1. SIDS? Not SIDS? A New Look at Sudden Infant Death Syndrome

2. Explanation of Concepts and Definitions Sleep Position: There are generally three positions in which babies sleep: 1) supine, i.e. on the back, 2) prone, i.e. on the stomach, and 3) on the side. The supine sleep position is promoted by AAP and the Cribs for Kids Campaign. Sleep Surface: The surface on which a baby is placed for sleep constitutes a sleep surface. Ideally, infants should sleep in a crib on a firm mattress that meets current federal safety standards. Soft Bedding: This can include any type of bedding other than a firm, tight- fitting mattress in a crib that meets current safety standards. Examples include: pillows, quilts, comforters, sheepskins, stuffed toys, blankets, waterbeds, soft mattresses, sofas, and other soft products.

3. Explanation of Concepts and Definitions Bedsharing: When an infant sleeps with others in an adult bed. Co-sleeping: Involves the infant sleeping in its own space, such as in a safety-approved crib, but adjacent to the parent or caregiver. Roomsharing: When the baby sleeps in its own crib in the same room as the parents. Safe Sleep Environment: This involves a combination of proper sleep position (supine) on a firm mattress, in a safety-approved crib, with no soft bedding or blankets in the crib, in a smoke-free environment.

4. autopsy examination of the scene of death review of the case history The sudden death of an infant under one year of age which remains unexplained after the performance of a complete post-mortem investigation including: Sudden Infant Death Syndrome ICD-9 Definition

5. The umbrella under which falls: Sudden Infant Death Syndrome Accidental Suffocation Entrapment Asphyxia Neglect Homicide Hypothermia/hyperthermia Metabolic disorders Unknown Can be explained or unexplained; natural/undetermined SUID: Sudden Unexpected Infant Death

6. The overwhelming majority of babies who die from SUID/SIDS are discovered in an unacceptable sleep position or sleep location! FACT!

7. FACT: Half of the infants in the U.S. who die from sudden unexpected death do so while sleeping with their parents –Bedsharing and infant death is very different in the U.S. than it is in other cultures –If babies routinely sleep with their parents in other cultures, they: Use a firm mat on the floor Have a separate mat for the infant Do not use soft bedding Bedsharing and Infant Death

8. Triple Risk Model to Explain SIDS Critical period of development Underlying Vulnerability Modifiable Pre- and Post-Natal Environmental Stressors HIGHEST RISK FOR SIDS Possible Brainstem Abnormality (Filiano and Kinney, modified) First 6 months Prone/Side Sleep Position Nicotine Exposure Soft Bedding Overheating Bed sharing

9. Trachea Esophagus Anatomy and Physiology In the supine position, the trachea lies on top of the esophagus. Anything regurgitated or refluxed from the esophagus has to go against gravity to be aspirated into the trachea. Permission to use figure granted by First Candle/SIDS Alliance.

10. Babies at Risk African American babies (2x greater risk) Mothers who smoke during pregnancy (3x greater risk) Babies who breathe secondhand smoke (2.5x greater risk) Babies who sleep on their tummies (5x greater risk) Babies put on their tummies to sleep who usually sleep on their backs (18-20x greater risk) Babies who sleep with parent(s) in adult bed (40x greater risk)

11. Bed Sharing with Siblings, Soft Bedding Increase SIDS Risk − Chicago Infant Mortality Study, Pediatrics, May, 2003 Sleeping on soft bedding: increased SIDS risk 5 times Sleeping on the stomach: increased SIDS risk 5 times SIDS victims were 5.4 times more likely to have shared a bed with other children. Sleeping on the stomach on soft bedding: increased risk of SIDS 21 times

12. SIDS is NOT Suffocation Although SIDS is different from suffocation, all the measures we use for SIDS risk reduction also help to prevent accidental deaths such as positional asphyxia, overlay, and entrapment. These are 100% PREVENTABLE deaths!

13. Unsafe Sleep Environment: Soft Bedding

14. Unsafe Sleep Environment

15. What is wrong with this picture?

16. Jennifer Lopez’s nursery What is wrong with these pictures?

17. Unsafe Sleep Environment

18. April 15, 1992 The American Academy of Pediatrics recommended that healthy infants: “when being put down for sleep, be positioned on their back or side.” December 1996 A revised statement by the AAP stated: “Back is best.” November 1998 Cribs for Kids® begins in Pittsburgh, PA. October 2005 AAP recommends: “Separate but proximate sleeping environment.” October 2011 AAP Revised Recommendations Released Back to Sleep Timeline

19. SIDS Death Rate and Sleep Position 1988 – 2003 (per 1000 Live Births)

20. NEW AAP POSITION STATEMENT OCTOBER 2011 Always place your baby on his or her back for every sleep time. Always use a firm sleep surface. Car seats and other sitting devices are not recommended for routine sleep. The baby should sleep in the same room as the parents, but not in the same bed (room-sharing without bed-sharing). Keep soft objects or loose bedding out of the crib. This includes pillows, blankets, and bumper pads. Wedges and positioners should not be used. Pregnant woman should receive regular prenatal care. Don’t smoke during pregnancy or after birth. Breastfeeding is recommended. Offer a pacifier at nap time and bedtime. Avoid covering the infant’s head or overheating. Do not use home monitors or commercial devices marketed to reduce the risk of SIDS. Infants should receive all recommended vaccinations. Supervised, awake tummy time is recommended daily to facilitate development and minimize the occurrence of positional plagiocephaly (flat heads).

21. Additions to AAP Position Statement OCTOBER 2011 Breastfeeding is recommended and is associated with a reduced risk of SIDS. Infants should be immunized. Evidence suggests that immunization reduces the risk of SIDS by 50 percent. Bumper pads should not be used in cribs. There is no evidence that bumper pads prevent injuries, and there is a potential risk of suffocation, strangulation or entrapment.

22. Safe-Sleep Survival Kit $74.99

23. Contact Information Regina Washington REMSA/Safe Kids Washoe County 450 Edison Way Reno, NV 89502 Office - (775) 858-5700, ext. 3139 Fax – (775) 858-5735 Email – rwashington@remsa-cf.comrwashington@remsa-cf.com Website – www.safekidswc.comwww.safekidswc.com