San Mateo County Safe Sleep Centers

8/13/2019 San Mateo County Safe Sleep Centers

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UnderstandingSIDS

& Creating a Safe Sleep Environment in Child Care CentersBy Susana Flores, PHN, SIDS Coordinator April 2012


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Numbers we should remember

2,300 Infants die eachyear of SIDS

5 Babies who are placed to

sleep on their tummies have

a 5times greater risk of

SIDS

20% SIDS deaths occurwhile the infant isunder non-parentalcare.

21 Babies who sleep on theirtummies on top of soft

bedding have a 21timesgreater risk of SIDS

87% A Scottish studyshowed 87%of SIDSoccurred in unsafesleep environments.Only 13%were found oncrib or bassinets


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SIDS in Child Care

Approximately 20% of SIDS deaths occur while the

infant is in the care of a non-parental caregiver. 60% in family child care

20% in child care centers

20% in relative care

Infants tend to be Caucasian, with older, more

educated parents. Moon et al, 2000


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SIDS in Child Care

Approximately 1/3of SIDS-related deaths in

child care occur in the first week, and 1/2ofthese occur on the first day.

Something intrinsic to child care? Not that

weve found yet. Stress, sleep deprivation?

Unaccustomed tummy sleeping? Yes


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Unaccustomed Tummy Sleeping

Increases risk of SIDS (as much as 18 times). Mitchell et al, 1999

Non-parental caregivers may use tummy

sleeping.

Less ability to lift head in tummy position.

Later development of upper body strength. Davis et al, 1998


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What is SIDS?

SIDS is the sudden unexplained death of a

seemingly healthy infant under 12 months of

age that remains unexplained after a

thorough death scene investigation, autopsy

and review of babys medical history. It is adiagnosis of exclusion.


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What is the Challenge in SIDS

Community?

SIDS rates are stagnating and other sleep-

related deaths are increasing. Everybody thinks that his/her baby is the

exception to the rule.

Gastro-esophageal reflux Premature

Bad sleeper


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What is the AAP Doing now?

They released a new set of recommendations to

reduce to risk of SIDS and sleep-related suffocation,asphyxia and entrapment cases, to be used

consistently until the infant is 1 year of age.

These new guidelines are more explicit, concrete

and based on scientific evidence. Theyve released

18 recommendations in total.


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A little History since past 20

years In 1992 the AAP recommended changing infants

sleep position from stomach to back as a result,SIDS rate dropped by 47% in California and 51%

nationally.

In 2006 a new set of recommendations werereleased which are the ones in your handouts.

Since 2006, SIDS rates have remained stable and

others sleep related deaths are increasing.


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SIDS Facts

The exact causes of SIDS are unknown, but

SIDS is NOT caused by

Immunizations

Vomiting or choking

Caused by cribs

Contagious or hereditary

Child abuse or neglect


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Gastro-esophageal reflux and

positioning facts

North American Society of Pediatric

Gastroenterology and nutrition: infants with GEreflux should be placed for sleep in the supine

position except for the rare infant for whom the risk

of death from complication of GE reflux is greater

than the risk of SIDS. (Valdenplas, 2009) Examples: Type 3 or 4 laryngeal cleft (uncorrected) or other

defects where the airways in unprotected


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GE reflux and positioning

Elevating the head of the infants crib while

the infant is supine is no effective in reducing

GE reflux. (Meyers, 1982;Tobin, 1997)

May also result in the infant sliding to the foot of

the crib into a position that may compromiserespirations and therefore is not recommended.


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GE reflux and positioning

Placing infant in sitting devices (car seats,

etc.) makes GE reflux worse. (Orenstein,1983)

May increase risk for upper airway obstruction,

falls and suffocation.


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Triple Risk Model

SIDS

Critical development

period

External stressorsVulnerable

infant


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Modifying SIDS Risks

Risks that can be modified

Risks that cannot be modified

Revised12/08


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SIDS Risk FactorsPregnancy

Low birth weight (less than 5 pounds)

Premature (less than 37 weeks) Mothers who smoke during pregnancy (3x greater risk)

Babies who breathe secondhand smoke

(2.5x greater risk)

Multiple births (e.g. twins, triplets)

Maternal age younger than 20 years

Less than 18 months between births


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Babies at Risk for SIDS

African Americans (2x greater risk)

Partly genetic

Partly behavioral (sleep position, bedsharing)

American Indians (more than 2x greater risk)

Secondhand smoke exposure

Binge alcohol drinking during pregnancy

Overdressing of babies


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Reasons that people place babies

on their tummies They think that babies are more likely to

choke or aspirate if they vomit or spit up

They are worried that babies wont sleep as

well

Parental requests

When babies sleep on the backs, they dont

develop normally.


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Reasons that people place babies

on their tummies Babies sleep better/longer/more deeply when

theyre on their stomachs

The baby will get a flat head if the baby

sleeps on the back.

The baby will get a bald spot from sleeping

on the back.


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Why Child Care Providers

Use Tummy Sleeping Lack of awareness

25% of licensed child care providers say they never heardof the relationship between SIDS and sleep position.

Misconceptions about risk of sleep position Supine and aspiration, choking

Belief that tummy sleeping improves infant comfort Parental preference

Lack of information

Lack of education


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Healthy Child Care America Back to Sleep

Campaign

Launched in 2003

Activities

Increase awareness.

Decrease incidence of SIDS in child care.

Educate policy makers to include back-to-sleep

positioning in child care regulations


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Safe Sleep Practices: Reducing the

Risk of SIDS and other related deaths

Back to sleep for every sleep.

Side sleeping is not safe and is not advised.

Avoid overheating.

Do not overdress baby.

Never cover babys head with a blanket.

Room temperature should be comfortable for a

lightly clothed adult.


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Risk of SIDS and other related deaths Breast-feeding is recommended.

Pacifiers may be offered to babies to reduce the risk of SIDS If breastfed, wait until breastfeeding is well established

(approximately 3 - 4 weeks of age), before offering apacifier.

If the baby refuses the pacifier, dont force it. If the pacifier falls out while the baby is asleep, you do not

have to re-insert it.


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Safe crib, firm mattress.

Avoid chairs, sofas, air mattresses, water

beds, and adult beds.

Room-sharing without bed-sharing is

recommended.

Do not have more than one baby per crib.


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Safe Sleep Practices: Reducing theRisk of SIDS and other related deaths

Avoid smoke exposure during and after

pregnancy.

Avoid alcohol and illicit drug use during

pregnancy and after birth.

Do no use cardio-respiratory monitors as

strategy for reducing the risk of SIDS.

Spread the word.


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Infants should be immunized in accordance with

recommendations of the AAP and CDC. Avoid commercial devices marketed to reduce the

risk of SIDS.

Supervised, awake tummy time is recommended tofacilitate development and to minimize development

of positional plagio-cephaly.


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What does a safe sleepenvironment looks like?


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Benefits of a Safe Sleep Policy

May save lives of babies.

Shows parents babys health and safety is

your #1 priority.

Educates staff.

Consistent care

Educate parents

Professional development


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Elements of a Safe Sleep Policy

Healthy babies always sleep on their backs.

Obtain physicians note for nonback sleepers.

The note should include prescribed sleep position and the medical reason fornot using the back position.

Use safety-approved cribs and firm mattresses.

Crib: free of toys, stuffed animals, and excess bedding.

If blankets are to be used, practice feet-to-foot rule.

Sleep only one baby per crib. Room temperature is comfortable for a lightly clothed adult.

Monitor sleeping babies.

Have supervised tummy time for awake babies.


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Alternate Sleep Position

Require written and signed physicians note.

Identifies medical reason why baby sleeps

in position other than on back


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Handling Parents Concerns

Discuss SIDS and risk reduction strategies

with parents.

Discuss sleep position policies.

Discuss medical waiver and implications.


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What We Need to Do

Implement the Caring for Our Children

standards. Have a safe sleep policy.

Train all caregivers.

Talk with a child care health consultant. Be able to handle an infant medical

emergency.

Be aware of bereavement resources.


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First AidUnresponsive Infant

Teaching resuscitation skills is beyond the scope of this

workshop. You must first practice resuscitation on amannequin.

Call 911.

Get help to care for the other children.

Call the childs parents or emergency contact.

Call the parents of the other children.

Do not disturb the scene (e.g., dont try to tidy up).

Notify licensing agency and insurance agency.


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Handling a Medical Emergency

Have a plan in place.

Review the plan with all staff perodically.

Be sure you have received training and have

successfully practiced rescue breathing and

skills for handling a blocked airway for infants

in a fist aid course.


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What to Expect if a Baby Dies

Investigation

Several people will ask for the same informationso they can help.

Law enforcement

Note babys health, behavior, etc. Take photos.

Limit disturbance of the area.


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What to Expect if a Baby Dies

Licensing agency

Questions about licensing regulations.

SIDS death not a reason for revoking a license.

Coroner/medical examiner

Conducts autopsy.

Determines cause of death.


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Caring for Our ChildrenNational Standards

Seek support and information from local, state,

or national SIDS organizations. Provide SIDS information to the parents

of the children in the facility.

Provide age-appropriate informationto the other children in the facility.

Make resources for support available

to families and children.


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National Resource Center forHealth and Safety in Child Care

and Early EducationCaring for Our Children: National

Health and Safety Performance

Standards, Third Edition is available

in three formats:

Full PDF - Now available with the

current changes;

grayscaleor color

PDF by Chapter- Now available with

the current changes; smaller file sizes

HTML Version- Now available with the

current changes

These online PDF and HTML formats of

Caring for our Children, Third Edition,

(CFOC3)are updated to reflectchanges/additions since the second

printing of CFOC3in August 2011.

(Each is updated as of April 2012.)

PDFs can be viewed with Adobe

Acrobat Reader

Get Adobe Acrobat Reader
http://nrckids.org/CFOC3/CFOC3-grayscale.pdfhttp://nrckids.org/CFOC3/CFOC3_color.pdfhttp://nrckids.org/CFOC3/PDFVersion/list.htmlhttp://nrckids.org/CFOC3/HTMLVersion/Inside_Cover.htmlhttp://nrckids.org/CFOC3/HTMLVersion/Inside_Cover.htmlhttp://nrckids.org/CFOC3/PDFVersion/list.htmlhttp://nrckids.org/CFOC3/CFOC3_color.pdfhttp://nrckids.org/CFOC3/CFOC3-grayscale.pdf


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NRCKIDS

Mailing Address:

National Resource Center for Health and

Safety in Child Care and Early Education

13120 E. 19th Ave., Mail Stop F541

PO Box 6511

Aurora, CO 80045

Fax:(303)724-0960

Our offices are open Monday through Friday 7:30am to 4:30pm Mountain

Time

Please send any comments or questions to [email protected] call us at

1-800-598-KIDS (5437)
mailto:[email protected]:[email protected]


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Partners and Resources

Back to Sleep campaign

www.nichd.nih.gov/sids Phone: 1-800-505-CRIB (2742)

You can receive informational brochures, posters to

provide to families and child care providers

Cause-Coalition against Unsafe Sleep Environments.

http://cribsforkids.org/cause-coalition-against-unsafe-sleep-

environments/
http://www.nichd.nih.gov/sidshttp://www.nichd.nih.gov/sids


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Partners and Resources

First Candle/SIDS Alliance. 1314 Bedford Avenue,

Suite 210Baltimore, MD [email protected]

Call us toll-free at 1-800-221-7437 Grief Counselors Available 24/7

National SIDS and Infant Death Program Support Center. 2115 Wisconsin Ave, N.W., Suite 601 Washington, DC 20001-2292

Phone; (866)866-7437 E-mail: [email protected]

CJ Foundation for SIDS-888/8CJ-SIDS. (201)996-5301 WWW.CJSIDS.COM
mailto:[email protected]:[email protected]


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Baby in a Safe Crib

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