SAFE BEGINNINGS

A PREVENTION PROGRAM FOR

SACRAMENTO COUNTY TO REDUCE

INFANT SLEEP-RELATED DEATHS

IN CHILDREN AGES 0-5

1 Funded by California Kids Plates

CALIFORNIA KID’S PLATES FUNDING In 1992, the California legislature passed a

bill allowing for the sale of Kids' Plates motor vehicle license plates and the creation of the Child Health and Safety Fund.

Revenue from the sale of Kids' Plates goes into the Child Health and Safety Fund and is appropriated to support three child safety issues in California: 1. unintentional childhood injury prevention, 2. child abuse prevention, 3. child care licensing and inspection activities. 2

SAFE BEGINNINGS COLLABORATIVE

Joint effort between the Child Abuse Prevention Council of Sacramento (CAPC) and Safe Kids Greater Sacramento

Ensures each child has a “safe beginning.”

Partnership brings together the childhood injury and child maltreatment prevention fields, to protect children from injury and death.

3

SACRAMENTO COUNTY SAFE BEGINNINGS COLLABORATIVE

PARTNERS Sacramento County Hospital systems:

Kaiser Permanente, Dignity Health Care Systems (formerly Mercy), Sutter Medical Center Sacramento and UC-Davis Medical Center

Sacramento County Department of Health and Human Services: Child Protective Services, Public Health,

Communication and Media Officer, Women Infants and Children Program (WIC), Child Action, Inc.

Child Abuse Prevention Council of Sacramento Safe Kids Greater Sacramento Sacramento Metro Fire, Cosumnes Fire Child Death Review Team (CDRT) Sacramento County Building Inspection Division Sacramento County Coroner

4

SACRAMENTO COUNTY SAFE BEGINNINGS COLLABORATIVE

PROCESS

How Safe Beginnings was developed: Reviewed Sacramento, California and

nationwide infant sleep-related death data Surveyed Sacramento County service

providers (135 responses) Conducted parent focus groups (276 Parents) Researched best/promising practice

prevention program models Developed SBC Infant Safe Sleeping Program

utilizing the above5

SAFE BEGINNINGSSACRAMENTO COUNTY SERVICE

PROVIDERSQUESTIONNAIRE RESPONSES

What do you think are the major risk factors for infant sleep-related deaths?

69% Co-sleeping with adults and/or siblings 58% Infants sleeping somewhere other than a crib 44% of parents put infant to sleep on tummy

6

SAFE BEGINNINGS COLLABORATIVEPARENT FOCUS GROUP RESPONSES

What do you know about infant sleep-related deaths?

Think of infant sleep-related deaths as a completely natural phenomenon.

Think of SIDS and believe parents have little ability to prevent these deaths

Agreed Infant sleep-related deaths are a major problem Heard of infant sleep-related deaths on TV, but not

within their families/communities

7

SAFE BEGINNINGS COLLABORATIVE

Sacramento County service providers and parent focus group participants overwhelmingly agreed:

An education campaign to raise awareness of the importance of infants (particularly those 6 months of age and younger) sleeping in safe environments was needed for Sacramento County.

Information delivered by: Birthing Hospitals Health Care Professionals Child Care Providers Family Resource Centers Community Programs

8

SAFE BEGINNINGS

SAFE BEGINNINGS GOAL Decrease the number of infant sleep-related injuries and deaths in targeted

Sacramento County communities.

Program elements to reduce infant sleep-related deaths include:Educate service providersEducate parents and caregiversDevelop and Implement media campaign

(print, TV, radio, video)9

SACRAMENTO COUNTY SAFE BEGINNINGS

Infant Safe SleepingTraining for Service Providers

10

LEARNING OBJECTIVES

After training, participants will be able to:

Define infant sleep-related deaths terms Learn the American Academy of Pediatrics established risk

factors for infant sleep-related deaths Know Sacramento County statistics on infant sleep-related

deaths Become familiar with the AAP 2011 recommendations for

Infant Safe-Sleeping Learn the ABC’s of infant safe sleeping Identify resources for additional information on infant safe

sleeping

11

INFANT SLEEP-RELATED DEATHS:A QUICK AND SILENT KILLER

Infant sleep-related deaths are the leading cause of death for babies one month to one year of age.

Most babies that have an infant sleep-related death appear to be healthy prior to death.

Infant sleep-related deaths occur in all socio-economic, racial and ethnic groups. African American and Native American babies are 2-3 times more likely than Caucasian babies to have an infant sleep-related death.

12

www.firstcandle.org

INFANT SLEEP-RELATED DEATHS DEFINITIONS

SIDS – The sudden death of an infant under one year of age, which remains unexplained following an investigation of the case, including the performance of a complete autopsy and review of the clinical history.

13

Vulnerable Infant

Critical Development Period (2-4

months)

Outside Stressors

SIDS

INFANT SLEEP-RELATED DEATHS DEFINITIONS

SUIDS – The sudden unexpected/unexplained infant death (SUID) applies to the death of an infant less than one year of age, in which investigation, autopsy, medical history review, and appropriate laboratory testing fails to identify a specific cause of death. 

SUIDS includes cases that meet the definition of Sudden Infant Death Syndrome (SIDS). If there are external or exogenous stressors [risk factors] that a medical examiner would like to incorporate on a death certificate, such as: co-sleeping or bed sharing, they may be added to the cause of

death, such as in the following way: Sudden unexplained (or unexpected) infant death while bed-sharing.

14

INFANT SLEEP-RELATED DEATHS DEFINITIONS

Undetermined Manner – death in which the cause or manner may not be medically identifiable. In this category the manner of death may not be determined due to uncertainty regarding how the fatal condition developed or was inflicted.

Deaths that had insufficient information to assign a manner included in this category are: infant sleep-related deaths where there is not enough evidence

to determine whether the death was caused by parental overlay, SIDS or SUIDS.

15

AAP ESTABLISHED RISK FACTORS

16

Other Risk FactorsMaternal smoking during pregnancyYoung maternal ageLate or no prenatal careMaternal drinking and /or drug useMale sexAfrican AmericanNative American

Sleep Environment Risk Factors:

Soft sleep surface (adult bed, couch or pillow) Extra items in the crib: bumpers, quilts, blankets, toysCo-sleepingSleep position-on stomach or sideOverheatingEnvironmental tobacco smoke

SIDS and Other Sleep-Related Infant Deaths: Expansion of Recommendations for a Safe Infant Sleeping Environment; Pediatrics Journal, October 2011

BABIES WHO….

17www.cjsids.org

• …sleep in an adult bed have a 40 times greater risk of SIDS.• …sleep on their tummieshave a 5 times greater risk of SIDS.• ……sleep on soft beddinghave a 5 times greater risk of SIDS.

• …sleep on their tummies on top of soft bedding

have a 21 timesgreater risk of SIDS.

Babies of mothers who smoke during pregnancy… have a 3 times greater risk of SIDS.

• .... breath secondhand smoke

have a 2.5 times greater risk of SIDS

SACRAMENTO COUNTY INFANT SLEEP-RELATED DEATHS

2,111 infants died between 1990-2009.

20% (420) of these were infant sleep-related deaths.

CDRT 20 Year Report

18

Sacramento County ResidentInfant Sleep-Related Deaths

1990-2009(Kernel Density Distribution)

95 Infant Sleep Related Deaths were recorded in Sacramento County from 2007-2011.

94% had at least one known infant sleep environmental risk factor:

78% were NOT sleeping in a crib or bassinet (unsafe sleep environment)

65% were sleeping on an adult bed or couch 55% were co-sleeping with an adult 36% were not put on their backs to sleep

19

SACRAMENTO COUNTY INFANT SLEEP-RELATED DEATHS

SACRAMENTO COUNTY INFANT SLEEP-RELATED DEATHS

20

INFANT SAFE SLEEPING

Recent research from the American Academy of Pediatrics indicates that infant sleep-related deaths can be prevented by implementing safe sleeping techniques for every nap and every night.

Recommendations for sleep position and environment should be used consistently for infants up to 1 year of age.

21

AMERICAN ACADEMY OF PEDIATRICS INFANT SAFE SLEEPING 2011 RECOMMENDATIONS

22

Back to sleep always, for every sleep

23

Firm Sleep Surface Keep soft objects

out of cribs Avoid overheating-

no more than one layer more than an adult

Infant clothing that is designed to keep infants warm without possible head covering or entrapment (such as loose blankets)

AMERICAN ACADEMY OF PEDIATRICS INFANT SAFE SLEEPING 2011 RECOMMENDATIONS

24

Room-sharing without bed-sharing is recommended.

AMERICAN ACADEMY OF PEDIATRICS INFANT SAFE SLEEPING 2011 RECOMMENDATIONS

25

Supervised tummy-time while awake…

…beginning at as early of an age as possible, to promote motor

development.

AMERICAN ACADEMY OF PEDIATRICS INFANT SAFE SLEEPING 2011 RECOMMENDATIONS

26

Breastfeeding lowers the risk for SIDS.

Put your baby back into his or her own crib to sleep after feeding.

AMERICAN ACADEMY OF PEDIATRICS INFANT SAFE SLEEPING 2011 RECOMMENDATIONS

Consider offering a clean, dry pacifier at nap and bedtime, but

do not force it.

27

AMERICAN ACADEMY OF PEDIATRICS INFANT SAFE SLEEPING 2011 RECOMMENDATIONS

If breastfeeding, wait 3-4 weeks to introduce the pacifier until the

baby has a good latch.

SACRAMENTO COUNTY ABC’S OF INFANT SAFE SLEEPING

A for Alone Babies should always sleep alone in their

own crib or bassinette. Co-sleeping with other children or even

parents can be dangerous – others in bed with your baby can accidentally suffocate them by simply lying too close to their mouth or nose, or by rolling onto them while asleep.

Your baby should not sleep with stuffed animals, pillows or blankets — these soft items could accidentally fall over your baby’s face and suffocate them.

A blanket sleeper or sleep sack is enough to keep your baby comfortable.

28

SACRAMENTO COUNTY – ABC’S OF INFANT SAFE SLEEPING

B for Back Babies who sleep on their backs are much less

likely to die of infant sleep-related deaths. According to doctors, “back sleeping” will not

increase a baby’s risk of choking. Many of our own mothers and grandmothers were

taught to put a baby on their tummy to sleep — so you’ll need to gently remind them that to prevent infant sleep-related deaths, it’s “back to sleep.” 29

SACRAMENTO COUNTY – ABC’S OF INFANT SAFE SLEEPING

C for Crib Cribs and bassinets are the safest places

for babies to sleep – as long as you keep them safe!

To make breastfeeding easier keep a crib or bassinet next to your bed and always put your baby back to sleep afterwards.

Cribs should be free of pillows, bumpers, stuffed toys, extra blankets or anything that could accidentally cover your babies face and suffocate them. A blanket sleeper or sleep sack is sufficient.

Make sure that the crib mattress is firm and fits snuggly with no space between the mattress and the side of the crib, where the baby could become trapped.

Unlike firm crib mattresses, today’s adult beds are soft and can cause babies to suffocate. 30

ACCESSING RESOURCES

Child Abuse Prevention Centerwww.thecapcenter.org

First Candlewww.firstcandle.org

Consumer Product Safety Commissionwww.cpsc.gov

American Academy of Pediatrics www.aap.org Juvenile Products Manufacturers

Association www.jpma.org Halo Sleep Sack www.halosleep.com

31

32

SACRAMENTO COUNTY FAMILY RESOURCE CENTERS

La Familia Counseling Center5523 34th StreetSacramento, CA 95820(916) 452-3601

North Sacramento Family Resource Center

1217 Del Paso Blvd.Sacramento, CA 95815(916) 679-3743

Folsom Cordova Community Partnership

10455 Investment CircleRancho Cordova, CA 95670(916) 361-8684

River Oak Family Resource Center4322 4th AvenueSacramento, CA 95817(916) 244-5800

The Effort Resource Center6015 Watt Avenue, Suite 2North Highlands, CA 95660(916) 679-3925

The Firehouse - Mutual Assistance Network810 Grand AvenueSacramento, CA 95838(916) 567-9567

Meadowview Family Resource Center2251 Florin Road, Suite 158Sacramento, CA 95822(916) 394-6300

Valley Hi Family Resource Center7000 Franklin Blvd., Suite 820Sacramento, CA 95823(916) 290-8281