1993-2102
Why Use Soft Bedding
Soft Bedding for Older Infants
To Swaddle or Not to Swaddle That is the Question
Swaddling
SwaddlingmdashIs it Safe
SwaddlingmdashMore Questionshellip
wwwhealthychildrenorg
Pacifiers
Pacifiers and Breastfeeding
Baby Friendly USA Pacifiers
Addressing Sleep Deprivation
Overcoming Barriers to Change What Parents are Sayinghellip
Factors Associated With Choice of Infant Sleep Position
Slide Number 65
What is Working
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Infant Sleep Safety
Safe Sleep Nurse Modeling
Physician Advocacy
Healthcare Provider Advice to New Mothers Safe Sleep
Mason Clinical Peds 713
Bundled Intervention = Behavior Change
Hospital Unsafe Sleep Persists
Washington DC
TodaysBaby QI Safe Sleep Teaching
TodaysBaby QI Safe Sleep Teaching
Social Media and Risk-Reduction Training Study (SMART)
The National Safe Sleep Hospital Certification Program
Coordinated Education Efforts Work
Coordinated Education Efforts Work
And Finallyhellip
Encouraging Parents to Take Action
Motivational Interviewing
Impact of Eliminating Sleep-Related Deaths
Thank You
Contact Information
Slide Number 89
IMR over time Finland vs US
Column1
correct advice
55
incorrect advice
25
no advice
20
correct advice
incorrect advice
no advice
SIDS Rate
Percent Back Sleeping
1988
14
1989
139
1990
13
1991
13
1992
12
13
1993
117
17
1994
103
269
1995
087
386
1996
074
353
1997
077
531
1998
072
557
1999
067
644
2000
062
666
2001
056
716
2002
057
711
2003
053
728
2004
056
701
2005
055
722
2006
055
757
2007
057
703
2008
055
721
2009
054
741
2010
051
728
2011
048
2012
042
2013
04
2014
039
httpwwwcdcgovNCHSdatanvsrnvsr58nvsr58_19pdf
Xu JQ Kochanek KD Murphy SL Tejada-Vera B Deaths Final data for
2007
National vital statistics reports vol 58 no 19 Hyattsville MD
National Center for Health Statistics 2010
1988
1988
1989
1989
1990
1990
1991
1991
1992
1992
1993
1993
1994
1994
1995
1995
1996
1996
1997
1997
1998
1998
1999
1999
2000
2000
2001
2001
2002
2002
2003
2003
2004
2004
2005
2005
2006
2006
2007
2007
2008
2008
2009
2009
2010
2010
2011
2012
2013
2014
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Swaddling
There is insufficient evidence to recommend routine swaddling as a strategy to reduce the incidence of SIDS
Swaddling must be correctly applied to avoid the possible hazards
Swaddling does not reduce the necessity to follow recommended safe sleep practices Ambrogio Lorenzettis Madonna and Child (1319)
Wikipedia
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
McDonnell E Moon RY Infant deaths and injuries associated with wearable blankets swaddle wraps and swaddling J Pediatr 20141641152-1156
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
SwaddlingmdashMore Questionshellip
Pease 2016 Pediatrics Pooled OR = 138
o Prone = 1299 o Side = 316o Supine = 193
Increased risk with age Limitations
o Heterogeneity definitions other risk factorsPease AS Fleming PJ Hauck FR et al Swaddling and the risk of sudden infant death syndrome a meta-analysis Pediatrics 2016137(6)e20153
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
wwwhealthychildrenorg
Swaddling (wrapping a light blanket snuggly around a baby) may help calm a crying baby If you swaddle your baby be sure to place him on his back to sleep Stop swaddling your baby when he starts to roll
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers
AAP recommendation Consider offering a pacifier at nap time and bedtime
Studies consistently demonstrate a protective effect of pacifiers on SIDS
Mechanism unknowno Dislodge within 15 to 60 minuteso Decreased arousal threshold
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers and Breastfeeding Well-designed trials
o 2 found no association among term infants
o 1 found no association among preterm infants
o 1 found slightly decreased breastfeeding duration at one month if pacifier introduced in first week of life but NO difference if pacifier introduced after one month
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Baby Friendly USA Pacifiers
Breastfeeding babies should not be given pacifiers by the staff of the facility with the exception of o Limited use to decrease pain during procedures when
the baby cannot safely be held or breastfed (pacifiers used should be discarded after these procedures)
o Babies who are being tube-fed in NICUo Other rare specific medical reasons
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Addressing Sleep Deprivation
Give parents tools to cope with fussy babies
Sleep-deprived parents may make poor judgments
Make use of tools o Swaddling side carrying
shushing swinging and sucking
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Overcoming Barriers to Change What Parents are Sayinghellip
Prone positioning fear of choking Baby sleeps ldquobetterrdquo on stomach Soft things are safer for the baby SIDS is ldquoGodrsquos willrdquo Why bother Recommendations keep changing
anyway Vigilance sleep with baby for protection
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Factors Associated With Choice of Infant Sleep Position 3300 mothers from 32 hospitals 77 usually use supine position 49 exclusive use supine position Most likely to use prone
o African-American motherso Mothers with lt high school educationo Lack of perceived controlo Personal attitudesocietal norms
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
A continuum starting in childhoodo Secondary school baby sitting classes
Pre-pregnancy Pregnancyprenatal education
o Prior to baby showerhellipldquowrong giftsrdquo In-hospital education and modeling
o Include family friends baby sitters Re-enforcement in the doctorrsquos office
o Especially between 1 to 4 months Grandparents They hold great power The general public (day cares religious leaders)
A Lifetime of Infant Sleep Safety
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Chart1
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
14
139
13
13
12
13
117
17
103
269
087
386
074
353
077
531
072
557
067
644
062
666
056
716
057
711
053
728
056
701
055
722
055
757
057
703
055
721
054
741
051
728
048
042
04
039
Sheet1
Sheet1
ampA
Page ampP
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
Sheet2
Pre-AAP recommendation Post-AAP RecommendationBack to SleepSafe to Sleep Campaign
Sheet3
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Infant Sleep Safety
Requires a consistent and repetitive message in the community to prevent accidental deaths
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Safe Sleep Nurse Modeling
People trust nurses Whatever the nurse does must
be correct and it will be imitated in the home
Fact supine positioning in the nursery can almost DOUBLE its use in the home
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Physician Advocacy
Srivatsa 1997 HCP education to new familieshellip34 reduction in prone sleeping
Eron 2009 Study of Central NY state physicianshellip30 identified incorrect safest sleep positionhellip30 do not discuss with families
Colson 2009 Only 13 mothers advised by MD to use supine positionhellip3 times more likely to position the baby properly
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Healthcare Provider Advice to New Mothers Safe Sleep
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Chart1
Column1
[]
[]
[]
55
25
20
Sheet1
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Mason Clinical Peds 713
Bundled interventiono Nursing education policy model behavior safe sleep
video posters in rooms declaration of safe sleep practice
Safe sleep environment uarr from 25 to 58 Intention in home 95 supine none ldquoco-sleepingrdquo
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bundled Intervention = Behavior Change
QUESTION GROUP p-value
ISS Study NISP
Behavior Questions n = 490 n = 1046
Baby routinely placed to sleep on back 925 73 lt 0001
Baby routinely sleeps in bassinetcrib 995 71 lt 00001
Baby sleeps under a thin sheet 992 86 lt 0001
Baby given a pacifier for sleep 741 84 lt 0001Goodstein MH Bell T Krugman SD Improving infant sleep safety through a comprehensive hospital-based program Clinical Pediatrics 201554(3)212-221
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
o Baseline Safe sleep 49 of 264 infants o Post 312 of 234 infants (P lt 001) o Extra blankets most common o Baseline 77 vs 44 post-intervention o Mean number of unsafe items reduced by 50 (P lt 001)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Washington DC
2 urban DC nurseries 26 did not believe or unsure that infant positioning
was associated with SIDS Top 3 factors influencing sleep position
o 56 PERSONAL PREFERENCE Why non-supine Clinical experience (25)
o Increase risk aspirationo Decrease sleep and comfort
Bartow KL Nursesrsquo knowledge and adherence to sudden infant death syndrome prevention guidelines Pediatr Nurs 201642(1)7-13
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
TodaysBaby QI Safe Sleep Teaching
QI intervention median = 160 days Mothers reported receiving information 72 to 95
(increase of 24-57) 94 babies observed supine (plus 24) 88 infants in safe sleep environment
o Increase of 33 Gains maintained up to 12 months
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Social Media and Risk-Reduction Training Study (SMART) Cluster randomization 4 groups Safe sleep or breast feeding education Nursing QI and social media (mobile health) N = 1600 1263 responses (79) Safe sleep NQI and MHealth
o Supine sleep 925 o Room-sharing 859o No soft bedding 819o Pacifier use 762
Moon RY Hauck FR Colson ER et al The effect of nursing quality improvement and mobile health interventions on infant sleep practices a randomized clinical trial JAMA 2017318(4)351-359
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Hospital Initiative ComponentswwwcribsforkidsorgHospitalInitiativeToolkit INTRODUCTORY LETTER HOSPITAL INITIATIVE TOOL KIT
INSTRUCTIONS ORGANIZATIONAL CHART HOSPITAL POLICY ACKNOWLEDGMENT FORM (Engl amp
Span) SAFE SLEEP EDUCATIONAL FLIP CHART
NONCOMPLIANCE WAIVER (Engl amp Span)
NURSING EDUCATION MODULE
SAFE SLEEP POSTERS DOOR HANGERS (Engl amp Span) GRADUATION CERTIFICATE SAMPLE LETTER TO HOSPITALS SAMPLE LETTER TO PROVIDERS INFANT SAFE SLEEP BROCHURES
(Engl amp Span) PRESS KIT
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
All materials available on-lineo No major costs to the hospital
Easy on-line access for documentation
NO FEE FOR PARTICIPATION
wwwCribsforKidsorgHospitalInitiative
Tiffany Price (tpricecribsforkidsorg)
The National Safe Sleep Hospital Certification Program
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
TNmdash25 reduction in infant sleep-related deaths in 2 years
SDmdashOver 7915 Pack lsquon Plays distributed since 2012 Infant mortality rate decreased from 86 (2012) to 48 (2016)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
2009 to 2015 38 decrease in infant mortality Decreased from 135 to 84 per 1000 SUID decreased gt50 Decrease in racial disparityhttphealthybabiesbaltimorecomhome
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
And Finallyhellip
Health care providers should have open frank nonjudgmental conversations with families about their sleep practices
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Encouraging Parents to Take Action
According to the Social Learning Theory parents are more likely to recall and comply with instructions when
the health care provider
Uses a positive tone Provides adequate information Allows the parent to ask most of the questions
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Motivational Interviewing
ldquoa collaborative goal-oriented style of communication with particular attention to the language of changerdquo
o Strengthen personal motivation and commitment to a specific goal
o Explore onersquos reasons for change (barriers)o Patient generates own solutions
bull More likely to feel realisticbull Planting seeds of change
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Impact of Eliminating Sleep-Related Deaths
Every week we lose 70 children which is equivalent to 4 kindergarten classrooms
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Thank You
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Contact Information
mgoodsteinwellspanorg
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Visit Pediatric Care Online today for additional information on this and other topics
httppediatriccaresolutionsaaporgPediatric Care Online is a convenient electronic resource for immediate expert help with
virtually every pediatric clinical information need with must-have resources that are included in a comprehensive reference library and time-saving clinical tools
Donrsquot have a subscription to PCOThen take advantage of a free trial today
Call Mead Johnson Nutrition at 888363-2362 orfor more information go to
httppediatriccaresolutionsaaporgSSFree_Trialaspx
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
IMR over time Finland vs US
Slide Number 1
Disclaimer
Objectives for Todayrsquos Talk
Infant Mortality Rates for the Five Leading Causes of Infant Death in the United States 2005 and 2011
US Post-Neonatal Mortality 2015
FACT
What is SUID or SUDI
Some Causes of Deaths that Occur Suddenly and Unexpectedly during Infancy
What is SIDS
SIDS FACTS
SIDS FACTS
Triple Risk Model to Explain SIDS
Paterson DS Krous HF Kinney HC et al JAMA 2006
An Example of SIDS Pathogenesis
2016 AAP Recommendations Infant Sleep Safety
Strength of Recommendation
Recommendations Change as the Evidence Evolves
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
Correct Safe Sleep Environment
We Need to Move Beyond Back to Sleep
Sleep Position for Healthy Newborns
Sleep Position in Newborn Nursery
Sleep Position and Reflux
The Truth About Supine Sleep and Aspiration Ending the Fallacy
Title
Infant Sleep Location
Room-Share How Long Yoursquore Kidding Right
Supporting Data
More Recent Data
Why is Room-Sharing Protective
Room-Sharing and Sleep Quality
Insight Study (Paul 2017)
Insight Study (Paul 2017)
Insight Commentary (Hauck Moon)
Feeding the Baby at Night
Say NO to Couches Sofas and Cushioned Armchairs
High-Risk Bed Sharing Situations
Bedsharing in Low-Risk Breastfed Infants
Independent Review (Dr Robert Platt)
Bed Sharing
Bed Sharing
Bed Sharing with Overlay
Bed Sharing with Overlay
Bed Sharing with Overlay
Couch Sleeping
Couch Sleeping
Couch Sleeping
Unsafe Bedding NISP Trends 1993-2102
Why Use Soft Bedding
Soft Bedding for Older Infants
To Swaddle or Not to Swaddle That is the Question
Swaddling
SwaddlingmdashIs it Safe
SwaddlingmdashMore Questionshellip
wwwhealthychildrenorg
Pacifiers
Pacifiers and Breastfeeding
Baby Friendly USA Pacifiers
Addressing Sleep Deprivation
Overcoming Barriers to Change What Parents are Sayinghellip
Factors Associated With Choice of Infant Sleep Position
Slide Number 65
What is Working
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Infant Sleep Safety
Safe Sleep Nurse Modeling
Physician Advocacy
Healthcare Provider Advice to New Mothers Safe Sleep
Mason Clinical Peds 713
Bundled Intervention = Behavior Change
Hospital Unsafe Sleep Persists
Washington DC
TodaysBaby QI Safe Sleep Teaching
TodaysBaby QI Safe Sleep Teaching
Social Media and Risk-Reduction Training Study (SMART)
The National Safe Sleep Hospital Certification Program
Coordinated Education Efforts Work
Coordinated Education Efforts Work
And Finallyhellip
Encouraging Parents to Take Action
Motivational Interviewing
Impact of Eliminating Sleep-Related Deaths
Thank You
Contact Information
Slide Number 89
IMR over time Finland vs US
Column1
correct advice
55
incorrect advice
25
no advice
20
correct advice
incorrect advice
no advice
SIDS Rate
Percent Back Sleeping
1988
14
1989
139
1990
13
1991
13
1992
12
13
1993
117
17
1994
103
269
1995
087
386
1996
074
353
1997
077
531
1998
072
557
1999
067
644
2000
062
666
2001
056
716
2002
057
711
2003
053
728
2004
056
701
2005
055
722
2006
055
757
2007
057
703
2008
055
721
2009
054
741
2010
051
728
2011
048
2012
042
2013
04
2014
039
httpwwwcdcgovNCHSdatanvsrnvsr58nvsr58_19pdf
Xu JQ Kochanek KD Murphy SL Tejada-Vera B Deaths Final data for
2007
National vital statistics reports vol 58 no 19 Hyattsville MD
National Center for Health Statistics 2010
1988
1988
1989
1989
1990
1990
1991
1991
1992
1992
1993
1993
1994
1994
1995
1995
1996
1996
1997
1997
1998
1998
1999
1999
2000
2000
2001
2001
2002
2002
2003
2003
2004
2004
2005
2005
2006
2006
2007
2007
2008
2008
2009
2009
2010
2010
2011
2012
2013
2014
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
McDonnell E Moon RY Infant deaths and injuries associated with wearable blankets swaddle wraps and swaddling J Pediatr 20141641152-1156
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
SwaddlingmdashMore Questionshellip
Pease 2016 Pediatrics Pooled OR = 138
o Prone = 1299 o Side = 316o Supine = 193
Increased risk with age Limitations
o Heterogeneity definitions other risk factorsPease AS Fleming PJ Hauck FR et al Swaddling and the risk of sudden infant death syndrome a meta-analysis Pediatrics 2016137(6)e20153
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
wwwhealthychildrenorg
Swaddling (wrapping a light blanket snuggly around a baby) may help calm a crying baby If you swaddle your baby be sure to place him on his back to sleep Stop swaddling your baby when he starts to roll
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers
AAP recommendation Consider offering a pacifier at nap time and bedtime
Studies consistently demonstrate a protective effect of pacifiers on SIDS
Mechanism unknowno Dislodge within 15 to 60 minuteso Decreased arousal threshold
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers and Breastfeeding Well-designed trials
o 2 found no association among term infants
o 1 found no association among preterm infants
o 1 found slightly decreased breastfeeding duration at one month if pacifier introduced in first week of life but NO difference if pacifier introduced after one month
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Baby Friendly USA Pacifiers
Breastfeeding babies should not be given pacifiers by the staff of the facility with the exception of o Limited use to decrease pain during procedures when
the baby cannot safely be held or breastfed (pacifiers used should be discarded after these procedures)
o Babies who are being tube-fed in NICUo Other rare specific medical reasons
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Addressing Sleep Deprivation
Give parents tools to cope with fussy babies
Sleep-deprived parents may make poor judgments
Make use of tools o Swaddling side carrying
shushing swinging and sucking
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Overcoming Barriers to Change What Parents are Sayinghellip
Prone positioning fear of choking Baby sleeps ldquobetterrdquo on stomach Soft things are safer for the baby SIDS is ldquoGodrsquos willrdquo Why bother Recommendations keep changing
anyway Vigilance sleep with baby for protection
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Factors Associated With Choice of Infant Sleep Position 3300 mothers from 32 hospitals 77 usually use supine position 49 exclusive use supine position Most likely to use prone
o African-American motherso Mothers with lt high school educationo Lack of perceived controlo Personal attitudesocietal norms
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
A continuum starting in childhoodo Secondary school baby sitting classes
Pre-pregnancy Pregnancyprenatal education
o Prior to baby showerhellipldquowrong giftsrdquo In-hospital education and modeling
o Include family friends baby sitters Re-enforcement in the doctorrsquos office
o Especially between 1 to 4 months Grandparents They hold great power The general public (day cares religious leaders)
A Lifetime of Infant Sleep Safety
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Chart1
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
14
139
13
13
12
13
117
17
103
269
087
386
074
353
077
531
072
557
067
644
062
666
056
716
057
711
053
728
056
701
055
722
055
757
057
703
055
721
054
741
051
728
048
042
04
039
Sheet1
Sheet1
ampA
Page ampP
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
Sheet2
Pre-AAP recommendation Post-AAP RecommendationBack to SleepSafe to Sleep Campaign
Sheet3
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Infant Sleep Safety
Requires a consistent and repetitive message in the community to prevent accidental deaths
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Safe Sleep Nurse Modeling
People trust nurses Whatever the nurse does must
be correct and it will be imitated in the home
Fact supine positioning in the nursery can almost DOUBLE its use in the home
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Physician Advocacy
Srivatsa 1997 HCP education to new familieshellip34 reduction in prone sleeping
Eron 2009 Study of Central NY state physicianshellip30 identified incorrect safest sleep positionhellip30 do not discuss with families
Colson 2009 Only 13 mothers advised by MD to use supine positionhellip3 times more likely to position the baby properly
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Healthcare Provider Advice to New Mothers Safe Sleep
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Chart1
Column1
[]
[]
[]
55
25
20
Sheet1
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Mason Clinical Peds 713
Bundled interventiono Nursing education policy model behavior safe sleep
video posters in rooms declaration of safe sleep practice
Safe sleep environment uarr from 25 to 58 Intention in home 95 supine none ldquoco-sleepingrdquo
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bundled Intervention = Behavior Change
QUESTION GROUP p-value
ISS Study NISP
Behavior Questions n = 490 n = 1046
Baby routinely placed to sleep on back 925 73 lt 0001
Baby routinely sleeps in bassinetcrib 995 71 lt 00001
Baby sleeps under a thin sheet 992 86 lt 0001
Baby given a pacifier for sleep 741 84 lt 0001Goodstein MH Bell T Krugman SD Improving infant sleep safety through a comprehensive hospital-based program Clinical Pediatrics 201554(3)212-221
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
o Baseline Safe sleep 49 of 264 infants o Post 312 of 234 infants (P lt 001) o Extra blankets most common o Baseline 77 vs 44 post-intervention o Mean number of unsafe items reduced by 50 (P lt 001)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Washington DC
2 urban DC nurseries 26 did not believe or unsure that infant positioning
was associated with SIDS Top 3 factors influencing sleep position
o 56 PERSONAL PREFERENCE Why non-supine Clinical experience (25)
o Increase risk aspirationo Decrease sleep and comfort
Bartow KL Nursesrsquo knowledge and adherence to sudden infant death syndrome prevention guidelines Pediatr Nurs 201642(1)7-13
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
TodaysBaby QI Safe Sleep Teaching
QI intervention median = 160 days Mothers reported receiving information 72 to 95
(increase of 24-57) 94 babies observed supine (plus 24) 88 infants in safe sleep environment
o Increase of 33 Gains maintained up to 12 months
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Social Media and Risk-Reduction Training Study (SMART) Cluster randomization 4 groups Safe sleep or breast feeding education Nursing QI and social media (mobile health) N = 1600 1263 responses (79) Safe sleep NQI and MHealth
o Supine sleep 925 o Room-sharing 859o No soft bedding 819o Pacifier use 762
Moon RY Hauck FR Colson ER et al The effect of nursing quality improvement and mobile health interventions on infant sleep practices a randomized clinical trial JAMA 2017318(4)351-359
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Hospital Initiative ComponentswwwcribsforkidsorgHospitalInitiativeToolkit INTRODUCTORY LETTER HOSPITAL INITIATIVE TOOL KIT
INSTRUCTIONS ORGANIZATIONAL CHART HOSPITAL POLICY ACKNOWLEDGMENT FORM (Engl amp
Span) SAFE SLEEP EDUCATIONAL FLIP CHART
NONCOMPLIANCE WAIVER (Engl amp Span)
NURSING EDUCATION MODULE
SAFE SLEEP POSTERS DOOR HANGERS (Engl amp Span) GRADUATION CERTIFICATE SAMPLE LETTER TO HOSPITALS SAMPLE LETTER TO PROVIDERS INFANT SAFE SLEEP BROCHURES
(Engl amp Span) PRESS KIT
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
All materials available on-lineo No major costs to the hospital
Easy on-line access for documentation
NO FEE FOR PARTICIPATION
wwwCribsforKidsorgHospitalInitiative
Tiffany Price (tpricecribsforkidsorg)
The National Safe Sleep Hospital Certification Program
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
TNmdash25 reduction in infant sleep-related deaths in 2 years
SDmdashOver 7915 Pack lsquon Plays distributed since 2012 Infant mortality rate decreased from 86 (2012) to 48 (2016)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
2009 to 2015 38 decrease in infant mortality Decreased from 135 to 84 per 1000 SUID decreased gt50 Decrease in racial disparityhttphealthybabiesbaltimorecomhome
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
And Finallyhellip
Health care providers should have open frank nonjudgmental conversations with families about their sleep practices
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Encouraging Parents to Take Action
According to the Social Learning Theory parents are more likely to recall and comply with instructions when
the health care provider
Uses a positive tone Provides adequate information Allows the parent to ask most of the questions
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Motivational Interviewing
ldquoa collaborative goal-oriented style of communication with particular attention to the language of changerdquo
o Strengthen personal motivation and commitment to a specific goal
o Explore onersquos reasons for change (barriers)o Patient generates own solutions
bull More likely to feel realisticbull Planting seeds of change
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Impact of Eliminating Sleep-Related Deaths
Every week we lose 70 children which is equivalent to 4 kindergarten classrooms
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Thank You
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Contact Information
mgoodsteinwellspanorg
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Visit Pediatric Care Online today for additional information on this and other topics
httppediatriccaresolutionsaaporgPediatric Care Online is a convenient electronic resource for immediate expert help with
virtually every pediatric clinical information need with must-have resources that are included in a comprehensive reference library and time-saving clinical tools
Donrsquot have a subscription to PCOThen take advantage of a free trial today
Call Mead Johnson Nutrition at 888363-2362 orfor more information go to
httppediatriccaresolutionsaaporgSSFree_Trialaspx
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
IMR over time Finland vs US
Slide Number 1
Disclaimer
Objectives for Todayrsquos Talk
Infant Mortality Rates for the Five Leading Causes of Infant Death in the United States 2005 and 2011
US Post-Neonatal Mortality 2015
FACT
What is SUID or SUDI
Some Causes of Deaths that Occur Suddenly and Unexpectedly during Infancy
What is SIDS
SIDS FACTS
SIDS FACTS
Triple Risk Model to Explain SIDS
Paterson DS Krous HF Kinney HC et al JAMA 2006
An Example of SIDS Pathogenesis
2016 AAP Recommendations Infant Sleep Safety
Strength of Recommendation
Recommendations Change as the Evidence Evolves
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
Correct Safe Sleep Environment
We Need to Move Beyond Back to Sleep
Sleep Position for Healthy Newborns
Sleep Position in Newborn Nursery
Sleep Position and Reflux
The Truth About Supine Sleep and Aspiration Ending the Fallacy
Title
Infant Sleep Location
Room-Share How Long Yoursquore Kidding Right
Supporting Data
More Recent Data
Why is Room-Sharing Protective
Room-Sharing and Sleep Quality
Insight Study (Paul 2017)
Insight Study (Paul 2017)
Insight Commentary (Hauck Moon)
Feeding the Baby at Night
Say NO to Couches Sofas and Cushioned Armchairs
High-Risk Bed Sharing Situations
Bedsharing in Low-Risk Breastfed Infants
Independent Review (Dr Robert Platt)
Bed Sharing
Bed Sharing
Bed Sharing with Overlay
Bed Sharing with Overlay
Bed Sharing with Overlay
Couch Sleeping
Couch Sleeping
Couch Sleeping
Unsafe Bedding NISP Trends 1993-2102
Why Use Soft Bedding
Soft Bedding for Older Infants
To Swaddle or Not to Swaddle That is the Question
Swaddling
SwaddlingmdashIs it Safe
SwaddlingmdashMore Questionshellip
wwwhealthychildrenorg
Pacifiers
Pacifiers and Breastfeeding
Baby Friendly USA Pacifiers
Addressing Sleep Deprivation
Overcoming Barriers to Change What Parents are Sayinghellip
Factors Associated With Choice of Infant Sleep Position
Slide Number 65
What is Working
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Infant Sleep Safety
Safe Sleep Nurse Modeling
Physician Advocacy
Healthcare Provider Advice to New Mothers Safe Sleep
Mason Clinical Peds 713
Bundled Intervention = Behavior Change
Hospital Unsafe Sleep Persists
Washington DC
TodaysBaby QI Safe Sleep Teaching
TodaysBaby QI Safe Sleep Teaching
Social Media and Risk-Reduction Training Study (SMART)
The National Safe Sleep Hospital Certification Program
Coordinated Education Efforts Work
Coordinated Education Efforts Work
And Finallyhellip
Encouraging Parents to Take Action
Motivational Interviewing
Impact of Eliminating Sleep-Related Deaths
Thank You
Contact Information
Slide Number 89
IMR over time Finland vs US
Column1
correct advice
55
incorrect advice
25
no advice
20
correct advice
incorrect advice
no advice
SIDS Rate
Percent Back Sleeping
1988
14
1989
139
1990
13
1991
13
1992
12
13
1993
117
17
1994
103
269
1995
087
386
1996
074
353
1997
077
531
1998
072
557
1999
067
644
2000
062
666
2001
056
716
2002
057
711
2003
053
728
2004
056
701
2005
055
722
2006
055
757
2007
057
703
2008
055
721
2009
054
741
2010
051
728
2011
048
2012
042
2013
04
2014
039
httpwwwcdcgovNCHSdatanvsrnvsr58nvsr58_19pdf
Xu JQ Kochanek KD Murphy SL Tejada-Vera B Deaths Final data for
2007
National vital statistics reports vol 58 no 19 Hyattsville MD
National Center for Health Statistics 2010
1988
1988
1989
1989
1990
1990
1991
1991
1992
1992
1993
1993
1994
1994
1995
1995
1996
1996
1997
1997
1998
1998
1999
1999
2000
2000
2001
2001
2002
2002
2003
2003
2004
2004
2005
2005
2006
2006
2007
2007
2008
2008
2009
2009
2010
2010
2011
2012
2013
2014
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
SwaddlingmdashMore Questionshellip
Pease 2016 Pediatrics Pooled OR = 138
o Prone = 1299 o Side = 316o Supine = 193
Increased risk with age Limitations
o Heterogeneity definitions other risk factorsPease AS Fleming PJ Hauck FR et al Swaddling and the risk of sudden infant death syndrome a meta-analysis Pediatrics 2016137(6)e20153
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
wwwhealthychildrenorg
Swaddling (wrapping a light blanket snuggly around a baby) may help calm a crying baby If you swaddle your baby be sure to place him on his back to sleep Stop swaddling your baby when he starts to roll
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers
AAP recommendation Consider offering a pacifier at nap time and bedtime
Studies consistently demonstrate a protective effect of pacifiers on SIDS
Mechanism unknowno Dislodge within 15 to 60 minuteso Decreased arousal threshold
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers and Breastfeeding Well-designed trials
o 2 found no association among term infants
o 1 found no association among preterm infants
o 1 found slightly decreased breastfeeding duration at one month if pacifier introduced in first week of life but NO difference if pacifier introduced after one month
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Baby Friendly USA Pacifiers
Breastfeeding babies should not be given pacifiers by the staff of the facility with the exception of o Limited use to decrease pain during procedures when
the baby cannot safely be held or breastfed (pacifiers used should be discarded after these procedures)
o Babies who are being tube-fed in NICUo Other rare specific medical reasons
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Addressing Sleep Deprivation
Give parents tools to cope with fussy babies
Sleep-deprived parents may make poor judgments
Make use of tools o Swaddling side carrying
shushing swinging and sucking
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Overcoming Barriers to Change What Parents are Sayinghellip
Prone positioning fear of choking Baby sleeps ldquobetterrdquo on stomach Soft things are safer for the baby SIDS is ldquoGodrsquos willrdquo Why bother Recommendations keep changing
anyway Vigilance sleep with baby for protection
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Factors Associated With Choice of Infant Sleep Position 3300 mothers from 32 hospitals 77 usually use supine position 49 exclusive use supine position Most likely to use prone
o African-American motherso Mothers with lt high school educationo Lack of perceived controlo Personal attitudesocietal norms
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
A continuum starting in childhoodo Secondary school baby sitting classes
Pre-pregnancy Pregnancyprenatal education
o Prior to baby showerhellipldquowrong giftsrdquo In-hospital education and modeling
o Include family friends baby sitters Re-enforcement in the doctorrsquos office
o Especially between 1 to 4 months Grandparents They hold great power The general public (day cares religious leaders)
A Lifetime of Infant Sleep Safety
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Chart1
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
14
139
13
13
12
13
117
17
103
269
087
386
074
353
077
531
072
557
067
644
062
666
056
716
057
711
053
728
056
701
055
722
055
757
057
703
055
721
054
741
051
728
048
042
04
039
Sheet1
Sheet1
ampA
Page ampP
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
Sheet2
Pre-AAP recommendation Post-AAP RecommendationBack to SleepSafe to Sleep Campaign
Sheet3
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Infant Sleep Safety
Requires a consistent and repetitive message in the community to prevent accidental deaths
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Safe Sleep Nurse Modeling
People trust nurses Whatever the nurse does must
be correct and it will be imitated in the home
Fact supine positioning in the nursery can almost DOUBLE its use in the home
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Physician Advocacy
Srivatsa 1997 HCP education to new familieshellip34 reduction in prone sleeping
Eron 2009 Study of Central NY state physicianshellip30 identified incorrect safest sleep positionhellip30 do not discuss with families
Colson 2009 Only 13 mothers advised by MD to use supine positionhellip3 times more likely to position the baby properly
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Healthcare Provider Advice to New Mothers Safe Sleep
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Chart1
Column1
[]
[]
[]
55
25
20
Sheet1
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Mason Clinical Peds 713
Bundled interventiono Nursing education policy model behavior safe sleep
video posters in rooms declaration of safe sleep practice
Safe sleep environment uarr from 25 to 58 Intention in home 95 supine none ldquoco-sleepingrdquo
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bundled Intervention = Behavior Change
QUESTION GROUP p-value
ISS Study NISP
Behavior Questions n = 490 n = 1046
Baby routinely placed to sleep on back 925 73 lt 0001
Baby routinely sleeps in bassinetcrib 995 71 lt 00001
Baby sleeps under a thin sheet 992 86 lt 0001
Baby given a pacifier for sleep 741 84 lt 0001Goodstein MH Bell T Krugman SD Improving infant sleep safety through a comprehensive hospital-based program Clinical Pediatrics 201554(3)212-221
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
o Baseline Safe sleep 49 of 264 infants o Post 312 of 234 infants (P lt 001) o Extra blankets most common o Baseline 77 vs 44 post-intervention o Mean number of unsafe items reduced by 50 (P lt 001)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Washington DC
2 urban DC nurseries 26 did not believe or unsure that infant positioning
was associated with SIDS Top 3 factors influencing sleep position
o 56 PERSONAL PREFERENCE Why non-supine Clinical experience (25)
o Increase risk aspirationo Decrease sleep and comfort
Bartow KL Nursesrsquo knowledge and adherence to sudden infant death syndrome prevention guidelines Pediatr Nurs 201642(1)7-13
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
TodaysBaby QI Safe Sleep Teaching
QI intervention median = 160 days Mothers reported receiving information 72 to 95
(increase of 24-57) 94 babies observed supine (plus 24) 88 infants in safe sleep environment
o Increase of 33 Gains maintained up to 12 months
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Social Media and Risk-Reduction Training Study (SMART) Cluster randomization 4 groups Safe sleep or breast feeding education Nursing QI and social media (mobile health) N = 1600 1263 responses (79) Safe sleep NQI and MHealth
o Supine sleep 925 o Room-sharing 859o No soft bedding 819o Pacifier use 762
Moon RY Hauck FR Colson ER et al The effect of nursing quality improvement and mobile health interventions on infant sleep practices a randomized clinical trial JAMA 2017318(4)351-359
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Hospital Initiative ComponentswwwcribsforkidsorgHospitalInitiativeToolkit INTRODUCTORY LETTER HOSPITAL INITIATIVE TOOL KIT
INSTRUCTIONS ORGANIZATIONAL CHART HOSPITAL POLICY ACKNOWLEDGMENT FORM (Engl amp
Span) SAFE SLEEP EDUCATIONAL FLIP CHART
NONCOMPLIANCE WAIVER (Engl amp Span)
NURSING EDUCATION MODULE
SAFE SLEEP POSTERS DOOR HANGERS (Engl amp Span) GRADUATION CERTIFICATE SAMPLE LETTER TO HOSPITALS SAMPLE LETTER TO PROVIDERS INFANT SAFE SLEEP BROCHURES
(Engl amp Span) PRESS KIT
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
All materials available on-lineo No major costs to the hospital
Easy on-line access for documentation
NO FEE FOR PARTICIPATION
wwwCribsforKidsorgHospitalInitiative
Tiffany Price (tpricecribsforkidsorg)
The National Safe Sleep Hospital Certification Program
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
TNmdash25 reduction in infant sleep-related deaths in 2 years
SDmdashOver 7915 Pack lsquon Plays distributed since 2012 Infant mortality rate decreased from 86 (2012) to 48 (2016)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
2009 to 2015 38 decrease in infant mortality Decreased from 135 to 84 per 1000 SUID decreased gt50 Decrease in racial disparityhttphealthybabiesbaltimorecomhome
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
And Finallyhellip
Health care providers should have open frank nonjudgmental conversations with families about their sleep practices
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Encouraging Parents to Take Action
According to the Social Learning Theory parents are more likely to recall and comply with instructions when
the health care provider
Uses a positive tone Provides adequate information Allows the parent to ask most of the questions
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Motivational Interviewing
ldquoa collaborative goal-oriented style of communication with particular attention to the language of changerdquo
o Strengthen personal motivation and commitment to a specific goal
o Explore onersquos reasons for change (barriers)o Patient generates own solutions
bull More likely to feel realisticbull Planting seeds of change
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Impact of Eliminating Sleep-Related Deaths
Every week we lose 70 children which is equivalent to 4 kindergarten classrooms
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Thank You
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Contact Information
mgoodsteinwellspanorg
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Visit Pediatric Care Online today for additional information on this and other topics
httppediatriccaresolutionsaaporgPediatric Care Online is a convenient electronic resource for immediate expert help with
virtually every pediatric clinical information need with must-have resources that are included in a comprehensive reference library and time-saving clinical tools
Donrsquot have a subscription to PCOThen take advantage of a free trial today
Call Mead Johnson Nutrition at 888363-2362 orfor more information go to
httppediatriccaresolutionsaaporgSSFree_Trialaspx
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
IMR over time Finland vs US
Slide Number 1
Disclaimer
Objectives for Todayrsquos Talk
Infant Mortality Rates for the Five Leading Causes of Infant Death in the United States 2005 and 2011
US Post-Neonatal Mortality 2015
FACT
What is SUID or SUDI
Some Causes of Deaths that Occur Suddenly and Unexpectedly during Infancy
What is SIDS
SIDS FACTS
SIDS FACTS
Triple Risk Model to Explain SIDS
Paterson DS Krous HF Kinney HC et al JAMA 2006
An Example of SIDS Pathogenesis
2016 AAP Recommendations Infant Sleep Safety
Strength of Recommendation
Recommendations Change as the Evidence Evolves
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
Correct Safe Sleep Environment
We Need to Move Beyond Back to Sleep
Sleep Position for Healthy Newborns
Sleep Position in Newborn Nursery
Sleep Position and Reflux
The Truth About Supine Sleep and Aspiration Ending the Fallacy
Title
Infant Sleep Location
Room-Share How Long Yoursquore Kidding Right
Supporting Data
More Recent Data
Why is Room-Sharing Protective
Room-Sharing and Sleep Quality
Insight Study (Paul 2017)
Insight Study (Paul 2017)
Insight Commentary (Hauck Moon)
Feeding the Baby at Night
Say NO to Couches Sofas and Cushioned Armchairs
High-Risk Bed Sharing Situations
Bedsharing in Low-Risk Breastfed Infants
Independent Review (Dr Robert Platt)
Bed Sharing
Bed Sharing
Bed Sharing with Overlay
Bed Sharing with Overlay
Bed Sharing with Overlay
Couch Sleeping
Couch Sleeping
Couch Sleeping
Unsafe Bedding NISP Trends 1993-2102
Why Use Soft Bedding
Soft Bedding for Older Infants
To Swaddle or Not to Swaddle That is the Question
Swaddling
SwaddlingmdashIs it Safe
SwaddlingmdashMore Questionshellip
wwwhealthychildrenorg
Pacifiers
Pacifiers and Breastfeeding
Baby Friendly USA Pacifiers
Addressing Sleep Deprivation
Overcoming Barriers to Change What Parents are Sayinghellip
Factors Associated With Choice of Infant Sleep Position
Slide Number 65
What is Working
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Infant Sleep Safety
Safe Sleep Nurse Modeling
Physician Advocacy
Healthcare Provider Advice to New Mothers Safe Sleep
Mason Clinical Peds 713
Bundled Intervention = Behavior Change
Hospital Unsafe Sleep Persists
Washington DC
TodaysBaby QI Safe Sleep Teaching
TodaysBaby QI Safe Sleep Teaching
Social Media and Risk-Reduction Training Study (SMART)
The National Safe Sleep Hospital Certification Program
Coordinated Education Efforts Work
Coordinated Education Efforts Work
And Finallyhellip
Encouraging Parents to Take Action
Motivational Interviewing
Impact of Eliminating Sleep-Related Deaths
Thank You
Contact Information
Slide Number 89
IMR over time Finland vs US
Column1
correct advice
55
incorrect advice
25
no advice
20
correct advice
incorrect advice
no advice
SIDS Rate
Percent Back Sleeping
1988
14
1989
139
1990
13
1991
13
1992
12
13
1993
117
17
1994
103
269
1995
087
386
1996
074
353
1997
077
531
1998
072
557
1999
067
644
2000
062
666
2001
056
716
2002
057
711
2003
053
728
2004
056
701
2005
055
722
2006
055
757
2007
057
703
2008
055
721
2009
054
741
2010
051
728
2011
048
2012
042
2013
04
2014
039
httpwwwcdcgovNCHSdatanvsrnvsr58nvsr58_19pdf
Xu JQ Kochanek KD Murphy SL Tejada-Vera B Deaths Final data for
2007
National vital statistics reports vol 58 no 19 Hyattsville MD
National Center for Health Statistics 2010
1988
1988
1989
1989
1990
1990
1991
1991
1992
1992
1993
1993
1994
1994
1995
1995
1996
1996
1997
1997
1998
1998
1999
1999
2000
2000
2001
2001
2002
2002
2003
2003
2004
2004
2005
2005
2006
2006
2007
2007
2008
2008
2009
2009
2010
2010
2011
2012
2013
2014
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
wwwhealthychildrenorg
Swaddling (wrapping a light blanket snuggly around a baby) may help calm a crying baby If you swaddle your baby be sure to place him on his back to sleep Stop swaddling your baby when he starts to roll
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers
AAP recommendation Consider offering a pacifier at nap time and bedtime
Studies consistently demonstrate a protective effect of pacifiers on SIDS
Mechanism unknowno Dislodge within 15 to 60 minuteso Decreased arousal threshold
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers and Breastfeeding Well-designed trials
o 2 found no association among term infants
o 1 found no association among preterm infants
o 1 found slightly decreased breastfeeding duration at one month if pacifier introduced in first week of life but NO difference if pacifier introduced after one month
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Baby Friendly USA Pacifiers
Breastfeeding babies should not be given pacifiers by the staff of the facility with the exception of o Limited use to decrease pain during procedures when
the baby cannot safely be held or breastfed (pacifiers used should be discarded after these procedures)
o Babies who are being tube-fed in NICUo Other rare specific medical reasons
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Addressing Sleep Deprivation
Give parents tools to cope with fussy babies
Sleep-deprived parents may make poor judgments
Make use of tools o Swaddling side carrying
shushing swinging and sucking
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Overcoming Barriers to Change What Parents are Sayinghellip
Prone positioning fear of choking Baby sleeps ldquobetterrdquo on stomach Soft things are safer for the baby SIDS is ldquoGodrsquos willrdquo Why bother Recommendations keep changing
anyway Vigilance sleep with baby for protection
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Factors Associated With Choice of Infant Sleep Position 3300 mothers from 32 hospitals 77 usually use supine position 49 exclusive use supine position Most likely to use prone
o African-American motherso Mothers with lt high school educationo Lack of perceived controlo Personal attitudesocietal norms
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
A continuum starting in childhoodo Secondary school baby sitting classes
Pre-pregnancy Pregnancyprenatal education
o Prior to baby showerhellipldquowrong giftsrdquo In-hospital education and modeling
o Include family friends baby sitters Re-enforcement in the doctorrsquos office
o Especially between 1 to 4 months Grandparents They hold great power The general public (day cares religious leaders)
A Lifetime of Infant Sleep Safety
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Chart1
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
14
139
13
13
12
13
117
17
103
269
087
386
074
353
077
531
072
557
067
644
062
666
056
716
057
711
053
728
056
701
055
722
055
757
057
703
055
721
054
741
051
728
048
042
04
039
Sheet1
Sheet1
ampA
Page ampP
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
Sheet2
Pre-AAP recommendation Post-AAP RecommendationBack to SleepSafe to Sleep Campaign
Sheet3
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Infant Sleep Safety
Requires a consistent and repetitive message in the community to prevent accidental deaths
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Safe Sleep Nurse Modeling
People trust nurses Whatever the nurse does must
be correct and it will be imitated in the home
Fact supine positioning in the nursery can almost DOUBLE its use in the home
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Physician Advocacy
Srivatsa 1997 HCP education to new familieshellip34 reduction in prone sleeping
Eron 2009 Study of Central NY state physicianshellip30 identified incorrect safest sleep positionhellip30 do not discuss with families
Colson 2009 Only 13 mothers advised by MD to use supine positionhellip3 times more likely to position the baby properly
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Healthcare Provider Advice to New Mothers Safe Sleep
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Chart1
Column1
[]
[]
[]
55
25
20
Sheet1
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Mason Clinical Peds 713
Bundled interventiono Nursing education policy model behavior safe sleep
video posters in rooms declaration of safe sleep practice
Safe sleep environment uarr from 25 to 58 Intention in home 95 supine none ldquoco-sleepingrdquo
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bundled Intervention = Behavior Change
QUESTION GROUP p-value
ISS Study NISP
Behavior Questions n = 490 n = 1046
Baby routinely placed to sleep on back 925 73 lt 0001
Baby routinely sleeps in bassinetcrib 995 71 lt 00001
Baby sleeps under a thin sheet 992 86 lt 0001
Baby given a pacifier for sleep 741 84 lt 0001Goodstein MH Bell T Krugman SD Improving infant sleep safety through a comprehensive hospital-based program Clinical Pediatrics 201554(3)212-221
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
o Baseline Safe sleep 49 of 264 infants o Post 312 of 234 infants (P lt 001) o Extra blankets most common o Baseline 77 vs 44 post-intervention o Mean number of unsafe items reduced by 50 (P lt 001)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Washington DC
2 urban DC nurseries 26 did not believe or unsure that infant positioning
was associated with SIDS Top 3 factors influencing sleep position
o 56 PERSONAL PREFERENCE Why non-supine Clinical experience (25)
o Increase risk aspirationo Decrease sleep and comfort
Bartow KL Nursesrsquo knowledge and adherence to sudden infant death syndrome prevention guidelines Pediatr Nurs 201642(1)7-13
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
TodaysBaby QI Safe Sleep Teaching
QI intervention median = 160 days Mothers reported receiving information 72 to 95
(increase of 24-57) 94 babies observed supine (plus 24) 88 infants in safe sleep environment
o Increase of 33 Gains maintained up to 12 months
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Social Media and Risk-Reduction Training Study (SMART) Cluster randomization 4 groups Safe sleep or breast feeding education Nursing QI and social media (mobile health) N = 1600 1263 responses (79) Safe sleep NQI and MHealth
o Supine sleep 925 o Room-sharing 859o No soft bedding 819o Pacifier use 762
Moon RY Hauck FR Colson ER et al The effect of nursing quality improvement and mobile health interventions on infant sleep practices a randomized clinical trial JAMA 2017318(4)351-359
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Hospital Initiative ComponentswwwcribsforkidsorgHospitalInitiativeToolkit INTRODUCTORY LETTER HOSPITAL INITIATIVE TOOL KIT
INSTRUCTIONS ORGANIZATIONAL CHART HOSPITAL POLICY ACKNOWLEDGMENT FORM (Engl amp
Span) SAFE SLEEP EDUCATIONAL FLIP CHART
NONCOMPLIANCE WAIVER (Engl amp Span)
NURSING EDUCATION MODULE
SAFE SLEEP POSTERS DOOR HANGERS (Engl amp Span) GRADUATION CERTIFICATE SAMPLE LETTER TO HOSPITALS SAMPLE LETTER TO PROVIDERS INFANT SAFE SLEEP BROCHURES
(Engl amp Span) PRESS KIT
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
All materials available on-lineo No major costs to the hospital
Easy on-line access for documentation
NO FEE FOR PARTICIPATION
wwwCribsforKidsorgHospitalInitiative
Tiffany Price (tpricecribsforkidsorg)
The National Safe Sleep Hospital Certification Program
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
TNmdash25 reduction in infant sleep-related deaths in 2 years
SDmdashOver 7915 Pack lsquon Plays distributed since 2012 Infant mortality rate decreased from 86 (2012) to 48 (2016)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
2009 to 2015 38 decrease in infant mortality Decreased from 135 to 84 per 1000 SUID decreased gt50 Decrease in racial disparityhttphealthybabiesbaltimorecomhome
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
And Finallyhellip
Health care providers should have open frank nonjudgmental conversations with families about their sleep practices
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Encouraging Parents to Take Action
According to the Social Learning Theory parents are more likely to recall and comply with instructions when
the health care provider
Uses a positive tone Provides adequate information Allows the parent to ask most of the questions
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Motivational Interviewing
ldquoa collaborative goal-oriented style of communication with particular attention to the language of changerdquo
o Strengthen personal motivation and commitment to a specific goal
o Explore onersquos reasons for change (barriers)o Patient generates own solutions
bull More likely to feel realisticbull Planting seeds of change
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Impact of Eliminating Sleep-Related Deaths
Every week we lose 70 children which is equivalent to 4 kindergarten classrooms
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Thank You
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Contact Information
mgoodsteinwellspanorg
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Visit Pediatric Care Online today for additional information on this and other topics
httppediatriccaresolutionsaaporgPediatric Care Online is a convenient electronic resource for immediate expert help with
virtually every pediatric clinical information need with must-have resources that are included in a comprehensive reference library and time-saving clinical tools
Donrsquot have a subscription to PCOThen take advantage of a free trial today
Call Mead Johnson Nutrition at 888363-2362 orfor more information go to
httppediatriccaresolutionsaaporgSSFree_Trialaspx
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
IMR over time Finland vs US
Slide Number 1
Disclaimer
Objectives for Todayrsquos Talk
Infant Mortality Rates for the Five Leading Causes of Infant Death in the United States 2005 and 2011
US Post-Neonatal Mortality 2015
FACT
What is SUID or SUDI
Some Causes of Deaths that Occur Suddenly and Unexpectedly during Infancy
What is SIDS
SIDS FACTS
SIDS FACTS
Triple Risk Model to Explain SIDS
Paterson DS Krous HF Kinney HC et al JAMA 2006
An Example of SIDS Pathogenesis
2016 AAP Recommendations Infant Sleep Safety
Strength of Recommendation
Recommendations Change as the Evidence Evolves
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
Correct Safe Sleep Environment
We Need to Move Beyond Back to Sleep
Sleep Position for Healthy Newborns
Sleep Position in Newborn Nursery
Sleep Position and Reflux
The Truth About Supine Sleep and Aspiration Ending the Fallacy
Title
Infant Sleep Location
Room-Share How Long Yoursquore Kidding Right
Supporting Data
More Recent Data
Why is Room-Sharing Protective
Room-Sharing and Sleep Quality
Insight Study (Paul 2017)
Insight Study (Paul 2017)
Insight Commentary (Hauck Moon)
Feeding the Baby at Night
Say NO to Couches Sofas and Cushioned Armchairs
High-Risk Bed Sharing Situations
Bedsharing in Low-Risk Breastfed Infants
Independent Review (Dr Robert Platt)
Bed Sharing
Bed Sharing
Bed Sharing with Overlay
Bed Sharing with Overlay
Bed Sharing with Overlay
Couch Sleeping
Couch Sleeping
Couch Sleeping
Unsafe Bedding NISP Trends 1993-2102
Why Use Soft Bedding
Soft Bedding for Older Infants
To Swaddle or Not to Swaddle That is the Question
Swaddling
SwaddlingmdashIs it Safe
SwaddlingmdashMore Questionshellip
wwwhealthychildrenorg
Pacifiers
Pacifiers and Breastfeeding
Baby Friendly USA Pacifiers
Addressing Sleep Deprivation
Overcoming Barriers to Change What Parents are Sayinghellip
Factors Associated With Choice of Infant Sleep Position
Slide Number 65
What is Working
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Infant Sleep Safety
Safe Sleep Nurse Modeling
Physician Advocacy
Healthcare Provider Advice to New Mothers Safe Sleep
Mason Clinical Peds 713
Bundled Intervention = Behavior Change
Hospital Unsafe Sleep Persists
Washington DC
TodaysBaby QI Safe Sleep Teaching
TodaysBaby QI Safe Sleep Teaching
Social Media and Risk-Reduction Training Study (SMART)
The National Safe Sleep Hospital Certification Program
Coordinated Education Efforts Work
Coordinated Education Efforts Work
And Finallyhellip
Encouraging Parents to Take Action
Motivational Interviewing
Impact of Eliminating Sleep-Related Deaths
Thank You
Contact Information
Slide Number 89
IMR over time Finland vs US
Column1
correct advice
55
incorrect advice
25
no advice
20
correct advice
incorrect advice
no advice
SIDS Rate
Percent Back Sleeping
1988
14
1989
139
1990
13
1991
13
1992
12
13
1993
117
17
1994
103
269
1995
087
386
1996
074
353
1997
077
531
1998
072
557
1999
067
644
2000
062
666
2001
056
716
2002
057
711
2003
053
728
2004
056
701
2005
055
722
2006
055
757
2007
057
703
2008
055
721
2009
054
741
2010
051
728
2011
048
2012
042
2013
04
2014
039
httpwwwcdcgovNCHSdatanvsrnvsr58nvsr58_19pdf
Xu JQ Kochanek KD Murphy SL Tejada-Vera B Deaths Final data for
2007
National vital statistics reports vol 58 no 19 Hyattsville MD
National Center for Health Statistics 2010
1988
1988
1989
1989
1990
1990
1991
1991
1992
1992
1993
1993
1994
1994
1995
1995
1996
1996
1997
1997
1998
1998
1999
1999
2000
2000
2001
2001
2002
2002
2003
2003
2004
2004
2005
2005
2006
2006
2007
2007
2008
2008
2009
2009
2010
2010
2011
2012
2013
2014
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers
AAP recommendation Consider offering a pacifier at nap time and bedtime
Studies consistently demonstrate a protective effect of pacifiers on SIDS
Mechanism unknowno Dislodge within 15 to 60 minuteso Decreased arousal threshold
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers and Breastfeeding Well-designed trials
o 2 found no association among term infants
o 1 found no association among preterm infants
o 1 found slightly decreased breastfeeding duration at one month if pacifier introduced in first week of life but NO difference if pacifier introduced after one month
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Baby Friendly USA Pacifiers
Breastfeeding babies should not be given pacifiers by the staff of the facility with the exception of o Limited use to decrease pain during procedures when
the baby cannot safely be held or breastfed (pacifiers used should be discarded after these procedures)
o Babies who are being tube-fed in NICUo Other rare specific medical reasons
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Addressing Sleep Deprivation
Give parents tools to cope with fussy babies
Sleep-deprived parents may make poor judgments
Make use of tools o Swaddling side carrying
shushing swinging and sucking
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Overcoming Barriers to Change What Parents are Sayinghellip
Prone positioning fear of choking Baby sleeps ldquobetterrdquo on stomach Soft things are safer for the baby SIDS is ldquoGodrsquos willrdquo Why bother Recommendations keep changing
anyway Vigilance sleep with baby for protection
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Factors Associated With Choice of Infant Sleep Position 3300 mothers from 32 hospitals 77 usually use supine position 49 exclusive use supine position Most likely to use prone
o African-American motherso Mothers with lt high school educationo Lack of perceived controlo Personal attitudesocietal norms
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
A continuum starting in childhoodo Secondary school baby sitting classes
Pre-pregnancy Pregnancyprenatal education
o Prior to baby showerhellipldquowrong giftsrdquo In-hospital education and modeling
o Include family friends baby sitters Re-enforcement in the doctorrsquos office
o Especially between 1 to 4 months Grandparents They hold great power The general public (day cares religious leaders)
A Lifetime of Infant Sleep Safety
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Chart1
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
14
139
13
13
12
13
117
17
103
269
087
386
074
353
077
531
072
557
067
644
062
666
056
716
057
711
053
728
056
701
055
722
055
757
057
703
055
721
054
741
051
728
048
042
04
039
Sheet1
Sheet1
ampA
Page ampP
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
Sheet2
Pre-AAP recommendation Post-AAP RecommendationBack to SleepSafe to Sleep Campaign
Sheet3
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Infant Sleep Safety
Requires a consistent and repetitive message in the community to prevent accidental deaths
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Safe Sleep Nurse Modeling
People trust nurses Whatever the nurse does must
be correct and it will be imitated in the home
Fact supine positioning in the nursery can almost DOUBLE its use in the home
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Physician Advocacy
Srivatsa 1997 HCP education to new familieshellip34 reduction in prone sleeping
Eron 2009 Study of Central NY state physicianshellip30 identified incorrect safest sleep positionhellip30 do not discuss with families
Colson 2009 Only 13 mothers advised by MD to use supine positionhellip3 times more likely to position the baby properly
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Healthcare Provider Advice to New Mothers Safe Sleep
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Chart1
Column1
[]
[]
[]
55
25
20
Sheet1
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Mason Clinical Peds 713
Bundled interventiono Nursing education policy model behavior safe sleep
video posters in rooms declaration of safe sleep practice
Safe sleep environment uarr from 25 to 58 Intention in home 95 supine none ldquoco-sleepingrdquo
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bundled Intervention = Behavior Change
QUESTION GROUP p-value
ISS Study NISP
Behavior Questions n = 490 n = 1046
Baby routinely placed to sleep on back 925 73 lt 0001
Baby routinely sleeps in bassinetcrib 995 71 lt 00001
Baby sleeps under a thin sheet 992 86 lt 0001
Baby given a pacifier for sleep 741 84 lt 0001Goodstein MH Bell T Krugman SD Improving infant sleep safety through a comprehensive hospital-based program Clinical Pediatrics 201554(3)212-221
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
o Baseline Safe sleep 49 of 264 infants o Post 312 of 234 infants (P lt 001) o Extra blankets most common o Baseline 77 vs 44 post-intervention o Mean number of unsafe items reduced by 50 (P lt 001)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Washington DC
2 urban DC nurseries 26 did not believe or unsure that infant positioning
was associated with SIDS Top 3 factors influencing sleep position
o 56 PERSONAL PREFERENCE Why non-supine Clinical experience (25)
o Increase risk aspirationo Decrease sleep and comfort
Bartow KL Nursesrsquo knowledge and adherence to sudden infant death syndrome prevention guidelines Pediatr Nurs 201642(1)7-13
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
TodaysBaby QI Safe Sleep Teaching
QI intervention median = 160 days Mothers reported receiving information 72 to 95
(increase of 24-57) 94 babies observed supine (plus 24) 88 infants in safe sleep environment
o Increase of 33 Gains maintained up to 12 months
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Social Media and Risk-Reduction Training Study (SMART) Cluster randomization 4 groups Safe sleep or breast feeding education Nursing QI and social media (mobile health) N = 1600 1263 responses (79) Safe sleep NQI and MHealth
o Supine sleep 925 o Room-sharing 859o No soft bedding 819o Pacifier use 762
Moon RY Hauck FR Colson ER et al The effect of nursing quality improvement and mobile health interventions on infant sleep practices a randomized clinical trial JAMA 2017318(4)351-359
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Hospital Initiative ComponentswwwcribsforkidsorgHospitalInitiativeToolkit INTRODUCTORY LETTER HOSPITAL INITIATIVE TOOL KIT
INSTRUCTIONS ORGANIZATIONAL CHART HOSPITAL POLICY ACKNOWLEDGMENT FORM (Engl amp
Span) SAFE SLEEP EDUCATIONAL FLIP CHART
NONCOMPLIANCE WAIVER (Engl amp Span)
NURSING EDUCATION MODULE
SAFE SLEEP POSTERS DOOR HANGERS (Engl amp Span) GRADUATION CERTIFICATE SAMPLE LETTER TO HOSPITALS SAMPLE LETTER TO PROVIDERS INFANT SAFE SLEEP BROCHURES
(Engl amp Span) PRESS KIT
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
All materials available on-lineo No major costs to the hospital
Easy on-line access for documentation
NO FEE FOR PARTICIPATION
wwwCribsforKidsorgHospitalInitiative
Tiffany Price (tpricecribsforkidsorg)
The National Safe Sleep Hospital Certification Program
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
TNmdash25 reduction in infant sleep-related deaths in 2 years
SDmdashOver 7915 Pack lsquon Plays distributed since 2012 Infant mortality rate decreased from 86 (2012) to 48 (2016)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
2009 to 2015 38 decrease in infant mortality Decreased from 135 to 84 per 1000 SUID decreased gt50 Decrease in racial disparityhttphealthybabiesbaltimorecomhome
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
And Finallyhellip
Health care providers should have open frank nonjudgmental conversations with families about their sleep practices
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Encouraging Parents to Take Action
According to the Social Learning Theory parents are more likely to recall and comply with instructions when
the health care provider
Uses a positive tone Provides adequate information Allows the parent to ask most of the questions
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Motivational Interviewing
ldquoa collaborative goal-oriented style of communication with particular attention to the language of changerdquo
o Strengthen personal motivation and commitment to a specific goal
o Explore onersquos reasons for change (barriers)o Patient generates own solutions
bull More likely to feel realisticbull Planting seeds of change
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Impact of Eliminating Sleep-Related Deaths
Every week we lose 70 children which is equivalent to 4 kindergarten classrooms
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Thank You
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Contact Information
mgoodsteinwellspanorg
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Visit Pediatric Care Online today for additional information on this and other topics
httppediatriccaresolutionsaaporgPediatric Care Online is a convenient electronic resource for immediate expert help with
virtually every pediatric clinical information need with must-have resources that are included in a comprehensive reference library and time-saving clinical tools
Donrsquot have a subscription to PCOThen take advantage of a free trial today
Call Mead Johnson Nutrition at 888363-2362 orfor more information go to
httppediatriccaresolutionsaaporgSSFree_Trialaspx
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
IMR over time Finland vs US
Slide Number 1
Disclaimer
Objectives for Todayrsquos Talk
Infant Mortality Rates for the Five Leading Causes of Infant Death in the United States 2005 and 2011
US Post-Neonatal Mortality 2015
FACT
What is SUID or SUDI
Some Causes of Deaths that Occur Suddenly and Unexpectedly during Infancy
What is SIDS
SIDS FACTS
SIDS FACTS
Triple Risk Model to Explain SIDS
Paterson DS Krous HF Kinney HC et al JAMA 2006
An Example of SIDS Pathogenesis
2016 AAP Recommendations Infant Sleep Safety
Strength of Recommendation
Recommendations Change as the Evidence Evolves
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
Correct Safe Sleep Environment
We Need to Move Beyond Back to Sleep
Sleep Position for Healthy Newborns
Sleep Position in Newborn Nursery
Sleep Position and Reflux
The Truth About Supine Sleep and Aspiration Ending the Fallacy
Title
Infant Sleep Location
Room-Share How Long Yoursquore Kidding Right
Supporting Data
More Recent Data
Why is Room-Sharing Protective
Room-Sharing and Sleep Quality
Insight Study (Paul 2017)
Insight Study (Paul 2017)
Insight Commentary (Hauck Moon)
Feeding the Baby at Night
Say NO to Couches Sofas and Cushioned Armchairs
High-Risk Bed Sharing Situations
Bedsharing in Low-Risk Breastfed Infants
Independent Review (Dr Robert Platt)
Bed Sharing
Bed Sharing
Bed Sharing with Overlay
Bed Sharing with Overlay
Bed Sharing with Overlay
Couch Sleeping
Couch Sleeping
Couch Sleeping
Unsafe Bedding NISP Trends 1993-2102
Why Use Soft Bedding
Soft Bedding for Older Infants
To Swaddle or Not to Swaddle That is the Question
Swaddling
SwaddlingmdashIs it Safe
SwaddlingmdashMore Questionshellip
wwwhealthychildrenorg
Pacifiers
Pacifiers and Breastfeeding
Baby Friendly USA Pacifiers
Addressing Sleep Deprivation
Overcoming Barriers to Change What Parents are Sayinghellip
Factors Associated With Choice of Infant Sleep Position
Slide Number 65
What is Working
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Infant Sleep Safety
Safe Sleep Nurse Modeling
Physician Advocacy
Healthcare Provider Advice to New Mothers Safe Sleep
Mason Clinical Peds 713
Bundled Intervention = Behavior Change
Hospital Unsafe Sleep Persists
Washington DC
TodaysBaby QI Safe Sleep Teaching
TodaysBaby QI Safe Sleep Teaching
Social Media and Risk-Reduction Training Study (SMART)
The National Safe Sleep Hospital Certification Program
Coordinated Education Efforts Work
Coordinated Education Efforts Work
And Finallyhellip
Encouraging Parents to Take Action
Motivational Interviewing
Impact of Eliminating Sleep-Related Deaths
Thank You
Contact Information
Slide Number 89
IMR over time Finland vs US
Column1
correct advice
55
incorrect advice
25
no advice
20
correct advice
incorrect advice
no advice
SIDS Rate
Percent Back Sleeping
1988
14
1989
139
1990
13
1991
13
1992
12
13
1993
117
17
1994
103
269
1995
087
386
1996
074
353
1997
077
531
1998
072
557
1999
067
644
2000
062
666
2001
056
716
2002
057
711
2003
053
728
2004
056
701
2005
055
722
2006
055
757
2007
057
703
2008
055
721
2009
054
741
2010
051
728
2011
048
2012
042
2013
04
2014
039
httpwwwcdcgovNCHSdatanvsrnvsr58nvsr58_19pdf
Xu JQ Kochanek KD Murphy SL Tejada-Vera B Deaths Final data for
2007
National vital statistics reports vol 58 no 19 Hyattsville MD
National Center for Health Statistics 2010
1988
1988
1989
1989
1990
1990
1991
1991
1992
1992
1993
1993
1994
1994
1995
1995
1996
1996
1997
1997
1998
1998
1999
1999
2000
2000
2001
2001
2002
2002
2003
2003
2004
2004
2005
2005
2006
2006
2007
2007
2008
2008
2009
2009
2010
2010
2011
2012
2013
2014
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Pacifiers and Breastfeeding Well-designed trials
o 2 found no association among term infants
o 1 found no association among preterm infants
o 1 found slightly decreased breastfeeding duration at one month if pacifier introduced in first week of life but NO difference if pacifier introduced after one month
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Baby Friendly USA Pacifiers
Breastfeeding babies should not be given pacifiers by the staff of the facility with the exception of o Limited use to decrease pain during procedures when
the baby cannot safely be held or breastfed (pacifiers used should be discarded after these procedures)
o Babies who are being tube-fed in NICUo Other rare specific medical reasons
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Addressing Sleep Deprivation
Give parents tools to cope with fussy babies
Sleep-deprived parents may make poor judgments
Make use of tools o Swaddling side carrying
shushing swinging and sucking
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Overcoming Barriers to Change What Parents are Sayinghellip
Prone positioning fear of choking Baby sleeps ldquobetterrdquo on stomach Soft things are safer for the baby SIDS is ldquoGodrsquos willrdquo Why bother Recommendations keep changing
anyway Vigilance sleep with baby for protection
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Factors Associated With Choice of Infant Sleep Position 3300 mothers from 32 hospitals 77 usually use supine position 49 exclusive use supine position Most likely to use prone
o African-American motherso Mothers with lt high school educationo Lack of perceived controlo Personal attitudesocietal norms
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
A continuum starting in childhoodo Secondary school baby sitting classes
Pre-pregnancy Pregnancyprenatal education
o Prior to baby showerhellipldquowrong giftsrdquo In-hospital education and modeling
o Include family friends baby sitters Re-enforcement in the doctorrsquos office
o Especially between 1 to 4 months Grandparents They hold great power The general public (day cares religious leaders)
A Lifetime of Infant Sleep Safety
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Chart1
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
14
139
13
13
12
13
117
17
103
269
087
386
074
353
077
531
072
557
067
644
062
666
056
716
057
711
053
728
056
701
055
722
055
757
057
703
055
721
054
741
051
728
048
042
04
039
Sheet1
Sheet1
ampA
Page ampP
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
Sheet2
Pre-AAP recommendation Post-AAP RecommendationBack to SleepSafe to Sleep Campaign
Sheet3
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Infant Sleep Safety
Requires a consistent and repetitive message in the community to prevent accidental deaths
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Safe Sleep Nurse Modeling
People trust nurses Whatever the nurse does must
be correct and it will be imitated in the home
Fact supine positioning in the nursery can almost DOUBLE its use in the home
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Physician Advocacy
Srivatsa 1997 HCP education to new familieshellip34 reduction in prone sleeping
Eron 2009 Study of Central NY state physicianshellip30 identified incorrect safest sleep positionhellip30 do not discuss with families
Colson 2009 Only 13 mothers advised by MD to use supine positionhellip3 times more likely to position the baby properly
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Healthcare Provider Advice to New Mothers Safe Sleep
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Chart1
Column1
[]
[]
[]
55
25
20
Sheet1
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Mason Clinical Peds 713
Bundled interventiono Nursing education policy model behavior safe sleep
video posters in rooms declaration of safe sleep practice
Safe sleep environment uarr from 25 to 58 Intention in home 95 supine none ldquoco-sleepingrdquo
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bundled Intervention = Behavior Change
QUESTION GROUP p-value
ISS Study NISP
Behavior Questions n = 490 n = 1046
Baby routinely placed to sleep on back 925 73 lt 0001
Baby routinely sleeps in bassinetcrib 995 71 lt 00001
Baby sleeps under a thin sheet 992 86 lt 0001
Baby given a pacifier for sleep 741 84 lt 0001Goodstein MH Bell T Krugman SD Improving infant sleep safety through a comprehensive hospital-based program Clinical Pediatrics 201554(3)212-221
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
o Baseline Safe sleep 49 of 264 infants o Post 312 of 234 infants (P lt 001) o Extra blankets most common o Baseline 77 vs 44 post-intervention o Mean number of unsafe items reduced by 50 (P lt 001)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Washington DC
2 urban DC nurseries 26 did not believe or unsure that infant positioning
was associated with SIDS Top 3 factors influencing sleep position
o 56 PERSONAL PREFERENCE Why non-supine Clinical experience (25)
o Increase risk aspirationo Decrease sleep and comfort
Bartow KL Nursesrsquo knowledge and adherence to sudden infant death syndrome prevention guidelines Pediatr Nurs 201642(1)7-13
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
TodaysBaby QI Safe Sleep Teaching
QI intervention median = 160 days Mothers reported receiving information 72 to 95
(increase of 24-57) 94 babies observed supine (plus 24) 88 infants in safe sleep environment
o Increase of 33 Gains maintained up to 12 months
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Social Media and Risk-Reduction Training Study (SMART) Cluster randomization 4 groups Safe sleep or breast feeding education Nursing QI and social media (mobile health) N = 1600 1263 responses (79) Safe sleep NQI and MHealth
o Supine sleep 925 o Room-sharing 859o No soft bedding 819o Pacifier use 762
Moon RY Hauck FR Colson ER et al The effect of nursing quality improvement and mobile health interventions on infant sleep practices a randomized clinical trial JAMA 2017318(4)351-359
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Hospital Initiative ComponentswwwcribsforkidsorgHospitalInitiativeToolkit INTRODUCTORY LETTER HOSPITAL INITIATIVE TOOL KIT
INSTRUCTIONS ORGANIZATIONAL CHART HOSPITAL POLICY ACKNOWLEDGMENT FORM (Engl amp
Span) SAFE SLEEP EDUCATIONAL FLIP CHART
NONCOMPLIANCE WAIVER (Engl amp Span)
NURSING EDUCATION MODULE
SAFE SLEEP POSTERS DOOR HANGERS (Engl amp Span) GRADUATION CERTIFICATE SAMPLE LETTER TO HOSPITALS SAMPLE LETTER TO PROVIDERS INFANT SAFE SLEEP BROCHURES
(Engl amp Span) PRESS KIT
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
All materials available on-lineo No major costs to the hospital
Easy on-line access for documentation
NO FEE FOR PARTICIPATION
wwwCribsforKidsorgHospitalInitiative
Tiffany Price (tpricecribsforkidsorg)
The National Safe Sleep Hospital Certification Program
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
TNmdash25 reduction in infant sleep-related deaths in 2 years
SDmdashOver 7915 Pack lsquon Plays distributed since 2012 Infant mortality rate decreased from 86 (2012) to 48 (2016)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
2009 to 2015 38 decrease in infant mortality Decreased from 135 to 84 per 1000 SUID decreased gt50 Decrease in racial disparityhttphealthybabiesbaltimorecomhome
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
And Finallyhellip
Health care providers should have open frank nonjudgmental conversations with families about their sleep practices
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Encouraging Parents to Take Action
According to the Social Learning Theory parents are more likely to recall and comply with instructions when
the health care provider
Uses a positive tone Provides adequate information Allows the parent to ask most of the questions
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Motivational Interviewing
ldquoa collaborative goal-oriented style of communication with particular attention to the language of changerdquo
o Strengthen personal motivation and commitment to a specific goal
o Explore onersquos reasons for change (barriers)o Patient generates own solutions
bull More likely to feel realisticbull Planting seeds of change
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Impact of Eliminating Sleep-Related Deaths
Every week we lose 70 children which is equivalent to 4 kindergarten classrooms
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Thank You
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Contact Information
mgoodsteinwellspanorg
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Visit Pediatric Care Online today for additional information on this and other topics
httppediatriccaresolutionsaaporgPediatric Care Online is a convenient electronic resource for immediate expert help with
virtually every pediatric clinical information need with must-have resources that are included in a comprehensive reference library and time-saving clinical tools
Donrsquot have a subscription to PCOThen take advantage of a free trial today
Call Mead Johnson Nutrition at 888363-2362 orfor more information go to
httppediatriccaresolutionsaaporgSSFree_Trialaspx
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
IMR over time Finland vs US
Slide Number 1
Disclaimer
Objectives for Todayrsquos Talk
Infant Mortality Rates for the Five Leading Causes of Infant Death in the United States 2005 and 2011
US Post-Neonatal Mortality 2015
FACT
What is SUID or SUDI
Some Causes of Deaths that Occur Suddenly and Unexpectedly during Infancy
What is SIDS
SIDS FACTS
SIDS FACTS
Triple Risk Model to Explain SIDS
Paterson DS Krous HF Kinney HC et al JAMA 2006
An Example of SIDS Pathogenesis
2016 AAP Recommendations Infant Sleep Safety
Strength of Recommendation
Recommendations Change as the Evidence Evolves
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
Correct Safe Sleep Environment
We Need to Move Beyond Back to Sleep
Sleep Position for Healthy Newborns
Sleep Position in Newborn Nursery
Sleep Position and Reflux
The Truth About Supine Sleep and Aspiration Ending the Fallacy
Title
Infant Sleep Location
Room-Share How Long Yoursquore Kidding Right
Supporting Data
More Recent Data
Why is Room-Sharing Protective
Room-Sharing and Sleep Quality
Insight Study (Paul 2017)
Insight Study (Paul 2017)
Insight Commentary (Hauck Moon)
Feeding the Baby at Night
Say NO to Couches Sofas and Cushioned Armchairs
High-Risk Bed Sharing Situations
Bedsharing in Low-Risk Breastfed Infants
Independent Review (Dr Robert Platt)
Bed Sharing
Bed Sharing
Bed Sharing with Overlay
Bed Sharing with Overlay
Bed Sharing with Overlay
Couch Sleeping
Couch Sleeping
Couch Sleeping
Unsafe Bedding NISP Trends 1993-2102
Why Use Soft Bedding
Soft Bedding for Older Infants
To Swaddle or Not to Swaddle That is the Question
Swaddling
SwaddlingmdashIs it Safe
SwaddlingmdashMore Questionshellip
wwwhealthychildrenorg
Pacifiers
Pacifiers and Breastfeeding
Baby Friendly USA Pacifiers
Addressing Sleep Deprivation
Overcoming Barriers to Change What Parents are Sayinghellip
Factors Associated With Choice of Infant Sleep Position
Slide Number 65
What is Working
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Infant Sleep Safety
Safe Sleep Nurse Modeling
Physician Advocacy
Healthcare Provider Advice to New Mothers Safe Sleep
Mason Clinical Peds 713
Bundled Intervention = Behavior Change
Hospital Unsafe Sleep Persists
Washington DC
TodaysBaby QI Safe Sleep Teaching
TodaysBaby QI Safe Sleep Teaching
Social Media and Risk-Reduction Training Study (SMART)
The National Safe Sleep Hospital Certification Program
Coordinated Education Efforts Work
Coordinated Education Efforts Work
And Finallyhellip
Encouraging Parents to Take Action
Motivational Interviewing
Impact of Eliminating Sleep-Related Deaths
Thank You
Contact Information
Slide Number 89
IMR over time Finland vs US
Column1
correct advice
55
incorrect advice
25
no advice
20
correct advice
incorrect advice
no advice
SIDS Rate
Percent Back Sleeping
1988
14
1989
139
1990
13
1991
13
1992
12
13
1993
117
17
1994
103
269
1995
087
386
1996
074
353
1997
077
531
1998
072
557
1999
067
644
2000
062
666
2001
056
716
2002
057
711
2003
053
728
2004
056
701
2005
055
722
2006
055
757
2007
057
703
2008
055
721
2009
054
741
2010
051
728
2011
048
2012
042
2013
04
2014
039
httpwwwcdcgovNCHSdatanvsrnvsr58nvsr58_19pdf
Xu JQ Kochanek KD Murphy SL Tejada-Vera B Deaths Final data for
2007
National vital statistics reports vol 58 no 19 Hyattsville MD
National Center for Health Statistics 2010
1988
1988
1989
1989
1990
1990
1991
1991
1992
1992
1993
1993
1994
1994
1995
1995
1996
1996
1997
1997
1998
1998
1999
1999
2000
2000
2001
2001
2002
2002
2003
2003
2004
2004
2005
2005
2006
2006
2007
2007
2008
2008
2009
2009
2010
2010
2011
2012
2013
2014
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Baby Friendly USA Pacifiers
Breastfeeding babies should not be given pacifiers by the staff of the facility with the exception of o Limited use to decrease pain during procedures when
the baby cannot safely be held or breastfed (pacifiers used should be discarded after these procedures)
o Babies who are being tube-fed in NICUo Other rare specific medical reasons
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Addressing Sleep Deprivation
Give parents tools to cope with fussy babies
Sleep-deprived parents may make poor judgments
Make use of tools o Swaddling side carrying
shushing swinging and sucking
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Overcoming Barriers to Change What Parents are Sayinghellip
Prone positioning fear of choking Baby sleeps ldquobetterrdquo on stomach Soft things are safer for the baby SIDS is ldquoGodrsquos willrdquo Why bother Recommendations keep changing
anyway Vigilance sleep with baby for protection
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Factors Associated With Choice of Infant Sleep Position 3300 mothers from 32 hospitals 77 usually use supine position 49 exclusive use supine position Most likely to use prone
o African-American motherso Mothers with lt high school educationo Lack of perceived controlo Personal attitudesocietal norms
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
A continuum starting in childhoodo Secondary school baby sitting classes
Pre-pregnancy Pregnancyprenatal education
o Prior to baby showerhellipldquowrong giftsrdquo In-hospital education and modeling
o Include family friends baby sitters Re-enforcement in the doctorrsquos office
o Especially between 1 to 4 months Grandparents They hold great power The general public (day cares religious leaders)
A Lifetime of Infant Sleep Safety
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Chart1
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
14
139
13
13
12
13
117
17
103
269
087
386
074
353
077
531
072
557
067
644
062
666
056
716
057
711
053
728
056
701
055
722
055
757
057
703
055
721
054
741
051
728
048
042
04
039
Sheet1
Sheet1
ampA
Page ampP
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
Sheet2
Pre-AAP recommendation Post-AAP RecommendationBack to SleepSafe to Sleep Campaign
Sheet3
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Infant Sleep Safety
Requires a consistent and repetitive message in the community to prevent accidental deaths
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Safe Sleep Nurse Modeling
People trust nurses Whatever the nurse does must
be correct and it will be imitated in the home
Fact supine positioning in the nursery can almost DOUBLE its use in the home
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Physician Advocacy
Srivatsa 1997 HCP education to new familieshellip34 reduction in prone sleeping
Eron 2009 Study of Central NY state physicianshellip30 identified incorrect safest sleep positionhellip30 do not discuss with families
Colson 2009 Only 13 mothers advised by MD to use supine positionhellip3 times more likely to position the baby properly
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Healthcare Provider Advice to New Mothers Safe Sleep
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Chart1
Column1
[]
[]
[]
55
25
20
Sheet1
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Mason Clinical Peds 713
Bundled interventiono Nursing education policy model behavior safe sleep
video posters in rooms declaration of safe sleep practice
Safe sleep environment uarr from 25 to 58 Intention in home 95 supine none ldquoco-sleepingrdquo
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bundled Intervention = Behavior Change
QUESTION GROUP p-value
ISS Study NISP
Behavior Questions n = 490 n = 1046
Baby routinely placed to sleep on back 925 73 lt 0001
Baby routinely sleeps in bassinetcrib 995 71 lt 00001
Baby sleeps under a thin sheet 992 86 lt 0001
Baby given a pacifier for sleep 741 84 lt 0001Goodstein MH Bell T Krugman SD Improving infant sleep safety through a comprehensive hospital-based program Clinical Pediatrics 201554(3)212-221
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
o Baseline Safe sleep 49 of 264 infants o Post 312 of 234 infants (P lt 001) o Extra blankets most common o Baseline 77 vs 44 post-intervention o Mean number of unsafe items reduced by 50 (P lt 001)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Washington DC
2 urban DC nurseries 26 did not believe or unsure that infant positioning
was associated with SIDS Top 3 factors influencing sleep position
o 56 PERSONAL PREFERENCE Why non-supine Clinical experience (25)
o Increase risk aspirationo Decrease sleep and comfort
Bartow KL Nursesrsquo knowledge and adherence to sudden infant death syndrome prevention guidelines Pediatr Nurs 201642(1)7-13
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
TodaysBaby QI Safe Sleep Teaching
QI intervention median = 160 days Mothers reported receiving information 72 to 95
(increase of 24-57) 94 babies observed supine (plus 24) 88 infants in safe sleep environment
o Increase of 33 Gains maintained up to 12 months
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Social Media and Risk-Reduction Training Study (SMART) Cluster randomization 4 groups Safe sleep or breast feeding education Nursing QI and social media (mobile health) N = 1600 1263 responses (79) Safe sleep NQI and MHealth
o Supine sleep 925 o Room-sharing 859o No soft bedding 819o Pacifier use 762
Moon RY Hauck FR Colson ER et al The effect of nursing quality improvement and mobile health interventions on infant sleep practices a randomized clinical trial JAMA 2017318(4)351-359
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Hospital Initiative ComponentswwwcribsforkidsorgHospitalInitiativeToolkit INTRODUCTORY LETTER HOSPITAL INITIATIVE TOOL KIT
INSTRUCTIONS ORGANIZATIONAL CHART HOSPITAL POLICY ACKNOWLEDGMENT FORM (Engl amp
Span) SAFE SLEEP EDUCATIONAL FLIP CHART
NONCOMPLIANCE WAIVER (Engl amp Span)
NURSING EDUCATION MODULE
SAFE SLEEP POSTERS DOOR HANGERS (Engl amp Span) GRADUATION CERTIFICATE SAMPLE LETTER TO HOSPITALS SAMPLE LETTER TO PROVIDERS INFANT SAFE SLEEP BROCHURES
(Engl amp Span) PRESS KIT
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
All materials available on-lineo No major costs to the hospital
Easy on-line access for documentation
NO FEE FOR PARTICIPATION
wwwCribsforKidsorgHospitalInitiative
Tiffany Price (tpricecribsforkidsorg)
The National Safe Sleep Hospital Certification Program
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
TNmdash25 reduction in infant sleep-related deaths in 2 years
SDmdashOver 7915 Pack lsquon Plays distributed since 2012 Infant mortality rate decreased from 86 (2012) to 48 (2016)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
2009 to 2015 38 decrease in infant mortality Decreased from 135 to 84 per 1000 SUID decreased gt50 Decrease in racial disparityhttphealthybabiesbaltimorecomhome
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
And Finallyhellip
Health care providers should have open frank nonjudgmental conversations with families about their sleep practices
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Encouraging Parents to Take Action
According to the Social Learning Theory parents are more likely to recall and comply with instructions when
the health care provider
Uses a positive tone Provides adequate information Allows the parent to ask most of the questions
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Motivational Interviewing
ldquoa collaborative goal-oriented style of communication with particular attention to the language of changerdquo
o Strengthen personal motivation and commitment to a specific goal
o Explore onersquos reasons for change (barriers)o Patient generates own solutions
bull More likely to feel realisticbull Planting seeds of change
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Impact of Eliminating Sleep-Related Deaths
Every week we lose 70 children which is equivalent to 4 kindergarten classrooms
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Thank You
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Contact Information
mgoodsteinwellspanorg
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Visit Pediatric Care Online today for additional information on this and other topics
httppediatriccaresolutionsaaporgPediatric Care Online is a convenient electronic resource for immediate expert help with
virtually every pediatric clinical information need with must-have resources that are included in a comprehensive reference library and time-saving clinical tools
Donrsquot have a subscription to PCOThen take advantage of a free trial today
Call Mead Johnson Nutrition at 888363-2362 orfor more information go to
httppediatriccaresolutionsaaporgSSFree_Trialaspx
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
IMR over time Finland vs US
Slide Number 1
Disclaimer
Objectives for Todayrsquos Talk
Infant Mortality Rates for the Five Leading Causes of Infant Death in the United States 2005 and 2011
US Post-Neonatal Mortality 2015
FACT
What is SUID or SUDI
Some Causes of Deaths that Occur Suddenly and Unexpectedly during Infancy
What is SIDS
SIDS FACTS
SIDS FACTS
Triple Risk Model to Explain SIDS
Paterson DS Krous HF Kinney HC et al JAMA 2006
An Example of SIDS Pathogenesis
2016 AAP Recommendations Infant Sleep Safety
Strength of Recommendation
Recommendations Change as the Evidence Evolves
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
Correct Safe Sleep Environment
We Need to Move Beyond Back to Sleep
Sleep Position for Healthy Newborns
Sleep Position in Newborn Nursery
Sleep Position and Reflux
The Truth About Supine Sleep and Aspiration Ending the Fallacy
Title
Infant Sleep Location
Room-Share How Long Yoursquore Kidding Right
Supporting Data
More Recent Data
Why is Room-Sharing Protective
Room-Sharing and Sleep Quality
Insight Study (Paul 2017)
Insight Study (Paul 2017)
Insight Commentary (Hauck Moon)
Feeding the Baby at Night
Say NO to Couches Sofas and Cushioned Armchairs
High-Risk Bed Sharing Situations
Bedsharing in Low-Risk Breastfed Infants
Independent Review (Dr Robert Platt)
Bed Sharing
Bed Sharing
Bed Sharing with Overlay
Bed Sharing with Overlay
Bed Sharing with Overlay
Couch Sleeping
Couch Sleeping
Couch Sleeping
Unsafe Bedding NISP Trends 1993-2102
Why Use Soft Bedding
Soft Bedding for Older Infants
To Swaddle or Not to Swaddle That is the Question
Swaddling
SwaddlingmdashIs it Safe
SwaddlingmdashMore Questionshellip
wwwhealthychildrenorg
Pacifiers
Pacifiers and Breastfeeding
Baby Friendly USA Pacifiers
Addressing Sleep Deprivation
Overcoming Barriers to Change What Parents are Sayinghellip
Factors Associated With Choice of Infant Sleep Position
Slide Number 65
What is Working
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Infant Sleep Safety
Safe Sleep Nurse Modeling
Physician Advocacy
Healthcare Provider Advice to New Mothers Safe Sleep
Mason Clinical Peds 713
Bundled Intervention = Behavior Change
Hospital Unsafe Sleep Persists
Washington DC
TodaysBaby QI Safe Sleep Teaching
TodaysBaby QI Safe Sleep Teaching
Social Media and Risk-Reduction Training Study (SMART)
The National Safe Sleep Hospital Certification Program
Coordinated Education Efforts Work
Coordinated Education Efforts Work
And Finallyhellip
Encouraging Parents to Take Action
Motivational Interviewing
Impact of Eliminating Sleep-Related Deaths
Thank You
Contact Information
Slide Number 89
IMR over time Finland vs US
Column1
correct advice
55
incorrect advice
25
no advice
20
correct advice
incorrect advice
no advice
SIDS Rate
Percent Back Sleeping
1988
14
1989
139
1990
13
1991
13
1992
12
13
1993
117
17
1994
103
269
1995
087
386
1996
074
353
1997
077
531
1998
072
557
1999
067
644
2000
062
666
2001
056
716
2002
057
711
2003
053
728
2004
056
701
2005
055
722
2006
055
757
2007
057
703
2008
055
721
2009
054
741
2010
051
728
2011
048
2012
042
2013
04
2014
039
httpwwwcdcgovNCHSdatanvsrnvsr58nvsr58_19pdf
Xu JQ Kochanek KD Murphy SL Tejada-Vera B Deaths Final data for
2007
National vital statistics reports vol 58 no 19 Hyattsville MD
National Center for Health Statistics 2010
1988
1988
1989
1989
1990
1990
1991
1991
1992
1992
1993
1993
1994
1994
1995
1995
1996
1996
1997
1997
1998
1998
1999
1999
2000
2000
2001
2001
2002
2002
2003
2003
2004
2004
2005
2005
2006
2006
2007
2007
2008
2008
2009
2009
2010
2010
2011
2012
2013
2014
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Addressing Sleep Deprivation
Give parents tools to cope with fussy babies
Sleep-deprived parents may make poor judgments
Make use of tools o Swaddling side carrying
shushing swinging and sucking
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Overcoming Barriers to Change What Parents are Sayinghellip
Prone positioning fear of choking Baby sleeps ldquobetterrdquo on stomach Soft things are safer for the baby SIDS is ldquoGodrsquos willrdquo Why bother Recommendations keep changing
anyway Vigilance sleep with baby for protection
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Factors Associated With Choice of Infant Sleep Position 3300 mothers from 32 hospitals 77 usually use supine position 49 exclusive use supine position Most likely to use prone
o African-American motherso Mothers with lt high school educationo Lack of perceived controlo Personal attitudesocietal norms
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
A continuum starting in childhoodo Secondary school baby sitting classes
Pre-pregnancy Pregnancyprenatal education
o Prior to baby showerhellipldquowrong giftsrdquo In-hospital education and modeling
o Include family friends baby sitters Re-enforcement in the doctorrsquos office
o Especially between 1 to 4 months Grandparents They hold great power The general public (day cares religious leaders)
A Lifetime of Infant Sleep Safety
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Chart1
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
14
139
13
13
12
13
117
17
103
269
087
386
074
353
077
531
072
557
067
644
062
666
056
716
057
711
053
728
056
701
055
722
055
757
057
703
055
721
054
741
051
728
048
042
04
039
Sheet1
Sheet1
ampA
Page ampP
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
Sheet2
Pre-AAP recommendation Post-AAP RecommendationBack to SleepSafe to Sleep Campaign
Sheet3
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Infant Sleep Safety
Requires a consistent and repetitive message in the community to prevent accidental deaths
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Safe Sleep Nurse Modeling
People trust nurses Whatever the nurse does must
be correct and it will be imitated in the home
Fact supine positioning in the nursery can almost DOUBLE its use in the home
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Physician Advocacy
Srivatsa 1997 HCP education to new familieshellip34 reduction in prone sleeping
Eron 2009 Study of Central NY state physicianshellip30 identified incorrect safest sleep positionhellip30 do not discuss with families
Colson 2009 Only 13 mothers advised by MD to use supine positionhellip3 times more likely to position the baby properly
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Healthcare Provider Advice to New Mothers Safe Sleep
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Chart1
Column1
[]
[]
[]
55
25
20
Sheet1
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Mason Clinical Peds 713
Bundled interventiono Nursing education policy model behavior safe sleep
video posters in rooms declaration of safe sleep practice
Safe sleep environment uarr from 25 to 58 Intention in home 95 supine none ldquoco-sleepingrdquo
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bundled Intervention = Behavior Change
QUESTION GROUP p-value
ISS Study NISP
Behavior Questions n = 490 n = 1046
Baby routinely placed to sleep on back 925 73 lt 0001
Baby routinely sleeps in bassinetcrib 995 71 lt 00001
Baby sleeps under a thin sheet 992 86 lt 0001
Baby given a pacifier for sleep 741 84 lt 0001Goodstein MH Bell T Krugman SD Improving infant sleep safety through a comprehensive hospital-based program Clinical Pediatrics 201554(3)212-221
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
o Baseline Safe sleep 49 of 264 infants o Post 312 of 234 infants (P lt 001) o Extra blankets most common o Baseline 77 vs 44 post-intervention o Mean number of unsafe items reduced by 50 (P lt 001)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Washington DC
2 urban DC nurseries 26 did not believe or unsure that infant positioning
was associated with SIDS Top 3 factors influencing sleep position
o 56 PERSONAL PREFERENCE Why non-supine Clinical experience (25)
o Increase risk aspirationo Decrease sleep and comfort
Bartow KL Nursesrsquo knowledge and adherence to sudden infant death syndrome prevention guidelines Pediatr Nurs 201642(1)7-13
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
TodaysBaby QI Safe Sleep Teaching
QI intervention median = 160 days Mothers reported receiving information 72 to 95
(increase of 24-57) 94 babies observed supine (plus 24) 88 infants in safe sleep environment
o Increase of 33 Gains maintained up to 12 months
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Social Media and Risk-Reduction Training Study (SMART) Cluster randomization 4 groups Safe sleep or breast feeding education Nursing QI and social media (mobile health) N = 1600 1263 responses (79) Safe sleep NQI and MHealth
o Supine sleep 925 o Room-sharing 859o No soft bedding 819o Pacifier use 762
Moon RY Hauck FR Colson ER et al The effect of nursing quality improvement and mobile health interventions on infant sleep practices a randomized clinical trial JAMA 2017318(4)351-359
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Hospital Initiative ComponentswwwcribsforkidsorgHospitalInitiativeToolkit INTRODUCTORY LETTER HOSPITAL INITIATIVE TOOL KIT
INSTRUCTIONS ORGANIZATIONAL CHART HOSPITAL POLICY ACKNOWLEDGMENT FORM (Engl amp
Span) SAFE SLEEP EDUCATIONAL FLIP CHART
NONCOMPLIANCE WAIVER (Engl amp Span)
NURSING EDUCATION MODULE
SAFE SLEEP POSTERS DOOR HANGERS (Engl amp Span) GRADUATION CERTIFICATE SAMPLE LETTER TO HOSPITALS SAMPLE LETTER TO PROVIDERS INFANT SAFE SLEEP BROCHURES
(Engl amp Span) PRESS KIT
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
All materials available on-lineo No major costs to the hospital
Easy on-line access for documentation
NO FEE FOR PARTICIPATION
wwwCribsforKidsorgHospitalInitiative
Tiffany Price (tpricecribsforkidsorg)
The National Safe Sleep Hospital Certification Program
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
TNmdash25 reduction in infant sleep-related deaths in 2 years
SDmdashOver 7915 Pack lsquon Plays distributed since 2012 Infant mortality rate decreased from 86 (2012) to 48 (2016)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
2009 to 2015 38 decrease in infant mortality Decreased from 135 to 84 per 1000 SUID decreased gt50 Decrease in racial disparityhttphealthybabiesbaltimorecomhome
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
And Finallyhellip
Health care providers should have open frank nonjudgmental conversations with families about their sleep practices
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Encouraging Parents to Take Action
According to the Social Learning Theory parents are more likely to recall and comply with instructions when
the health care provider
Uses a positive tone Provides adequate information Allows the parent to ask most of the questions
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Motivational Interviewing
ldquoa collaborative goal-oriented style of communication with particular attention to the language of changerdquo
o Strengthen personal motivation and commitment to a specific goal
o Explore onersquos reasons for change (barriers)o Patient generates own solutions
bull More likely to feel realisticbull Planting seeds of change
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Impact of Eliminating Sleep-Related Deaths
Every week we lose 70 children which is equivalent to 4 kindergarten classrooms
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Thank You
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Contact Information
mgoodsteinwellspanorg
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Visit Pediatric Care Online today for additional information on this and other topics
httppediatriccaresolutionsaaporgPediatric Care Online is a convenient electronic resource for immediate expert help with
virtually every pediatric clinical information need with must-have resources that are included in a comprehensive reference library and time-saving clinical tools
Donrsquot have a subscription to PCOThen take advantage of a free trial today
Call Mead Johnson Nutrition at 888363-2362 orfor more information go to
httppediatriccaresolutionsaaporgSSFree_Trialaspx
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
IMR over time Finland vs US
Slide Number 1
Disclaimer
Objectives for Todayrsquos Talk
Infant Mortality Rates for the Five Leading Causes of Infant Death in the United States 2005 and 2011
US Post-Neonatal Mortality 2015
FACT
What is SUID or SUDI
Some Causes of Deaths that Occur Suddenly and Unexpectedly during Infancy
What is SIDS
SIDS FACTS
SIDS FACTS
Triple Risk Model to Explain SIDS
Paterson DS Krous HF Kinney HC et al JAMA 2006
An Example of SIDS Pathogenesis
2016 AAP Recommendations Infant Sleep Safety
Strength of Recommendation
Recommendations Change as the Evidence Evolves
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
Correct Safe Sleep Environment
We Need to Move Beyond Back to Sleep
Sleep Position for Healthy Newborns
Sleep Position in Newborn Nursery
Sleep Position and Reflux
The Truth About Supine Sleep and Aspiration Ending the Fallacy
Title
Infant Sleep Location
Room-Share How Long Yoursquore Kidding Right
Supporting Data
More Recent Data
Why is Room-Sharing Protective
Room-Sharing and Sleep Quality
Insight Study (Paul 2017)
Insight Study (Paul 2017)
Insight Commentary (Hauck Moon)
Feeding the Baby at Night
Say NO to Couches Sofas and Cushioned Armchairs
High-Risk Bed Sharing Situations
Bedsharing in Low-Risk Breastfed Infants
Independent Review (Dr Robert Platt)
Bed Sharing
Bed Sharing
Bed Sharing with Overlay
Bed Sharing with Overlay
Bed Sharing with Overlay
Couch Sleeping
Couch Sleeping
Couch Sleeping
Unsafe Bedding NISP Trends 1993-2102
Why Use Soft Bedding
Soft Bedding for Older Infants
To Swaddle or Not to Swaddle That is the Question
Swaddling
SwaddlingmdashIs it Safe
SwaddlingmdashMore Questionshellip
wwwhealthychildrenorg
Pacifiers
Pacifiers and Breastfeeding
Baby Friendly USA Pacifiers
Addressing Sleep Deprivation
Overcoming Barriers to Change What Parents are Sayinghellip
Factors Associated With Choice of Infant Sleep Position
Slide Number 65
What is Working
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Infant Sleep Safety
Safe Sleep Nurse Modeling
Physician Advocacy
Healthcare Provider Advice to New Mothers Safe Sleep
Mason Clinical Peds 713
Bundled Intervention = Behavior Change
Hospital Unsafe Sleep Persists
Washington DC
TodaysBaby QI Safe Sleep Teaching
TodaysBaby QI Safe Sleep Teaching
Social Media and Risk-Reduction Training Study (SMART)
The National Safe Sleep Hospital Certification Program
Coordinated Education Efforts Work
Coordinated Education Efforts Work
And Finallyhellip
Encouraging Parents to Take Action
Motivational Interviewing
Impact of Eliminating Sleep-Related Deaths
Thank You
Contact Information
Slide Number 89
IMR over time Finland vs US
Column1
correct advice
55
incorrect advice
25
no advice
20
correct advice
incorrect advice
no advice
SIDS Rate
Percent Back Sleeping
1988
14
1989
139
1990
13
1991
13
1992
12
13
1993
117
17
1994
103
269
1995
087
386
1996
074
353
1997
077
531
1998
072
557
1999
067
644
2000
062
666
2001
056
716
2002
057
711
2003
053
728
2004
056
701
2005
055
722
2006
055
757
2007
057
703
2008
055
721
2009
054
741
2010
051
728
2011
048
2012
042
2013
04
2014
039
httpwwwcdcgovNCHSdatanvsrnvsr58nvsr58_19pdf
Xu JQ Kochanek KD Murphy SL Tejada-Vera B Deaths Final data for
2007
National vital statistics reports vol 58 no 19 Hyattsville MD
National Center for Health Statistics 2010
1988
1988
1989
1989
1990
1990
1991
1991
1992
1992
1993
1993
1994
1994
1995
1995
1996
1996
1997
1997
1998
1998
1999
1999
2000
2000
2001
2001
2002
2002
2003
2003
2004
2004
2005
2005
2006
2006
2007
2007
2008
2008
2009
2009
2010
2010
2011
2012
2013
2014
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Overcoming Barriers to Change What Parents are Sayinghellip
Prone positioning fear of choking Baby sleeps ldquobetterrdquo on stomach Soft things are safer for the baby SIDS is ldquoGodrsquos willrdquo Why bother Recommendations keep changing
anyway Vigilance sleep with baby for protection
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Factors Associated With Choice of Infant Sleep Position 3300 mothers from 32 hospitals 77 usually use supine position 49 exclusive use supine position Most likely to use prone
o African-American motherso Mothers with lt high school educationo Lack of perceived controlo Personal attitudesocietal norms
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
A continuum starting in childhoodo Secondary school baby sitting classes
Pre-pregnancy Pregnancyprenatal education
o Prior to baby showerhellipldquowrong giftsrdquo In-hospital education and modeling
o Include family friends baby sitters Re-enforcement in the doctorrsquos office
o Especially between 1 to 4 months Grandparents They hold great power The general public (day cares religious leaders)
A Lifetime of Infant Sleep Safety
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Chart1
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
14
139
13
13
12
13
117
17
103
269
087
386
074
353
077
531
072
557
067
644
062
666
056
716
057
711
053
728
056
701
055
722
055
757
057
703
055
721
054
741
051
728
048
042
04
039
Sheet1
Sheet1
ampA
Page ampP
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
Sheet2
Pre-AAP recommendation Post-AAP RecommendationBack to SleepSafe to Sleep Campaign
Sheet3
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Infant Sleep Safety
Requires a consistent and repetitive message in the community to prevent accidental deaths
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Safe Sleep Nurse Modeling
People trust nurses Whatever the nurse does must
be correct and it will be imitated in the home
Fact supine positioning in the nursery can almost DOUBLE its use in the home
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Physician Advocacy
Srivatsa 1997 HCP education to new familieshellip34 reduction in prone sleeping
Eron 2009 Study of Central NY state physicianshellip30 identified incorrect safest sleep positionhellip30 do not discuss with families
Colson 2009 Only 13 mothers advised by MD to use supine positionhellip3 times more likely to position the baby properly
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Healthcare Provider Advice to New Mothers Safe Sleep
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Chart1
Column1
[]
[]
[]
55
25
20
Sheet1
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Mason Clinical Peds 713
Bundled interventiono Nursing education policy model behavior safe sleep
video posters in rooms declaration of safe sleep practice
Safe sleep environment uarr from 25 to 58 Intention in home 95 supine none ldquoco-sleepingrdquo
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bundled Intervention = Behavior Change
QUESTION GROUP p-value
ISS Study NISP
Behavior Questions n = 490 n = 1046
Baby routinely placed to sleep on back 925 73 lt 0001
Baby routinely sleeps in bassinetcrib 995 71 lt 00001
Baby sleeps under a thin sheet 992 86 lt 0001
Baby given a pacifier for sleep 741 84 lt 0001Goodstein MH Bell T Krugman SD Improving infant sleep safety through a comprehensive hospital-based program Clinical Pediatrics 201554(3)212-221
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
o Baseline Safe sleep 49 of 264 infants o Post 312 of 234 infants (P lt 001) o Extra blankets most common o Baseline 77 vs 44 post-intervention o Mean number of unsafe items reduced by 50 (P lt 001)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Washington DC
2 urban DC nurseries 26 did not believe or unsure that infant positioning
was associated with SIDS Top 3 factors influencing sleep position
o 56 PERSONAL PREFERENCE Why non-supine Clinical experience (25)
o Increase risk aspirationo Decrease sleep and comfort
Bartow KL Nursesrsquo knowledge and adherence to sudden infant death syndrome prevention guidelines Pediatr Nurs 201642(1)7-13
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
TodaysBaby QI Safe Sleep Teaching
QI intervention median = 160 days Mothers reported receiving information 72 to 95
(increase of 24-57) 94 babies observed supine (plus 24) 88 infants in safe sleep environment
o Increase of 33 Gains maintained up to 12 months
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Social Media and Risk-Reduction Training Study (SMART) Cluster randomization 4 groups Safe sleep or breast feeding education Nursing QI and social media (mobile health) N = 1600 1263 responses (79) Safe sleep NQI and MHealth
o Supine sleep 925 o Room-sharing 859o No soft bedding 819o Pacifier use 762
Moon RY Hauck FR Colson ER et al The effect of nursing quality improvement and mobile health interventions on infant sleep practices a randomized clinical trial JAMA 2017318(4)351-359
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Hospital Initiative ComponentswwwcribsforkidsorgHospitalInitiativeToolkit INTRODUCTORY LETTER HOSPITAL INITIATIVE TOOL KIT
INSTRUCTIONS ORGANIZATIONAL CHART HOSPITAL POLICY ACKNOWLEDGMENT FORM (Engl amp
Span) SAFE SLEEP EDUCATIONAL FLIP CHART
NONCOMPLIANCE WAIVER (Engl amp Span)
NURSING EDUCATION MODULE
SAFE SLEEP POSTERS DOOR HANGERS (Engl amp Span) GRADUATION CERTIFICATE SAMPLE LETTER TO HOSPITALS SAMPLE LETTER TO PROVIDERS INFANT SAFE SLEEP BROCHURES
(Engl amp Span) PRESS KIT
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
All materials available on-lineo No major costs to the hospital
Easy on-line access for documentation
NO FEE FOR PARTICIPATION
wwwCribsforKidsorgHospitalInitiative
Tiffany Price (tpricecribsforkidsorg)
The National Safe Sleep Hospital Certification Program
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
TNmdash25 reduction in infant sleep-related deaths in 2 years
SDmdashOver 7915 Pack lsquon Plays distributed since 2012 Infant mortality rate decreased from 86 (2012) to 48 (2016)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
2009 to 2015 38 decrease in infant mortality Decreased from 135 to 84 per 1000 SUID decreased gt50 Decrease in racial disparityhttphealthybabiesbaltimorecomhome
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
And Finallyhellip
Health care providers should have open frank nonjudgmental conversations with families about their sleep practices
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Encouraging Parents to Take Action
According to the Social Learning Theory parents are more likely to recall and comply with instructions when
the health care provider
Uses a positive tone Provides adequate information Allows the parent to ask most of the questions
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Motivational Interviewing
ldquoa collaborative goal-oriented style of communication with particular attention to the language of changerdquo
o Strengthen personal motivation and commitment to a specific goal
o Explore onersquos reasons for change (barriers)o Patient generates own solutions
bull More likely to feel realisticbull Planting seeds of change
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Impact of Eliminating Sleep-Related Deaths
Every week we lose 70 children which is equivalent to 4 kindergarten classrooms
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Thank You
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Contact Information
mgoodsteinwellspanorg
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Visit Pediatric Care Online today for additional information on this and other topics
httppediatriccaresolutionsaaporgPediatric Care Online is a convenient electronic resource for immediate expert help with
virtually every pediatric clinical information need with must-have resources that are included in a comprehensive reference library and time-saving clinical tools
Donrsquot have a subscription to PCOThen take advantage of a free trial today
Call Mead Johnson Nutrition at 888363-2362 orfor more information go to
httppediatriccaresolutionsaaporgSSFree_Trialaspx
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
IMR over time Finland vs US
Slide Number 1
Disclaimer
Objectives for Todayrsquos Talk
Infant Mortality Rates for the Five Leading Causes of Infant Death in the United States 2005 and 2011
US Post-Neonatal Mortality 2015
FACT
What is SUID or SUDI
Some Causes of Deaths that Occur Suddenly and Unexpectedly during Infancy
What is SIDS
SIDS FACTS
SIDS FACTS
Triple Risk Model to Explain SIDS
Paterson DS Krous HF Kinney HC et al JAMA 2006
An Example of SIDS Pathogenesis
2016 AAP Recommendations Infant Sleep Safety
Strength of Recommendation
Recommendations Change as the Evidence Evolves
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
Correct Safe Sleep Environment
We Need to Move Beyond Back to Sleep
Sleep Position for Healthy Newborns
Sleep Position in Newborn Nursery
Sleep Position and Reflux
The Truth About Supine Sleep and Aspiration Ending the Fallacy
Title
Infant Sleep Location
Room-Share How Long Yoursquore Kidding Right
Supporting Data
More Recent Data
Why is Room-Sharing Protective
Room-Sharing and Sleep Quality
Insight Study (Paul 2017)
Insight Study (Paul 2017)
Insight Commentary (Hauck Moon)
Feeding the Baby at Night
Say NO to Couches Sofas and Cushioned Armchairs
High-Risk Bed Sharing Situations
Bedsharing in Low-Risk Breastfed Infants
Independent Review (Dr Robert Platt)
Bed Sharing
Bed Sharing
Bed Sharing with Overlay
Bed Sharing with Overlay
Bed Sharing with Overlay
Couch Sleeping
Couch Sleeping
Couch Sleeping
Unsafe Bedding NISP Trends 1993-2102
Why Use Soft Bedding
Soft Bedding for Older Infants
To Swaddle or Not to Swaddle That is the Question
Swaddling
SwaddlingmdashIs it Safe
SwaddlingmdashMore Questionshellip
wwwhealthychildrenorg
Pacifiers
Pacifiers and Breastfeeding
Baby Friendly USA Pacifiers
Addressing Sleep Deprivation
Overcoming Barriers to Change What Parents are Sayinghellip
Factors Associated With Choice of Infant Sleep Position
Slide Number 65
What is Working
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Infant Sleep Safety
Safe Sleep Nurse Modeling
Physician Advocacy
Healthcare Provider Advice to New Mothers Safe Sleep
Mason Clinical Peds 713
Bundled Intervention = Behavior Change
Hospital Unsafe Sleep Persists
Washington DC
TodaysBaby QI Safe Sleep Teaching
TodaysBaby QI Safe Sleep Teaching
Social Media and Risk-Reduction Training Study (SMART)
The National Safe Sleep Hospital Certification Program
Coordinated Education Efforts Work
Coordinated Education Efforts Work
And Finallyhellip
Encouraging Parents to Take Action
Motivational Interviewing
Impact of Eliminating Sleep-Related Deaths
Thank You
Contact Information
Slide Number 89
IMR over time Finland vs US
Column1
correct advice
55
incorrect advice
25
no advice
20
correct advice
incorrect advice
no advice
SIDS Rate
Percent Back Sleeping
1988
14
1989
139
1990
13
1991
13
1992
12
13
1993
117
17
1994
103
269
1995
087
386
1996
074
353
1997
077
531
1998
072
557
1999
067
644
2000
062
666
2001
056
716
2002
057
711
2003
053
728
2004
056
701
2005
055
722
2006
055
757
2007
057
703
2008
055
721
2009
054
741
2010
051
728
2011
048
2012
042
2013
04
2014
039
httpwwwcdcgovNCHSdatanvsrnvsr58nvsr58_19pdf
Xu JQ Kochanek KD Murphy SL Tejada-Vera B Deaths Final data for
2007
National vital statistics reports vol 58 no 19 Hyattsville MD
National Center for Health Statistics 2010
1988
1988
1989
1989
1990
1990
1991
1991
1992
1992
1993
1993
1994
1994
1995
1995
1996
1996
1997
1997
1998
1998
1999
1999
2000
2000
2001
2001
2002
2002
2003
2003
2004
2004
2005
2005
2006
2006
2007
2007
2008
2008
2009
2009
2010
2010
2011
2012
2013
2014
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Factors Associated With Choice of Infant Sleep Position 3300 mothers from 32 hospitals 77 usually use supine position 49 exclusive use supine position Most likely to use prone
o African-American motherso Mothers with lt high school educationo Lack of perceived controlo Personal attitudesocietal norms
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
A continuum starting in childhoodo Secondary school baby sitting classes
Pre-pregnancy Pregnancyprenatal education
o Prior to baby showerhellipldquowrong giftsrdquo In-hospital education and modeling
o Include family friends baby sitters Re-enforcement in the doctorrsquos office
o Especially between 1 to 4 months Grandparents They hold great power The general public (day cares religious leaders)
A Lifetime of Infant Sleep Safety
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Chart1
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
14
139
13
13
12
13
117
17
103
269
087
386
074
353
077
531
072
557
067
644
062
666
056
716
057
711
053
728
056
701
055
722
055
757
057
703
055
721
054
741
051
728
048
042
04
039
Sheet1
Sheet1
ampA
Page ampP
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
Sheet2
Pre-AAP recommendation Post-AAP RecommendationBack to SleepSafe to Sleep Campaign
Sheet3
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Infant Sleep Safety
Requires a consistent and repetitive message in the community to prevent accidental deaths
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Safe Sleep Nurse Modeling
People trust nurses Whatever the nurse does must
be correct and it will be imitated in the home
Fact supine positioning in the nursery can almost DOUBLE its use in the home
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Physician Advocacy
Srivatsa 1997 HCP education to new familieshellip34 reduction in prone sleeping
Eron 2009 Study of Central NY state physicianshellip30 identified incorrect safest sleep positionhellip30 do not discuss with families
Colson 2009 Only 13 mothers advised by MD to use supine positionhellip3 times more likely to position the baby properly
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Healthcare Provider Advice to New Mothers Safe Sleep
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Chart1
Column1
[]
[]
[]
55
25
20
Sheet1
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Mason Clinical Peds 713
Bundled interventiono Nursing education policy model behavior safe sleep
video posters in rooms declaration of safe sleep practice
Safe sleep environment uarr from 25 to 58 Intention in home 95 supine none ldquoco-sleepingrdquo
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bundled Intervention = Behavior Change
QUESTION GROUP p-value
ISS Study NISP
Behavior Questions n = 490 n = 1046
Baby routinely placed to sleep on back 925 73 lt 0001
Baby routinely sleeps in bassinetcrib 995 71 lt 00001
Baby sleeps under a thin sheet 992 86 lt 0001
Baby given a pacifier for sleep 741 84 lt 0001Goodstein MH Bell T Krugman SD Improving infant sleep safety through a comprehensive hospital-based program Clinical Pediatrics 201554(3)212-221
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
o Baseline Safe sleep 49 of 264 infants o Post 312 of 234 infants (P lt 001) o Extra blankets most common o Baseline 77 vs 44 post-intervention o Mean number of unsafe items reduced by 50 (P lt 001)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Washington DC
2 urban DC nurseries 26 did not believe or unsure that infant positioning
was associated with SIDS Top 3 factors influencing sleep position
o 56 PERSONAL PREFERENCE Why non-supine Clinical experience (25)
o Increase risk aspirationo Decrease sleep and comfort
Bartow KL Nursesrsquo knowledge and adherence to sudden infant death syndrome prevention guidelines Pediatr Nurs 201642(1)7-13
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
TodaysBaby QI Safe Sleep Teaching
QI intervention median = 160 days Mothers reported receiving information 72 to 95
(increase of 24-57) 94 babies observed supine (plus 24) 88 infants in safe sleep environment
o Increase of 33 Gains maintained up to 12 months
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Social Media and Risk-Reduction Training Study (SMART) Cluster randomization 4 groups Safe sleep or breast feeding education Nursing QI and social media (mobile health) N = 1600 1263 responses (79) Safe sleep NQI and MHealth
o Supine sleep 925 o Room-sharing 859o No soft bedding 819o Pacifier use 762
Moon RY Hauck FR Colson ER et al The effect of nursing quality improvement and mobile health interventions on infant sleep practices a randomized clinical trial JAMA 2017318(4)351-359
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Hospital Initiative ComponentswwwcribsforkidsorgHospitalInitiativeToolkit INTRODUCTORY LETTER HOSPITAL INITIATIVE TOOL KIT
INSTRUCTIONS ORGANIZATIONAL CHART HOSPITAL POLICY ACKNOWLEDGMENT FORM (Engl amp
Span) SAFE SLEEP EDUCATIONAL FLIP CHART
NONCOMPLIANCE WAIVER (Engl amp Span)
NURSING EDUCATION MODULE
SAFE SLEEP POSTERS DOOR HANGERS (Engl amp Span) GRADUATION CERTIFICATE SAMPLE LETTER TO HOSPITALS SAMPLE LETTER TO PROVIDERS INFANT SAFE SLEEP BROCHURES
(Engl amp Span) PRESS KIT
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
All materials available on-lineo No major costs to the hospital
Easy on-line access for documentation
NO FEE FOR PARTICIPATION
wwwCribsforKidsorgHospitalInitiative
Tiffany Price (tpricecribsforkidsorg)
The National Safe Sleep Hospital Certification Program
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
TNmdash25 reduction in infant sleep-related deaths in 2 years
SDmdashOver 7915 Pack lsquon Plays distributed since 2012 Infant mortality rate decreased from 86 (2012) to 48 (2016)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
2009 to 2015 38 decrease in infant mortality Decreased from 135 to 84 per 1000 SUID decreased gt50 Decrease in racial disparityhttphealthybabiesbaltimorecomhome
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
And Finallyhellip
Health care providers should have open frank nonjudgmental conversations with families about their sleep practices
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Encouraging Parents to Take Action
According to the Social Learning Theory parents are more likely to recall and comply with instructions when
the health care provider
Uses a positive tone Provides adequate information Allows the parent to ask most of the questions
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Motivational Interviewing
ldquoa collaborative goal-oriented style of communication with particular attention to the language of changerdquo
o Strengthen personal motivation and commitment to a specific goal
o Explore onersquos reasons for change (barriers)o Patient generates own solutions
bull More likely to feel realisticbull Planting seeds of change
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Impact of Eliminating Sleep-Related Deaths
Every week we lose 70 children which is equivalent to 4 kindergarten classrooms
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Thank You
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Contact Information
mgoodsteinwellspanorg
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Visit Pediatric Care Online today for additional information on this and other topics
httppediatriccaresolutionsaaporgPediatric Care Online is a convenient electronic resource for immediate expert help with
virtually every pediatric clinical information need with must-have resources that are included in a comprehensive reference library and time-saving clinical tools
Donrsquot have a subscription to PCOThen take advantage of a free trial today
Call Mead Johnson Nutrition at 888363-2362 orfor more information go to
httppediatriccaresolutionsaaporgSSFree_Trialaspx
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
IMR over time Finland vs US
Slide Number 1
Disclaimer
Objectives for Todayrsquos Talk
Infant Mortality Rates for the Five Leading Causes of Infant Death in the United States 2005 and 2011
US Post-Neonatal Mortality 2015
FACT
What is SUID or SUDI
Some Causes of Deaths that Occur Suddenly and Unexpectedly during Infancy
What is SIDS
SIDS FACTS
SIDS FACTS
Triple Risk Model to Explain SIDS
Paterson DS Krous HF Kinney HC et al JAMA 2006
An Example of SIDS Pathogenesis
2016 AAP Recommendations Infant Sleep Safety
Strength of Recommendation
Recommendations Change as the Evidence Evolves
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
Correct Safe Sleep Environment
We Need to Move Beyond Back to Sleep
Sleep Position for Healthy Newborns
Sleep Position in Newborn Nursery
Sleep Position and Reflux
The Truth About Supine Sleep and Aspiration Ending the Fallacy
Title
Infant Sleep Location
Room-Share How Long Yoursquore Kidding Right
Supporting Data
More Recent Data
Why is Room-Sharing Protective
Room-Sharing and Sleep Quality
Insight Study (Paul 2017)
Insight Study (Paul 2017)
Insight Commentary (Hauck Moon)
Feeding the Baby at Night
Say NO to Couches Sofas and Cushioned Armchairs
High-Risk Bed Sharing Situations
Bedsharing in Low-Risk Breastfed Infants
Independent Review (Dr Robert Platt)
Bed Sharing
Bed Sharing
Bed Sharing with Overlay
Bed Sharing with Overlay
Bed Sharing with Overlay
Couch Sleeping
Couch Sleeping
Couch Sleeping
Unsafe Bedding NISP Trends 1993-2102
Why Use Soft Bedding
Soft Bedding for Older Infants
To Swaddle or Not to Swaddle That is the Question
Swaddling
SwaddlingmdashIs it Safe
SwaddlingmdashMore Questionshellip
wwwhealthychildrenorg
Pacifiers
Pacifiers and Breastfeeding
Baby Friendly USA Pacifiers
Addressing Sleep Deprivation
Overcoming Barriers to Change What Parents are Sayinghellip
Factors Associated With Choice of Infant Sleep Position
Slide Number 65
What is Working
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Infant Sleep Safety
Safe Sleep Nurse Modeling
Physician Advocacy
Healthcare Provider Advice to New Mothers Safe Sleep
Mason Clinical Peds 713
Bundled Intervention = Behavior Change
Hospital Unsafe Sleep Persists
Washington DC
TodaysBaby QI Safe Sleep Teaching
TodaysBaby QI Safe Sleep Teaching
Social Media and Risk-Reduction Training Study (SMART)
The National Safe Sleep Hospital Certification Program
Coordinated Education Efforts Work
Coordinated Education Efforts Work
And Finallyhellip
Encouraging Parents to Take Action
Motivational Interviewing
Impact of Eliminating Sleep-Related Deaths
Thank You
Contact Information
Slide Number 89
IMR over time Finland vs US
Column1
correct advice
55
incorrect advice
25
no advice
20
correct advice
incorrect advice
no advice
SIDS Rate
Percent Back Sleeping
1988
14
1989
139
1990
13
1991
13
1992
12
13
1993
117
17
1994
103
269
1995
087
386
1996
074
353
1997
077
531
1998
072
557
1999
067
644
2000
062
666
2001
056
716
2002
057
711
2003
053
728
2004
056
701
2005
055
722
2006
055
757
2007
057
703
2008
055
721
2009
054
741
2010
051
728
2011
048
2012
042
2013
04
2014
039
httpwwwcdcgovNCHSdatanvsrnvsr58nvsr58_19pdf
Xu JQ Kochanek KD Murphy SL Tejada-Vera B Deaths Final data for
2007
National vital statistics reports vol 58 no 19 Hyattsville MD
National Center for Health Statistics 2010
1988
1988
1989
1989
1990
1990
1991
1991
1992
1992
1993
1993
1994
1994
1995
1995
1996
1996
1997
1997
1998
1998
1999
1999
2000
2000
2001
2001
2002
2002
2003
2003
2004
2004
2005
2005
2006
2006
2007
2007
2008
2008
2009
2009
2010
2010
2011
2012
2013
2014
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
A continuum starting in childhoodo Secondary school baby sitting classes
Pre-pregnancy Pregnancyprenatal education
o Prior to baby showerhellipldquowrong giftsrdquo In-hospital education and modeling
o Include family friends baby sitters Re-enforcement in the doctorrsquos office
o Especially between 1 to 4 months Grandparents They hold great power The general public (day cares religious leaders)
A Lifetime of Infant Sleep Safety
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Chart1
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
14
139
13
13
12
13
117
17
103
269
087
386
074
353
077
531
072
557
067
644
062
666
056
716
057
711
053
728
056
701
055
722
055
757
057
703
055
721
054
741
051
728
048
042
04
039
Sheet1
Sheet1
ampA
Page ampP
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
Sheet2
Pre-AAP recommendation Post-AAP RecommendationBack to SleepSafe to Sleep Campaign
Sheet3
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Infant Sleep Safety
Requires a consistent and repetitive message in the community to prevent accidental deaths
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Safe Sleep Nurse Modeling
People trust nurses Whatever the nurse does must
be correct and it will be imitated in the home
Fact supine positioning in the nursery can almost DOUBLE its use in the home
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Physician Advocacy
Srivatsa 1997 HCP education to new familieshellip34 reduction in prone sleeping
Eron 2009 Study of Central NY state physicianshellip30 identified incorrect safest sleep positionhellip30 do not discuss with families
Colson 2009 Only 13 mothers advised by MD to use supine positionhellip3 times more likely to position the baby properly
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Healthcare Provider Advice to New Mothers Safe Sleep
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Chart1
Column1
[]
[]
[]
55
25
20
Sheet1
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Mason Clinical Peds 713
Bundled interventiono Nursing education policy model behavior safe sleep
video posters in rooms declaration of safe sleep practice
Safe sleep environment uarr from 25 to 58 Intention in home 95 supine none ldquoco-sleepingrdquo
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bundled Intervention = Behavior Change
QUESTION GROUP p-value
ISS Study NISP
Behavior Questions n = 490 n = 1046
Baby routinely placed to sleep on back 925 73 lt 0001
Baby routinely sleeps in bassinetcrib 995 71 lt 00001
Baby sleeps under a thin sheet 992 86 lt 0001
Baby given a pacifier for sleep 741 84 lt 0001Goodstein MH Bell T Krugman SD Improving infant sleep safety through a comprehensive hospital-based program Clinical Pediatrics 201554(3)212-221
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
o Baseline Safe sleep 49 of 264 infants o Post 312 of 234 infants (P lt 001) o Extra blankets most common o Baseline 77 vs 44 post-intervention o Mean number of unsafe items reduced by 50 (P lt 001)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Washington DC
2 urban DC nurseries 26 did not believe or unsure that infant positioning
was associated with SIDS Top 3 factors influencing sleep position
o 56 PERSONAL PREFERENCE Why non-supine Clinical experience (25)
o Increase risk aspirationo Decrease sleep and comfort
Bartow KL Nursesrsquo knowledge and adherence to sudden infant death syndrome prevention guidelines Pediatr Nurs 201642(1)7-13
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
TodaysBaby QI Safe Sleep Teaching
QI intervention median = 160 days Mothers reported receiving information 72 to 95
(increase of 24-57) 94 babies observed supine (plus 24) 88 infants in safe sleep environment
o Increase of 33 Gains maintained up to 12 months
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Social Media and Risk-Reduction Training Study (SMART) Cluster randomization 4 groups Safe sleep or breast feeding education Nursing QI and social media (mobile health) N = 1600 1263 responses (79) Safe sleep NQI and MHealth
o Supine sleep 925 o Room-sharing 859o No soft bedding 819o Pacifier use 762
Moon RY Hauck FR Colson ER et al The effect of nursing quality improvement and mobile health interventions on infant sleep practices a randomized clinical trial JAMA 2017318(4)351-359
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Hospital Initiative ComponentswwwcribsforkidsorgHospitalInitiativeToolkit INTRODUCTORY LETTER HOSPITAL INITIATIVE TOOL KIT
INSTRUCTIONS ORGANIZATIONAL CHART HOSPITAL POLICY ACKNOWLEDGMENT FORM (Engl amp
Span) SAFE SLEEP EDUCATIONAL FLIP CHART
NONCOMPLIANCE WAIVER (Engl amp Span)
NURSING EDUCATION MODULE
SAFE SLEEP POSTERS DOOR HANGERS (Engl amp Span) GRADUATION CERTIFICATE SAMPLE LETTER TO HOSPITALS SAMPLE LETTER TO PROVIDERS INFANT SAFE SLEEP BROCHURES
(Engl amp Span) PRESS KIT
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
All materials available on-lineo No major costs to the hospital
Easy on-line access for documentation
NO FEE FOR PARTICIPATION
wwwCribsforKidsorgHospitalInitiative
Tiffany Price (tpricecribsforkidsorg)
The National Safe Sleep Hospital Certification Program
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
TNmdash25 reduction in infant sleep-related deaths in 2 years
SDmdashOver 7915 Pack lsquon Plays distributed since 2012 Infant mortality rate decreased from 86 (2012) to 48 (2016)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
2009 to 2015 38 decrease in infant mortality Decreased from 135 to 84 per 1000 SUID decreased gt50 Decrease in racial disparityhttphealthybabiesbaltimorecomhome
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
And Finallyhellip
Health care providers should have open frank nonjudgmental conversations with families about their sleep practices
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Encouraging Parents to Take Action
According to the Social Learning Theory parents are more likely to recall and comply with instructions when
the health care provider
Uses a positive tone Provides adequate information Allows the parent to ask most of the questions
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Motivational Interviewing
ldquoa collaborative goal-oriented style of communication with particular attention to the language of changerdquo
o Strengthen personal motivation and commitment to a specific goal
o Explore onersquos reasons for change (barriers)o Patient generates own solutions
bull More likely to feel realisticbull Planting seeds of change
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Impact of Eliminating Sleep-Related Deaths
Every week we lose 70 children which is equivalent to 4 kindergarten classrooms
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Thank You
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Contact Information
mgoodsteinwellspanorg
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Visit Pediatric Care Online today for additional information on this and other topics
httppediatriccaresolutionsaaporgPediatric Care Online is a convenient electronic resource for immediate expert help with
virtually every pediatric clinical information need with must-have resources that are included in a comprehensive reference library and time-saving clinical tools
Donrsquot have a subscription to PCOThen take advantage of a free trial today
Call Mead Johnson Nutrition at 888363-2362 orfor more information go to
httppediatriccaresolutionsaaporgSSFree_Trialaspx
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
IMR over time Finland vs US
Slide Number 1
Disclaimer
Objectives for Todayrsquos Talk
Infant Mortality Rates for the Five Leading Causes of Infant Death in the United States 2005 and 2011
US Post-Neonatal Mortality 2015
FACT
What is SUID or SUDI
Some Causes of Deaths that Occur Suddenly and Unexpectedly during Infancy
What is SIDS
SIDS FACTS
SIDS FACTS
Triple Risk Model to Explain SIDS
Paterson DS Krous HF Kinney HC et al JAMA 2006
An Example of SIDS Pathogenesis
2016 AAP Recommendations Infant Sleep Safety
Strength of Recommendation
Recommendations Change as the Evidence Evolves
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
Correct Safe Sleep Environment
We Need to Move Beyond Back to Sleep
Sleep Position for Healthy Newborns
Sleep Position in Newborn Nursery
Sleep Position and Reflux
The Truth About Supine Sleep and Aspiration Ending the Fallacy
Title
Infant Sleep Location
Room-Share How Long Yoursquore Kidding Right
Supporting Data
More Recent Data
Why is Room-Sharing Protective
Room-Sharing and Sleep Quality
Insight Study (Paul 2017)
Insight Study (Paul 2017)
Insight Commentary (Hauck Moon)
Feeding the Baby at Night
Say NO to Couches Sofas and Cushioned Armchairs
High-Risk Bed Sharing Situations
Bedsharing in Low-Risk Breastfed Infants
Independent Review (Dr Robert Platt)
Bed Sharing
Bed Sharing
Bed Sharing with Overlay
Bed Sharing with Overlay
Bed Sharing with Overlay
Couch Sleeping
Couch Sleeping
Couch Sleeping
Unsafe Bedding NISP Trends 1993-2102
Why Use Soft Bedding
Soft Bedding for Older Infants
To Swaddle or Not to Swaddle That is the Question
Swaddling
SwaddlingmdashIs it Safe
SwaddlingmdashMore Questionshellip
wwwhealthychildrenorg
Pacifiers
Pacifiers and Breastfeeding
Baby Friendly USA Pacifiers
Addressing Sleep Deprivation
Overcoming Barriers to Change What Parents are Sayinghellip
Factors Associated With Choice of Infant Sleep Position
Slide Number 65
What is Working
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Infant Sleep Safety
Safe Sleep Nurse Modeling
Physician Advocacy
Healthcare Provider Advice to New Mothers Safe Sleep
Mason Clinical Peds 713
Bundled Intervention = Behavior Change
Hospital Unsafe Sleep Persists
Washington DC
TodaysBaby QI Safe Sleep Teaching
TodaysBaby QI Safe Sleep Teaching
Social Media and Risk-Reduction Training Study (SMART)
The National Safe Sleep Hospital Certification Program
Coordinated Education Efforts Work
Coordinated Education Efforts Work
And Finallyhellip
Encouraging Parents to Take Action
Motivational Interviewing
Impact of Eliminating Sleep-Related Deaths
Thank You
Contact Information
Slide Number 89
IMR over time Finland vs US
Column1
correct advice
55
incorrect advice
25
no advice
20
correct advice
incorrect advice
no advice
SIDS Rate
Percent Back Sleeping
1988
14
1989
139
1990
13
1991
13
1992
12
13
1993
117
17
1994
103
269
1995
087
386
1996
074
353
1997
077
531
1998
072
557
1999
067
644
2000
062
666
2001
056
716
2002
057
711
2003
053
728
2004
056
701
2005
055
722
2006
055
757
2007
057
703
2008
055
721
2009
054
741
2010
051
728
2011
048
2012
042
2013
04
2014
039
httpwwwcdcgovNCHSdatanvsrnvsr58nvsr58_19pdf
Xu JQ Kochanek KD Murphy SL Tejada-Vera B Deaths Final data for
2007
National vital statistics reports vol 58 no 19 Hyattsville MD
National Center for Health Statistics 2010
1988
1988
1989
1989
1990
1990
1991
1991
1992
1992
1993
1993
1994
1994
1995
1995
1996
1996
1997
1997
1998
1998
1999
1999
2000
2000
2001
2001
2002
2002
2003
2003
2004
2004
2005
2005
2006
2006
2007
2007
2008
2008
2009
2009
2010
2010
2011
2012
2013
2014
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Chart1
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
14
139
13
13
12
13
117
17
103
269
087
386
074
353
077
531
072
557
067
644
062
666
056
716
057
711
053
728
056
701
055
722
055
757
057
703
055
721
054
741
051
728
048
042
04
039
Sheet1
Sheet1
ampA
Page ampP
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
Sheet2
Pre-AAP recommendation Post-AAP RecommendationBack to SleepSafe to Sleep Campaign
Sheet3
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Infant Sleep Safety
Requires a consistent and repetitive message in the community to prevent accidental deaths
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Safe Sleep Nurse Modeling
People trust nurses Whatever the nurse does must
be correct and it will be imitated in the home
Fact supine positioning in the nursery can almost DOUBLE its use in the home
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Physician Advocacy
Srivatsa 1997 HCP education to new familieshellip34 reduction in prone sleeping
Eron 2009 Study of Central NY state physicianshellip30 identified incorrect safest sleep positionhellip30 do not discuss with families
Colson 2009 Only 13 mothers advised by MD to use supine positionhellip3 times more likely to position the baby properly
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Healthcare Provider Advice to New Mothers Safe Sleep
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Chart1
Column1
[]
[]
[]
55
25
20
Sheet1
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Mason Clinical Peds 713
Bundled interventiono Nursing education policy model behavior safe sleep
video posters in rooms declaration of safe sleep practice
Safe sleep environment uarr from 25 to 58 Intention in home 95 supine none ldquoco-sleepingrdquo
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bundled Intervention = Behavior Change
QUESTION GROUP p-value
ISS Study NISP
Behavior Questions n = 490 n = 1046
Baby routinely placed to sleep on back 925 73 lt 0001
Baby routinely sleeps in bassinetcrib 995 71 lt 00001
Baby sleeps under a thin sheet 992 86 lt 0001
Baby given a pacifier for sleep 741 84 lt 0001Goodstein MH Bell T Krugman SD Improving infant sleep safety through a comprehensive hospital-based program Clinical Pediatrics 201554(3)212-221
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
o Baseline Safe sleep 49 of 264 infants o Post 312 of 234 infants (P lt 001) o Extra blankets most common o Baseline 77 vs 44 post-intervention o Mean number of unsafe items reduced by 50 (P lt 001)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Washington DC
2 urban DC nurseries 26 did not believe or unsure that infant positioning
was associated with SIDS Top 3 factors influencing sleep position
o 56 PERSONAL PREFERENCE Why non-supine Clinical experience (25)
o Increase risk aspirationo Decrease sleep and comfort
Bartow KL Nursesrsquo knowledge and adherence to sudden infant death syndrome prevention guidelines Pediatr Nurs 201642(1)7-13
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
TodaysBaby QI Safe Sleep Teaching
QI intervention median = 160 days Mothers reported receiving information 72 to 95
(increase of 24-57) 94 babies observed supine (plus 24) 88 infants in safe sleep environment
o Increase of 33 Gains maintained up to 12 months
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Social Media and Risk-Reduction Training Study (SMART) Cluster randomization 4 groups Safe sleep or breast feeding education Nursing QI and social media (mobile health) N = 1600 1263 responses (79) Safe sleep NQI and MHealth
o Supine sleep 925 o Room-sharing 859o No soft bedding 819o Pacifier use 762
Moon RY Hauck FR Colson ER et al The effect of nursing quality improvement and mobile health interventions on infant sleep practices a randomized clinical trial JAMA 2017318(4)351-359
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Hospital Initiative ComponentswwwcribsforkidsorgHospitalInitiativeToolkit INTRODUCTORY LETTER HOSPITAL INITIATIVE TOOL KIT
INSTRUCTIONS ORGANIZATIONAL CHART HOSPITAL POLICY ACKNOWLEDGMENT FORM (Engl amp
Span) SAFE SLEEP EDUCATIONAL FLIP CHART
NONCOMPLIANCE WAIVER (Engl amp Span)
NURSING EDUCATION MODULE
SAFE SLEEP POSTERS DOOR HANGERS (Engl amp Span) GRADUATION CERTIFICATE SAMPLE LETTER TO HOSPITALS SAMPLE LETTER TO PROVIDERS INFANT SAFE SLEEP BROCHURES
(Engl amp Span) PRESS KIT
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
All materials available on-lineo No major costs to the hospital
Easy on-line access for documentation
NO FEE FOR PARTICIPATION
wwwCribsforKidsorgHospitalInitiative
Tiffany Price (tpricecribsforkidsorg)
The National Safe Sleep Hospital Certification Program
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
TNmdash25 reduction in infant sleep-related deaths in 2 years
SDmdashOver 7915 Pack lsquon Plays distributed since 2012 Infant mortality rate decreased from 86 (2012) to 48 (2016)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
2009 to 2015 38 decrease in infant mortality Decreased from 135 to 84 per 1000 SUID decreased gt50 Decrease in racial disparityhttphealthybabiesbaltimorecomhome
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
And Finallyhellip
Health care providers should have open frank nonjudgmental conversations with families about their sleep practices
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Encouraging Parents to Take Action
According to the Social Learning Theory parents are more likely to recall and comply with instructions when
the health care provider
Uses a positive tone Provides adequate information Allows the parent to ask most of the questions
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Motivational Interviewing
ldquoa collaborative goal-oriented style of communication with particular attention to the language of changerdquo
o Strengthen personal motivation and commitment to a specific goal
o Explore onersquos reasons for change (barriers)o Patient generates own solutions
bull More likely to feel realisticbull Planting seeds of change
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Impact of Eliminating Sleep-Related Deaths
Every week we lose 70 children which is equivalent to 4 kindergarten classrooms
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Thank You
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Contact Information
mgoodsteinwellspanorg
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Visit Pediatric Care Online today for additional information on this and other topics
httppediatriccaresolutionsaaporgPediatric Care Online is a convenient electronic resource for immediate expert help with
virtually every pediatric clinical information need with must-have resources that are included in a comprehensive reference library and time-saving clinical tools
Donrsquot have a subscription to PCOThen take advantage of a free trial today
Call Mead Johnson Nutrition at 888363-2362 orfor more information go to
httppediatriccaresolutionsaaporgSSFree_Trialaspx
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
IMR over time Finland vs US
Slide Number 1
Disclaimer
Objectives for Todayrsquos Talk
Infant Mortality Rates for the Five Leading Causes of Infant Death in the United States 2005 and 2011
US Post-Neonatal Mortality 2015
FACT
What is SUID or SUDI
Some Causes of Deaths that Occur Suddenly and Unexpectedly during Infancy
What is SIDS
SIDS FACTS
SIDS FACTS
Triple Risk Model to Explain SIDS
Paterson DS Krous HF Kinney HC et al JAMA 2006
An Example of SIDS Pathogenesis
2016 AAP Recommendations Infant Sleep Safety
Strength of Recommendation
Recommendations Change as the Evidence Evolves
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
Correct Safe Sleep Environment
We Need to Move Beyond Back to Sleep
Sleep Position for Healthy Newborns
Sleep Position in Newborn Nursery
Sleep Position and Reflux
The Truth About Supine Sleep and Aspiration Ending the Fallacy
Title
Infant Sleep Location
Room-Share How Long Yoursquore Kidding Right
Supporting Data
More Recent Data
Why is Room-Sharing Protective
Room-Sharing and Sleep Quality
Insight Study (Paul 2017)
Insight Study (Paul 2017)
Insight Commentary (Hauck Moon)
Feeding the Baby at Night
Say NO to Couches Sofas and Cushioned Armchairs
High-Risk Bed Sharing Situations
Bedsharing in Low-Risk Breastfed Infants
Independent Review (Dr Robert Platt)
Bed Sharing
Bed Sharing
Bed Sharing with Overlay
Bed Sharing with Overlay
Bed Sharing with Overlay
Couch Sleeping
Couch Sleeping
Couch Sleeping
Unsafe Bedding NISP Trends 1993-2102
Why Use Soft Bedding
Soft Bedding for Older Infants
To Swaddle or Not to Swaddle That is the Question
Swaddling
SwaddlingmdashIs it Safe
SwaddlingmdashMore Questionshellip
wwwhealthychildrenorg
Pacifiers
Pacifiers and Breastfeeding
Baby Friendly USA Pacifiers
Addressing Sleep Deprivation
Overcoming Barriers to Change What Parents are Sayinghellip
Factors Associated With Choice of Infant Sleep Position
Slide Number 65
What is Working
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Infant Sleep Safety
Safe Sleep Nurse Modeling
Physician Advocacy
Healthcare Provider Advice to New Mothers Safe Sleep
Mason Clinical Peds 713
Bundled Intervention = Behavior Change
Hospital Unsafe Sleep Persists
Washington DC
TodaysBaby QI Safe Sleep Teaching
TodaysBaby QI Safe Sleep Teaching
Social Media and Risk-Reduction Training Study (SMART)
The National Safe Sleep Hospital Certification Program
Coordinated Education Efforts Work
Coordinated Education Efforts Work
And Finallyhellip
Encouraging Parents to Take Action
Motivational Interviewing
Impact of Eliminating Sleep-Related Deaths
Thank You
Contact Information
Slide Number 89
IMR over time Finland vs US
Column1
correct advice
55
incorrect advice
25
no advice
20
correct advice
incorrect advice
no advice
SIDS Rate
Percent Back Sleeping
1988
14
1989
139
1990
13
1991
13
1992
12
13
1993
117
17
1994
103
269
1995
087
386
1996
074
353
1997
077
531
1998
072
557
1999
067
644
2000
062
666
2001
056
716
2002
057
711
2003
053
728
2004
056
701
2005
055
722
2006
055
757
2007
057
703
2008
055
721
2009
054
741
2010
051
728
2011
048
2012
042
2013
04
2014
039
httpwwwcdcgovNCHSdatanvsrnvsr58nvsr58_19pdf
Xu JQ Kochanek KD Murphy SL Tejada-Vera B Deaths Final data for
2007
National vital statistics reports vol 58 no 19 Hyattsville MD
National Center for Health Statistics 2010
1988
1988
1989
1989
1990
1990
1991
1991
1992
1992
1993
1993
1994
1994
1995
1995
1996
1996
1997
1997
1998
1998
1999
1999
2000
2000
2001
2001
2002
2002
2003
2003
2004
2004
2005
2005
2006
2006
2007
2007
2008
2008
2009
2009
2010
2010
2011
2012
2013
2014
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Chart1
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
14
139
13
13
12
13
117
17
103
269
087
386
074
353
077
531
072
557
067
644
062
666
056
716
057
711
053
728
056
701
055
722
055
757
057
703
055
721
054
741
051
728
048
042
04
039
Sheet1
Sheet1
ampA
Page ampP
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
Sheet2
Pre-AAP recommendation Post-AAP RecommendationBack to SleepSafe to Sleep Campaign
Sheet3
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Infant Sleep Safety
Requires a consistent and repetitive message in the community to prevent accidental deaths
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Safe Sleep Nurse Modeling
People trust nurses Whatever the nurse does must
be correct and it will be imitated in the home
Fact supine positioning in the nursery can almost DOUBLE its use in the home
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Physician Advocacy
Srivatsa 1997 HCP education to new familieshellip34 reduction in prone sleeping
Eron 2009 Study of Central NY state physicianshellip30 identified incorrect safest sleep positionhellip30 do not discuss with families
Colson 2009 Only 13 mothers advised by MD to use supine positionhellip3 times more likely to position the baby properly
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Healthcare Provider Advice to New Mothers Safe Sleep
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Chart1
Column1
[]
[]
[]
55
25
20
Sheet1
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Mason Clinical Peds 713
Bundled interventiono Nursing education policy model behavior safe sleep
video posters in rooms declaration of safe sleep practice
Safe sleep environment uarr from 25 to 58 Intention in home 95 supine none ldquoco-sleepingrdquo
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bundled Intervention = Behavior Change
QUESTION GROUP p-value
ISS Study NISP
Behavior Questions n = 490 n = 1046
Baby routinely placed to sleep on back 925 73 lt 0001
Baby routinely sleeps in bassinetcrib 995 71 lt 00001
Baby sleeps under a thin sheet 992 86 lt 0001
Baby given a pacifier for sleep 741 84 lt 0001Goodstein MH Bell T Krugman SD Improving infant sleep safety through a comprehensive hospital-based program Clinical Pediatrics 201554(3)212-221
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
o Baseline Safe sleep 49 of 264 infants o Post 312 of 234 infants (P lt 001) o Extra blankets most common o Baseline 77 vs 44 post-intervention o Mean number of unsafe items reduced by 50 (P lt 001)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Washington DC
2 urban DC nurseries 26 did not believe or unsure that infant positioning
was associated with SIDS Top 3 factors influencing sleep position
o 56 PERSONAL PREFERENCE Why non-supine Clinical experience (25)
o Increase risk aspirationo Decrease sleep and comfort
Bartow KL Nursesrsquo knowledge and adherence to sudden infant death syndrome prevention guidelines Pediatr Nurs 201642(1)7-13
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
TodaysBaby QI Safe Sleep Teaching
QI intervention median = 160 days Mothers reported receiving information 72 to 95
(increase of 24-57) 94 babies observed supine (plus 24) 88 infants in safe sleep environment
o Increase of 33 Gains maintained up to 12 months
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Social Media and Risk-Reduction Training Study (SMART) Cluster randomization 4 groups Safe sleep or breast feeding education Nursing QI and social media (mobile health) N = 1600 1263 responses (79) Safe sleep NQI and MHealth
o Supine sleep 925 o Room-sharing 859o No soft bedding 819o Pacifier use 762
Moon RY Hauck FR Colson ER et al The effect of nursing quality improvement and mobile health interventions on infant sleep practices a randomized clinical trial JAMA 2017318(4)351-359
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Hospital Initiative ComponentswwwcribsforkidsorgHospitalInitiativeToolkit INTRODUCTORY LETTER HOSPITAL INITIATIVE TOOL KIT
INSTRUCTIONS ORGANIZATIONAL CHART HOSPITAL POLICY ACKNOWLEDGMENT FORM (Engl amp
Span) SAFE SLEEP EDUCATIONAL FLIP CHART
NONCOMPLIANCE WAIVER (Engl amp Span)
NURSING EDUCATION MODULE
SAFE SLEEP POSTERS DOOR HANGERS (Engl amp Span) GRADUATION CERTIFICATE SAMPLE LETTER TO HOSPITALS SAMPLE LETTER TO PROVIDERS INFANT SAFE SLEEP BROCHURES
(Engl amp Span) PRESS KIT
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
All materials available on-lineo No major costs to the hospital
Easy on-line access for documentation
NO FEE FOR PARTICIPATION
wwwCribsforKidsorgHospitalInitiative
Tiffany Price (tpricecribsforkidsorg)
The National Safe Sleep Hospital Certification Program
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
TNmdash25 reduction in infant sleep-related deaths in 2 years
SDmdashOver 7915 Pack lsquon Plays distributed since 2012 Infant mortality rate decreased from 86 (2012) to 48 (2016)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
2009 to 2015 38 decrease in infant mortality Decreased from 135 to 84 per 1000 SUID decreased gt50 Decrease in racial disparityhttphealthybabiesbaltimorecomhome
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
And Finallyhellip
Health care providers should have open frank nonjudgmental conversations with families about their sleep practices
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Encouraging Parents to Take Action
According to the Social Learning Theory parents are more likely to recall and comply with instructions when
the health care provider
Uses a positive tone Provides adequate information Allows the parent to ask most of the questions
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Motivational Interviewing
ldquoa collaborative goal-oriented style of communication with particular attention to the language of changerdquo
o Strengthen personal motivation and commitment to a specific goal
o Explore onersquos reasons for change (barriers)o Patient generates own solutions
bull More likely to feel realisticbull Planting seeds of change
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Impact of Eliminating Sleep-Related Deaths
Every week we lose 70 children which is equivalent to 4 kindergarten classrooms
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Thank You
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Contact Information
mgoodsteinwellspanorg
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Visit Pediatric Care Online today for additional information on this and other topics
httppediatriccaresolutionsaaporgPediatric Care Online is a convenient electronic resource for immediate expert help with
virtually every pediatric clinical information need with must-have resources that are included in a comprehensive reference library and time-saving clinical tools
Donrsquot have a subscription to PCOThen take advantage of a free trial today
Call Mead Johnson Nutrition at 888363-2362 orfor more information go to
httppediatriccaresolutionsaaporgSSFree_Trialaspx
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
IMR over time Finland vs US
Slide Number 1
Disclaimer
Objectives for Todayrsquos Talk
Infant Mortality Rates for the Five Leading Causes of Infant Death in the United States 2005 and 2011
US Post-Neonatal Mortality 2015
FACT
What is SUID or SUDI
Some Causes of Deaths that Occur Suddenly and Unexpectedly during Infancy
What is SIDS
SIDS FACTS
SIDS FACTS
Triple Risk Model to Explain SIDS
Paterson DS Krous HF Kinney HC et al JAMA 2006
An Example of SIDS Pathogenesis
2016 AAP Recommendations Infant Sleep Safety
Strength of Recommendation
Recommendations Change as the Evidence Evolves
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
Correct Safe Sleep Environment
We Need to Move Beyond Back to Sleep
Sleep Position for Healthy Newborns
Sleep Position in Newborn Nursery
Sleep Position and Reflux
The Truth About Supine Sleep and Aspiration Ending the Fallacy
Title
Infant Sleep Location
Room-Share How Long Yoursquore Kidding Right
Supporting Data
More Recent Data
Why is Room-Sharing Protective
Room-Sharing and Sleep Quality
Insight Study (Paul 2017)
Insight Study (Paul 2017)
Insight Commentary (Hauck Moon)
Feeding the Baby at Night
Say NO to Couches Sofas and Cushioned Armchairs
High-Risk Bed Sharing Situations
Bedsharing in Low-Risk Breastfed Infants
Independent Review (Dr Robert Platt)
Bed Sharing
Bed Sharing
Bed Sharing with Overlay
Bed Sharing with Overlay
Bed Sharing with Overlay
Couch Sleeping
Couch Sleeping
Couch Sleeping
Unsafe Bedding NISP Trends 1993-2102
Why Use Soft Bedding
Soft Bedding for Older Infants
To Swaddle or Not to Swaddle That is the Question
Swaddling
SwaddlingmdashIs it Safe
SwaddlingmdashMore Questionshellip
wwwhealthychildrenorg
Pacifiers
Pacifiers and Breastfeeding
Baby Friendly USA Pacifiers
Addressing Sleep Deprivation
Overcoming Barriers to Change What Parents are Sayinghellip
Factors Associated With Choice of Infant Sleep Position
Slide Number 65
What is Working
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Infant Sleep Safety
Safe Sleep Nurse Modeling
Physician Advocacy
Healthcare Provider Advice to New Mothers Safe Sleep
Mason Clinical Peds 713
Bundled Intervention = Behavior Change
Hospital Unsafe Sleep Persists
Washington DC
TodaysBaby QI Safe Sleep Teaching
TodaysBaby QI Safe Sleep Teaching
Social Media and Risk-Reduction Training Study (SMART)
The National Safe Sleep Hospital Certification Program
Coordinated Education Efforts Work
Coordinated Education Efforts Work
And Finallyhellip
Encouraging Parents to Take Action
Motivational Interviewing
Impact of Eliminating Sleep-Related Deaths
Thank You
Contact Information
Slide Number 89
IMR over time Finland vs US
Column1
correct advice
55
incorrect advice
25
no advice
20
correct advice
incorrect advice
no advice
SIDS Rate
Percent Back Sleeping
1988
14
1989
139
1990
13
1991
13
1992
12
13
1993
117
17
1994
103
269
1995
087
386
1996
074
353
1997
077
531
1998
072
557
1999
067
644
2000
062
666
2001
056
716
2002
057
711
2003
053
728
2004
056
701
2005
055
722
2006
055
757
2007
057
703
2008
055
721
2009
054
741
2010
051
728
2011
048
2012
042
2013
04
2014
039
httpwwwcdcgovNCHSdatanvsrnvsr58nvsr58_19pdf
Xu JQ Kochanek KD Murphy SL Tejada-Vera B Deaths Final data for
2007
National vital statistics reports vol 58 no 19 Hyattsville MD
National Center for Health Statistics 2010
1988
1988
1989
1989
1990
1990
1991
1991
1992
1992
1993
1993
1994
1994
1995
1995
1996
1996
1997
1997
1998
1998
1999
1999
2000
2000
2001
2001
2002
2002
2003
2003
2004
2004
2005
2005
2006
2006
2007
2007
2008
2008
2009
2009
2010
2010
2011
2012
2013
2014
Chart1
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
14
139
13
13
12
13
117
17
103
269
087
386
074
353
077
531
072
557
067
644
062
666
056
716
057
711
053
728
056
701
055
722
055
757
057
703
055
721
054
741
051
728
048
042
04
039
Sheet1
Sheet1
ampA
Page ampP
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
Sheet2
Pre-AAP recommendation Post-AAP RecommendationBack to SleepSafe to Sleep Campaign
Sheet3
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Infant Sleep Safety
Requires a consistent and repetitive message in the community to prevent accidental deaths
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Safe Sleep Nurse Modeling
People trust nurses Whatever the nurse does must
be correct and it will be imitated in the home
Fact supine positioning in the nursery can almost DOUBLE its use in the home
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Physician Advocacy
Srivatsa 1997 HCP education to new familieshellip34 reduction in prone sleeping
Eron 2009 Study of Central NY state physicianshellip30 identified incorrect safest sleep positionhellip30 do not discuss with families
Colson 2009 Only 13 mothers advised by MD to use supine positionhellip3 times more likely to position the baby properly
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Healthcare Provider Advice to New Mothers Safe Sleep
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Chart1
Column1
[]
[]
[]
55
25
20
Sheet1
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Mason Clinical Peds 713
Bundled interventiono Nursing education policy model behavior safe sleep
video posters in rooms declaration of safe sleep practice
Safe sleep environment uarr from 25 to 58 Intention in home 95 supine none ldquoco-sleepingrdquo
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bundled Intervention = Behavior Change
QUESTION GROUP p-value
ISS Study NISP
Behavior Questions n = 490 n = 1046
Baby routinely placed to sleep on back 925 73 lt 0001
Baby routinely sleeps in bassinetcrib 995 71 lt 00001
Baby sleeps under a thin sheet 992 86 lt 0001
Baby given a pacifier for sleep 741 84 lt 0001Goodstein MH Bell T Krugman SD Improving infant sleep safety through a comprehensive hospital-based program Clinical Pediatrics 201554(3)212-221
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
o Baseline Safe sleep 49 of 264 infants o Post 312 of 234 infants (P lt 001) o Extra blankets most common o Baseline 77 vs 44 post-intervention o Mean number of unsafe items reduced by 50 (P lt 001)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Washington DC
2 urban DC nurseries 26 did not believe or unsure that infant positioning
was associated with SIDS Top 3 factors influencing sleep position
o 56 PERSONAL PREFERENCE Why non-supine Clinical experience (25)
o Increase risk aspirationo Decrease sleep and comfort
Bartow KL Nursesrsquo knowledge and adherence to sudden infant death syndrome prevention guidelines Pediatr Nurs 201642(1)7-13
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
TodaysBaby QI Safe Sleep Teaching
QI intervention median = 160 days Mothers reported receiving information 72 to 95
(increase of 24-57) 94 babies observed supine (plus 24) 88 infants in safe sleep environment
o Increase of 33 Gains maintained up to 12 months
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Social Media and Risk-Reduction Training Study (SMART) Cluster randomization 4 groups Safe sleep or breast feeding education Nursing QI and social media (mobile health) N = 1600 1263 responses (79) Safe sleep NQI and MHealth
o Supine sleep 925 o Room-sharing 859o No soft bedding 819o Pacifier use 762
Moon RY Hauck FR Colson ER et al The effect of nursing quality improvement and mobile health interventions on infant sleep practices a randomized clinical trial JAMA 2017318(4)351-359
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Hospital Initiative ComponentswwwcribsforkidsorgHospitalInitiativeToolkit INTRODUCTORY LETTER HOSPITAL INITIATIVE TOOL KIT
INSTRUCTIONS ORGANIZATIONAL CHART HOSPITAL POLICY ACKNOWLEDGMENT FORM (Engl amp
Span) SAFE SLEEP EDUCATIONAL FLIP CHART
NONCOMPLIANCE WAIVER (Engl amp Span)
NURSING EDUCATION MODULE
SAFE SLEEP POSTERS DOOR HANGERS (Engl amp Span) GRADUATION CERTIFICATE SAMPLE LETTER TO HOSPITALS SAMPLE LETTER TO PROVIDERS INFANT SAFE SLEEP BROCHURES
(Engl amp Span) PRESS KIT
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
All materials available on-lineo No major costs to the hospital
Easy on-line access for documentation
NO FEE FOR PARTICIPATION
wwwCribsforKidsorgHospitalInitiative
Tiffany Price (tpricecribsforkidsorg)
The National Safe Sleep Hospital Certification Program
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
TNmdash25 reduction in infant sleep-related deaths in 2 years
SDmdashOver 7915 Pack lsquon Plays distributed since 2012 Infant mortality rate decreased from 86 (2012) to 48 (2016)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
2009 to 2015 38 decrease in infant mortality Decreased from 135 to 84 per 1000 SUID decreased gt50 Decrease in racial disparityhttphealthybabiesbaltimorecomhome
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
And Finallyhellip
Health care providers should have open frank nonjudgmental conversations with families about their sleep practices
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Encouraging Parents to Take Action
According to the Social Learning Theory parents are more likely to recall and comply with instructions when
the health care provider
Uses a positive tone Provides adequate information Allows the parent to ask most of the questions
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Motivational Interviewing
ldquoa collaborative goal-oriented style of communication with particular attention to the language of changerdquo
o Strengthen personal motivation and commitment to a specific goal
o Explore onersquos reasons for change (barriers)o Patient generates own solutions
bull More likely to feel realisticbull Planting seeds of change
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Impact of Eliminating Sleep-Related Deaths
Every week we lose 70 children which is equivalent to 4 kindergarten classrooms
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Thank You
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Contact Information
mgoodsteinwellspanorg
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Visit Pediatric Care Online today for additional information on this and other topics
httppediatriccaresolutionsaaporgPediatric Care Online is a convenient electronic resource for immediate expert help with
virtually every pediatric clinical information need with must-have resources that are included in a comprehensive reference library and time-saving clinical tools
Donrsquot have a subscription to PCOThen take advantage of a free trial today
Call Mead Johnson Nutrition at 888363-2362 orfor more information go to
httppediatriccaresolutionsaaporgSSFree_Trialaspx
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
IMR over time Finland vs US
Slide Number 1
Disclaimer
Objectives for Todayrsquos Talk
Infant Mortality Rates for the Five Leading Causes of Infant Death in the United States 2005 and 2011
US Post-Neonatal Mortality 2015
FACT
What is SUID or SUDI
Some Causes of Deaths that Occur Suddenly and Unexpectedly during Infancy
What is SIDS
SIDS FACTS
SIDS FACTS
Triple Risk Model to Explain SIDS
Paterson DS Krous HF Kinney HC et al JAMA 2006
An Example of SIDS Pathogenesis
2016 AAP Recommendations Infant Sleep Safety
Strength of Recommendation
Recommendations Change as the Evidence Evolves
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
Correct Safe Sleep Environment
We Need to Move Beyond Back to Sleep
Sleep Position for Healthy Newborns
Sleep Position in Newborn Nursery
Sleep Position and Reflux
The Truth About Supine Sleep and Aspiration Ending the Fallacy
Title
Infant Sleep Location
Room-Share How Long Yoursquore Kidding Right
Supporting Data
More Recent Data
Why is Room-Sharing Protective
Room-Sharing and Sleep Quality
Insight Study (Paul 2017)
Insight Study (Paul 2017)
Insight Commentary (Hauck Moon)
Feeding the Baby at Night
Say NO to Couches Sofas and Cushioned Armchairs
High-Risk Bed Sharing Situations
Bedsharing in Low-Risk Breastfed Infants
Independent Review (Dr Robert Platt)
Bed Sharing
Bed Sharing
Bed Sharing with Overlay
Bed Sharing with Overlay
Bed Sharing with Overlay
Couch Sleeping
Couch Sleeping
Couch Sleeping
Unsafe Bedding NISP Trends 1993-2102
Why Use Soft Bedding
Soft Bedding for Older Infants
To Swaddle or Not to Swaddle That is the Question
Swaddling
SwaddlingmdashIs it Safe
SwaddlingmdashMore Questionshellip
wwwhealthychildrenorg
Pacifiers
Pacifiers and Breastfeeding
Baby Friendly USA Pacifiers
Addressing Sleep Deprivation
Overcoming Barriers to Change What Parents are Sayinghellip
Factors Associated With Choice of Infant Sleep Position
Slide Number 65
What is Working
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Infant Sleep Safety
Safe Sleep Nurse Modeling
Physician Advocacy
Healthcare Provider Advice to New Mothers Safe Sleep
Mason Clinical Peds 713
Bundled Intervention = Behavior Change
Hospital Unsafe Sleep Persists
Washington DC
TodaysBaby QI Safe Sleep Teaching
TodaysBaby QI Safe Sleep Teaching
Social Media and Risk-Reduction Training Study (SMART)
The National Safe Sleep Hospital Certification Program
Coordinated Education Efforts Work
Coordinated Education Efforts Work
And Finallyhellip
Encouraging Parents to Take Action
Motivational Interviewing
Impact of Eliminating Sleep-Related Deaths
Thank You
Contact Information
Slide Number 89
IMR over time Finland vs US
Column1
correct advice
55
incorrect advice
25
no advice
20
correct advice
incorrect advice
no advice
SIDS Rate
Percent Back Sleeping
1988
14
1989
139
1990
13
1991
13
1992
12
13
1993
117
17
1994
103
269
1995
087
386
1996
074
353
1997
077
531
1998
072
557
1999
067
644
2000
062
666
2001
056
716
2002
057
711
2003
053
728
2004
056
701
2005
055
722
2006
055
757
2007
057
703
2008
055
721
2009
054
741
2010
051
728
2011
048
2012
042
2013
04
2014
039
httpwwwcdcgovNCHSdatanvsrnvsr58nvsr58_19pdf
Xu JQ Kochanek KD Murphy SL Tejada-Vera B Deaths Final data for
2007
National vital statistics reports vol 58 no 19 Hyattsville MD
National Center for Health Statistics 2010
1988
1988
1989
1989
1990
1990
1991
1991
1992
1992
1993
1993
1994
1994
1995
1995
1996
1996
1997
1997
1998
1998
1999
1999
2000
2000
2001
2001
2002
2002
2003
2003
2004
2004
2005
2005
2006
2006
2007
2007
2008
2008
2009
2009
2010
2010
2011
2012
2013
2014
Sheet1
Sheet1
ampA
Page ampP
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
Sheet2
Pre-AAP recommendation Post-AAP RecommendationBack to SleepSafe to Sleep Campaign
Sheet3
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Infant Sleep Safety
Requires a consistent and repetitive message in the community to prevent accidental deaths
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Safe Sleep Nurse Modeling
People trust nurses Whatever the nurse does must
be correct and it will be imitated in the home
Fact supine positioning in the nursery can almost DOUBLE its use in the home
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Physician Advocacy
Srivatsa 1997 HCP education to new familieshellip34 reduction in prone sleeping
Eron 2009 Study of Central NY state physicianshellip30 identified incorrect safest sleep positionhellip30 do not discuss with families
Colson 2009 Only 13 mothers advised by MD to use supine positionhellip3 times more likely to position the baby properly
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Healthcare Provider Advice to New Mothers Safe Sleep
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Chart1
Column1
[]
[]
[]
55
25
20
Sheet1
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Mason Clinical Peds 713
Bundled interventiono Nursing education policy model behavior safe sleep
video posters in rooms declaration of safe sleep practice
Safe sleep environment uarr from 25 to 58 Intention in home 95 supine none ldquoco-sleepingrdquo
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bundled Intervention = Behavior Change
QUESTION GROUP p-value
ISS Study NISP
Behavior Questions n = 490 n = 1046
Baby routinely placed to sleep on back 925 73 lt 0001
Baby routinely sleeps in bassinetcrib 995 71 lt 00001
Baby sleeps under a thin sheet 992 86 lt 0001
Baby given a pacifier for sleep 741 84 lt 0001Goodstein MH Bell T Krugman SD Improving infant sleep safety through a comprehensive hospital-based program Clinical Pediatrics 201554(3)212-221
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
o Baseline Safe sleep 49 of 264 infants o Post 312 of 234 infants (P lt 001) o Extra blankets most common o Baseline 77 vs 44 post-intervention o Mean number of unsafe items reduced by 50 (P lt 001)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Washington DC
2 urban DC nurseries 26 did not believe or unsure that infant positioning
was associated with SIDS Top 3 factors influencing sleep position
o 56 PERSONAL PREFERENCE Why non-supine Clinical experience (25)
o Increase risk aspirationo Decrease sleep and comfort
Bartow KL Nursesrsquo knowledge and adherence to sudden infant death syndrome prevention guidelines Pediatr Nurs 201642(1)7-13
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
TodaysBaby QI Safe Sleep Teaching
QI intervention median = 160 days Mothers reported receiving information 72 to 95
(increase of 24-57) 94 babies observed supine (plus 24) 88 infants in safe sleep environment
o Increase of 33 Gains maintained up to 12 months
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Social Media and Risk-Reduction Training Study (SMART) Cluster randomization 4 groups Safe sleep or breast feeding education Nursing QI and social media (mobile health) N = 1600 1263 responses (79) Safe sleep NQI and MHealth
o Supine sleep 925 o Room-sharing 859o No soft bedding 819o Pacifier use 762
Moon RY Hauck FR Colson ER et al The effect of nursing quality improvement and mobile health interventions on infant sleep practices a randomized clinical trial JAMA 2017318(4)351-359
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Hospital Initiative ComponentswwwcribsforkidsorgHospitalInitiativeToolkit INTRODUCTORY LETTER HOSPITAL INITIATIVE TOOL KIT
INSTRUCTIONS ORGANIZATIONAL CHART HOSPITAL POLICY ACKNOWLEDGMENT FORM (Engl amp
Span) SAFE SLEEP EDUCATIONAL FLIP CHART
NONCOMPLIANCE WAIVER (Engl amp Span)
NURSING EDUCATION MODULE
SAFE SLEEP POSTERS DOOR HANGERS (Engl amp Span) GRADUATION CERTIFICATE SAMPLE LETTER TO HOSPITALS SAMPLE LETTER TO PROVIDERS INFANT SAFE SLEEP BROCHURES
(Engl amp Span) PRESS KIT
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
All materials available on-lineo No major costs to the hospital
Easy on-line access for documentation
NO FEE FOR PARTICIPATION
wwwCribsforKidsorgHospitalInitiative
Tiffany Price (tpricecribsforkidsorg)
The National Safe Sleep Hospital Certification Program
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
TNmdash25 reduction in infant sleep-related deaths in 2 years
SDmdashOver 7915 Pack lsquon Plays distributed since 2012 Infant mortality rate decreased from 86 (2012) to 48 (2016)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
2009 to 2015 38 decrease in infant mortality Decreased from 135 to 84 per 1000 SUID decreased gt50 Decrease in racial disparityhttphealthybabiesbaltimorecomhome
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
And Finallyhellip
Health care providers should have open frank nonjudgmental conversations with families about their sleep practices
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Encouraging Parents to Take Action
According to the Social Learning Theory parents are more likely to recall and comply with instructions when
the health care provider
Uses a positive tone Provides adequate information Allows the parent to ask most of the questions
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Motivational Interviewing
ldquoa collaborative goal-oriented style of communication with particular attention to the language of changerdquo
o Strengthen personal motivation and commitment to a specific goal
o Explore onersquos reasons for change (barriers)o Patient generates own solutions
bull More likely to feel realisticbull Planting seeds of change
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Impact of Eliminating Sleep-Related Deaths
Every week we lose 70 children which is equivalent to 4 kindergarten classrooms
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Thank You
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Contact Information
mgoodsteinwellspanorg
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Visit Pediatric Care Online today for additional information on this and other topics
httppediatriccaresolutionsaaporgPediatric Care Online is a convenient electronic resource for immediate expert help with
virtually every pediatric clinical information need with must-have resources that are included in a comprehensive reference library and time-saving clinical tools
Donrsquot have a subscription to PCOThen take advantage of a free trial today
Call Mead Johnson Nutrition at 888363-2362 orfor more information go to
httppediatriccaresolutionsaaporgSSFree_Trialaspx
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
IMR over time Finland vs US
Slide Number 1
Disclaimer
Objectives for Todayrsquos Talk
Infant Mortality Rates for the Five Leading Causes of Infant Death in the United States 2005 and 2011
US Post-Neonatal Mortality 2015
FACT
What is SUID or SUDI
Some Causes of Deaths that Occur Suddenly and Unexpectedly during Infancy
What is SIDS
SIDS FACTS
SIDS FACTS
Triple Risk Model to Explain SIDS
Paterson DS Krous HF Kinney HC et al JAMA 2006
An Example of SIDS Pathogenesis
2016 AAP Recommendations Infant Sleep Safety
Strength of Recommendation
Recommendations Change as the Evidence Evolves
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
Correct Safe Sleep Environment
We Need to Move Beyond Back to Sleep
Sleep Position for Healthy Newborns
Sleep Position in Newborn Nursery
Sleep Position and Reflux
The Truth About Supine Sleep and Aspiration Ending the Fallacy
Title
Infant Sleep Location
Room-Share How Long Yoursquore Kidding Right
Supporting Data
More Recent Data
Why is Room-Sharing Protective
Room-Sharing and Sleep Quality
Insight Study (Paul 2017)
Insight Study (Paul 2017)
Insight Commentary (Hauck Moon)
Feeding the Baby at Night
Say NO to Couches Sofas and Cushioned Armchairs
High-Risk Bed Sharing Situations
Bedsharing in Low-Risk Breastfed Infants
Independent Review (Dr Robert Platt)
Bed Sharing
Bed Sharing
Bed Sharing with Overlay
Bed Sharing with Overlay
Bed Sharing with Overlay
Couch Sleeping
Couch Sleeping
Couch Sleeping
Unsafe Bedding NISP Trends 1993-2102
Why Use Soft Bedding
Soft Bedding for Older Infants
To Swaddle or Not to Swaddle That is the Question
Swaddling
SwaddlingmdashIs it Safe
SwaddlingmdashMore Questionshellip
wwwhealthychildrenorg
Pacifiers
Pacifiers and Breastfeeding
Baby Friendly USA Pacifiers
Addressing Sleep Deprivation
Overcoming Barriers to Change What Parents are Sayinghellip
Factors Associated With Choice of Infant Sleep Position
Slide Number 65
What is Working
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Infant Sleep Safety
Safe Sleep Nurse Modeling
Physician Advocacy
Healthcare Provider Advice to New Mothers Safe Sleep
Mason Clinical Peds 713
Bundled Intervention = Behavior Change
Hospital Unsafe Sleep Persists
Washington DC
TodaysBaby QI Safe Sleep Teaching
TodaysBaby QI Safe Sleep Teaching
Social Media and Risk-Reduction Training Study (SMART)
The National Safe Sleep Hospital Certification Program
Coordinated Education Efforts Work
Coordinated Education Efforts Work
And Finallyhellip
Encouraging Parents to Take Action
Motivational Interviewing
Impact of Eliminating Sleep-Related Deaths
Thank You
Contact Information
Slide Number 89
IMR over time Finland vs US
Column1
correct advice
55
incorrect advice
25
no advice
20
correct advice
incorrect advice
no advice
SIDS Rate
Percent Back Sleeping
1988
14
1989
139
1990
13
1991
13
1992
12
13
1993
117
17
1994
103
269
1995
087
386
1996
074
353
1997
077
531
1998
072
557
1999
067
644
2000
062
666
2001
056
716
2002
057
711
2003
053
728
2004
056
701
2005
055
722
2006
055
757
2007
057
703
2008
055
721
2009
054
741
2010
051
728
2011
048
2012
042
2013
04
2014
039
httpwwwcdcgovNCHSdatanvsrnvsr58nvsr58_19pdf
Xu JQ Kochanek KD Murphy SL Tejada-Vera B Deaths Final data for
2007
National vital statistics reports vol 58 no 19 Hyattsville MD
National Center for Health Statistics 2010
Sheet1
ampA
Page ampP
(data available to 2010)
SIDS Rate
Percent Back Sleeping
Year
SIDS rate
Percent back sleeping
SIDS Rate (1998-2014) and Infant Sleep Position (1988-2010)
Sheet2
Pre-AAP recommendation Post-AAP RecommendationBack to SleepSafe to Sleep Campaign
Sheet3
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Infant Sleep Safety
Requires a consistent and repetitive message in the community to prevent accidental deaths
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Safe Sleep Nurse Modeling
People trust nurses Whatever the nurse does must
be correct and it will be imitated in the home
Fact supine positioning in the nursery can almost DOUBLE its use in the home
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Physician Advocacy
Srivatsa 1997 HCP education to new familieshellip34 reduction in prone sleeping
Eron 2009 Study of Central NY state physicianshellip30 identified incorrect safest sleep positionhellip30 do not discuss with families
Colson 2009 Only 13 mothers advised by MD to use supine positionhellip3 times more likely to position the baby properly
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Healthcare Provider Advice to New Mothers Safe Sleep
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Chart1
Column1
[]
[]
[]
55
25
20
Sheet1
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Mason Clinical Peds 713
Bundled interventiono Nursing education policy model behavior safe sleep
video posters in rooms declaration of safe sleep practice
Safe sleep environment uarr from 25 to 58 Intention in home 95 supine none ldquoco-sleepingrdquo
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bundled Intervention = Behavior Change
QUESTION GROUP p-value
ISS Study NISP
Behavior Questions n = 490 n = 1046
Baby routinely placed to sleep on back 925 73 lt 0001
Baby routinely sleeps in bassinetcrib 995 71 lt 00001
Baby sleeps under a thin sheet 992 86 lt 0001
Baby given a pacifier for sleep 741 84 lt 0001Goodstein MH Bell T Krugman SD Improving infant sleep safety through a comprehensive hospital-based program Clinical Pediatrics 201554(3)212-221
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
o Baseline Safe sleep 49 of 264 infants o Post 312 of 234 infants (P lt 001) o Extra blankets most common o Baseline 77 vs 44 post-intervention o Mean number of unsafe items reduced by 50 (P lt 001)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Washington DC
2 urban DC nurseries 26 did not believe or unsure that infant positioning
was associated with SIDS Top 3 factors influencing sleep position
o 56 PERSONAL PREFERENCE Why non-supine Clinical experience (25)
o Increase risk aspirationo Decrease sleep and comfort
Bartow KL Nursesrsquo knowledge and adherence to sudden infant death syndrome prevention guidelines Pediatr Nurs 201642(1)7-13
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
TodaysBaby QI Safe Sleep Teaching
QI intervention median = 160 days Mothers reported receiving information 72 to 95
(increase of 24-57) 94 babies observed supine (plus 24) 88 infants in safe sleep environment
o Increase of 33 Gains maintained up to 12 months
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Social Media and Risk-Reduction Training Study (SMART) Cluster randomization 4 groups Safe sleep or breast feeding education Nursing QI and social media (mobile health) N = 1600 1263 responses (79) Safe sleep NQI and MHealth
o Supine sleep 925 o Room-sharing 859o No soft bedding 819o Pacifier use 762
Moon RY Hauck FR Colson ER et al The effect of nursing quality improvement and mobile health interventions on infant sleep practices a randomized clinical trial JAMA 2017318(4)351-359
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Hospital Initiative ComponentswwwcribsforkidsorgHospitalInitiativeToolkit INTRODUCTORY LETTER HOSPITAL INITIATIVE TOOL KIT
INSTRUCTIONS ORGANIZATIONAL CHART HOSPITAL POLICY ACKNOWLEDGMENT FORM (Engl amp
Span) SAFE SLEEP EDUCATIONAL FLIP CHART
NONCOMPLIANCE WAIVER (Engl amp Span)
NURSING EDUCATION MODULE
SAFE SLEEP POSTERS DOOR HANGERS (Engl amp Span) GRADUATION CERTIFICATE SAMPLE LETTER TO HOSPITALS SAMPLE LETTER TO PROVIDERS INFANT SAFE SLEEP BROCHURES
(Engl amp Span) PRESS KIT
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
All materials available on-lineo No major costs to the hospital
Easy on-line access for documentation
NO FEE FOR PARTICIPATION
wwwCribsforKidsorgHospitalInitiative
Tiffany Price (tpricecribsforkidsorg)
The National Safe Sleep Hospital Certification Program
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
TNmdash25 reduction in infant sleep-related deaths in 2 years
SDmdashOver 7915 Pack lsquon Plays distributed since 2012 Infant mortality rate decreased from 86 (2012) to 48 (2016)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
2009 to 2015 38 decrease in infant mortality Decreased from 135 to 84 per 1000 SUID decreased gt50 Decrease in racial disparityhttphealthybabiesbaltimorecomhome
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
And Finallyhellip
Health care providers should have open frank nonjudgmental conversations with families about their sleep practices
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Encouraging Parents to Take Action
According to the Social Learning Theory parents are more likely to recall and comply with instructions when
the health care provider
Uses a positive tone Provides adequate information Allows the parent to ask most of the questions
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Motivational Interviewing
ldquoa collaborative goal-oriented style of communication with particular attention to the language of changerdquo
o Strengthen personal motivation and commitment to a specific goal
o Explore onersquos reasons for change (barriers)o Patient generates own solutions
bull More likely to feel realisticbull Planting seeds of change
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Impact of Eliminating Sleep-Related Deaths
Every week we lose 70 children which is equivalent to 4 kindergarten classrooms
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Thank You
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Contact Information
mgoodsteinwellspanorg
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Visit Pediatric Care Online today for additional information on this and other topics
httppediatriccaresolutionsaaporgPediatric Care Online is a convenient electronic resource for immediate expert help with
virtually every pediatric clinical information need with must-have resources that are included in a comprehensive reference library and time-saving clinical tools
Donrsquot have a subscription to PCOThen take advantage of a free trial today
Call Mead Johnson Nutrition at 888363-2362 orfor more information go to
httppediatriccaresolutionsaaporgSSFree_Trialaspx
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
IMR over time Finland vs US
Slide Number 1
Disclaimer
Objectives for Todayrsquos Talk
Infant Mortality Rates for the Five Leading Causes of Infant Death in the United States 2005 and 2011
US Post-Neonatal Mortality 2015
FACT
What is SUID or SUDI
Some Causes of Deaths that Occur Suddenly and Unexpectedly during Infancy
What is SIDS
SIDS FACTS
SIDS FACTS
Triple Risk Model to Explain SIDS
Paterson DS Krous HF Kinney HC et al JAMA 2006
An Example of SIDS Pathogenesis
2016 AAP Recommendations Infant Sleep Safety
Strength of Recommendation
Recommendations Change as the Evidence Evolves
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
Correct Safe Sleep Environment
We Need to Move Beyond Back to Sleep
Sleep Position for Healthy Newborns
Sleep Position in Newborn Nursery
Sleep Position and Reflux
The Truth About Supine Sleep and Aspiration Ending the Fallacy
Title
Infant Sleep Location
Room-Share How Long Yoursquore Kidding Right
Supporting Data
More Recent Data
Why is Room-Sharing Protective
Room-Sharing and Sleep Quality
Insight Study (Paul 2017)
Insight Study (Paul 2017)
Insight Commentary (Hauck Moon)
Feeding the Baby at Night
Say NO to Couches Sofas and Cushioned Armchairs
High-Risk Bed Sharing Situations
Bedsharing in Low-Risk Breastfed Infants
Independent Review (Dr Robert Platt)
Bed Sharing
Bed Sharing
Bed Sharing with Overlay
Bed Sharing with Overlay
Bed Sharing with Overlay
Couch Sleeping
Couch Sleeping
Couch Sleeping
Unsafe Bedding NISP Trends 1993-2102
Why Use Soft Bedding
Soft Bedding for Older Infants
To Swaddle or Not to Swaddle That is the Question
Swaddling
SwaddlingmdashIs it Safe
SwaddlingmdashMore Questionshellip
wwwhealthychildrenorg
Pacifiers
Pacifiers and Breastfeeding
Baby Friendly USA Pacifiers
Addressing Sleep Deprivation
Overcoming Barriers to Change What Parents are Sayinghellip
Factors Associated With Choice of Infant Sleep Position
Slide Number 65
What is Working
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Infant Sleep Safety
Safe Sleep Nurse Modeling
Physician Advocacy
Healthcare Provider Advice to New Mothers Safe Sleep
Mason Clinical Peds 713
Bundled Intervention = Behavior Change
Hospital Unsafe Sleep Persists
Washington DC
TodaysBaby QI Safe Sleep Teaching
TodaysBaby QI Safe Sleep Teaching
Social Media and Risk-Reduction Training Study (SMART)
The National Safe Sleep Hospital Certification Program
Coordinated Education Efforts Work
Coordinated Education Efforts Work
And Finallyhellip
Encouraging Parents to Take Action
Motivational Interviewing
Impact of Eliminating Sleep-Related Deaths
Thank You
Contact Information
Slide Number 89
IMR over time Finland vs US
Column1
correct advice
55
incorrect advice
25
no advice
20
correct advice
incorrect advice
no advice
Sheet2
Pre-AAP recommendation Post-AAP RecommendationBack to SleepSafe to Sleep Campaign
Sheet3
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Infant Sleep Safety
Requires a consistent and repetitive message in the community to prevent accidental deaths
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Safe Sleep Nurse Modeling
People trust nurses Whatever the nurse does must
be correct and it will be imitated in the home
Fact supine positioning in the nursery can almost DOUBLE its use in the home
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Physician Advocacy
Srivatsa 1997 HCP education to new familieshellip34 reduction in prone sleeping
Eron 2009 Study of Central NY state physicianshellip30 identified incorrect safest sleep positionhellip30 do not discuss with families
Colson 2009 Only 13 mothers advised by MD to use supine positionhellip3 times more likely to position the baby properly
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Healthcare Provider Advice to New Mothers Safe Sleep
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Chart1
Column1
[]
[]
[]
55
25
20
Sheet1
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Mason Clinical Peds 713
Bundled interventiono Nursing education policy model behavior safe sleep
video posters in rooms declaration of safe sleep practice
Safe sleep environment uarr from 25 to 58 Intention in home 95 supine none ldquoco-sleepingrdquo
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bundled Intervention = Behavior Change
QUESTION GROUP p-value
ISS Study NISP
Behavior Questions n = 490 n = 1046
Baby routinely placed to sleep on back 925 73 lt 0001
Baby routinely sleeps in bassinetcrib 995 71 lt 00001
Baby sleeps under a thin sheet 992 86 lt 0001
Baby given a pacifier for sleep 741 84 lt 0001Goodstein MH Bell T Krugman SD Improving infant sleep safety through a comprehensive hospital-based program Clinical Pediatrics 201554(3)212-221
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
o Baseline Safe sleep 49 of 264 infants o Post 312 of 234 infants (P lt 001) o Extra blankets most common o Baseline 77 vs 44 post-intervention o Mean number of unsafe items reduced by 50 (P lt 001)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Washington DC
2 urban DC nurseries 26 did not believe or unsure that infant positioning
was associated with SIDS Top 3 factors influencing sleep position
o 56 PERSONAL PREFERENCE Why non-supine Clinical experience (25)
o Increase risk aspirationo Decrease sleep and comfort
Bartow KL Nursesrsquo knowledge and adherence to sudden infant death syndrome prevention guidelines Pediatr Nurs 201642(1)7-13
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
TodaysBaby QI Safe Sleep Teaching
QI intervention median = 160 days Mothers reported receiving information 72 to 95
(increase of 24-57) 94 babies observed supine (plus 24) 88 infants in safe sleep environment
o Increase of 33 Gains maintained up to 12 months
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Social Media and Risk-Reduction Training Study (SMART) Cluster randomization 4 groups Safe sleep or breast feeding education Nursing QI and social media (mobile health) N = 1600 1263 responses (79) Safe sleep NQI and MHealth
o Supine sleep 925 o Room-sharing 859o No soft bedding 819o Pacifier use 762
Moon RY Hauck FR Colson ER et al The effect of nursing quality improvement and mobile health interventions on infant sleep practices a randomized clinical trial JAMA 2017318(4)351-359
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Hospital Initiative ComponentswwwcribsforkidsorgHospitalInitiativeToolkit INTRODUCTORY LETTER HOSPITAL INITIATIVE TOOL KIT
INSTRUCTIONS ORGANIZATIONAL CHART HOSPITAL POLICY ACKNOWLEDGMENT FORM (Engl amp
Span) SAFE SLEEP EDUCATIONAL FLIP CHART
NONCOMPLIANCE WAIVER (Engl amp Span)
NURSING EDUCATION MODULE
SAFE SLEEP POSTERS DOOR HANGERS (Engl amp Span) GRADUATION CERTIFICATE SAMPLE LETTER TO HOSPITALS SAMPLE LETTER TO PROVIDERS INFANT SAFE SLEEP BROCHURES
(Engl amp Span) PRESS KIT
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
All materials available on-lineo No major costs to the hospital
Easy on-line access for documentation
NO FEE FOR PARTICIPATION
wwwCribsforKidsorgHospitalInitiative
Tiffany Price (tpricecribsforkidsorg)
The National Safe Sleep Hospital Certification Program
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
TNmdash25 reduction in infant sleep-related deaths in 2 years
SDmdashOver 7915 Pack lsquon Plays distributed since 2012 Infant mortality rate decreased from 86 (2012) to 48 (2016)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
2009 to 2015 38 decrease in infant mortality Decreased from 135 to 84 per 1000 SUID decreased gt50 Decrease in racial disparityhttphealthybabiesbaltimorecomhome
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
And Finallyhellip
Health care providers should have open frank nonjudgmental conversations with families about their sleep practices
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Encouraging Parents to Take Action
According to the Social Learning Theory parents are more likely to recall and comply with instructions when
the health care provider
Uses a positive tone Provides adequate information Allows the parent to ask most of the questions
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Motivational Interviewing
ldquoa collaborative goal-oriented style of communication with particular attention to the language of changerdquo
o Strengthen personal motivation and commitment to a specific goal
o Explore onersquos reasons for change (barriers)o Patient generates own solutions
bull More likely to feel realisticbull Planting seeds of change
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Impact of Eliminating Sleep-Related Deaths
Every week we lose 70 children which is equivalent to 4 kindergarten classrooms
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Thank You
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Contact Information
mgoodsteinwellspanorg
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Visit Pediatric Care Online today for additional information on this and other topics
httppediatriccaresolutionsaaporgPediatric Care Online is a convenient electronic resource for immediate expert help with
virtually every pediatric clinical information need with must-have resources that are included in a comprehensive reference library and time-saving clinical tools
Donrsquot have a subscription to PCOThen take advantage of a free trial today
Call Mead Johnson Nutrition at 888363-2362 orfor more information go to
httppediatriccaresolutionsaaporgSSFree_Trialaspx
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
IMR over time Finland vs US
Slide Number 1
Disclaimer
Objectives for Todayrsquos Talk
Infant Mortality Rates for the Five Leading Causes of Infant Death in the United States 2005 and 2011
US Post-Neonatal Mortality 2015
FACT
What is SUID or SUDI
Some Causes of Deaths that Occur Suddenly and Unexpectedly during Infancy
What is SIDS
SIDS FACTS
SIDS FACTS
Triple Risk Model to Explain SIDS
Paterson DS Krous HF Kinney HC et al JAMA 2006
An Example of SIDS Pathogenesis
2016 AAP Recommendations Infant Sleep Safety
Strength of Recommendation
Recommendations Change as the Evidence Evolves
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
Correct Safe Sleep Environment
We Need to Move Beyond Back to Sleep
Sleep Position for Healthy Newborns
Sleep Position in Newborn Nursery
Sleep Position and Reflux
The Truth About Supine Sleep and Aspiration Ending the Fallacy
Title
Infant Sleep Location
Room-Share How Long Yoursquore Kidding Right
Supporting Data
More Recent Data
Why is Room-Sharing Protective
Room-Sharing and Sleep Quality
Insight Study (Paul 2017)
Insight Study (Paul 2017)
Insight Commentary (Hauck Moon)
Feeding the Baby at Night
Say NO to Couches Sofas and Cushioned Armchairs
High-Risk Bed Sharing Situations
Bedsharing in Low-Risk Breastfed Infants
Independent Review (Dr Robert Platt)
Bed Sharing
Bed Sharing
Bed Sharing with Overlay
Bed Sharing with Overlay
Bed Sharing with Overlay
Couch Sleeping
Couch Sleeping
Couch Sleeping
Unsafe Bedding NISP Trends 1993-2102
Why Use Soft Bedding
Soft Bedding for Older Infants
To Swaddle or Not to Swaddle That is the Question
Swaddling
SwaddlingmdashIs it Safe
SwaddlingmdashMore Questionshellip
wwwhealthychildrenorg
Pacifiers
Pacifiers and Breastfeeding
Baby Friendly USA Pacifiers
Addressing Sleep Deprivation
Overcoming Barriers to Change What Parents are Sayinghellip
Factors Associated With Choice of Infant Sleep Position
Slide Number 65
What is Working
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Infant Sleep Safety
Safe Sleep Nurse Modeling
Physician Advocacy
Healthcare Provider Advice to New Mothers Safe Sleep
Mason Clinical Peds 713
Bundled Intervention = Behavior Change
Hospital Unsafe Sleep Persists
Washington DC
TodaysBaby QI Safe Sleep Teaching
TodaysBaby QI Safe Sleep Teaching
Social Media and Risk-Reduction Training Study (SMART)
The National Safe Sleep Hospital Certification Program
Coordinated Education Efforts Work
Coordinated Education Efforts Work
And Finallyhellip
Encouraging Parents to Take Action
Motivational Interviewing
Impact of Eliminating Sleep-Related Deaths
Thank You
Contact Information
Slide Number 89
IMR over time Finland vs US
Column1
correct advice
55
incorrect advice
25
no advice
20
correct advice
incorrect advice
no advice
Sheet3
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Infant Sleep Safety
Requires a consistent and repetitive message in the community to prevent accidental deaths
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Safe Sleep Nurse Modeling
People trust nurses Whatever the nurse does must
be correct and it will be imitated in the home
Fact supine positioning in the nursery can almost DOUBLE its use in the home
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Physician Advocacy
Srivatsa 1997 HCP education to new familieshellip34 reduction in prone sleeping
Eron 2009 Study of Central NY state physicianshellip30 identified incorrect safest sleep positionhellip30 do not discuss with families
Colson 2009 Only 13 mothers advised by MD to use supine positionhellip3 times more likely to position the baby properly
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Healthcare Provider Advice to New Mothers Safe Sleep
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Chart1
Column1
[]
[]
[]
55
25
20
Sheet1
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Mason Clinical Peds 713
Bundled interventiono Nursing education policy model behavior safe sleep
video posters in rooms declaration of safe sleep practice
Safe sleep environment uarr from 25 to 58 Intention in home 95 supine none ldquoco-sleepingrdquo
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bundled Intervention = Behavior Change
QUESTION GROUP p-value
ISS Study NISP
Behavior Questions n = 490 n = 1046
Baby routinely placed to sleep on back 925 73 lt 0001
Baby routinely sleeps in bassinetcrib 995 71 lt 00001
Baby sleeps under a thin sheet 992 86 lt 0001
Baby given a pacifier for sleep 741 84 lt 0001Goodstein MH Bell T Krugman SD Improving infant sleep safety through a comprehensive hospital-based program Clinical Pediatrics 201554(3)212-221
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
o Baseline Safe sleep 49 of 264 infants o Post 312 of 234 infants (P lt 001) o Extra blankets most common o Baseline 77 vs 44 post-intervention o Mean number of unsafe items reduced by 50 (P lt 001)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Washington DC
2 urban DC nurseries 26 did not believe or unsure that infant positioning
was associated with SIDS Top 3 factors influencing sleep position
o 56 PERSONAL PREFERENCE Why non-supine Clinical experience (25)
o Increase risk aspirationo Decrease sleep and comfort
Bartow KL Nursesrsquo knowledge and adherence to sudden infant death syndrome prevention guidelines Pediatr Nurs 201642(1)7-13
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
TodaysBaby QI Safe Sleep Teaching
QI intervention median = 160 days Mothers reported receiving information 72 to 95
(increase of 24-57) 94 babies observed supine (plus 24) 88 infants in safe sleep environment
o Increase of 33 Gains maintained up to 12 months
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Social Media and Risk-Reduction Training Study (SMART) Cluster randomization 4 groups Safe sleep or breast feeding education Nursing QI and social media (mobile health) N = 1600 1263 responses (79) Safe sleep NQI and MHealth
o Supine sleep 925 o Room-sharing 859o No soft bedding 819o Pacifier use 762
Moon RY Hauck FR Colson ER et al The effect of nursing quality improvement and mobile health interventions on infant sleep practices a randomized clinical trial JAMA 2017318(4)351-359
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Hospital Initiative ComponentswwwcribsforkidsorgHospitalInitiativeToolkit INTRODUCTORY LETTER HOSPITAL INITIATIVE TOOL KIT
INSTRUCTIONS ORGANIZATIONAL CHART HOSPITAL POLICY ACKNOWLEDGMENT FORM (Engl amp
Span) SAFE SLEEP EDUCATIONAL FLIP CHART
NONCOMPLIANCE WAIVER (Engl amp Span)
NURSING EDUCATION MODULE
SAFE SLEEP POSTERS DOOR HANGERS (Engl amp Span) GRADUATION CERTIFICATE SAMPLE LETTER TO HOSPITALS SAMPLE LETTER TO PROVIDERS INFANT SAFE SLEEP BROCHURES
(Engl amp Span) PRESS KIT
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
All materials available on-lineo No major costs to the hospital
Easy on-line access for documentation
NO FEE FOR PARTICIPATION
wwwCribsforKidsorgHospitalInitiative
Tiffany Price (tpricecribsforkidsorg)
The National Safe Sleep Hospital Certification Program
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
TNmdash25 reduction in infant sleep-related deaths in 2 years
SDmdashOver 7915 Pack lsquon Plays distributed since 2012 Infant mortality rate decreased from 86 (2012) to 48 (2016)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
2009 to 2015 38 decrease in infant mortality Decreased from 135 to 84 per 1000 SUID decreased gt50 Decrease in racial disparityhttphealthybabiesbaltimorecomhome
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
And Finallyhellip
Health care providers should have open frank nonjudgmental conversations with families about their sleep practices
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Encouraging Parents to Take Action
According to the Social Learning Theory parents are more likely to recall and comply with instructions when
the health care provider
Uses a positive tone Provides adequate information Allows the parent to ask most of the questions
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Motivational Interviewing
ldquoa collaborative goal-oriented style of communication with particular attention to the language of changerdquo
o Strengthen personal motivation and commitment to a specific goal
o Explore onersquos reasons for change (barriers)o Patient generates own solutions
bull More likely to feel realisticbull Planting seeds of change
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Impact of Eliminating Sleep-Related Deaths
Every week we lose 70 children which is equivalent to 4 kindergarten classrooms
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Thank You
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Contact Information
mgoodsteinwellspanorg
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Visit Pediatric Care Online today for additional information on this and other topics
httppediatriccaresolutionsaaporgPediatric Care Online is a convenient electronic resource for immediate expert help with
virtually every pediatric clinical information need with must-have resources that are included in a comprehensive reference library and time-saving clinical tools
Donrsquot have a subscription to PCOThen take advantage of a free trial today
Call Mead Johnson Nutrition at 888363-2362 orfor more information go to
httppediatriccaresolutionsaaporgSSFree_Trialaspx
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
IMR over time Finland vs US
Slide Number 1
Disclaimer
Objectives for Todayrsquos Talk
Infant Mortality Rates for the Five Leading Causes of Infant Death in the United States 2005 and 2011
US Post-Neonatal Mortality 2015
FACT
What is SUID or SUDI
Some Causes of Deaths that Occur Suddenly and Unexpectedly during Infancy
What is SIDS
SIDS FACTS
SIDS FACTS
Triple Risk Model to Explain SIDS
Paterson DS Krous HF Kinney HC et al JAMA 2006
An Example of SIDS Pathogenesis
2016 AAP Recommendations Infant Sleep Safety
Strength of Recommendation
Recommendations Change as the Evidence Evolves
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
Correct Safe Sleep Environment
We Need to Move Beyond Back to Sleep
Sleep Position for Healthy Newborns
Sleep Position in Newborn Nursery
Sleep Position and Reflux
The Truth About Supine Sleep and Aspiration Ending the Fallacy
Title
Infant Sleep Location
Room-Share How Long Yoursquore Kidding Right
Supporting Data
More Recent Data
Why is Room-Sharing Protective
Room-Sharing and Sleep Quality
Insight Study (Paul 2017)
Insight Study (Paul 2017)
Insight Commentary (Hauck Moon)
Feeding the Baby at Night
Say NO to Couches Sofas and Cushioned Armchairs
High-Risk Bed Sharing Situations
Bedsharing in Low-Risk Breastfed Infants
Independent Review (Dr Robert Platt)
Bed Sharing
Bed Sharing
Bed Sharing with Overlay
Bed Sharing with Overlay
Bed Sharing with Overlay
Couch Sleeping
Couch Sleeping
Couch Sleeping
Unsafe Bedding NISP Trends 1993-2102
Why Use Soft Bedding
Soft Bedding for Older Infants
To Swaddle or Not to Swaddle That is the Question
Swaddling
SwaddlingmdashIs it Safe
SwaddlingmdashMore Questionshellip
wwwhealthychildrenorg
Pacifiers
Pacifiers and Breastfeeding
Baby Friendly USA Pacifiers
Addressing Sleep Deprivation
Overcoming Barriers to Change What Parents are Sayinghellip
Factors Associated With Choice of Infant Sleep Position
Slide Number 65
What is Working
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Infant Sleep Safety
Safe Sleep Nurse Modeling
Physician Advocacy
Healthcare Provider Advice to New Mothers Safe Sleep
Mason Clinical Peds 713
Bundled Intervention = Behavior Change
Hospital Unsafe Sleep Persists
Washington DC
TodaysBaby QI Safe Sleep Teaching
TodaysBaby QI Safe Sleep Teaching
Social Media and Risk-Reduction Training Study (SMART)
The National Safe Sleep Hospital Certification Program
Coordinated Education Efforts Work
Coordinated Education Efforts Work
And Finallyhellip
Encouraging Parents to Take Action
Motivational Interviewing
Impact of Eliminating Sleep-Related Deaths
Thank You
Contact Information
Slide Number 89
IMR over time Finland vs US
Column1
correct advice
55
incorrect advice
25
no advice
20
correct advice
incorrect advice
no advice
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Infant Sleep Safety
Requires a consistent and repetitive message in the community to prevent accidental deaths
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Safe Sleep Nurse Modeling
People trust nurses Whatever the nurse does must
be correct and it will be imitated in the home
Fact supine positioning in the nursery can almost DOUBLE its use in the home
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Physician Advocacy
Srivatsa 1997 HCP education to new familieshellip34 reduction in prone sleeping
Eron 2009 Study of Central NY state physicianshellip30 identified incorrect safest sleep positionhellip30 do not discuss with families
Colson 2009 Only 13 mothers advised by MD to use supine positionhellip3 times more likely to position the baby properly
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Healthcare Provider Advice to New Mothers Safe Sleep
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Chart1
Column1
[]
[]
[]
55
25
20
Sheet1
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Mason Clinical Peds 713
Bundled interventiono Nursing education policy model behavior safe sleep
video posters in rooms declaration of safe sleep practice
Safe sleep environment uarr from 25 to 58 Intention in home 95 supine none ldquoco-sleepingrdquo
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bundled Intervention = Behavior Change
QUESTION GROUP p-value
ISS Study NISP
Behavior Questions n = 490 n = 1046
Baby routinely placed to sleep on back 925 73 lt 0001
Baby routinely sleeps in bassinetcrib 995 71 lt 00001
Baby sleeps under a thin sheet 992 86 lt 0001
Baby given a pacifier for sleep 741 84 lt 0001Goodstein MH Bell T Krugman SD Improving infant sleep safety through a comprehensive hospital-based program Clinical Pediatrics 201554(3)212-221
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
o Baseline Safe sleep 49 of 264 infants o Post 312 of 234 infants (P lt 001) o Extra blankets most common o Baseline 77 vs 44 post-intervention o Mean number of unsafe items reduced by 50 (P lt 001)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Washington DC
2 urban DC nurseries 26 did not believe or unsure that infant positioning
was associated with SIDS Top 3 factors influencing sleep position
o 56 PERSONAL PREFERENCE Why non-supine Clinical experience (25)
o Increase risk aspirationo Decrease sleep and comfort
Bartow KL Nursesrsquo knowledge and adherence to sudden infant death syndrome prevention guidelines Pediatr Nurs 201642(1)7-13
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
TodaysBaby QI Safe Sleep Teaching
QI intervention median = 160 days Mothers reported receiving information 72 to 95
(increase of 24-57) 94 babies observed supine (plus 24) 88 infants in safe sleep environment
o Increase of 33 Gains maintained up to 12 months
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Social Media and Risk-Reduction Training Study (SMART) Cluster randomization 4 groups Safe sleep or breast feeding education Nursing QI and social media (mobile health) N = 1600 1263 responses (79) Safe sleep NQI and MHealth
o Supine sleep 925 o Room-sharing 859o No soft bedding 819o Pacifier use 762
Moon RY Hauck FR Colson ER et al The effect of nursing quality improvement and mobile health interventions on infant sleep practices a randomized clinical trial JAMA 2017318(4)351-359
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Hospital Initiative ComponentswwwcribsforkidsorgHospitalInitiativeToolkit INTRODUCTORY LETTER HOSPITAL INITIATIVE TOOL KIT
INSTRUCTIONS ORGANIZATIONAL CHART HOSPITAL POLICY ACKNOWLEDGMENT FORM (Engl amp
Span) SAFE SLEEP EDUCATIONAL FLIP CHART
NONCOMPLIANCE WAIVER (Engl amp Span)
NURSING EDUCATION MODULE
SAFE SLEEP POSTERS DOOR HANGERS (Engl amp Span) GRADUATION CERTIFICATE SAMPLE LETTER TO HOSPITALS SAMPLE LETTER TO PROVIDERS INFANT SAFE SLEEP BROCHURES
(Engl amp Span) PRESS KIT
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
All materials available on-lineo No major costs to the hospital
Easy on-line access for documentation
NO FEE FOR PARTICIPATION
wwwCribsforKidsorgHospitalInitiative
Tiffany Price (tpricecribsforkidsorg)
The National Safe Sleep Hospital Certification Program
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
TNmdash25 reduction in infant sleep-related deaths in 2 years
SDmdashOver 7915 Pack lsquon Plays distributed since 2012 Infant mortality rate decreased from 86 (2012) to 48 (2016)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
2009 to 2015 38 decrease in infant mortality Decreased from 135 to 84 per 1000 SUID decreased gt50 Decrease in racial disparityhttphealthybabiesbaltimorecomhome
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
And Finallyhellip
Health care providers should have open frank nonjudgmental conversations with families about their sleep practices
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Encouraging Parents to Take Action
According to the Social Learning Theory parents are more likely to recall and comply with instructions when
the health care provider
Uses a positive tone Provides adequate information Allows the parent to ask most of the questions
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Motivational Interviewing
ldquoa collaborative goal-oriented style of communication with particular attention to the language of changerdquo
o Strengthen personal motivation and commitment to a specific goal
o Explore onersquos reasons for change (barriers)o Patient generates own solutions
bull More likely to feel realisticbull Planting seeds of change
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Impact of Eliminating Sleep-Related Deaths
Every week we lose 70 children which is equivalent to 4 kindergarten classrooms
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Thank You
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Contact Information
mgoodsteinwellspanorg
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Visit Pediatric Care Online today for additional information on this and other topics
httppediatriccaresolutionsaaporgPediatric Care Online is a convenient electronic resource for immediate expert help with
virtually every pediatric clinical information need with must-have resources that are included in a comprehensive reference library and time-saving clinical tools
Donrsquot have a subscription to PCOThen take advantage of a free trial today
Call Mead Johnson Nutrition at 888363-2362 orfor more information go to
httppediatriccaresolutionsaaporgSSFree_Trialaspx
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
IMR over time Finland vs US
Slide Number 1
Disclaimer
Objectives for Todayrsquos Talk
Infant Mortality Rates for the Five Leading Causes of Infant Death in the United States 2005 and 2011
US Post-Neonatal Mortality 2015
FACT
What is SUID or SUDI
Some Causes of Deaths that Occur Suddenly and Unexpectedly during Infancy
What is SIDS
SIDS FACTS
SIDS FACTS
Triple Risk Model to Explain SIDS
Paterson DS Krous HF Kinney HC et al JAMA 2006
An Example of SIDS Pathogenesis
2016 AAP Recommendations Infant Sleep Safety
Strength of Recommendation
Recommendations Change as the Evidence Evolves
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
Correct Safe Sleep Environment
We Need to Move Beyond Back to Sleep
Sleep Position for Healthy Newborns
Sleep Position in Newborn Nursery
Sleep Position and Reflux
The Truth About Supine Sleep and Aspiration Ending the Fallacy
Title
Infant Sleep Location
Room-Share How Long Yoursquore Kidding Right
Supporting Data
More Recent Data
Why is Room-Sharing Protective
Room-Sharing and Sleep Quality
Insight Study (Paul 2017)
Insight Study (Paul 2017)
Insight Commentary (Hauck Moon)
Feeding the Baby at Night
Say NO to Couches Sofas and Cushioned Armchairs
High-Risk Bed Sharing Situations
Bedsharing in Low-Risk Breastfed Infants
Independent Review (Dr Robert Platt)
Bed Sharing
Bed Sharing
Bed Sharing with Overlay
Bed Sharing with Overlay
Bed Sharing with Overlay
Couch Sleeping
Couch Sleeping
Couch Sleeping
Unsafe Bedding NISP Trends 1993-2102
Why Use Soft Bedding
Soft Bedding for Older Infants
To Swaddle or Not to Swaddle That is the Question
Swaddling
SwaddlingmdashIs it Safe
SwaddlingmdashMore Questionshellip
wwwhealthychildrenorg
Pacifiers
Pacifiers and Breastfeeding
Baby Friendly USA Pacifiers
Addressing Sleep Deprivation
Overcoming Barriers to Change What Parents are Sayinghellip
Factors Associated With Choice of Infant Sleep Position
Slide Number 65
What is Working
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Infant Sleep Safety
Safe Sleep Nurse Modeling
Physician Advocacy
Healthcare Provider Advice to New Mothers Safe Sleep
Mason Clinical Peds 713
Bundled Intervention = Behavior Change
Hospital Unsafe Sleep Persists
Washington DC
TodaysBaby QI Safe Sleep Teaching
TodaysBaby QI Safe Sleep Teaching
Social Media and Risk-Reduction Training Study (SMART)
The National Safe Sleep Hospital Certification Program
Coordinated Education Efforts Work
Coordinated Education Efforts Work
And Finallyhellip
Encouraging Parents to Take Action
Motivational Interviewing
Impact of Eliminating Sleep-Related Deaths
Thank You
Contact Information
Slide Number 89
IMR over time Finland vs US
Column1
correct advice
55
incorrect advice
25
no advice
20
correct advice
incorrect advice
no advice
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Safe Sleep Nurse Modeling
People trust nurses Whatever the nurse does must
be correct and it will be imitated in the home
Fact supine positioning in the nursery can almost DOUBLE its use in the home
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Physician Advocacy
Srivatsa 1997 HCP education to new familieshellip34 reduction in prone sleeping
Eron 2009 Study of Central NY state physicianshellip30 identified incorrect safest sleep positionhellip30 do not discuss with families
Colson 2009 Only 13 mothers advised by MD to use supine positionhellip3 times more likely to position the baby properly
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Healthcare Provider Advice to New Mothers Safe Sleep
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Chart1
Column1
[]
[]
[]
55
25
20
Sheet1
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Mason Clinical Peds 713
Bundled interventiono Nursing education policy model behavior safe sleep
video posters in rooms declaration of safe sleep practice
Safe sleep environment uarr from 25 to 58 Intention in home 95 supine none ldquoco-sleepingrdquo
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bundled Intervention = Behavior Change
QUESTION GROUP p-value
ISS Study NISP
Behavior Questions n = 490 n = 1046
Baby routinely placed to sleep on back 925 73 lt 0001
Baby routinely sleeps in bassinetcrib 995 71 lt 00001
Baby sleeps under a thin sheet 992 86 lt 0001
Baby given a pacifier for sleep 741 84 lt 0001Goodstein MH Bell T Krugman SD Improving infant sleep safety through a comprehensive hospital-based program Clinical Pediatrics 201554(3)212-221
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
o Baseline Safe sleep 49 of 264 infants o Post 312 of 234 infants (P lt 001) o Extra blankets most common o Baseline 77 vs 44 post-intervention o Mean number of unsafe items reduced by 50 (P lt 001)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Washington DC
2 urban DC nurseries 26 did not believe or unsure that infant positioning
was associated with SIDS Top 3 factors influencing sleep position
o 56 PERSONAL PREFERENCE Why non-supine Clinical experience (25)
o Increase risk aspirationo Decrease sleep and comfort
Bartow KL Nursesrsquo knowledge and adherence to sudden infant death syndrome prevention guidelines Pediatr Nurs 201642(1)7-13
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
TodaysBaby QI Safe Sleep Teaching
QI intervention median = 160 days Mothers reported receiving information 72 to 95
(increase of 24-57) 94 babies observed supine (plus 24) 88 infants in safe sleep environment
o Increase of 33 Gains maintained up to 12 months
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Social Media and Risk-Reduction Training Study (SMART) Cluster randomization 4 groups Safe sleep or breast feeding education Nursing QI and social media (mobile health) N = 1600 1263 responses (79) Safe sleep NQI and MHealth
o Supine sleep 925 o Room-sharing 859o No soft bedding 819o Pacifier use 762
Moon RY Hauck FR Colson ER et al The effect of nursing quality improvement and mobile health interventions on infant sleep practices a randomized clinical trial JAMA 2017318(4)351-359
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Hospital Initiative ComponentswwwcribsforkidsorgHospitalInitiativeToolkit INTRODUCTORY LETTER HOSPITAL INITIATIVE TOOL KIT
INSTRUCTIONS ORGANIZATIONAL CHART HOSPITAL POLICY ACKNOWLEDGMENT FORM (Engl amp
Span) SAFE SLEEP EDUCATIONAL FLIP CHART
NONCOMPLIANCE WAIVER (Engl amp Span)
NURSING EDUCATION MODULE
SAFE SLEEP POSTERS DOOR HANGERS (Engl amp Span) GRADUATION CERTIFICATE SAMPLE LETTER TO HOSPITALS SAMPLE LETTER TO PROVIDERS INFANT SAFE SLEEP BROCHURES
(Engl amp Span) PRESS KIT
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
All materials available on-lineo No major costs to the hospital
Easy on-line access for documentation
NO FEE FOR PARTICIPATION
wwwCribsforKidsorgHospitalInitiative
Tiffany Price (tpricecribsforkidsorg)
The National Safe Sleep Hospital Certification Program
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
TNmdash25 reduction in infant sleep-related deaths in 2 years
SDmdashOver 7915 Pack lsquon Plays distributed since 2012 Infant mortality rate decreased from 86 (2012) to 48 (2016)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
2009 to 2015 38 decrease in infant mortality Decreased from 135 to 84 per 1000 SUID decreased gt50 Decrease in racial disparityhttphealthybabiesbaltimorecomhome
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
And Finallyhellip
Health care providers should have open frank nonjudgmental conversations with families about their sleep practices
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Encouraging Parents to Take Action
According to the Social Learning Theory parents are more likely to recall and comply with instructions when
the health care provider
Uses a positive tone Provides adequate information Allows the parent to ask most of the questions
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Motivational Interviewing
ldquoa collaborative goal-oriented style of communication with particular attention to the language of changerdquo
o Strengthen personal motivation and commitment to a specific goal
o Explore onersquos reasons for change (barriers)o Patient generates own solutions
bull More likely to feel realisticbull Planting seeds of change
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Impact of Eliminating Sleep-Related Deaths
Every week we lose 70 children which is equivalent to 4 kindergarten classrooms
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Thank You
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Contact Information
mgoodsteinwellspanorg
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Visit Pediatric Care Online today for additional information on this and other topics
httppediatriccaresolutionsaaporgPediatric Care Online is a convenient electronic resource for immediate expert help with
virtually every pediatric clinical information need with must-have resources that are included in a comprehensive reference library and time-saving clinical tools
Donrsquot have a subscription to PCOThen take advantage of a free trial today
Call Mead Johnson Nutrition at 888363-2362 orfor more information go to
httppediatriccaresolutionsaaporgSSFree_Trialaspx
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
IMR over time Finland vs US
Slide Number 1
Disclaimer
Objectives for Todayrsquos Talk
Infant Mortality Rates for the Five Leading Causes of Infant Death in the United States 2005 and 2011
US Post-Neonatal Mortality 2015
FACT
What is SUID or SUDI
Some Causes of Deaths that Occur Suddenly and Unexpectedly during Infancy
What is SIDS
SIDS FACTS
SIDS FACTS
Triple Risk Model to Explain SIDS
Paterson DS Krous HF Kinney HC et al JAMA 2006
An Example of SIDS Pathogenesis
2016 AAP Recommendations Infant Sleep Safety
Strength of Recommendation
Recommendations Change as the Evidence Evolves
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
Correct Safe Sleep Environment
We Need to Move Beyond Back to Sleep
Sleep Position for Healthy Newborns
Sleep Position in Newborn Nursery
Sleep Position and Reflux
The Truth About Supine Sleep and Aspiration Ending the Fallacy
Title
Infant Sleep Location
Room-Share How Long Yoursquore Kidding Right
Supporting Data
More Recent Data
Why is Room-Sharing Protective
Room-Sharing and Sleep Quality
Insight Study (Paul 2017)
Insight Study (Paul 2017)
Insight Commentary (Hauck Moon)
Feeding the Baby at Night
Say NO to Couches Sofas and Cushioned Armchairs
High-Risk Bed Sharing Situations
Bedsharing in Low-Risk Breastfed Infants
Independent Review (Dr Robert Platt)
Bed Sharing
Bed Sharing
Bed Sharing with Overlay
Bed Sharing with Overlay
Bed Sharing with Overlay
Couch Sleeping
Couch Sleeping
Couch Sleeping
Unsafe Bedding NISP Trends 1993-2102
Why Use Soft Bedding
Soft Bedding for Older Infants
To Swaddle or Not to Swaddle That is the Question
Swaddling
SwaddlingmdashIs it Safe
SwaddlingmdashMore Questionshellip
wwwhealthychildrenorg
Pacifiers
Pacifiers and Breastfeeding
Baby Friendly USA Pacifiers
Addressing Sleep Deprivation
Overcoming Barriers to Change What Parents are Sayinghellip
Factors Associated With Choice of Infant Sleep Position
Slide Number 65
What is Working
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Infant Sleep Safety
Safe Sleep Nurse Modeling
Physician Advocacy
Healthcare Provider Advice to New Mothers Safe Sleep
Mason Clinical Peds 713
Bundled Intervention = Behavior Change
Hospital Unsafe Sleep Persists
Washington DC
TodaysBaby QI Safe Sleep Teaching
TodaysBaby QI Safe Sleep Teaching
Social Media and Risk-Reduction Training Study (SMART)
The National Safe Sleep Hospital Certification Program
Coordinated Education Efforts Work
Coordinated Education Efforts Work
And Finallyhellip
Encouraging Parents to Take Action
Motivational Interviewing
Impact of Eliminating Sleep-Related Deaths
Thank You
Contact Information
Slide Number 89
IMR over time Finland vs US
Column1
correct advice
55
incorrect advice
25
no advice
20
correct advice
incorrect advice
no advice
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Physician Advocacy
Srivatsa 1997 HCP education to new familieshellip34 reduction in prone sleeping
Eron 2009 Study of Central NY state physicianshellip30 identified incorrect safest sleep positionhellip30 do not discuss with families
Colson 2009 Only 13 mothers advised by MD to use supine positionhellip3 times more likely to position the baby properly
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Healthcare Provider Advice to New Mothers Safe Sleep
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Chart1
Column1
[]
[]
[]
55
25
20
Sheet1
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Mason Clinical Peds 713
Bundled interventiono Nursing education policy model behavior safe sleep
video posters in rooms declaration of safe sleep practice
Safe sleep environment uarr from 25 to 58 Intention in home 95 supine none ldquoco-sleepingrdquo
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bundled Intervention = Behavior Change
QUESTION GROUP p-value
ISS Study NISP
Behavior Questions n = 490 n = 1046
Baby routinely placed to sleep on back 925 73 lt 0001
Baby routinely sleeps in bassinetcrib 995 71 lt 00001
Baby sleeps under a thin sheet 992 86 lt 0001
Baby given a pacifier for sleep 741 84 lt 0001Goodstein MH Bell T Krugman SD Improving infant sleep safety through a comprehensive hospital-based program Clinical Pediatrics 201554(3)212-221
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
o Baseline Safe sleep 49 of 264 infants o Post 312 of 234 infants (P lt 001) o Extra blankets most common o Baseline 77 vs 44 post-intervention o Mean number of unsafe items reduced by 50 (P lt 001)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Washington DC
2 urban DC nurseries 26 did not believe or unsure that infant positioning
was associated with SIDS Top 3 factors influencing sleep position
o 56 PERSONAL PREFERENCE Why non-supine Clinical experience (25)
o Increase risk aspirationo Decrease sleep and comfort
Bartow KL Nursesrsquo knowledge and adherence to sudden infant death syndrome prevention guidelines Pediatr Nurs 201642(1)7-13
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
TodaysBaby QI Safe Sleep Teaching
QI intervention median = 160 days Mothers reported receiving information 72 to 95
(increase of 24-57) 94 babies observed supine (plus 24) 88 infants in safe sleep environment
o Increase of 33 Gains maintained up to 12 months
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Social Media and Risk-Reduction Training Study (SMART) Cluster randomization 4 groups Safe sleep or breast feeding education Nursing QI and social media (mobile health) N = 1600 1263 responses (79) Safe sleep NQI and MHealth
o Supine sleep 925 o Room-sharing 859o No soft bedding 819o Pacifier use 762
Moon RY Hauck FR Colson ER et al The effect of nursing quality improvement and mobile health interventions on infant sleep practices a randomized clinical trial JAMA 2017318(4)351-359
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Hospital Initiative ComponentswwwcribsforkidsorgHospitalInitiativeToolkit INTRODUCTORY LETTER HOSPITAL INITIATIVE TOOL KIT
INSTRUCTIONS ORGANIZATIONAL CHART HOSPITAL POLICY ACKNOWLEDGMENT FORM (Engl amp
Span) SAFE SLEEP EDUCATIONAL FLIP CHART
NONCOMPLIANCE WAIVER (Engl amp Span)
NURSING EDUCATION MODULE
SAFE SLEEP POSTERS DOOR HANGERS (Engl amp Span) GRADUATION CERTIFICATE SAMPLE LETTER TO HOSPITALS SAMPLE LETTER TO PROVIDERS INFANT SAFE SLEEP BROCHURES
(Engl amp Span) PRESS KIT
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
All materials available on-lineo No major costs to the hospital
Easy on-line access for documentation
NO FEE FOR PARTICIPATION
wwwCribsforKidsorgHospitalInitiative
Tiffany Price (tpricecribsforkidsorg)
The National Safe Sleep Hospital Certification Program
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
TNmdash25 reduction in infant sleep-related deaths in 2 years
SDmdashOver 7915 Pack lsquon Plays distributed since 2012 Infant mortality rate decreased from 86 (2012) to 48 (2016)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
2009 to 2015 38 decrease in infant mortality Decreased from 135 to 84 per 1000 SUID decreased gt50 Decrease in racial disparityhttphealthybabiesbaltimorecomhome
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
And Finallyhellip
Health care providers should have open frank nonjudgmental conversations with families about their sleep practices
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Encouraging Parents to Take Action
According to the Social Learning Theory parents are more likely to recall and comply with instructions when
the health care provider
Uses a positive tone Provides adequate information Allows the parent to ask most of the questions
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Motivational Interviewing
ldquoa collaborative goal-oriented style of communication with particular attention to the language of changerdquo
o Strengthen personal motivation and commitment to a specific goal
o Explore onersquos reasons for change (barriers)o Patient generates own solutions
bull More likely to feel realisticbull Planting seeds of change
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Impact of Eliminating Sleep-Related Deaths
Every week we lose 70 children which is equivalent to 4 kindergarten classrooms
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Thank You
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Contact Information
mgoodsteinwellspanorg
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Visit Pediatric Care Online today for additional information on this and other topics
httppediatriccaresolutionsaaporgPediatric Care Online is a convenient electronic resource for immediate expert help with
virtually every pediatric clinical information need with must-have resources that are included in a comprehensive reference library and time-saving clinical tools
Donrsquot have a subscription to PCOThen take advantage of a free trial today
Call Mead Johnson Nutrition at 888363-2362 orfor more information go to
httppediatriccaresolutionsaaporgSSFree_Trialaspx
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
IMR over time Finland vs US
Slide Number 1
Disclaimer
Objectives for Todayrsquos Talk
Infant Mortality Rates for the Five Leading Causes of Infant Death in the United States 2005 and 2011
US Post-Neonatal Mortality 2015
FACT
What is SUID or SUDI
Some Causes of Deaths that Occur Suddenly and Unexpectedly during Infancy
What is SIDS
SIDS FACTS
SIDS FACTS
Triple Risk Model to Explain SIDS
Paterson DS Krous HF Kinney HC et al JAMA 2006
An Example of SIDS Pathogenesis
2016 AAP Recommendations Infant Sleep Safety
Strength of Recommendation
Recommendations Change as the Evidence Evolves
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
Correct Safe Sleep Environment
We Need to Move Beyond Back to Sleep
Sleep Position for Healthy Newborns
Sleep Position in Newborn Nursery
Sleep Position and Reflux
The Truth About Supine Sleep and Aspiration Ending the Fallacy
Title
Infant Sleep Location
Room-Share How Long Yoursquore Kidding Right
Supporting Data
More Recent Data
Why is Room-Sharing Protective
Room-Sharing and Sleep Quality
Insight Study (Paul 2017)
Insight Study (Paul 2017)
Insight Commentary (Hauck Moon)
Feeding the Baby at Night
Say NO to Couches Sofas and Cushioned Armchairs
High-Risk Bed Sharing Situations
Bedsharing in Low-Risk Breastfed Infants
Independent Review (Dr Robert Platt)
Bed Sharing
Bed Sharing
Bed Sharing with Overlay
Bed Sharing with Overlay
Bed Sharing with Overlay
Couch Sleeping
Couch Sleeping
Couch Sleeping
Unsafe Bedding NISP Trends 1993-2102
Why Use Soft Bedding
Soft Bedding for Older Infants
To Swaddle or Not to Swaddle That is the Question
Swaddling
SwaddlingmdashIs it Safe
SwaddlingmdashMore Questionshellip
wwwhealthychildrenorg
Pacifiers
Pacifiers and Breastfeeding
Baby Friendly USA Pacifiers
Addressing Sleep Deprivation
Overcoming Barriers to Change What Parents are Sayinghellip
Factors Associated With Choice of Infant Sleep Position
Slide Number 65
What is Working
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Infant Sleep Safety
Safe Sleep Nurse Modeling
Physician Advocacy
Healthcare Provider Advice to New Mothers Safe Sleep
Mason Clinical Peds 713
Bundled Intervention = Behavior Change
Hospital Unsafe Sleep Persists
Washington DC
TodaysBaby QI Safe Sleep Teaching
TodaysBaby QI Safe Sleep Teaching
Social Media and Risk-Reduction Training Study (SMART)
The National Safe Sleep Hospital Certification Program
Coordinated Education Efforts Work
Coordinated Education Efforts Work
And Finallyhellip
Encouraging Parents to Take Action
Motivational Interviewing
Impact of Eliminating Sleep-Related Deaths
Thank You
Contact Information
Slide Number 89
IMR over time Finland vs US
Column1
correct advice
55
incorrect advice
25
no advice
20
correct advice
incorrect advice
no advice
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Healthcare Provider Advice to New Mothers Safe Sleep
Colson ER Geller NL Heeren T Corwin MJ Factors associated with choice of infant sleep position Pediatrics 2017140(3)e20170596
Chart1
Column1
[]
[]
[]
55
25
20
Sheet1
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Mason Clinical Peds 713
Bundled interventiono Nursing education policy model behavior safe sleep
video posters in rooms declaration of safe sleep practice
Safe sleep environment uarr from 25 to 58 Intention in home 95 supine none ldquoco-sleepingrdquo
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bundled Intervention = Behavior Change
QUESTION GROUP p-value
ISS Study NISP
Behavior Questions n = 490 n = 1046
Baby routinely placed to sleep on back 925 73 lt 0001
Baby routinely sleeps in bassinetcrib 995 71 lt 00001
Baby sleeps under a thin sheet 992 86 lt 0001
Baby given a pacifier for sleep 741 84 lt 0001Goodstein MH Bell T Krugman SD Improving infant sleep safety through a comprehensive hospital-based program Clinical Pediatrics 201554(3)212-221
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
o Baseline Safe sleep 49 of 264 infants o Post 312 of 234 infants (P lt 001) o Extra blankets most common o Baseline 77 vs 44 post-intervention o Mean number of unsafe items reduced by 50 (P lt 001)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Washington DC
2 urban DC nurseries 26 did not believe or unsure that infant positioning
was associated with SIDS Top 3 factors influencing sleep position
o 56 PERSONAL PREFERENCE Why non-supine Clinical experience (25)
o Increase risk aspirationo Decrease sleep and comfort
Bartow KL Nursesrsquo knowledge and adherence to sudden infant death syndrome prevention guidelines Pediatr Nurs 201642(1)7-13
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
TodaysBaby QI Safe Sleep Teaching
QI intervention median = 160 days Mothers reported receiving information 72 to 95
(increase of 24-57) 94 babies observed supine (plus 24) 88 infants in safe sleep environment
o Increase of 33 Gains maintained up to 12 months
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Social Media and Risk-Reduction Training Study (SMART) Cluster randomization 4 groups Safe sleep or breast feeding education Nursing QI and social media (mobile health) N = 1600 1263 responses (79) Safe sleep NQI and MHealth
o Supine sleep 925 o Room-sharing 859o No soft bedding 819o Pacifier use 762
Moon RY Hauck FR Colson ER et al The effect of nursing quality improvement and mobile health interventions on infant sleep practices a randomized clinical trial JAMA 2017318(4)351-359
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Hospital Initiative ComponentswwwcribsforkidsorgHospitalInitiativeToolkit INTRODUCTORY LETTER HOSPITAL INITIATIVE TOOL KIT
INSTRUCTIONS ORGANIZATIONAL CHART HOSPITAL POLICY ACKNOWLEDGMENT FORM (Engl amp
Span) SAFE SLEEP EDUCATIONAL FLIP CHART
NONCOMPLIANCE WAIVER (Engl amp Span)
NURSING EDUCATION MODULE
SAFE SLEEP POSTERS DOOR HANGERS (Engl amp Span) GRADUATION CERTIFICATE SAMPLE LETTER TO HOSPITALS SAMPLE LETTER TO PROVIDERS INFANT SAFE SLEEP BROCHURES
(Engl amp Span) PRESS KIT
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
All materials available on-lineo No major costs to the hospital
Easy on-line access for documentation
NO FEE FOR PARTICIPATION
wwwCribsforKidsorgHospitalInitiative
Tiffany Price (tpricecribsforkidsorg)
The National Safe Sleep Hospital Certification Program
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
TNmdash25 reduction in infant sleep-related deaths in 2 years
SDmdashOver 7915 Pack lsquon Plays distributed since 2012 Infant mortality rate decreased from 86 (2012) to 48 (2016)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
2009 to 2015 38 decrease in infant mortality Decreased from 135 to 84 per 1000 SUID decreased gt50 Decrease in racial disparityhttphealthybabiesbaltimorecomhome
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
And Finallyhellip
Health care providers should have open frank nonjudgmental conversations with families about their sleep practices
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Encouraging Parents to Take Action
According to the Social Learning Theory parents are more likely to recall and comply with instructions when
the health care provider
Uses a positive tone Provides adequate information Allows the parent to ask most of the questions
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Motivational Interviewing
ldquoa collaborative goal-oriented style of communication with particular attention to the language of changerdquo
o Strengthen personal motivation and commitment to a specific goal
o Explore onersquos reasons for change (barriers)o Patient generates own solutions
bull More likely to feel realisticbull Planting seeds of change
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Impact of Eliminating Sleep-Related Deaths
Every week we lose 70 children which is equivalent to 4 kindergarten classrooms
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Thank You
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Contact Information
mgoodsteinwellspanorg
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Visit Pediatric Care Online today for additional information on this and other topics
httppediatriccaresolutionsaaporgPediatric Care Online is a convenient electronic resource for immediate expert help with
virtually every pediatric clinical information need with must-have resources that are included in a comprehensive reference library and time-saving clinical tools
Donrsquot have a subscription to PCOThen take advantage of a free trial today
Call Mead Johnson Nutrition at 888363-2362 orfor more information go to
httppediatriccaresolutionsaaporgSSFree_Trialaspx
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
IMR over time Finland vs US
Slide Number 1
Disclaimer
Objectives for Todayrsquos Talk
Infant Mortality Rates for the Five Leading Causes of Infant Death in the United States 2005 and 2011
US Post-Neonatal Mortality 2015
FACT
What is SUID or SUDI
Some Causes of Deaths that Occur Suddenly and Unexpectedly during Infancy
What is SIDS
SIDS FACTS
SIDS FACTS
Triple Risk Model to Explain SIDS
Paterson DS Krous HF Kinney HC et al JAMA 2006
An Example of SIDS Pathogenesis
2016 AAP Recommendations Infant Sleep Safety
Strength of Recommendation
Recommendations Change as the Evidence Evolves
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
Correct Safe Sleep Environment
We Need to Move Beyond Back to Sleep
Sleep Position for Healthy Newborns
Sleep Position in Newborn Nursery
Sleep Position and Reflux
The Truth About Supine Sleep and Aspiration Ending the Fallacy
Title
Infant Sleep Location
Room-Share How Long Yoursquore Kidding Right
Supporting Data
More Recent Data
Why is Room-Sharing Protective
Room-Sharing and Sleep Quality
Insight Study (Paul 2017)
Insight Study (Paul 2017)
Insight Commentary (Hauck Moon)
Feeding the Baby at Night
Say NO to Couches Sofas and Cushioned Armchairs
High-Risk Bed Sharing Situations
Bedsharing in Low-Risk Breastfed Infants
Independent Review (Dr Robert Platt)
Bed Sharing
Bed Sharing
Bed Sharing with Overlay
Bed Sharing with Overlay
Bed Sharing with Overlay
Couch Sleeping
Couch Sleeping
Couch Sleeping
Unsafe Bedding NISP Trends 1993-2102
Why Use Soft Bedding
Soft Bedding for Older Infants
To Swaddle or Not to Swaddle That is the Question
Swaddling
SwaddlingmdashIs it Safe
SwaddlingmdashMore Questionshellip
wwwhealthychildrenorg
Pacifiers
Pacifiers and Breastfeeding
Baby Friendly USA Pacifiers
Addressing Sleep Deprivation
Overcoming Barriers to Change What Parents are Sayinghellip
Factors Associated With Choice of Infant Sleep Position
Slide Number 65
What is Working
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Infant Sleep Safety
Safe Sleep Nurse Modeling
Physician Advocacy
Healthcare Provider Advice to New Mothers Safe Sleep
Mason Clinical Peds 713
Bundled Intervention = Behavior Change
Hospital Unsafe Sleep Persists
Washington DC
TodaysBaby QI Safe Sleep Teaching
TodaysBaby QI Safe Sleep Teaching
Social Media and Risk-Reduction Training Study (SMART)
The National Safe Sleep Hospital Certification Program
Coordinated Education Efforts Work
Coordinated Education Efforts Work
And Finallyhellip
Encouraging Parents to Take Action
Motivational Interviewing
Impact of Eliminating Sleep-Related Deaths
Thank You
Contact Information
Slide Number 89
IMR over time Finland vs US
Column1
correct advice
55
incorrect advice
25
no advice
20
correct advice
incorrect advice
no advice
Chart1
Column1
[]
[]
[]
55
25
20
Sheet1
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Mason Clinical Peds 713
Bundled interventiono Nursing education policy model behavior safe sleep
video posters in rooms declaration of safe sleep practice
Safe sleep environment uarr from 25 to 58 Intention in home 95 supine none ldquoco-sleepingrdquo
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bundled Intervention = Behavior Change
QUESTION GROUP p-value
ISS Study NISP
Behavior Questions n = 490 n = 1046
Baby routinely placed to sleep on back 925 73 lt 0001
Baby routinely sleeps in bassinetcrib 995 71 lt 00001
Baby sleeps under a thin sheet 992 86 lt 0001
Baby given a pacifier for sleep 741 84 lt 0001Goodstein MH Bell T Krugman SD Improving infant sleep safety through a comprehensive hospital-based program Clinical Pediatrics 201554(3)212-221
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
o Baseline Safe sleep 49 of 264 infants o Post 312 of 234 infants (P lt 001) o Extra blankets most common o Baseline 77 vs 44 post-intervention o Mean number of unsafe items reduced by 50 (P lt 001)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Washington DC
2 urban DC nurseries 26 did not believe or unsure that infant positioning
was associated with SIDS Top 3 factors influencing sleep position
o 56 PERSONAL PREFERENCE Why non-supine Clinical experience (25)
o Increase risk aspirationo Decrease sleep and comfort
Bartow KL Nursesrsquo knowledge and adherence to sudden infant death syndrome prevention guidelines Pediatr Nurs 201642(1)7-13
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
TodaysBaby QI Safe Sleep Teaching
QI intervention median = 160 days Mothers reported receiving information 72 to 95
(increase of 24-57) 94 babies observed supine (plus 24) 88 infants in safe sleep environment
o Increase of 33 Gains maintained up to 12 months
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Social Media and Risk-Reduction Training Study (SMART) Cluster randomization 4 groups Safe sleep or breast feeding education Nursing QI and social media (mobile health) N = 1600 1263 responses (79) Safe sleep NQI and MHealth
o Supine sleep 925 o Room-sharing 859o No soft bedding 819o Pacifier use 762
Moon RY Hauck FR Colson ER et al The effect of nursing quality improvement and mobile health interventions on infant sleep practices a randomized clinical trial JAMA 2017318(4)351-359
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Hospital Initiative ComponentswwwcribsforkidsorgHospitalInitiativeToolkit INTRODUCTORY LETTER HOSPITAL INITIATIVE TOOL KIT
INSTRUCTIONS ORGANIZATIONAL CHART HOSPITAL POLICY ACKNOWLEDGMENT FORM (Engl amp
Span) SAFE SLEEP EDUCATIONAL FLIP CHART
NONCOMPLIANCE WAIVER (Engl amp Span)
NURSING EDUCATION MODULE
SAFE SLEEP POSTERS DOOR HANGERS (Engl amp Span) GRADUATION CERTIFICATE SAMPLE LETTER TO HOSPITALS SAMPLE LETTER TO PROVIDERS INFANT SAFE SLEEP BROCHURES
(Engl amp Span) PRESS KIT
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
All materials available on-lineo No major costs to the hospital
Easy on-line access for documentation
NO FEE FOR PARTICIPATION
wwwCribsforKidsorgHospitalInitiative
Tiffany Price (tpricecribsforkidsorg)
The National Safe Sleep Hospital Certification Program
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
TNmdash25 reduction in infant sleep-related deaths in 2 years
SDmdashOver 7915 Pack lsquon Plays distributed since 2012 Infant mortality rate decreased from 86 (2012) to 48 (2016)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
2009 to 2015 38 decrease in infant mortality Decreased from 135 to 84 per 1000 SUID decreased gt50 Decrease in racial disparityhttphealthybabiesbaltimorecomhome
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
And Finallyhellip
Health care providers should have open frank nonjudgmental conversations with families about their sleep practices
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Encouraging Parents to Take Action
According to the Social Learning Theory parents are more likely to recall and comply with instructions when
the health care provider
Uses a positive tone Provides adequate information Allows the parent to ask most of the questions
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Motivational Interviewing
ldquoa collaborative goal-oriented style of communication with particular attention to the language of changerdquo
o Strengthen personal motivation and commitment to a specific goal
o Explore onersquos reasons for change (barriers)o Patient generates own solutions
bull More likely to feel realisticbull Planting seeds of change
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Impact of Eliminating Sleep-Related Deaths
Every week we lose 70 children which is equivalent to 4 kindergarten classrooms
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Thank You
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Contact Information
mgoodsteinwellspanorg
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Visit Pediatric Care Online today for additional information on this and other topics
httppediatriccaresolutionsaaporgPediatric Care Online is a convenient electronic resource for immediate expert help with
virtually every pediatric clinical information need with must-have resources that are included in a comprehensive reference library and time-saving clinical tools
Donrsquot have a subscription to PCOThen take advantage of a free trial today
Call Mead Johnson Nutrition at 888363-2362 orfor more information go to
httppediatriccaresolutionsaaporgSSFree_Trialaspx
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
IMR over time Finland vs US
Slide Number 1
Disclaimer
Objectives for Todayrsquos Talk
Infant Mortality Rates for the Five Leading Causes of Infant Death in the United States 2005 and 2011
US Post-Neonatal Mortality 2015
FACT
What is SUID or SUDI
Some Causes of Deaths that Occur Suddenly and Unexpectedly during Infancy
What is SIDS
SIDS FACTS
SIDS FACTS
Triple Risk Model to Explain SIDS
Paterson DS Krous HF Kinney HC et al JAMA 2006
An Example of SIDS Pathogenesis
2016 AAP Recommendations Infant Sleep Safety
Strength of Recommendation
Recommendations Change as the Evidence Evolves
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
Correct Safe Sleep Environment
We Need to Move Beyond Back to Sleep
Sleep Position for Healthy Newborns
Sleep Position in Newborn Nursery
Sleep Position and Reflux
The Truth About Supine Sleep and Aspiration Ending the Fallacy
Title
Infant Sleep Location
Room-Share How Long Yoursquore Kidding Right
Supporting Data
More Recent Data
Why is Room-Sharing Protective
Room-Sharing and Sleep Quality
Insight Study (Paul 2017)
Insight Study (Paul 2017)
Insight Commentary (Hauck Moon)
Feeding the Baby at Night
Say NO to Couches Sofas and Cushioned Armchairs
High-Risk Bed Sharing Situations
Bedsharing in Low-Risk Breastfed Infants
Independent Review (Dr Robert Platt)
Bed Sharing
Bed Sharing
Bed Sharing with Overlay
Bed Sharing with Overlay
Bed Sharing with Overlay
Couch Sleeping
Couch Sleeping
Couch Sleeping
Unsafe Bedding NISP Trends 1993-2102
Why Use Soft Bedding
Soft Bedding for Older Infants
To Swaddle or Not to Swaddle That is the Question
Swaddling
SwaddlingmdashIs it Safe
SwaddlingmdashMore Questionshellip
wwwhealthychildrenorg
Pacifiers
Pacifiers and Breastfeeding
Baby Friendly USA Pacifiers
Addressing Sleep Deprivation
Overcoming Barriers to Change What Parents are Sayinghellip
Factors Associated With Choice of Infant Sleep Position
Slide Number 65
What is Working
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Infant Sleep Safety
Safe Sleep Nurse Modeling
Physician Advocacy
Healthcare Provider Advice to New Mothers Safe Sleep
Mason Clinical Peds 713
Bundled Intervention = Behavior Change
Hospital Unsafe Sleep Persists
Washington DC
TodaysBaby QI Safe Sleep Teaching
TodaysBaby QI Safe Sleep Teaching
Social Media and Risk-Reduction Training Study (SMART)
The National Safe Sleep Hospital Certification Program
Coordinated Education Efforts Work
Coordinated Education Efforts Work
And Finallyhellip
Encouraging Parents to Take Action
Motivational Interviewing
Impact of Eliminating Sleep-Related Deaths
Thank You
Contact Information
Slide Number 89
IMR over time Finland vs US
Column1
correct advice
55
incorrect advice
25
no advice
20
correct advice
incorrect advice
no advice
Sheet1
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Mason Clinical Peds 713
Bundled interventiono Nursing education policy model behavior safe sleep
video posters in rooms declaration of safe sleep practice
Safe sleep environment uarr from 25 to 58 Intention in home 95 supine none ldquoco-sleepingrdquo
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bundled Intervention = Behavior Change
QUESTION GROUP p-value
ISS Study NISP
Behavior Questions n = 490 n = 1046
Baby routinely placed to sleep on back 925 73 lt 0001
Baby routinely sleeps in bassinetcrib 995 71 lt 00001
Baby sleeps under a thin sheet 992 86 lt 0001
Baby given a pacifier for sleep 741 84 lt 0001Goodstein MH Bell T Krugman SD Improving infant sleep safety through a comprehensive hospital-based program Clinical Pediatrics 201554(3)212-221
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
o Baseline Safe sleep 49 of 264 infants o Post 312 of 234 infants (P lt 001) o Extra blankets most common o Baseline 77 vs 44 post-intervention o Mean number of unsafe items reduced by 50 (P lt 001)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Washington DC
2 urban DC nurseries 26 did not believe or unsure that infant positioning
was associated with SIDS Top 3 factors influencing sleep position
o 56 PERSONAL PREFERENCE Why non-supine Clinical experience (25)
o Increase risk aspirationo Decrease sleep and comfort
Bartow KL Nursesrsquo knowledge and adherence to sudden infant death syndrome prevention guidelines Pediatr Nurs 201642(1)7-13
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
TodaysBaby QI Safe Sleep Teaching
QI intervention median = 160 days Mothers reported receiving information 72 to 95
(increase of 24-57) 94 babies observed supine (plus 24) 88 infants in safe sleep environment
o Increase of 33 Gains maintained up to 12 months
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Social Media and Risk-Reduction Training Study (SMART) Cluster randomization 4 groups Safe sleep or breast feeding education Nursing QI and social media (mobile health) N = 1600 1263 responses (79) Safe sleep NQI and MHealth
o Supine sleep 925 o Room-sharing 859o No soft bedding 819o Pacifier use 762
Moon RY Hauck FR Colson ER et al The effect of nursing quality improvement and mobile health interventions on infant sleep practices a randomized clinical trial JAMA 2017318(4)351-359
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Hospital Initiative ComponentswwwcribsforkidsorgHospitalInitiativeToolkit INTRODUCTORY LETTER HOSPITAL INITIATIVE TOOL KIT
INSTRUCTIONS ORGANIZATIONAL CHART HOSPITAL POLICY ACKNOWLEDGMENT FORM (Engl amp
Span) SAFE SLEEP EDUCATIONAL FLIP CHART
NONCOMPLIANCE WAIVER (Engl amp Span)
NURSING EDUCATION MODULE
SAFE SLEEP POSTERS DOOR HANGERS (Engl amp Span) GRADUATION CERTIFICATE SAMPLE LETTER TO HOSPITALS SAMPLE LETTER TO PROVIDERS INFANT SAFE SLEEP BROCHURES
(Engl amp Span) PRESS KIT
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
All materials available on-lineo No major costs to the hospital
Easy on-line access for documentation
NO FEE FOR PARTICIPATION
wwwCribsforKidsorgHospitalInitiative
Tiffany Price (tpricecribsforkidsorg)
The National Safe Sleep Hospital Certification Program
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
TNmdash25 reduction in infant sleep-related deaths in 2 years
SDmdashOver 7915 Pack lsquon Plays distributed since 2012 Infant mortality rate decreased from 86 (2012) to 48 (2016)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
2009 to 2015 38 decrease in infant mortality Decreased from 135 to 84 per 1000 SUID decreased gt50 Decrease in racial disparityhttphealthybabiesbaltimorecomhome
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
And Finallyhellip
Health care providers should have open frank nonjudgmental conversations with families about their sleep practices
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Encouraging Parents to Take Action
According to the Social Learning Theory parents are more likely to recall and comply with instructions when
the health care provider
Uses a positive tone Provides adequate information Allows the parent to ask most of the questions
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Motivational Interviewing
ldquoa collaborative goal-oriented style of communication with particular attention to the language of changerdquo
o Strengthen personal motivation and commitment to a specific goal
o Explore onersquos reasons for change (barriers)o Patient generates own solutions
bull More likely to feel realisticbull Planting seeds of change
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Impact of Eliminating Sleep-Related Deaths
Every week we lose 70 children which is equivalent to 4 kindergarten classrooms
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Thank You
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Contact Information
mgoodsteinwellspanorg
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Visit Pediatric Care Online today for additional information on this and other topics
httppediatriccaresolutionsaaporgPediatric Care Online is a convenient electronic resource for immediate expert help with
virtually every pediatric clinical information need with must-have resources that are included in a comprehensive reference library and time-saving clinical tools
Donrsquot have a subscription to PCOThen take advantage of a free trial today
Call Mead Johnson Nutrition at 888363-2362 orfor more information go to
httppediatriccaresolutionsaaporgSSFree_Trialaspx
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
IMR over time Finland vs US
Slide Number 1
Disclaimer
Objectives for Todayrsquos Talk
Infant Mortality Rates for the Five Leading Causes of Infant Death in the United States 2005 and 2011
US Post-Neonatal Mortality 2015
FACT
What is SUID or SUDI
Some Causes of Deaths that Occur Suddenly and Unexpectedly during Infancy
What is SIDS
SIDS FACTS
SIDS FACTS
Triple Risk Model to Explain SIDS
Paterson DS Krous HF Kinney HC et al JAMA 2006
An Example of SIDS Pathogenesis
2016 AAP Recommendations Infant Sleep Safety
Strength of Recommendation
Recommendations Change as the Evidence Evolves
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
Correct Safe Sleep Environment
We Need to Move Beyond Back to Sleep
Sleep Position for Healthy Newborns
Sleep Position in Newborn Nursery
Sleep Position and Reflux
The Truth About Supine Sleep and Aspiration Ending the Fallacy
Title
Infant Sleep Location
Room-Share How Long Yoursquore Kidding Right
Supporting Data
More Recent Data
Why is Room-Sharing Protective
Room-Sharing and Sleep Quality
Insight Study (Paul 2017)
Insight Study (Paul 2017)
Insight Commentary (Hauck Moon)
Feeding the Baby at Night
Say NO to Couches Sofas and Cushioned Armchairs
High-Risk Bed Sharing Situations
Bedsharing in Low-Risk Breastfed Infants
Independent Review (Dr Robert Platt)
Bed Sharing
Bed Sharing
Bed Sharing with Overlay
Bed Sharing with Overlay
Bed Sharing with Overlay
Couch Sleeping
Couch Sleeping
Couch Sleeping
Unsafe Bedding NISP Trends 1993-2102
Why Use Soft Bedding
Soft Bedding for Older Infants
To Swaddle or Not to Swaddle That is the Question
Swaddling
SwaddlingmdashIs it Safe
SwaddlingmdashMore Questionshellip
wwwhealthychildrenorg
Pacifiers
Pacifiers and Breastfeeding
Baby Friendly USA Pacifiers
Addressing Sleep Deprivation
Overcoming Barriers to Change What Parents are Sayinghellip
Factors Associated With Choice of Infant Sleep Position
Slide Number 65
What is Working
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Infant Sleep Safety
Safe Sleep Nurse Modeling
Physician Advocacy
Healthcare Provider Advice to New Mothers Safe Sleep
Mason Clinical Peds 713
Bundled Intervention = Behavior Change
Hospital Unsafe Sleep Persists
Washington DC
TodaysBaby QI Safe Sleep Teaching
TodaysBaby QI Safe Sleep Teaching
Social Media and Risk-Reduction Training Study (SMART)
The National Safe Sleep Hospital Certification Program
Coordinated Education Efforts Work
Coordinated Education Efforts Work
And Finallyhellip
Encouraging Parents to Take Action
Motivational Interviewing
Impact of Eliminating Sleep-Related Deaths
Thank You
Contact Information
Slide Number 89
IMR over time Finland vs US
Column1
correct advice
55
incorrect advice
25
no advice
20
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Mason Clinical Peds 713
Bundled interventiono Nursing education policy model behavior safe sleep
video posters in rooms declaration of safe sleep practice
Safe sleep environment uarr from 25 to 58 Intention in home 95 supine none ldquoco-sleepingrdquo
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bundled Intervention = Behavior Change
QUESTION GROUP p-value
ISS Study NISP
Behavior Questions n = 490 n = 1046
Baby routinely placed to sleep on back 925 73 lt 0001
Baby routinely sleeps in bassinetcrib 995 71 lt 00001
Baby sleeps under a thin sheet 992 86 lt 0001
Baby given a pacifier for sleep 741 84 lt 0001Goodstein MH Bell T Krugman SD Improving infant sleep safety through a comprehensive hospital-based program Clinical Pediatrics 201554(3)212-221
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
o Baseline Safe sleep 49 of 264 infants o Post 312 of 234 infants (P lt 001) o Extra blankets most common o Baseline 77 vs 44 post-intervention o Mean number of unsafe items reduced by 50 (P lt 001)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Washington DC
2 urban DC nurseries 26 did not believe or unsure that infant positioning
was associated with SIDS Top 3 factors influencing sleep position
o 56 PERSONAL PREFERENCE Why non-supine Clinical experience (25)
o Increase risk aspirationo Decrease sleep and comfort
Bartow KL Nursesrsquo knowledge and adherence to sudden infant death syndrome prevention guidelines Pediatr Nurs 201642(1)7-13
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
TodaysBaby QI Safe Sleep Teaching
QI intervention median = 160 days Mothers reported receiving information 72 to 95
(increase of 24-57) 94 babies observed supine (plus 24) 88 infants in safe sleep environment
o Increase of 33 Gains maintained up to 12 months
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Social Media and Risk-Reduction Training Study (SMART) Cluster randomization 4 groups Safe sleep or breast feeding education Nursing QI and social media (mobile health) N = 1600 1263 responses (79) Safe sleep NQI and MHealth
o Supine sleep 925 o Room-sharing 859o No soft bedding 819o Pacifier use 762
Moon RY Hauck FR Colson ER et al The effect of nursing quality improvement and mobile health interventions on infant sleep practices a randomized clinical trial JAMA 2017318(4)351-359
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Hospital Initiative ComponentswwwcribsforkidsorgHospitalInitiativeToolkit INTRODUCTORY LETTER HOSPITAL INITIATIVE TOOL KIT
INSTRUCTIONS ORGANIZATIONAL CHART HOSPITAL POLICY ACKNOWLEDGMENT FORM (Engl amp
Span) SAFE SLEEP EDUCATIONAL FLIP CHART
NONCOMPLIANCE WAIVER (Engl amp Span)
NURSING EDUCATION MODULE
SAFE SLEEP POSTERS DOOR HANGERS (Engl amp Span) GRADUATION CERTIFICATE SAMPLE LETTER TO HOSPITALS SAMPLE LETTER TO PROVIDERS INFANT SAFE SLEEP BROCHURES
(Engl amp Span) PRESS KIT
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
All materials available on-lineo No major costs to the hospital
Easy on-line access for documentation
NO FEE FOR PARTICIPATION
wwwCribsforKidsorgHospitalInitiative
Tiffany Price (tpricecribsforkidsorg)
The National Safe Sleep Hospital Certification Program
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
TNmdash25 reduction in infant sleep-related deaths in 2 years
SDmdashOver 7915 Pack lsquon Plays distributed since 2012 Infant mortality rate decreased from 86 (2012) to 48 (2016)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
2009 to 2015 38 decrease in infant mortality Decreased from 135 to 84 per 1000 SUID decreased gt50 Decrease in racial disparityhttphealthybabiesbaltimorecomhome
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
And Finallyhellip
Health care providers should have open frank nonjudgmental conversations with families about their sleep practices
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Encouraging Parents to Take Action
According to the Social Learning Theory parents are more likely to recall and comply with instructions when
the health care provider
Uses a positive tone Provides adequate information Allows the parent to ask most of the questions
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Motivational Interviewing
ldquoa collaborative goal-oriented style of communication with particular attention to the language of changerdquo
o Strengthen personal motivation and commitment to a specific goal
o Explore onersquos reasons for change (barriers)o Patient generates own solutions
bull More likely to feel realisticbull Planting seeds of change
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Impact of Eliminating Sleep-Related Deaths
Every week we lose 70 children which is equivalent to 4 kindergarten classrooms
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Thank You
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Contact Information
mgoodsteinwellspanorg
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Visit Pediatric Care Online today for additional information on this and other topics
httppediatriccaresolutionsaaporgPediatric Care Online is a convenient electronic resource for immediate expert help with
virtually every pediatric clinical information need with must-have resources that are included in a comprehensive reference library and time-saving clinical tools
Donrsquot have a subscription to PCOThen take advantage of a free trial today
Call Mead Johnson Nutrition at 888363-2362 orfor more information go to
httppediatriccaresolutionsaaporgSSFree_Trialaspx
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
IMR over time Finland vs US
Slide Number 1
Disclaimer
Objectives for Todayrsquos Talk
Infant Mortality Rates for the Five Leading Causes of Infant Death in the United States 2005 and 2011
US Post-Neonatal Mortality 2015
FACT
What is SUID or SUDI
Some Causes of Deaths that Occur Suddenly and Unexpectedly during Infancy
What is SIDS
SIDS FACTS
SIDS FACTS
Triple Risk Model to Explain SIDS
Paterson DS Krous HF Kinney HC et al JAMA 2006
An Example of SIDS Pathogenesis
2016 AAP Recommendations Infant Sleep Safety
Strength of Recommendation
Recommendations Change as the Evidence Evolves
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
Correct Safe Sleep Environment
We Need to Move Beyond Back to Sleep
Sleep Position for Healthy Newborns
Sleep Position in Newborn Nursery
Sleep Position and Reflux
The Truth About Supine Sleep and Aspiration Ending the Fallacy
Title
Infant Sleep Location
Room-Share How Long Yoursquore Kidding Right
Supporting Data
More Recent Data
Why is Room-Sharing Protective
Room-Sharing and Sleep Quality
Insight Study (Paul 2017)
Insight Study (Paul 2017)
Insight Commentary (Hauck Moon)
Feeding the Baby at Night
Say NO to Couches Sofas and Cushioned Armchairs
High-Risk Bed Sharing Situations
Bedsharing in Low-Risk Breastfed Infants
Independent Review (Dr Robert Platt)
Bed Sharing
Bed Sharing
Bed Sharing with Overlay
Bed Sharing with Overlay
Bed Sharing with Overlay
Couch Sleeping
Couch Sleeping
Couch Sleeping
Unsafe Bedding NISP Trends 1993-2102
Why Use Soft Bedding
Soft Bedding for Older Infants
To Swaddle or Not to Swaddle That is the Question
Swaddling
SwaddlingmdashIs it Safe
SwaddlingmdashMore Questionshellip
wwwhealthychildrenorg
Pacifiers
Pacifiers and Breastfeeding
Baby Friendly USA Pacifiers
Addressing Sleep Deprivation
Overcoming Barriers to Change What Parents are Sayinghellip
Factors Associated With Choice of Infant Sleep Position
Slide Number 65
What is Working
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Infant Sleep Safety
Safe Sleep Nurse Modeling
Physician Advocacy
Healthcare Provider Advice to New Mothers Safe Sleep
Mason Clinical Peds 713
Bundled Intervention = Behavior Change
Hospital Unsafe Sleep Persists
Washington DC
TodaysBaby QI Safe Sleep Teaching
TodaysBaby QI Safe Sleep Teaching
Social Media and Risk-Reduction Training Study (SMART)
The National Safe Sleep Hospital Certification Program
Coordinated Education Efforts Work
Coordinated Education Efforts Work
And Finallyhellip
Encouraging Parents to Take Action
Motivational Interviewing
Impact of Eliminating Sleep-Related Deaths
Thank You
Contact Information
Slide Number 89
IMR over time Finland vs US
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Bundled Intervention = Behavior Change
QUESTION GROUP p-value
ISS Study NISP
Behavior Questions n = 490 n = 1046
Baby routinely placed to sleep on back 925 73 lt 0001
Baby routinely sleeps in bassinetcrib 995 71 lt 00001
Baby sleeps under a thin sheet 992 86 lt 0001
Baby given a pacifier for sleep 741 84 lt 0001Goodstein MH Bell T Krugman SD Improving infant sleep safety through a comprehensive hospital-based program Clinical Pediatrics 201554(3)212-221
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
o Baseline Safe sleep 49 of 264 infants o Post 312 of 234 infants (P lt 001) o Extra blankets most common o Baseline 77 vs 44 post-intervention o Mean number of unsafe items reduced by 50 (P lt 001)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Washington DC
2 urban DC nurseries 26 did not believe or unsure that infant positioning
was associated with SIDS Top 3 factors influencing sleep position
o 56 PERSONAL PREFERENCE Why non-supine Clinical experience (25)
o Increase risk aspirationo Decrease sleep and comfort
Bartow KL Nursesrsquo knowledge and adherence to sudden infant death syndrome prevention guidelines Pediatr Nurs 201642(1)7-13
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
TodaysBaby QI Safe Sleep Teaching
QI intervention median = 160 days Mothers reported receiving information 72 to 95
(increase of 24-57) 94 babies observed supine (plus 24) 88 infants in safe sleep environment
o Increase of 33 Gains maintained up to 12 months
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Social Media and Risk-Reduction Training Study (SMART) Cluster randomization 4 groups Safe sleep or breast feeding education Nursing QI and social media (mobile health) N = 1600 1263 responses (79) Safe sleep NQI and MHealth
o Supine sleep 925 o Room-sharing 859o No soft bedding 819o Pacifier use 762
Moon RY Hauck FR Colson ER et al The effect of nursing quality improvement and mobile health interventions on infant sleep practices a randomized clinical trial JAMA 2017318(4)351-359
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Hospital Initiative ComponentswwwcribsforkidsorgHospitalInitiativeToolkit INTRODUCTORY LETTER HOSPITAL INITIATIVE TOOL KIT
INSTRUCTIONS ORGANIZATIONAL CHART HOSPITAL POLICY ACKNOWLEDGMENT FORM (Engl amp
Span) SAFE SLEEP EDUCATIONAL FLIP CHART
NONCOMPLIANCE WAIVER (Engl amp Span)
NURSING EDUCATION MODULE
SAFE SLEEP POSTERS DOOR HANGERS (Engl amp Span) GRADUATION CERTIFICATE SAMPLE LETTER TO HOSPITALS SAMPLE LETTER TO PROVIDERS INFANT SAFE SLEEP BROCHURES
(Engl amp Span) PRESS KIT
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
All materials available on-lineo No major costs to the hospital
Easy on-line access for documentation
NO FEE FOR PARTICIPATION
wwwCribsforKidsorgHospitalInitiative
Tiffany Price (tpricecribsforkidsorg)
The National Safe Sleep Hospital Certification Program
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
TNmdash25 reduction in infant sleep-related deaths in 2 years
SDmdashOver 7915 Pack lsquon Plays distributed since 2012 Infant mortality rate decreased from 86 (2012) to 48 (2016)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
2009 to 2015 38 decrease in infant mortality Decreased from 135 to 84 per 1000 SUID decreased gt50 Decrease in racial disparityhttphealthybabiesbaltimorecomhome
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
And Finallyhellip
Health care providers should have open frank nonjudgmental conversations with families about their sleep practices
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Encouraging Parents to Take Action
According to the Social Learning Theory parents are more likely to recall and comply with instructions when
the health care provider
Uses a positive tone Provides adequate information Allows the parent to ask most of the questions
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Motivational Interviewing
ldquoa collaborative goal-oriented style of communication with particular attention to the language of changerdquo
o Strengthen personal motivation and commitment to a specific goal
o Explore onersquos reasons for change (barriers)o Patient generates own solutions
bull More likely to feel realisticbull Planting seeds of change
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Impact of Eliminating Sleep-Related Deaths
Every week we lose 70 children which is equivalent to 4 kindergarten classrooms
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Thank You
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Contact Information
mgoodsteinwellspanorg
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Visit Pediatric Care Online today for additional information on this and other topics
httppediatriccaresolutionsaaporgPediatric Care Online is a convenient electronic resource for immediate expert help with
virtually every pediatric clinical information need with must-have resources that are included in a comprehensive reference library and time-saving clinical tools
Donrsquot have a subscription to PCOThen take advantage of a free trial today
Call Mead Johnson Nutrition at 888363-2362 orfor more information go to
httppediatriccaresolutionsaaporgSSFree_Trialaspx
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
IMR over time Finland vs US
Slide Number 1
Disclaimer
Objectives for Todayrsquos Talk
Infant Mortality Rates for the Five Leading Causes of Infant Death in the United States 2005 and 2011
US Post-Neonatal Mortality 2015
FACT
What is SUID or SUDI
Some Causes of Deaths that Occur Suddenly and Unexpectedly during Infancy
What is SIDS
SIDS FACTS
SIDS FACTS
Triple Risk Model to Explain SIDS
Paterson DS Krous HF Kinney HC et al JAMA 2006
An Example of SIDS Pathogenesis
2016 AAP Recommendations Infant Sleep Safety
Strength of Recommendation
Recommendations Change as the Evidence Evolves
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
Correct Safe Sleep Environment
We Need to Move Beyond Back to Sleep
Sleep Position for Healthy Newborns
Sleep Position in Newborn Nursery
Sleep Position and Reflux
The Truth About Supine Sleep and Aspiration Ending the Fallacy
Title
Infant Sleep Location
Room-Share How Long Yoursquore Kidding Right
Supporting Data
More Recent Data
Why is Room-Sharing Protective
Room-Sharing and Sleep Quality
Insight Study (Paul 2017)
Insight Study (Paul 2017)
Insight Commentary (Hauck Moon)
Feeding the Baby at Night
Say NO to Couches Sofas and Cushioned Armchairs
High-Risk Bed Sharing Situations
Bedsharing in Low-Risk Breastfed Infants
Independent Review (Dr Robert Platt)
Bed Sharing
Bed Sharing
Bed Sharing with Overlay
Bed Sharing with Overlay
Bed Sharing with Overlay
Couch Sleeping
Couch Sleeping
Couch Sleeping
Unsafe Bedding NISP Trends 1993-2102
Why Use Soft Bedding
Soft Bedding for Older Infants
To Swaddle or Not to Swaddle That is the Question
Swaddling
SwaddlingmdashIs it Safe
SwaddlingmdashMore Questionshellip
wwwhealthychildrenorg
Pacifiers
Pacifiers and Breastfeeding
Baby Friendly USA Pacifiers
Addressing Sleep Deprivation
Overcoming Barriers to Change What Parents are Sayinghellip
Factors Associated With Choice of Infant Sleep Position
Slide Number 65
What is Working
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Infant Sleep Safety
Safe Sleep Nurse Modeling
Physician Advocacy
Healthcare Provider Advice to New Mothers Safe Sleep
Mason Clinical Peds 713
Bundled Intervention = Behavior Change
Hospital Unsafe Sleep Persists
Washington DC
TodaysBaby QI Safe Sleep Teaching
TodaysBaby QI Safe Sleep Teaching
Social Media and Risk-Reduction Training Study (SMART)
The National Safe Sleep Hospital Certification Program
Coordinated Education Efforts Work
Coordinated Education Efforts Work
And Finallyhellip
Encouraging Parents to Take Action
Motivational Interviewing
Impact of Eliminating Sleep-Related Deaths
Thank You
Contact Information
Slide Number 89
IMR over time Finland vs US
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
o Baseline Safe sleep 49 of 264 infants o Post 312 of 234 infants (P lt 001) o Extra blankets most common o Baseline 77 vs 44 post-intervention o Mean number of unsafe items reduced by 50 (P lt 001)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Washington DC
2 urban DC nurseries 26 did not believe or unsure that infant positioning
was associated with SIDS Top 3 factors influencing sleep position
o 56 PERSONAL PREFERENCE Why non-supine Clinical experience (25)
o Increase risk aspirationo Decrease sleep and comfort
Bartow KL Nursesrsquo knowledge and adherence to sudden infant death syndrome prevention guidelines Pediatr Nurs 201642(1)7-13
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
TodaysBaby QI Safe Sleep Teaching
QI intervention median = 160 days Mothers reported receiving information 72 to 95
(increase of 24-57) 94 babies observed supine (plus 24) 88 infants in safe sleep environment
o Increase of 33 Gains maintained up to 12 months
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Social Media and Risk-Reduction Training Study (SMART) Cluster randomization 4 groups Safe sleep or breast feeding education Nursing QI and social media (mobile health) N = 1600 1263 responses (79) Safe sleep NQI and MHealth
o Supine sleep 925 o Room-sharing 859o No soft bedding 819o Pacifier use 762
Moon RY Hauck FR Colson ER et al The effect of nursing quality improvement and mobile health interventions on infant sleep practices a randomized clinical trial JAMA 2017318(4)351-359
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Hospital Initiative ComponentswwwcribsforkidsorgHospitalInitiativeToolkit INTRODUCTORY LETTER HOSPITAL INITIATIVE TOOL KIT
INSTRUCTIONS ORGANIZATIONAL CHART HOSPITAL POLICY ACKNOWLEDGMENT FORM (Engl amp
Span) SAFE SLEEP EDUCATIONAL FLIP CHART
NONCOMPLIANCE WAIVER (Engl amp Span)
NURSING EDUCATION MODULE
SAFE SLEEP POSTERS DOOR HANGERS (Engl amp Span) GRADUATION CERTIFICATE SAMPLE LETTER TO HOSPITALS SAMPLE LETTER TO PROVIDERS INFANT SAFE SLEEP BROCHURES
(Engl amp Span) PRESS KIT
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
All materials available on-lineo No major costs to the hospital
Easy on-line access for documentation
NO FEE FOR PARTICIPATION
wwwCribsforKidsorgHospitalInitiative
Tiffany Price (tpricecribsforkidsorg)
The National Safe Sleep Hospital Certification Program
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
TNmdash25 reduction in infant sleep-related deaths in 2 years
SDmdashOver 7915 Pack lsquon Plays distributed since 2012 Infant mortality rate decreased from 86 (2012) to 48 (2016)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
2009 to 2015 38 decrease in infant mortality Decreased from 135 to 84 per 1000 SUID decreased gt50 Decrease in racial disparityhttphealthybabiesbaltimorecomhome
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
And Finallyhellip
Health care providers should have open frank nonjudgmental conversations with families about their sleep practices
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Encouraging Parents to Take Action
According to the Social Learning Theory parents are more likely to recall and comply with instructions when
the health care provider
Uses a positive tone Provides adequate information Allows the parent to ask most of the questions
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Motivational Interviewing
ldquoa collaborative goal-oriented style of communication with particular attention to the language of changerdquo
o Strengthen personal motivation and commitment to a specific goal
o Explore onersquos reasons for change (barriers)o Patient generates own solutions
bull More likely to feel realisticbull Planting seeds of change
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Impact of Eliminating Sleep-Related Deaths
Every week we lose 70 children which is equivalent to 4 kindergarten classrooms
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Thank You
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Contact Information
mgoodsteinwellspanorg
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Visit Pediatric Care Online today for additional information on this and other topics
httppediatriccaresolutionsaaporgPediatric Care Online is a convenient electronic resource for immediate expert help with
virtually every pediatric clinical information need with must-have resources that are included in a comprehensive reference library and time-saving clinical tools
Donrsquot have a subscription to PCOThen take advantage of a free trial today
Call Mead Johnson Nutrition at 888363-2362 orfor more information go to
httppediatriccaresolutionsaaporgSSFree_Trialaspx
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
IMR over time Finland vs US
Slide Number 1
Disclaimer
Objectives for Todayrsquos Talk
Infant Mortality Rates for the Five Leading Causes of Infant Death in the United States 2005 and 2011
US Post-Neonatal Mortality 2015
FACT
What is SUID or SUDI
Some Causes of Deaths that Occur Suddenly and Unexpectedly during Infancy
What is SIDS
SIDS FACTS
SIDS FACTS
Triple Risk Model to Explain SIDS
Paterson DS Krous HF Kinney HC et al JAMA 2006
An Example of SIDS Pathogenesis
2016 AAP Recommendations Infant Sleep Safety
Strength of Recommendation
Recommendations Change as the Evidence Evolves
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
Correct Safe Sleep Environment
We Need to Move Beyond Back to Sleep
Sleep Position for Healthy Newborns
Sleep Position in Newborn Nursery
Sleep Position and Reflux
The Truth About Supine Sleep and Aspiration Ending the Fallacy
Title
Infant Sleep Location
Room-Share How Long Yoursquore Kidding Right
Supporting Data
More Recent Data
Why is Room-Sharing Protective
Room-Sharing and Sleep Quality
Insight Study (Paul 2017)
Insight Study (Paul 2017)
Insight Commentary (Hauck Moon)
Feeding the Baby at Night
Say NO to Couches Sofas and Cushioned Armchairs
High-Risk Bed Sharing Situations
Bedsharing in Low-Risk Breastfed Infants
Independent Review (Dr Robert Platt)
Bed Sharing
Bed Sharing
Bed Sharing with Overlay
Bed Sharing with Overlay
Bed Sharing with Overlay
Couch Sleeping
Couch Sleeping
Couch Sleeping
Unsafe Bedding NISP Trends 1993-2102
Why Use Soft Bedding
Soft Bedding for Older Infants
To Swaddle or Not to Swaddle That is the Question
Swaddling
SwaddlingmdashIs it Safe
SwaddlingmdashMore Questionshellip
wwwhealthychildrenorg
Pacifiers
Pacifiers and Breastfeeding
Baby Friendly USA Pacifiers
Addressing Sleep Deprivation
Overcoming Barriers to Change What Parents are Sayinghellip
Factors Associated With Choice of Infant Sleep Position
Slide Number 65
What is Working
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Infant Sleep Safety
Safe Sleep Nurse Modeling
Physician Advocacy
Healthcare Provider Advice to New Mothers Safe Sleep
Mason Clinical Peds 713
Bundled Intervention = Behavior Change
Hospital Unsafe Sleep Persists
Washington DC
TodaysBaby QI Safe Sleep Teaching
TodaysBaby QI Safe Sleep Teaching
Social Media and Risk-Reduction Training Study (SMART)
The National Safe Sleep Hospital Certification Program
Coordinated Education Efforts Work
Coordinated Education Efforts Work
And Finallyhellip
Encouraging Parents to Take Action
Motivational Interviewing
Impact of Eliminating Sleep-Related Deaths
Thank You
Contact Information
Slide Number 89
IMR over time Finland vs US
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Washington DC
2 urban DC nurseries 26 did not believe or unsure that infant positioning
was associated with SIDS Top 3 factors influencing sleep position
o 56 PERSONAL PREFERENCE Why non-supine Clinical experience (25)
o Increase risk aspirationo Decrease sleep and comfort
Bartow KL Nursesrsquo knowledge and adherence to sudden infant death syndrome prevention guidelines Pediatr Nurs 201642(1)7-13
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
TodaysBaby QI Safe Sleep Teaching
QI intervention median = 160 days Mothers reported receiving information 72 to 95
(increase of 24-57) 94 babies observed supine (plus 24) 88 infants in safe sleep environment
o Increase of 33 Gains maintained up to 12 months
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Social Media and Risk-Reduction Training Study (SMART) Cluster randomization 4 groups Safe sleep or breast feeding education Nursing QI and social media (mobile health) N = 1600 1263 responses (79) Safe sleep NQI and MHealth
o Supine sleep 925 o Room-sharing 859o No soft bedding 819o Pacifier use 762
Moon RY Hauck FR Colson ER et al The effect of nursing quality improvement and mobile health interventions on infant sleep practices a randomized clinical trial JAMA 2017318(4)351-359
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Hospital Initiative ComponentswwwcribsforkidsorgHospitalInitiativeToolkit INTRODUCTORY LETTER HOSPITAL INITIATIVE TOOL KIT
INSTRUCTIONS ORGANIZATIONAL CHART HOSPITAL POLICY ACKNOWLEDGMENT FORM (Engl amp
Span) SAFE SLEEP EDUCATIONAL FLIP CHART
NONCOMPLIANCE WAIVER (Engl amp Span)
NURSING EDUCATION MODULE
SAFE SLEEP POSTERS DOOR HANGERS (Engl amp Span) GRADUATION CERTIFICATE SAMPLE LETTER TO HOSPITALS SAMPLE LETTER TO PROVIDERS INFANT SAFE SLEEP BROCHURES
(Engl amp Span) PRESS KIT
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
All materials available on-lineo No major costs to the hospital
Easy on-line access for documentation
NO FEE FOR PARTICIPATION
wwwCribsforKidsorgHospitalInitiative
Tiffany Price (tpricecribsforkidsorg)
The National Safe Sleep Hospital Certification Program
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
TNmdash25 reduction in infant sleep-related deaths in 2 years
SDmdashOver 7915 Pack lsquon Plays distributed since 2012 Infant mortality rate decreased from 86 (2012) to 48 (2016)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
2009 to 2015 38 decrease in infant mortality Decreased from 135 to 84 per 1000 SUID decreased gt50 Decrease in racial disparityhttphealthybabiesbaltimorecomhome
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
And Finallyhellip
Health care providers should have open frank nonjudgmental conversations with families about their sleep practices
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Encouraging Parents to Take Action
According to the Social Learning Theory parents are more likely to recall and comply with instructions when
the health care provider
Uses a positive tone Provides adequate information Allows the parent to ask most of the questions
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Motivational Interviewing
ldquoa collaborative goal-oriented style of communication with particular attention to the language of changerdquo
o Strengthen personal motivation and commitment to a specific goal
o Explore onersquos reasons for change (barriers)o Patient generates own solutions
bull More likely to feel realisticbull Planting seeds of change
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Impact of Eliminating Sleep-Related Deaths
Every week we lose 70 children which is equivalent to 4 kindergarten classrooms
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Thank You
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Contact Information
mgoodsteinwellspanorg
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Visit Pediatric Care Online today for additional information on this and other topics
httppediatriccaresolutionsaaporgPediatric Care Online is a convenient electronic resource for immediate expert help with
virtually every pediatric clinical information need with must-have resources that are included in a comprehensive reference library and time-saving clinical tools
Donrsquot have a subscription to PCOThen take advantage of a free trial today
Call Mead Johnson Nutrition at 888363-2362 orfor more information go to
httppediatriccaresolutionsaaporgSSFree_Trialaspx
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
IMR over time Finland vs US
Slide Number 1
Disclaimer
Objectives for Todayrsquos Talk
Infant Mortality Rates for the Five Leading Causes of Infant Death in the United States 2005 and 2011
US Post-Neonatal Mortality 2015
FACT
What is SUID or SUDI
Some Causes of Deaths that Occur Suddenly and Unexpectedly during Infancy
What is SIDS
SIDS FACTS
SIDS FACTS
Triple Risk Model to Explain SIDS
Paterson DS Krous HF Kinney HC et al JAMA 2006
An Example of SIDS Pathogenesis
2016 AAP Recommendations Infant Sleep Safety
Strength of Recommendation
Recommendations Change as the Evidence Evolves
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
Correct Safe Sleep Environment
We Need to Move Beyond Back to Sleep
Sleep Position for Healthy Newborns
Sleep Position in Newborn Nursery
Sleep Position and Reflux
The Truth About Supine Sleep and Aspiration Ending the Fallacy
Title
Infant Sleep Location
Room-Share How Long Yoursquore Kidding Right
Supporting Data
More Recent Data
Why is Room-Sharing Protective
Room-Sharing and Sleep Quality
Insight Study (Paul 2017)
Insight Study (Paul 2017)
Insight Commentary (Hauck Moon)
Feeding the Baby at Night
Say NO to Couches Sofas and Cushioned Armchairs
High-Risk Bed Sharing Situations
Bedsharing in Low-Risk Breastfed Infants
Independent Review (Dr Robert Platt)
Bed Sharing
Bed Sharing
Bed Sharing with Overlay
Bed Sharing with Overlay
Bed Sharing with Overlay
Couch Sleeping
Couch Sleeping
Couch Sleeping
Unsafe Bedding NISP Trends 1993-2102
Why Use Soft Bedding
Soft Bedding for Older Infants
To Swaddle or Not to Swaddle That is the Question
Swaddling
SwaddlingmdashIs it Safe
SwaddlingmdashMore Questionshellip
wwwhealthychildrenorg
Pacifiers
Pacifiers and Breastfeeding
Baby Friendly USA Pacifiers
Addressing Sleep Deprivation
Overcoming Barriers to Change What Parents are Sayinghellip
Factors Associated With Choice of Infant Sleep Position
Slide Number 65
What is Working
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Infant Sleep Safety
Safe Sleep Nurse Modeling
Physician Advocacy
Healthcare Provider Advice to New Mothers Safe Sleep
Mason Clinical Peds 713
Bundled Intervention = Behavior Change
Hospital Unsafe Sleep Persists
Washington DC
TodaysBaby QI Safe Sleep Teaching
TodaysBaby QI Safe Sleep Teaching
Social Media and Risk-Reduction Training Study (SMART)
The National Safe Sleep Hospital Certification Program
Coordinated Education Efforts Work
Coordinated Education Efforts Work
And Finallyhellip
Encouraging Parents to Take Action
Motivational Interviewing
Impact of Eliminating Sleep-Related Deaths
Thank You
Contact Information
Slide Number 89
IMR over time Finland vs US
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
TodaysBaby QI Safe Sleep Teaching
QI intervention median = 160 days Mothers reported receiving information 72 to 95
(increase of 24-57) 94 babies observed supine (plus 24) 88 infants in safe sleep environment
o Increase of 33 Gains maintained up to 12 months
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Social Media and Risk-Reduction Training Study (SMART) Cluster randomization 4 groups Safe sleep or breast feeding education Nursing QI and social media (mobile health) N = 1600 1263 responses (79) Safe sleep NQI and MHealth
o Supine sleep 925 o Room-sharing 859o No soft bedding 819o Pacifier use 762
Moon RY Hauck FR Colson ER et al The effect of nursing quality improvement and mobile health interventions on infant sleep practices a randomized clinical trial JAMA 2017318(4)351-359
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Hospital Initiative ComponentswwwcribsforkidsorgHospitalInitiativeToolkit INTRODUCTORY LETTER HOSPITAL INITIATIVE TOOL KIT
INSTRUCTIONS ORGANIZATIONAL CHART HOSPITAL POLICY ACKNOWLEDGMENT FORM (Engl amp
Span) SAFE SLEEP EDUCATIONAL FLIP CHART
NONCOMPLIANCE WAIVER (Engl amp Span)
NURSING EDUCATION MODULE
SAFE SLEEP POSTERS DOOR HANGERS (Engl amp Span) GRADUATION CERTIFICATE SAMPLE LETTER TO HOSPITALS SAMPLE LETTER TO PROVIDERS INFANT SAFE SLEEP BROCHURES
(Engl amp Span) PRESS KIT
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
All materials available on-lineo No major costs to the hospital
Easy on-line access for documentation
NO FEE FOR PARTICIPATION
wwwCribsforKidsorgHospitalInitiative
Tiffany Price (tpricecribsforkidsorg)
The National Safe Sleep Hospital Certification Program
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
TNmdash25 reduction in infant sleep-related deaths in 2 years
SDmdashOver 7915 Pack lsquon Plays distributed since 2012 Infant mortality rate decreased from 86 (2012) to 48 (2016)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
2009 to 2015 38 decrease in infant mortality Decreased from 135 to 84 per 1000 SUID decreased gt50 Decrease in racial disparityhttphealthybabiesbaltimorecomhome
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
And Finallyhellip
Health care providers should have open frank nonjudgmental conversations with families about their sleep practices
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Encouraging Parents to Take Action
According to the Social Learning Theory parents are more likely to recall and comply with instructions when
the health care provider
Uses a positive tone Provides adequate information Allows the parent to ask most of the questions
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Motivational Interviewing
ldquoa collaborative goal-oriented style of communication with particular attention to the language of changerdquo
o Strengthen personal motivation and commitment to a specific goal
o Explore onersquos reasons for change (barriers)o Patient generates own solutions
bull More likely to feel realisticbull Planting seeds of change
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Impact of Eliminating Sleep-Related Deaths
Every week we lose 70 children which is equivalent to 4 kindergarten classrooms
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Thank You
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Contact Information
mgoodsteinwellspanorg
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Visit Pediatric Care Online today for additional information on this and other topics
httppediatriccaresolutionsaaporgPediatric Care Online is a convenient electronic resource for immediate expert help with
virtually every pediatric clinical information need with must-have resources that are included in a comprehensive reference library and time-saving clinical tools
Donrsquot have a subscription to PCOThen take advantage of a free trial today
Call Mead Johnson Nutrition at 888363-2362 orfor more information go to
httppediatriccaresolutionsaaporgSSFree_Trialaspx
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
IMR over time Finland vs US
Slide Number 1
Disclaimer
Objectives for Todayrsquos Talk
Infant Mortality Rates for the Five Leading Causes of Infant Death in the United States 2005 and 2011
US Post-Neonatal Mortality 2015
FACT
What is SUID or SUDI
Some Causes of Deaths that Occur Suddenly and Unexpectedly during Infancy
What is SIDS
SIDS FACTS
SIDS FACTS
Triple Risk Model to Explain SIDS
Paterson DS Krous HF Kinney HC et al JAMA 2006
An Example of SIDS Pathogenesis
2016 AAP Recommendations Infant Sleep Safety
Strength of Recommendation
Recommendations Change as the Evidence Evolves
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
Correct Safe Sleep Environment
We Need to Move Beyond Back to Sleep
Sleep Position for Healthy Newborns
Sleep Position in Newborn Nursery
Sleep Position and Reflux
The Truth About Supine Sleep and Aspiration Ending the Fallacy
Title
Infant Sleep Location
Room-Share How Long Yoursquore Kidding Right
Supporting Data
More Recent Data
Why is Room-Sharing Protective
Room-Sharing and Sleep Quality
Insight Study (Paul 2017)
Insight Study (Paul 2017)
Insight Commentary (Hauck Moon)
Feeding the Baby at Night
Say NO to Couches Sofas and Cushioned Armchairs
High-Risk Bed Sharing Situations
Bedsharing in Low-Risk Breastfed Infants
Independent Review (Dr Robert Platt)
Bed Sharing
Bed Sharing
Bed Sharing with Overlay
Bed Sharing with Overlay
Bed Sharing with Overlay
Couch Sleeping
Couch Sleeping
Couch Sleeping
Unsafe Bedding NISP Trends 1993-2102
Why Use Soft Bedding
Soft Bedding for Older Infants
To Swaddle or Not to Swaddle That is the Question
Swaddling
SwaddlingmdashIs it Safe
SwaddlingmdashMore Questionshellip
wwwhealthychildrenorg
Pacifiers
Pacifiers and Breastfeeding
Baby Friendly USA Pacifiers
Addressing Sleep Deprivation
Overcoming Barriers to Change What Parents are Sayinghellip
Factors Associated With Choice of Infant Sleep Position
Slide Number 65
What is Working
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Infant Sleep Safety
Safe Sleep Nurse Modeling
Physician Advocacy
Healthcare Provider Advice to New Mothers Safe Sleep
Mason Clinical Peds 713
Bundled Intervention = Behavior Change
Hospital Unsafe Sleep Persists
Washington DC
TodaysBaby QI Safe Sleep Teaching
TodaysBaby QI Safe Sleep Teaching
Social Media and Risk-Reduction Training Study (SMART)
The National Safe Sleep Hospital Certification Program
Coordinated Education Efforts Work
Coordinated Education Efforts Work
And Finallyhellip
Encouraging Parents to Take Action
Motivational Interviewing
Impact of Eliminating Sleep-Related Deaths
Thank You
Contact Information
Slide Number 89
IMR over time Finland vs US
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
TodaysBaby QI Safe Sleep Teaching
QI intervention median = 160 days Mothers reported receiving information 72 to 95
(increase of 24-57) 94 babies observed supine (plus 24) 88 infants in safe sleep environment
o Increase of 33 Gains maintained up to 12 months
Kellams A Parker MG Geller NL et al TodaysBaby quality improvement safe sleep teaching and role modeling in 8 US maternity units Pediatrics 2017140(5)e20171816
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Social Media and Risk-Reduction Training Study (SMART) Cluster randomization 4 groups Safe sleep or breast feeding education Nursing QI and social media (mobile health) N = 1600 1263 responses (79) Safe sleep NQI and MHealth
o Supine sleep 925 o Room-sharing 859o No soft bedding 819o Pacifier use 762
Moon RY Hauck FR Colson ER et al The effect of nursing quality improvement and mobile health interventions on infant sleep practices a randomized clinical trial JAMA 2017318(4)351-359
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Hospital Initiative ComponentswwwcribsforkidsorgHospitalInitiativeToolkit INTRODUCTORY LETTER HOSPITAL INITIATIVE TOOL KIT
INSTRUCTIONS ORGANIZATIONAL CHART HOSPITAL POLICY ACKNOWLEDGMENT FORM (Engl amp
Span) SAFE SLEEP EDUCATIONAL FLIP CHART
NONCOMPLIANCE WAIVER (Engl amp Span)
NURSING EDUCATION MODULE
SAFE SLEEP POSTERS DOOR HANGERS (Engl amp Span) GRADUATION CERTIFICATE SAMPLE LETTER TO HOSPITALS SAMPLE LETTER TO PROVIDERS INFANT SAFE SLEEP BROCHURES
(Engl amp Span) PRESS KIT
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
All materials available on-lineo No major costs to the hospital
Easy on-line access for documentation
NO FEE FOR PARTICIPATION
wwwCribsforKidsorgHospitalInitiative
Tiffany Price (tpricecribsforkidsorg)
The National Safe Sleep Hospital Certification Program
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
TNmdash25 reduction in infant sleep-related deaths in 2 years
SDmdashOver 7915 Pack lsquon Plays distributed since 2012 Infant mortality rate decreased from 86 (2012) to 48 (2016)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
2009 to 2015 38 decrease in infant mortality Decreased from 135 to 84 per 1000 SUID decreased gt50 Decrease in racial disparityhttphealthybabiesbaltimorecomhome
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
And Finallyhellip
Health care providers should have open frank nonjudgmental conversations with families about their sleep practices
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Encouraging Parents to Take Action
According to the Social Learning Theory parents are more likely to recall and comply with instructions when
the health care provider
Uses a positive tone Provides adequate information Allows the parent to ask most of the questions
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Motivational Interviewing
ldquoa collaborative goal-oriented style of communication with particular attention to the language of changerdquo
o Strengthen personal motivation and commitment to a specific goal
o Explore onersquos reasons for change (barriers)o Patient generates own solutions
bull More likely to feel realisticbull Planting seeds of change
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Impact of Eliminating Sleep-Related Deaths
Every week we lose 70 children which is equivalent to 4 kindergarten classrooms
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Thank You
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Contact Information
mgoodsteinwellspanorg
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Visit Pediatric Care Online today for additional information on this and other topics
httppediatriccaresolutionsaaporgPediatric Care Online is a convenient electronic resource for immediate expert help with
virtually every pediatric clinical information need with must-have resources that are included in a comprehensive reference library and time-saving clinical tools
Donrsquot have a subscription to PCOThen take advantage of a free trial today
Call Mead Johnson Nutrition at 888363-2362 orfor more information go to
httppediatriccaresolutionsaaporgSSFree_Trialaspx
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
IMR over time Finland vs US
Slide Number 1
Disclaimer
Objectives for Todayrsquos Talk
Infant Mortality Rates for the Five Leading Causes of Infant Death in the United States 2005 and 2011
US Post-Neonatal Mortality 2015
FACT
What is SUID or SUDI
Some Causes of Deaths that Occur Suddenly and Unexpectedly during Infancy
What is SIDS
SIDS FACTS
SIDS FACTS
Triple Risk Model to Explain SIDS
Paterson DS Krous HF Kinney HC et al JAMA 2006
An Example of SIDS Pathogenesis
2016 AAP Recommendations Infant Sleep Safety
Strength of Recommendation
Recommendations Change as the Evidence Evolves
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
Correct Safe Sleep Environment
We Need to Move Beyond Back to Sleep
Sleep Position for Healthy Newborns
Sleep Position in Newborn Nursery
Sleep Position and Reflux
The Truth About Supine Sleep and Aspiration Ending the Fallacy
Title
Infant Sleep Location
Room-Share How Long Yoursquore Kidding Right
Supporting Data
More Recent Data
Why is Room-Sharing Protective
Room-Sharing and Sleep Quality
Insight Study (Paul 2017)
Insight Study (Paul 2017)
Insight Commentary (Hauck Moon)
Feeding the Baby at Night
Say NO to Couches Sofas and Cushioned Armchairs
High-Risk Bed Sharing Situations
Bedsharing in Low-Risk Breastfed Infants
Independent Review (Dr Robert Platt)
Bed Sharing
Bed Sharing
Bed Sharing with Overlay
Bed Sharing with Overlay
Bed Sharing with Overlay
Couch Sleeping
Couch Sleeping
Couch Sleeping
Unsafe Bedding NISP Trends 1993-2102
Why Use Soft Bedding
Soft Bedding for Older Infants
To Swaddle or Not to Swaddle That is the Question
Swaddling
SwaddlingmdashIs it Safe
SwaddlingmdashMore Questionshellip
wwwhealthychildrenorg
Pacifiers
Pacifiers and Breastfeeding
Baby Friendly USA Pacifiers
Addressing Sleep Deprivation
Overcoming Barriers to Change What Parents are Sayinghellip
Factors Associated With Choice of Infant Sleep Position
Slide Number 65
What is Working
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Infant Sleep Safety
Safe Sleep Nurse Modeling
Physician Advocacy
Healthcare Provider Advice to New Mothers Safe Sleep
Mason Clinical Peds 713
Bundled Intervention = Behavior Change
Hospital Unsafe Sleep Persists
Washington DC
TodaysBaby QI Safe Sleep Teaching
TodaysBaby QI Safe Sleep Teaching
Social Media and Risk-Reduction Training Study (SMART)
The National Safe Sleep Hospital Certification Program
Coordinated Education Efforts Work
Coordinated Education Efforts Work
And Finallyhellip
Encouraging Parents to Take Action
Motivational Interviewing
Impact of Eliminating Sleep-Related Deaths
Thank You
Contact Information
Slide Number 89
IMR over time Finland vs US
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Social Media and Risk-Reduction Training Study (SMART) Cluster randomization 4 groups Safe sleep or breast feeding education Nursing QI and social media (mobile health) N = 1600 1263 responses (79) Safe sleep NQI and MHealth
o Supine sleep 925 o Room-sharing 859o No soft bedding 819o Pacifier use 762
Moon RY Hauck FR Colson ER et al The effect of nursing quality improvement and mobile health interventions on infant sleep practices a randomized clinical trial JAMA 2017318(4)351-359
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Hospital Initiative ComponentswwwcribsforkidsorgHospitalInitiativeToolkit INTRODUCTORY LETTER HOSPITAL INITIATIVE TOOL KIT
INSTRUCTIONS ORGANIZATIONAL CHART HOSPITAL POLICY ACKNOWLEDGMENT FORM (Engl amp
Span) SAFE SLEEP EDUCATIONAL FLIP CHART
NONCOMPLIANCE WAIVER (Engl amp Span)
NURSING EDUCATION MODULE
SAFE SLEEP POSTERS DOOR HANGERS (Engl amp Span) GRADUATION CERTIFICATE SAMPLE LETTER TO HOSPITALS SAMPLE LETTER TO PROVIDERS INFANT SAFE SLEEP BROCHURES
(Engl amp Span) PRESS KIT
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
All materials available on-lineo No major costs to the hospital
Easy on-line access for documentation
NO FEE FOR PARTICIPATION
wwwCribsforKidsorgHospitalInitiative
Tiffany Price (tpricecribsforkidsorg)
The National Safe Sleep Hospital Certification Program
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
TNmdash25 reduction in infant sleep-related deaths in 2 years
SDmdashOver 7915 Pack lsquon Plays distributed since 2012 Infant mortality rate decreased from 86 (2012) to 48 (2016)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
2009 to 2015 38 decrease in infant mortality Decreased from 135 to 84 per 1000 SUID decreased gt50 Decrease in racial disparityhttphealthybabiesbaltimorecomhome
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
And Finallyhellip
Health care providers should have open frank nonjudgmental conversations with families about their sleep practices
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Encouraging Parents to Take Action
According to the Social Learning Theory parents are more likely to recall and comply with instructions when
the health care provider
Uses a positive tone Provides adequate information Allows the parent to ask most of the questions
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Motivational Interviewing
ldquoa collaborative goal-oriented style of communication with particular attention to the language of changerdquo
o Strengthen personal motivation and commitment to a specific goal
o Explore onersquos reasons for change (barriers)o Patient generates own solutions
bull More likely to feel realisticbull Planting seeds of change
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Impact of Eliminating Sleep-Related Deaths
Every week we lose 70 children which is equivalent to 4 kindergarten classrooms
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Thank You
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Contact Information
mgoodsteinwellspanorg
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Visit Pediatric Care Online today for additional information on this and other topics
httppediatriccaresolutionsaaporgPediatric Care Online is a convenient electronic resource for immediate expert help with
virtually every pediatric clinical information need with must-have resources that are included in a comprehensive reference library and time-saving clinical tools
Donrsquot have a subscription to PCOThen take advantage of a free trial today
Call Mead Johnson Nutrition at 888363-2362 orfor more information go to
httppediatriccaresolutionsaaporgSSFree_Trialaspx
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
IMR over time Finland vs US
Slide Number 1
Disclaimer
Objectives for Todayrsquos Talk
Infant Mortality Rates for the Five Leading Causes of Infant Death in the United States 2005 and 2011
US Post-Neonatal Mortality 2015
FACT
What is SUID or SUDI
Some Causes of Deaths that Occur Suddenly and Unexpectedly during Infancy
What is SIDS
SIDS FACTS
SIDS FACTS
Triple Risk Model to Explain SIDS
Paterson DS Krous HF Kinney HC et al JAMA 2006
An Example of SIDS Pathogenesis
2016 AAP Recommendations Infant Sleep Safety
Strength of Recommendation
Recommendations Change as the Evidence Evolves
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
Correct Safe Sleep Environment
We Need to Move Beyond Back to Sleep
Sleep Position for Healthy Newborns
Sleep Position in Newborn Nursery
Sleep Position and Reflux
The Truth About Supine Sleep and Aspiration Ending the Fallacy
Title
Infant Sleep Location
Room-Share How Long Yoursquore Kidding Right
Supporting Data
More Recent Data
Why is Room-Sharing Protective
Room-Sharing and Sleep Quality
Insight Study (Paul 2017)
Insight Study (Paul 2017)
Insight Commentary (Hauck Moon)
Feeding the Baby at Night
Say NO to Couches Sofas and Cushioned Armchairs
High-Risk Bed Sharing Situations
Bedsharing in Low-Risk Breastfed Infants
Independent Review (Dr Robert Platt)
Bed Sharing
Bed Sharing
Bed Sharing with Overlay
Bed Sharing with Overlay
Bed Sharing with Overlay
Couch Sleeping
Couch Sleeping
Couch Sleeping
Unsafe Bedding NISP Trends 1993-2102
Why Use Soft Bedding
Soft Bedding for Older Infants
To Swaddle or Not to Swaddle That is the Question
Swaddling
SwaddlingmdashIs it Safe
SwaddlingmdashMore Questionshellip
wwwhealthychildrenorg
Pacifiers
Pacifiers and Breastfeeding
Baby Friendly USA Pacifiers
Addressing Sleep Deprivation
Overcoming Barriers to Change What Parents are Sayinghellip
Factors Associated With Choice of Infant Sleep Position
Slide Number 65
What is Working
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Infant Sleep Safety
Safe Sleep Nurse Modeling
Physician Advocacy
Healthcare Provider Advice to New Mothers Safe Sleep
Mason Clinical Peds 713
Bundled Intervention = Behavior Change
Hospital Unsafe Sleep Persists
Washington DC
TodaysBaby QI Safe Sleep Teaching
TodaysBaby QI Safe Sleep Teaching
Social Media and Risk-Reduction Training Study (SMART)
The National Safe Sleep Hospital Certification Program
Coordinated Education Efforts Work
Coordinated Education Efforts Work
And Finallyhellip
Encouraging Parents to Take Action
Motivational Interviewing
Impact of Eliminating Sleep-Related Deaths
Thank You
Contact Information
Slide Number 89
IMR over time Finland vs US
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Hospital Initiative ComponentswwwcribsforkidsorgHospitalInitiativeToolkit INTRODUCTORY LETTER HOSPITAL INITIATIVE TOOL KIT
INSTRUCTIONS ORGANIZATIONAL CHART HOSPITAL POLICY ACKNOWLEDGMENT FORM (Engl amp
Span) SAFE SLEEP EDUCATIONAL FLIP CHART
NONCOMPLIANCE WAIVER (Engl amp Span)
NURSING EDUCATION MODULE
SAFE SLEEP POSTERS DOOR HANGERS (Engl amp Span) GRADUATION CERTIFICATE SAMPLE LETTER TO HOSPITALS SAMPLE LETTER TO PROVIDERS INFANT SAFE SLEEP BROCHURES
(Engl amp Span) PRESS KIT
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
All materials available on-lineo No major costs to the hospital
Easy on-line access for documentation
NO FEE FOR PARTICIPATION
wwwCribsforKidsorgHospitalInitiative
Tiffany Price (tpricecribsforkidsorg)
The National Safe Sleep Hospital Certification Program
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
TNmdash25 reduction in infant sleep-related deaths in 2 years
SDmdashOver 7915 Pack lsquon Plays distributed since 2012 Infant mortality rate decreased from 86 (2012) to 48 (2016)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
2009 to 2015 38 decrease in infant mortality Decreased from 135 to 84 per 1000 SUID decreased gt50 Decrease in racial disparityhttphealthybabiesbaltimorecomhome
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
And Finallyhellip
Health care providers should have open frank nonjudgmental conversations with families about their sleep practices
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Encouraging Parents to Take Action
According to the Social Learning Theory parents are more likely to recall and comply with instructions when
the health care provider
Uses a positive tone Provides adequate information Allows the parent to ask most of the questions
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Motivational Interviewing
ldquoa collaborative goal-oriented style of communication with particular attention to the language of changerdquo
o Strengthen personal motivation and commitment to a specific goal
o Explore onersquos reasons for change (barriers)o Patient generates own solutions
bull More likely to feel realisticbull Planting seeds of change
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Impact of Eliminating Sleep-Related Deaths
Every week we lose 70 children which is equivalent to 4 kindergarten classrooms
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Thank You
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Contact Information
mgoodsteinwellspanorg
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Visit Pediatric Care Online today for additional information on this and other topics
httppediatriccaresolutionsaaporgPediatric Care Online is a convenient electronic resource for immediate expert help with
virtually every pediatric clinical information need with must-have resources that are included in a comprehensive reference library and time-saving clinical tools
Donrsquot have a subscription to PCOThen take advantage of a free trial today
Call Mead Johnson Nutrition at 888363-2362 orfor more information go to
httppediatriccaresolutionsaaporgSSFree_Trialaspx
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
IMR over time Finland vs US
Slide Number 1
Disclaimer
Objectives for Todayrsquos Talk
Infant Mortality Rates for the Five Leading Causes of Infant Death in the United States 2005 and 2011
US Post-Neonatal Mortality 2015
FACT
What is SUID or SUDI
Some Causes of Deaths that Occur Suddenly and Unexpectedly during Infancy
What is SIDS
SIDS FACTS
SIDS FACTS
Triple Risk Model to Explain SIDS
Paterson DS Krous HF Kinney HC et al JAMA 2006
An Example of SIDS Pathogenesis
2016 AAP Recommendations Infant Sleep Safety
Strength of Recommendation
Recommendations Change as the Evidence Evolves
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
Correct Safe Sleep Environment
We Need to Move Beyond Back to Sleep
Sleep Position for Healthy Newborns
Sleep Position in Newborn Nursery
Sleep Position and Reflux
The Truth About Supine Sleep and Aspiration Ending the Fallacy
Title
Infant Sleep Location
Room-Share How Long Yoursquore Kidding Right
Supporting Data
More Recent Data
Why is Room-Sharing Protective
Room-Sharing and Sleep Quality
Insight Study (Paul 2017)
Insight Study (Paul 2017)
Insight Commentary (Hauck Moon)
Feeding the Baby at Night
Say NO to Couches Sofas and Cushioned Armchairs
High-Risk Bed Sharing Situations
Bedsharing in Low-Risk Breastfed Infants
Independent Review (Dr Robert Platt)
Bed Sharing
Bed Sharing
Bed Sharing with Overlay
Bed Sharing with Overlay
Bed Sharing with Overlay
Couch Sleeping
Couch Sleeping
Couch Sleeping
Unsafe Bedding NISP Trends 1993-2102
Why Use Soft Bedding
Soft Bedding for Older Infants
To Swaddle or Not to Swaddle That is the Question
Swaddling
SwaddlingmdashIs it Safe
SwaddlingmdashMore Questionshellip
wwwhealthychildrenorg
Pacifiers
Pacifiers and Breastfeeding
Baby Friendly USA Pacifiers
Addressing Sleep Deprivation
Overcoming Barriers to Change What Parents are Sayinghellip
Factors Associated With Choice of Infant Sleep Position
Slide Number 65
What is Working
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Infant Sleep Safety
Safe Sleep Nurse Modeling
Physician Advocacy
Healthcare Provider Advice to New Mothers Safe Sleep
Mason Clinical Peds 713
Bundled Intervention = Behavior Change
Hospital Unsafe Sleep Persists
Washington DC
TodaysBaby QI Safe Sleep Teaching
TodaysBaby QI Safe Sleep Teaching
Social Media and Risk-Reduction Training Study (SMART)
The National Safe Sleep Hospital Certification Program
Coordinated Education Efforts Work
Coordinated Education Efforts Work
And Finallyhellip
Encouraging Parents to Take Action
Motivational Interviewing
Impact of Eliminating Sleep-Related Deaths
Thank You
Contact Information
Slide Number 89
IMR over time Finland vs US
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
All materials available on-lineo No major costs to the hospital
Easy on-line access for documentation
NO FEE FOR PARTICIPATION
wwwCribsforKidsorgHospitalInitiative
Tiffany Price (tpricecribsforkidsorg)
The National Safe Sleep Hospital Certification Program
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
TNmdash25 reduction in infant sleep-related deaths in 2 years
SDmdashOver 7915 Pack lsquon Plays distributed since 2012 Infant mortality rate decreased from 86 (2012) to 48 (2016)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
2009 to 2015 38 decrease in infant mortality Decreased from 135 to 84 per 1000 SUID decreased gt50 Decrease in racial disparityhttphealthybabiesbaltimorecomhome
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
And Finallyhellip
Health care providers should have open frank nonjudgmental conversations with families about their sleep practices
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Encouraging Parents to Take Action
According to the Social Learning Theory parents are more likely to recall and comply with instructions when
the health care provider
Uses a positive tone Provides adequate information Allows the parent to ask most of the questions
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Motivational Interviewing
ldquoa collaborative goal-oriented style of communication with particular attention to the language of changerdquo
o Strengthen personal motivation and commitment to a specific goal
o Explore onersquos reasons for change (barriers)o Patient generates own solutions
bull More likely to feel realisticbull Planting seeds of change
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Impact of Eliminating Sleep-Related Deaths
Every week we lose 70 children which is equivalent to 4 kindergarten classrooms
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Thank You
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Contact Information
mgoodsteinwellspanorg
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Visit Pediatric Care Online today for additional information on this and other topics
httppediatriccaresolutionsaaporgPediatric Care Online is a convenient electronic resource for immediate expert help with
virtually every pediatric clinical information need with must-have resources that are included in a comprehensive reference library and time-saving clinical tools
Donrsquot have a subscription to PCOThen take advantage of a free trial today
Call Mead Johnson Nutrition at 888363-2362 orfor more information go to
httppediatriccaresolutionsaaporgSSFree_Trialaspx
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
IMR over time Finland vs US
Slide Number 1
Disclaimer
Objectives for Todayrsquos Talk
Infant Mortality Rates for the Five Leading Causes of Infant Death in the United States 2005 and 2011
US Post-Neonatal Mortality 2015
FACT
What is SUID or SUDI
Some Causes of Deaths that Occur Suddenly and Unexpectedly during Infancy
What is SIDS
SIDS FACTS
SIDS FACTS
Triple Risk Model to Explain SIDS
Paterson DS Krous HF Kinney HC et al JAMA 2006
An Example of SIDS Pathogenesis
2016 AAP Recommendations Infant Sleep Safety
Strength of Recommendation
Recommendations Change as the Evidence Evolves
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
Correct Safe Sleep Environment
We Need to Move Beyond Back to Sleep
Sleep Position for Healthy Newborns
Sleep Position in Newborn Nursery
Sleep Position and Reflux
The Truth About Supine Sleep and Aspiration Ending the Fallacy
Title
Infant Sleep Location
Room-Share How Long Yoursquore Kidding Right
Supporting Data
More Recent Data
Why is Room-Sharing Protective
Room-Sharing and Sleep Quality
Insight Study (Paul 2017)
Insight Study (Paul 2017)
Insight Commentary (Hauck Moon)
Feeding the Baby at Night
Say NO to Couches Sofas and Cushioned Armchairs
High-Risk Bed Sharing Situations
Bedsharing in Low-Risk Breastfed Infants
Independent Review (Dr Robert Platt)
Bed Sharing
Bed Sharing
Bed Sharing with Overlay
Bed Sharing with Overlay
Bed Sharing with Overlay
Couch Sleeping
Couch Sleeping
Couch Sleeping
Unsafe Bedding NISP Trends 1993-2102
Why Use Soft Bedding
Soft Bedding for Older Infants
To Swaddle or Not to Swaddle That is the Question
Swaddling
SwaddlingmdashIs it Safe
SwaddlingmdashMore Questionshellip
wwwhealthychildrenorg
Pacifiers
Pacifiers and Breastfeeding
Baby Friendly USA Pacifiers
Addressing Sleep Deprivation
Overcoming Barriers to Change What Parents are Sayinghellip
Factors Associated With Choice of Infant Sleep Position
Slide Number 65
What is Working
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Infant Sleep Safety
Safe Sleep Nurse Modeling
Physician Advocacy
Healthcare Provider Advice to New Mothers Safe Sleep
Mason Clinical Peds 713
Bundled Intervention = Behavior Change
Hospital Unsafe Sleep Persists
Washington DC
TodaysBaby QI Safe Sleep Teaching
TodaysBaby QI Safe Sleep Teaching
Social Media and Risk-Reduction Training Study (SMART)
The National Safe Sleep Hospital Certification Program
Coordinated Education Efforts Work
Coordinated Education Efforts Work
And Finallyhellip
Encouraging Parents to Take Action
Motivational Interviewing
Impact of Eliminating Sleep-Related Deaths
Thank You
Contact Information
Slide Number 89
IMR over time Finland vs US
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
TNmdash25 reduction in infant sleep-related deaths in 2 years
SDmdashOver 7915 Pack lsquon Plays distributed since 2012 Infant mortality rate decreased from 86 (2012) to 48 (2016)
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
2009 to 2015 38 decrease in infant mortality Decreased from 135 to 84 per 1000 SUID decreased gt50 Decrease in racial disparityhttphealthybabiesbaltimorecomhome
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
And Finallyhellip
Health care providers should have open frank nonjudgmental conversations with families about their sleep practices
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Encouraging Parents to Take Action
According to the Social Learning Theory parents are more likely to recall and comply with instructions when
the health care provider
Uses a positive tone Provides adequate information Allows the parent to ask most of the questions
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Motivational Interviewing
ldquoa collaborative goal-oriented style of communication with particular attention to the language of changerdquo
o Strengthen personal motivation and commitment to a specific goal
o Explore onersquos reasons for change (barriers)o Patient generates own solutions
bull More likely to feel realisticbull Planting seeds of change
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Impact of Eliminating Sleep-Related Deaths
Every week we lose 70 children which is equivalent to 4 kindergarten classrooms
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Thank You
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Contact Information
mgoodsteinwellspanorg
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Visit Pediatric Care Online today for additional information on this and other topics
httppediatriccaresolutionsaaporgPediatric Care Online is a convenient electronic resource for immediate expert help with
virtually every pediatric clinical information need with must-have resources that are included in a comprehensive reference library and time-saving clinical tools
Donrsquot have a subscription to PCOThen take advantage of a free trial today
Call Mead Johnson Nutrition at 888363-2362 orfor more information go to
httppediatriccaresolutionsaaporgSSFree_Trialaspx
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
IMR over time Finland vs US
Slide Number 1
Disclaimer
Objectives for Todayrsquos Talk
Infant Mortality Rates for the Five Leading Causes of Infant Death in the United States 2005 and 2011
US Post-Neonatal Mortality 2015
FACT
What is SUID or SUDI
Some Causes of Deaths that Occur Suddenly and Unexpectedly during Infancy
What is SIDS
SIDS FACTS
SIDS FACTS
Triple Risk Model to Explain SIDS
Paterson DS Krous HF Kinney HC et al JAMA 2006
An Example of SIDS Pathogenesis
2016 AAP Recommendations Infant Sleep Safety
Strength of Recommendation
Recommendations Change as the Evidence Evolves
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
Correct Safe Sleep Environment
We Need to Move Beyond Back to Sleep
Sleep Position for Healthy Newborns
Sleep Position in Newborn Nursery
Sleep Position and Reflux
The Truth About Supine Sleep and Aspiration Ending the Fallacy
Title
Infant Sleep Location
Room-Share How Long Yoursquore Kidding Right
Supporting Data
More Recent Data
Why is Room-Sharing Protective
Room-Sharing and Sleep Quality
Insight Study (Paul 2017)
Insight Study (Paul 2017)
Insight Commentary (Hauck Moon)
Feeding the Baby at Night
Say NO to Couches Sofas and Cushioned Armchairs
High-Risk Bed Sharing Situations
Bedsharing in Low-Risk Breastfed Infants
Independent Review (Dr Robert Platt)
Bed Sharing
Bed Sharing
Bed Sharing with Overlay
Bed Sharing with Overlay
Bed Sharing with Overlay
Couch Sleeping
Couch Sleeping
Couch Sleeping
Unsafe Bedding NISP Trends 1993-2102
Why Use Soft Bedding
Soft Bedding for Older Infants
To Swaddle or Not to Swaddle That is the Question
Swaddling
SwaddlingmdashIs it Safe
SwaddlingmdashMore Questionshellip
wwwhealthychildrenorg
Pacifiers
Pacifiers and Breastfeeding
Baby Friendly USA Pacifiers
Addressing Sleep Deprivation
Overcoming Barriers to Change What Parents are Sayinghellip
Factors Associated With Choice of Infant Sleep Position
Slide Number 65
What is Working
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Infant Sleep Safety
Safe Sleep Nurse Modeling
Physician Advocacy
Healthcare Provider Advice to New Mothers Safe Sleep
Mason Clinical Peds 713
Bundled Intervention = Behavior Change
Hospital Unsafe Sleep Persists
Washington DC
TodaysBaby QI Safe Sleep Teaching
TodaysBaby QI Safe Sleep Teaching
Social Media and Risk-Reduction Training Study (SMART)
The National Safe Sleep Hospital Certification Program
Coordinated Education Efforts Work
Coordinated Education Efforts Work
And Finallyhellip
Encouraging Parents to Take Action
Motivational Interviewing
Impact of Eliminating Sleep-Related Deaths
Thank You
Contact Information
Slide Number 89
IMR over time Finland vs US
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Coordinated Education Efforts Work
2009 to 2015 38 decrease in infant mortality Decreased from 135 to 84 per 1000 SUID decreased gt50 Decrease in racial disparityhttphealthybabiesbaltimorecomhome
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
And Finallyhellip
Health care providers should have open frank nonjudgmental conversations with families about their sleep practices
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Encouraging Parents to Take Action
According to the Social Learning Theory parents are more likely to recall and comply with instructions when
the health care provider
Uses a positive tone Provides adequate information Allows the parent to ask most of the questions
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Motivational Interviewing
ldquoa collaborative goal-oriented style of communication with particular attention to the language of changerdquo
o Strengthen personal motivation and commitment to a specific goal
o Explore onersquos reasons for change (barriers)o Patient generates own solutions
bull More likely to feel realisticbull Planting seeds of change
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Impact of Eliminating Sleep-Related Deaths
Every week we lose 70 children which is equivalent to 4 kindergarten classrooms
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Thank You
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Contact Information
mgoodsteinwellspanorg
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Visit Pediatric Care Online today for additional information on this and other topics
httppediatriccaresolutionsaaporgPediatric Care Online is a convenient electronic resource for immediate expert help with
virtually every pediatric clinical information need with must-have resources that are included in a comprehensive reference library and time-saving clinical tools
Donrsquot have a subscription to PCOThen take advantage of a free trial today
Call Mead Johnson Nutrition at 888363-2362 orfor more information go to
httppediatriccaresolutionsaaporgSSFree_Trialaspx
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
IMR over time Finland vs US
Slide Number 1
Disclaimer
Objectives for Todayrsquos Talk
Infant Mortality Rates for the Five Leading Causes of Infant Death in the United States 2005 and 2011
US Post-Neonatal Mortality 2015
FACT
What is SUID or SUDI
Some Causes of Deaths that Occur Suddenly and Unexpectedly during Infancy
What is SIDS
SIDS FACTS
SIDS FACTS
Triple Risk Model to Explain SIDS
Paterson DS Krous HF Kinney HC et al JAMA 2006
An Example of SIDS Pathogenesis
2016 AAP Recommendations Infant Sleep Safety
Strength of Recommendation
Recommendations Change as the Evidence Evolves
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
Correct Safe Sleep Environment
We Need to Move Beyond Back to Sleep
Sleep Position for Healthy Newborns
Sleep Position in Newborn Nursery
Sleep Position and Reflux
The Truth About Supine Sleep and Aspiration Ending the Fallacy
Title
Infant Sleep Location
Room-Share How Long Yoursquore Kidding Right
Supporting Data
More Recent Data
Why is Room-Sharing Protective
Room-Sharing and Sleep Quality
Insight Study (Paul 2017)
Insight Study (Paul 2017)
Insight Commentary (Hauck Moon)
Feeding the Baby at Night
Say NO to Couches Sofas and Cushioned Armchairs
High-Risk Bed Sharing Situations
Bedsharing in Low-Risk Breastfed Infants
Independent Review (Dr Robert Platt)
Bed Sharing
Bed Sharing
Bed Sharing with Overlay
Bed Sharing with Overlay
Bed Sharing with Overlay
Couch Sleeping
Couch Sleeping
Couch Sleeping
Unsafe Bedding NISP Trends 1993-2102
Why Use Soft Bedding
Soft Bedding for Older Infants
To Swaddle or Not to Swaddle That is the Question
Swaddling
SwaddlingmdashIs it Safe
SwaddlingmdashMore Questionshellip
wwwhealthychildrenorg
Pacifiers
Pacifiers and Breastfeeding
Baby Friendly USA Pacifiers
Addressing Sleep Deprivation
Overcoming Barriers to Change What Parents are Sayinghellip
Factors Associated With Choice of Infant Sleep Position
Slide Number 65
What is Working
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Infant Sleep Safety
Safe Sleep Nurse Modeling
Physician Advocacy
Healthcare Provider Advice to New Mothers Safe Sleep
Mason Clinical Peds 713
Bundled Intervention = Behavior Change
Hospital Unsafe Sleep Persists
Washington DC
TodaysBaby QI Safe Sleep Teaching
TodaysBaby QI Safe Sleep Teaching
Social Media and Risk-Reduction Training Study (SMART)
The National Safe Sleep Hospital Certification Program
Coordinated Education Efforts Work
Coordinated Education Efforts Work
And Finallyhellip
Encouraging Parents to Take Action
Motivational Interviewing
Impact of Eliminating Sleep-Related Deaths
Thank You
Contact Information
Slide Number 89
IMR over time Finland vs US
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
And Finallyhellip
Health care providers should have open frank nonjudgmental conversations with families about their sleep practices
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Encouraging Parents to Take Action
According to the Social Learning Theory parents are more likely to recall and comply with instructions when
the health care provider
Uses a positive tone Provides adequate information Allows the parent to ask most of the questions
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Motivational Interviewing
ldquoa collaborative goal-oriented style of communication with particular attention to the language of changerdquo
o Strengthen personal motivation and commitment to a specific goal
o Explore onersquos reasons for change (barriers)o Patient generates own solutions
bull More likely to feel realisticbull Planting seeds of change
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Impact of Eliminating Sleep-Related Deaths
Every week we lose 70 children which is equivalent to 4 kindergarten classrooms
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Thank You
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Contact Information
mgoodsteinwellspanorg
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Visit Pediatric Care Online today for additional information on this and other topics
httppediatriccaresolutionsaaporgPediatric Care Online is a convenient electronic resource for immediate expert help with
virtually every pediatric clinical information need with must-have resources that are included in a comprehensive reference library and time-saving clinical tools
Donrsquot have a subscription to PCOThen take advantage of a free trial today
Call Mead Johnson Nutrition at 888363-2362 orfor more information go to
httppediatriccaresolutionsaaporgSSFree_Trialaspx
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
IMR over time Finland vs US
Slide Number 1
Disclaimer
Objectives for Todayrsquos Talk
Infant Mortality Rates for the Five Leading Causes of Infant Death in the United States 2005 and 2011
US Post-Neonatal Mortality 2015
FACT
What is SUID or SUDI
Some Causes of Deaths that Occur Suddenly and Unexpectedly during Infancy
What is SIDS
SIDS FACTS
SIDS FACTS
Triple Risk Model to Explain SIDS
Paterson DS Krous HF Kinney HC et al JAMA 2006
An Example of SIDS Pathogenesis
2016 AAP Recommendations Infant Sleep Safety
Strength of Recommendation
Recommendations Change as the Evidence Evolves
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
Correct Safe Sleep Environment
We Need to Move Beyond Back to Sleep
Sleep Position for Healthy Newborns
Sleep Position in Newborn Nursery
Sleep Position and Reflux
The Truth About Supine Sleep and Aspiration Ending the Fallacy
Title
Infant Sleep Location
Room-Share How Long Yoursquore Kidding Right
Supporting Data
More Recent Data
Why is Room-Sharing Protective
Room-Sharing and Sleep Quality
Insight Study (Paul 2017)
Insight Study (Paul 2017)
Insight Commentary (Hauck Moon)
Feeding the Baby at Night
Say NO to Couches Sofas and Cushioned Armchairs
High-Risk Bed Sharing Situations
Bedsharing in Low-Risk Breastfed Infants
Independent Review (Dr Robert Platt)
Bed Sharing
Bed Sharing
Bed Sharing with Overlay
Bed Sharing with Overlay
Bed Sharing with Overlay
Couch Sleeping
Couch Sleeping
Couch Sleeping
Unsafe Bedding NISP Trends 1993-2102
Why Use Soft Bedding
Soft Bedding for Older Infants
To Swaddle or Not to Swaddle That is the Question
Swaddling
SwaddlingmdashIs it Safe
SwaddlingmdashMore Questionshellip
wwwhealthychildrenorg
Pacifiers
Pacifiers and Breastfeeding
Baby Friendly USA Pacifiers
Addressing Sleep Deprivation
Overcoming Barriers to Change What Parents are Sayinghellip
Factors Associated With Choice of Infant Sleep Position
Slide Number 65
What is Working
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Infant Sleep Safety
Safe Sleep Nurse Modeling
Physician Advocacy
Healthcare Provider Advice to New Mothers Safe Sleep
Mason Clinical Peds 713
Bundled Intervention = Behavior Change
Hospital Unsafe Sleep Persists
Washington DC
TodaysBaby QI Safe Sleep Teaching
TodaysBaby QI Safe Sleep Teaching
Social Media and Risk-Reduction Training Study (SMART)
The National Safe Sleep Hospital Certification Program
Coordinated Education Efforts Work
Coordinated Education Efforts Work
And Finallyhellip
Encouraging Parents to Take Action
Motivational Interviewing
Impact of Eliminating Sleep-Related Deaths
Thank You
Contact Information
Slide Number 89
IMR over time Finland vs US
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Encouraging Parents to Take Action
According to the Social Learning Theory parents are more likely to recall and comply with instructions when
the health care provider
Uses a positive tone Provides adequate information Allows the parent to ask most of the questions
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Motivational Interviewing
ldquoa collaborative goal-oriented style of communication with particular attention to the language of changerdquo
o Strengthen personal motivation and commitment to a specific goal
o Explore onersquos reasons for change (barriers)o Patient generates own solutions
bull More likely to feel realisticbull Planting seeds of change
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Impact of Eliminating Sleep-Related Deaths
Every week we lose 70 children which is equivalent to 4 kindergarten classrooms
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Thank You
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Contact Information
mgoodsteinwellspanorg
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Visit Pediatric Care Online today for additional information on this and other topics
httppediatriccaresolutionsaaporgPediatric Care Online is a convenient electronic resource for immediate expert help with
virtually every pediatric clinical information need with must-have resources that are included in a comprehensive reference library and time-saving clinical tools
Donrsquot have a subscription to PCOThen take advantage of a free trial today
Call Mead Johnson Nutrition at 888363-2362 orfor more information go to
httppediatriccaresolutionsaaporgSSFree_Trialaspx
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
IMR over time Finland vs US
Slide Number 1
Disclaimer
Objectives for Todayrsquos Talk
Infant Mortality Rates for the Five Leading Causes of Infant Death in the United States 2005 and 2011
US Post-Neonatal Mortality 2015
FACT
What is SUID or SUDI
Some Causes of Deaths that Occur Suddenly and Unexpectedly during Infancy
What is SIDS
SIDS FACTS
SIDS FACTS
Triple Risk Model to Explain SIDS
Paterson DS Krous HF Kinney HC et al JAMA 2006
An Example of SIDS Pathogenesis
2016 AAP Recommendations Infant Sleep Safety
Strength of Recommendation
Recommendations Change as the Evidence Evolves
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
Correct Safe Sleep Environment
We Need to Move Beyond Back to Sleep
Sleep Position for Healthy Newborns
Sleep Position in Newborn Nursery
Sleep Position and Reflux
The Truth About Supine Sleep and Aspiration Ending the Fallacy
Title
Infant Sleep Location
Room-Share How Long Yoursquore Kidding Right
Supporting Data
More Recent Data
Why is Room-Sharing Protective
Room-Sharing and Sleep Quality
Insight Study (Paul 2017)
Insight Study (Paul 2017)
Insight Commentary (Hauck Moon)
Feeding the Baby at Night
Say NO to Couches Sofas and Cushioned Armchairs
High-Risk Bed Sharing Situations
Bedsharing in Low-Risk Breastfed Infants
Independent Review (Dr Robert Platt)
Bed Sharing
Bed Sharing
Bed Sharing with Overlay
Bed Sharing with Overlay
Bed Sharing with Overlay
Couch Sleeping
Couch Sleeping
Couch Sleeping
Unsafe Bedding NISP Trends 1993-2102
Why Use Soft Bedding
Soft Bedding for Older Infants
To Swaddle or Not to Swaddle That is the Question
Swaddling
SwaddlingmdashIs it Safe
SwaddlingmdashMore Questionshellip
wwwhealthychildrenorg
Pacifiers
Pacifiers and Breastfeeding
Baby Friendly USA Pacifiers
Addressing Sleep Deprivation
Overcoming Barriers to Change What Parents are Sayinghellip
Factors Associated With Choice of Infant Sleep Position
Slide Number 65
What is Working
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Infant Sleep Safety
Safe Sleep Nurse Modeling
Physician Advocacy
Healthcare Provider Advice to New Mothers Safe Sleep
Mason Clinical Peds 713
Bundled Intervention = Behavior Change
Hospital Unsafe Sleep Persists
Washington DC
TodaysBaby QI Safe Sleep Teaching
TodaysBaby QI Safe Sleep Teaching
Social Media and Risk-Reduction Training Study (SMART)
The National Safe Sleep Hospital Certification Program
Coordinated Education Efforts Work
Coordinated Education Efforts Work
And Finallyhellip
Encouraging Parents to Take Action
Motivational Interviewing
Impact of Eliminating Sleep-Related Deaths
Thank You
Contact Information
Slide Number 89
IMR over time Finland vs US
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Motivational Interviewing
ldquoa collaborative goal-oriented style of communication with particular attention to the language of changerdquo
o Strengthen personal motivation and commitment to a specific goal
o Explore onersquos reasons for change (barriers)o Patient generates own solutions
bull More likely to feel realisticbull Planting seeds of change
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Impact of Eliminating Sleep-Related Deaths
Every week we lose 70 children which is equivalent to 4 kindergarten classrooms
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Thank You
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Contact Information
mgoodsteinwellspanorg
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Visit Pediatric Care Online today for additional information on this and other topics
httppediatriccaresolutionsaaporgPediatric Care Online is a convenient electronic resource for immediate expert help with
virtually every pediatric clinical information need with must-have resources that are included in a comprehensive reference library and time-saving clinical tools
Donrsquot have a subscription to PCOThen take advantage of a free trial today
Call Mead Johnson Nutrition at 888363-2362 orfor more information go to
httppediatriccaresolutionsaaporgSSFree_Trialaspx
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
IMR over time Finland vs US
Slide Number 1
Disclaimer
Objectives for Todayrsquos Talk
Infant Mortality Rates for the Five Leading Causes of Infant Death in the United States 2005 and 2011
US Post-Neonatal Mortality 2015
FACT
What is SUID or SUDI
Some Causes of Deaths that Occur Suddenly and Unexpectedly during Infancy
What is SIDS
SIDS FACTS
SIDS FACTS
Triple Risk Model to Explain SIDS
Paterson DS Krous HF Kinney HC et al JAMA 2006
An Example of SIDS Pathogenesis
2016 AAP Recommendations Infant Sleep Safety
Strength of Recommendation
Recommendations Change as the Evidence Evolves
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
Correct Safe Sleep Environment
We Need to Move Beyond Back to Sleep
Sleep Position for Healthy Newborns
Sleep Position in Newborn Nursery
Sleep Position and Reflux
The Truth About Supine Sleep and Aspiration Ending the Fallacy
Title
Infant Sleep Location
Room-Share How Long Yoursquore Kidding Right
Supporting Data
More Recent Data
Why is Room-Sharing Protective
Room-Sharing and Sleep Quality
Insight Study (Paul 2017)
Insight Study (Paul 2017)
Insight Commentary (Hauck Moon)
Feeding the Baby at Night
Say NO to Couches Sofas and Cushioned Armchairs
High-Risk Bed Sharing Situations
Bedsharing in Low-Risk Breastfed Infants
Independent Review (Dr Robert Platt)
Bed Sharing
Bed Sharing
Bed Sharing with Overlay
Bed Sharing with Overlay
Bed Sharing with Overlay
Couch Sleeping
Couch Sleeping
Couch Sleeping
Unsafe Bedding NISP Trends 1993-2102
Why Use Soft Bedding
Soft Bedding for Older Infants
To Swaddle or Not to Swaddle That is the Question
Swaddling
SwaddlingmdashIs it Safe
SwaddlingmdashMore Questionshellip
wwwhealthychildrenorg
Pacifiers
Pacifiers and Breastfeeding
Baby Friendly USA Pacifiers
Addressing Sleep Deprivation
Overcoming Barriers to Change What Parents are Sayinghellip
Factors Associated With Choice of Infant Sleep Position
Slide Number 65
What is Working
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Infant Sleep Safety
Safe Sleep Nurse Modeling
Physician Advocacy
Healthcare Provider Advice to New Mothers Safe Sleep
Mason Clinical Peds 713
Bundled Intervention = Behavior Change
Hospital Unsafe Sleep Persists
Washington DC
TodaysBaby QI Safe Sleep Teaching
TodaysBaby QI Safe Sleep Teaching
Social Media and Risk-Reduction Training Study (SMART)
The National Safe Sleep Hospital Certification Program
Coordinated Education Efforts Work
Coordinated Education Efforts Work
And Finallyhellip
Encouraging Parents to Take Action
Motivational Interviewing
Impact of Eliminating Sleep-Related Deaths
Thank You
Contact Information
Slide Number 89
IMR over time Finland vs US
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Impact of Eliminating Sleep-Related Deaths
Every week we lose 70 children which is equivalent to 4 kindergarten classrooms
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Thank You
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Contact Information
mgoodsteinwellspanorg
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Visit Pediatric Care Online today for additional information on this and other topics
httppediatriccaresolutionsaaporgPediatric Care Online is a convenient electronic resource for immediate expert help with
virtually every pediatric clinical information need with must-have resources that are included in a comprehensive reference library and time-saving clinical tools
Donrsquot have a subscription to PCOThen take advantage of a free trial today
Call Mead Johnson Nutrition at 888363-2362 orfor more information go to
httppediatriccaresolutionsaaporgSSFree_Trialaspx
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
IMR over time Finland vs US
Slide Number 1
Disclaimer
Objectives for Todayrsquos Talk
Infant Mortality Rates for the Five Leading Causes of Infant Death in the United States 2005 and 2011
US Post-Neonatal Mortality 2015
FACT
What is SUID or SUDI
Some Causes of Deaths that Occur Suddenly and Unexpectedly during Infancy
What is SIDS
SIDS FACTS
SIDS FACTS
Triple Risk Model to Explain SIDS
Paterson DS Krous HF Kinney HC et al JAMA 2006
An Example of SIDS Pathogenesis
2016 AAP Recommendations Infant Sleep Safety
Strength of Recommendation
Recommendations Change as the Evidence Evolves
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
Correct Safe Sleep Environment
We Need to Move Beyond Back to Sleep
Sleep Position for Healthy Newborns
Sleep Position in Newborn Nursery
Sleep Position and Reflux
The Truth About Supine Sleep and Aspiration Ending the Fallacy
Title
Infant Sleep Location
Room-Share How Long Yoursquore Kidding Right
Supporting Data
More Recent Data
Why is Room-Sharing Protective
Room-Sharing and Sleep Quality
Insight Study (Paul 2017)
Insight Study (Paul 2017)
Insight Commentary (Hauck Moon)
Feeding the Baby at Night
Say NO to Couches Sofas and Cushioned Armchairs
High-Risk Bed Sharing Situations
Bedsharing in Low-Risk Breastfed Infants
Independent Review (Dr Robert Platt)
Bed Sharing
Bed Sharing
Bed Sharing with Overlay
Bed Sharing with Overlay
Bed Sharing with Overlay
Couch Sleeping
Couch Sleeping
Couch Sleeping
Unsafe Bedding NISP Trends 1993-2102
Why Use Soft Bedding
Soft Bedding for Older Infants
To Swaddle or Not to Swaddle That is the Question
Swaddling
SwaddlingmdashIs it Safe
SwaddlingmdashMore Questionshellip
wwwhealthychildrenorg
Pacifiers
Pacifiers and Breastfeeding
Baby Friendly USA Pacifiers
Addressing Sleep Deprivation
Overcoming Barriers to Change What Parents are Sayinghellip
Factors Associated With Choice of Infant Sleep Position
Slide Number 65
What is Working
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Infant Sleep Safety
Safe Sleep Nurse Modeling
Physician Advocacy
Healthcare Provider Advice to New Mothers Safe Sleep
Mason Clinical Peds 713
Bundled Intervention = Behavior Change
Hospital Unsafe Sleep Persists
Washington DC
TodaysBaby QI Safe Sleep Teaching
TodaysBaby QI Safe Sleep Teaching
Social Media and Risk-Reduction Training Study (SMART)
The National Safe Sleep Hospital Certification Program
Coordinated Education Efforts Work
Coordinated Education Efforts Work
And Finallyhellip
Encouraging Parents to Take Action
Motivational Interviewing
Impact of Eliminating Sleep-Related Deaths
Thank You
Contact Information
Slide Number 89
IMR over time Finland vs US
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Thank You
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Contact Information
mgoodsteinwellspanorg
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Visit Pediatric Care Online today for additional information on this and other topics
httppediatriccaresolutionsaaporgPediatric Care Online is a convenient electronic resource for immediate expert help with
virtually every pediatric clinical information need with must-have resources that are included in a comprehensive reference library and time-saving clinical tools
Donrsquot have a subscription to PCOThen take advantage of a free trial today
Call Mead Johnson Nutrition at 888363-2362 orfor more information go to
httppediatriccaresolutionsaaporgSSFree_Trialaspx
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
IMR over time Finland vs US
Slide Number 1
Disclaimer
Objectives for Todayrsquos Talk
Infant Mortality Rates for the Five Leading Causes of Infant Death in the United States 2005 and 2011
US Post-Neonatal Mortality 2015
FACT
What is SUID or SUDI
Some Causes of Deaths that Occur Suddenly and Unexpectedly during Infancy
What is SIDS
SIDS FACTS
SIDS FACTS
Triple Risk Model to Explain SIDS
Paterson DS Krous HF Kinney HC et al JAMA 2006
An Example of SIDS Pathogenesis
2016 AAP Recommendations Infant Sleep Safety
Strength of Recommendation
Recommendations Change as the Evidence Evolves
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
Correct Safe Sleep Environment
We Need to Move Beyond Back to Sleep
Sleep Position for Healthy Newborns
Sleep Position in Newborn Nursery
Sleep Position and Reflux
The Truth About Supine Sleep and Aspiration Ending the Fallacy
Title
Infant Sleep Location
Room-Share How Long Yoursquore Kidding Right
Supporting Data
More Recent Data
Why is Room-Sharing Protective
Room-Sharing and Sleep Quality
Insight Study (Paul 2017)
Insight Study (Paul 2017)
Insight Commentary (Hauck Moon)
Feeding the Baby at Night
Say NO to Couches Sofas and Cushioned Armchairs
High-Risk Bed Sharing Situations
Bedsharing in Low-Risk Breastfed Infants
Independent Review (Dr Robert Platt)
Bed Sharing
Bed Sharing
Bed Sharing with Overlay
Bed Sharing with Overlay
Bed Sharing with Overlay
Couch Sleeping
Couch Sleeping
Couch Sleeping
Unsafe Bedding NISP Trends 1993-2102
Why Use Soft Bedding
Soft Bedding for Older Infants
To Swaddle or Not to Swaddle That is the Question
Swaddling
SwaddlingmdashIs it Safe
SwaddlingmdashMore Questionshellip
wwwhealthychildrenorg
Pacifiers
Pacifiers and Breastfeeding
Baby Friendly USA Pacifiers
Addressing Sleep Deprivation
Overcoming Barriers to Change What Parents are Sayinghellip
Factors Associated With Choice of Infant Sleep Position
Slide Number 65
What is Working
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Infant Sleep Safety
Safe Sleep Nurse Modeling
Physician Advocacy
Healthcare Provider Advice to New Mothers Safe Sleep
Mason Clinical Peds 713
Bundled Intervention = Behavior Change
Hospital Unsafe Sleep Persists
Washington DC
TodaysBaby QI Safe Sleep Teaching
TodaysBaby QI Safe Sleep Teaching
Social Media and Risk-Reduction Training Study (SMART)
The National Safe Sleep Hospital Certification Program
Coordinated Education Efforts Work
Coordinated Education Efforts Work
And Finallyhellip
Encouraging Parents to Take Action
Motivational Interviewing
Impact of Eliminating Sleep-Related Deaths
Thank You
Contact Information
Slide Number 89
IMR over time Finland vs US
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Contact Information
mgoodsteinwellspanorg
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Visit Pediatric Care Online today for additional information on this and other topics
httppediatriccaresolutionsaaporgPediatric Care Online is a convenient electronic resource for immediate expert help with
virtually every pediatric clinical information need with must-have resources that are included in a comprehensive reference library and time-saving clinical tools
Donrsquot have a subscription to PCOThen take advantage of a free trial today
Call Mead Johnson Nutrition at 888363-2362 orfor more information go to
httppediatriccaresolutionsaaporgSSFree_Trialaspx
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
IMR over time Finland vs US
Slide Number 1
Disclaimer
Objectives for Todayrsquos Talk
Infant Mortality Rates for the Five Leading Causes of Infant Death in the United States 2005 and 2011
US Post-Neonatal Mortality 2015
FACT
What is SUID or SUDI
Some Causes of Deaths that Occur Suddenly and Unexpectedly during Infancy
What is SIDS
SIDS FACTS
SIDS FACTS
Triple Risk Model to Explain SIDS
Paterson DS Krous HF Kinney HC et al JAMA 2006
An Example of SIDS Pathogenesis
2016 AAP Recommendations Infant Sleep Safety
Strength of Recommendation
Recommendations Change as the Evidence Evolves
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
Correct Safe Sleep Environment
We Need to Move Beyond Back to Sleep
Sleep Position for Healthy Newborns
Sleep Position in Newborn Nursery
Sleep Position and Reflux
The Truth About Supine Sleep and Aspiration Ending the Fallacy
Title
Infant Sleep Location
Room-Share How Long Yoursquore Kidding Right
Supporting Data
More Recent Data
Why is Room-Sharing Protective
Room-Sharing and Sleep Quality
Insight Study (Paul 2017)
Insight Study (Paul 2017)
Insight Commentary (Hauck Moon)
Feeding the Baby at Night
Say NO to Couches Sofas and Cushioned Armchairs
High-Risk Bed Sharing Situations
Bedsharing in Low-Risk Breastfed Infants
Independent Review (Dr Robert Platt)
Bed Sharing
Bed Sharing
Bed Sharing with Overlay
Bed Sharing with Overlay
Bed Sharing with Overlay
Couch Sleeping
Couch Sleeping
Couch Sleeping
Unsafe Bedding NISP Trends 1993-2102
Why Use Soft Bedding
Soft Bedding for Older Infants
To Swaddle or Not to Swaddle That is the Question
Swaddling
SwaddlingmdashIs it Safe
SwaddlingmdashMore Questionshellip
wwwhealthychildrenorg
Pacifiers
Pacifiers and Breastfeeding
Baby Friendly USA Pacifiers
Addressing Sleep Deprivation
Overcoming Barriers to Change What Parents are Sayinghellip
Factors Associated With Choice of Infant Sleep Position
Slide Number 65
What is Working
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Infant Sleep Safety
Safe Sleep Nurse Modeling
Physician Advocacy
Healthcare Provider Advice to New Mothers Safe Sleep
Mason Clinical Peds 713
Bundled Intervention = Behavior Change
Hospital Unsafe Sleep Persists
Washington DC
TodaysBaby QI Safe Sleep Teaching
TodaysBaby QI Safe Sleep Teaching
Social Media and Risk-Reduction Training Study (SMART)
The National Safe Sleep Hospital Certification Program
Coordinated Education Efforts Work
Coordinated Education Efforts Work
And Finallyhellip
Encouraging Parents to Take Action
Motivational Interviewing
Impact of Eliminating Sleep-Related Deaths
Thank You
Contact Information
Slide Number 89
IMR over time Finland vs US
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
Visit Pediatric Care Online today for additional information on this and other topics
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Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
IMR over time Finland vs US
Slide Number 1
Disclaimer
Objectives for Todayrsquos Talk
Infant Mortality Rates for the Five Leading Causes of Infant Death in the United States 2005 and 2011
US Post-Neonatal Mortality 2015
FACT
What is SUID or SUDI
Some Causes of Deaths that Occur Suddenly and Unexpectedly during Infancy
What is SIDS
SIDS FACTS
SIDS FACTS
Triple Risk Model to Explain SIDS
Paterson DS Krous HF Kinney HC et al JAMA 2006
An Example of SIDS Pathogenesis
2016 AAP Recommendations Infant Sleep Safety
Strength of Recommendation
Recommendations Change as the Evidence Evolves
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
Correct Safe Sleep Environment
We Need to Move Beyond Back to Sleep
Sleep Position for Healthy Newborns
Sleep Position in Newborn Nursery
Sleep Position and Reflux
The Truth About Supine Sleep and Aspiration Ending the Fallacy
Title
Infant Sleep Location
Room-Share How Long Yoursquore Kidding Right
Supporting Data
More Recent Data
Why is Room-Sharing Protective
Room-Sharing and Sleep Quality
Insight Study (Paul 2017)
Insight Study (Paul 2017)
Insight Commentary (Hauck Moon)
Feeding the Baby at Night
Say NO to Couches Sofas and Cushioned Armchairs
High-Risk Bed Sharing Situations
Bedsharing in Low-Risk Breastfed Infants
Independent Review (Dr Robert Platt)
Bed Sharing
Bed Sharing
Bed Sharing with Overlay
Bed Sharing with Overlay
Bed Sharing with Overlay
Couch Sleeping
Couch Sleeping
Couch Sleeping
Unsafe Bedding NISP Trends 1993-2102
Why Use Soft Bedding
Soft Bedding for Older Infants
To Swaddle or Not to Swaddle That is the Question
Swaddling
SwaddlingmdashIs it Safe
SwaddlingmdashMore Questionshellip
wwwhealthychildrenorg
Pacifiers
Pacifiers and Breastfeeding
Baby Friendly USA Pacifiers
Addressing Sleep Deprivation
Overcoming Barriers to Change What Parents are Sayinghellip
Factors Associated With Choice of Infant Sleep Position
Slide Number 65
What is Working
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Infant Sleep Safety
Safe Sleep Nurse Modeling
Physician Advocacy
Healthcare Provider Advice to New Mothers Safe Sleep
Mason Clinical Peds 713
Bundled Intervention = Behavior Change
Hospital Unsafe Sleep Persists
Washington DC
TodaysBaby QI Safe Sleep Teaching
TodaysBaby QI Safe Sleep Teaching
Social Media and Risk-Reduction Training Study (SMART)
The National Safe Sleep Hospital Certification Program
Coordinated Education Efforts Work
Coordinated Education Efforts Work
And Finallyhellip
Encouraging Parents to Take Action
Motivational Interviewing
Impact of Eliminating Sleep-Related Deaths
Thank You
Contact Information
Slide Number 89
IMR over time Finland vs US
Treat with confidence Trusted answers from the American Academy of PediatricsTreat with confidence Trusted answers from the American Academy of Pediatrics
IMR over time Finland vs US
Slide Number 1
Disclaimer
Objectives for Todayrsquos Talk
Infant Mortality Rates for the Five Leading Causes of Infant Death in the United States 2005 and 2011
US Post-Neonatal Mortality 2015
FACT
What is SUID or SUDI
Some Causes of Deaths that Occur Suddenly and Unexpectedly during Infancy
What is SIDS
SIDS FACTS
SIDS FACTS
Triple Risk Model to Explain SIDS
Paterson DS Krous HF Kinney HC et al JAMA 2006
An Example of SIDS Pathogenesis
2016 AAP Recommendations Infant Sleep Safety
Strength of Recommendation
Recommendations Change as the Evidence Evolves
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
2016 SIDS Task Force Policy Statement
Correct Safe Sleep Environment
We Need to Move Beyond Back to Sleep
Sleep Position for Healthy Newborns
Sleep Position in Newborn Nursery
Sleep Position and Reflux
The Truth About Supine Sleep and Aspiration Ending the Fallacy
Title
Infant Sleep Location
Room-Share How Long Yoursquore Kidding Right
Supporting Data
More Recent Data
Why is Room-Sharing Protective
Room-Sharing and Sleep Quality
Insight Study (Paul 2017)
Insight Study (Paul 2017)
Insight Commentary (Hauck Moon)
Feeding the Baby at Night
Say NO to Couches Sofas and Cushioned Armchairs
High-Risk Bed Sharing Situations
Bedsharing in Low-Risk Breastfed Infants
Independent Review (Dr Robert Platt)
Bed Sharing
Bed Sharing
Bed Sharing with Overlay
Bed Sharing with Overlay
Bed Sharing with Overlay
Couch Sleeping
Couch Sleeping
Couch Sleeping
Unsafe Bedding NISP Trends 1993-2102
Why Use Soft Bedding
Soft Bedding for Older Infants
To Swaddle or Not to Swaddle That is the Question
Swaddling
SwaddlingmdashIs it Safe
SwaddlingmdashMore Questionshellip
wwwhealthychildrenorg
Pacifiers
Pacifiers and Breastfeeding
Baby Friendly USA Pacifiers
Addressing Sleep Deprivation
Overcoming Barriers to Change What Parents are Sayinghellip
Factors Associated With Choice of Infant Sleep Position
Slide Number 65
What is Working
The Back to Sleep Campaign Resulted in a 53 Decrease in SIDS-related Deaths Over 10 Years
Infant Sleep Safety
Safe Sleep Nurse Modeling
Physician Advocacy
Healthcare Provider Advice to New Mothers Safe Sleep
Mason Clinical Peds 713
Bundled Intervention = Behavior Change
Hospital Unsafe Sleep Persists
Washington DC
TodaysBaby QI Safe Sleep Teaching
TodaysBaby QI Safe Sleep Teaching
Social Media and Risk-Reduction Training Study (SMART)
