Safe Sleep for Newborns Rocky Mountain Children’s Health Foundation Mary Kohn, MD May 13, 2019

Goal of this lecture is to empower new parents with tools to avoid unexpected infant death

S.I.D.S. V. S.U.I.D.S.

Two Types of Infant Death during Sleep in babies under 1 year of age S.I.D.S “Sudden Infant Death Syndrome” Also known as “Crib Death” SIDS is the unexplained and quiet death of an otherwise health newborn, usually during sleep S.U.I.D. “Sudden Unexpected Infant Death” This refers to accidental, sleep-related deaths in otherwise healthy newborns. Most commonly, smothering or entrapment

Both SIDS & SUIDS are parents’ worst nightmares But, there are things that you can do to prevent them

What is SIDS? Baby is put to bed and dies quietly in her sleep. Otherwise healthy infant Peaks between 1 and 4 months of age 90% occur in first 6 months of life More common in infants exposed to cigarette smoke before and after birth More common in premature babies and babies who are very small at birth No evidence of illness or smothering on post-mortem exam

What causes SIDS? Unknown Many hypotheses over the years: Not the cat’s fault! Not smothering Not caused by reflux or aspiration Does not seem to be caused by infection Does not seem related to heart disease

Current thinking is that it is associated with immaturity of arousal function of baby’s brain

What is SUIDS? These are deaths that are caused by accidents related to sleep. Smothering Entrapment Choking

Data Nearly 4 million babies born in U.S. in 2018 3500 babies under one year of age died of SIDS or SUIDS Chances of any baby dying of either is 8 per 10,000 Not common but tragic Often preventable

Prevention STRATEGIES SIDS & SUIDS Different causes but same prevention strategies

Prevention Strategies Breast feeding Sleep position Sleep surface Sleep location Bedding Pacifier Smoking & alcohol Overheating Fans, ventilation Immunizations Commercial devices Home monitors Swaddling

Breast Feeding Breast-fed babies are more easily awakened

Position Back-To-Sleep Campaign by NIH in 1992 “Safe to Sleep” is current program

Note that decline in SIDS deaths corresponds to change in recommendation for Back to Sleep

Sleep surface should be a firm mattress

Location Same room Separate surface 6-12 months

Various options

Baby Box Inexpensive alternative

Bedding Use fitted crib sheet of appropriate size Avoid “soft stuff in crib” Pillows Stuffed toys Bumper pads No loose blankets Beware of cords, curtains that are close by

Decorating ideas from Pinterest

Khloe Kardashian’s Baby Nursery

Pacifiers Have been shown to decrease the likelihood of SIDS May be due to increased arousal- baby is not as deeply asleep If it falls out of baby’s mouth, don’t replace it, still protective Don’t start until breast feeding is well-established

Cigarette smoking Major risk factor before and after birth Exposure to tobacco smoke decreases arousal Causes babies to be smaller, also a risk factor for SIDA Second-hand smoke is also a risk It is estimated that one-third of SIDS deaths could be prevented if all maternal smoking during pregnancy was eliminated.

Overheating Rule of thumb: Baby only needs one more layer of clothing than an adult in the room needs

Won’t baby get cold? Swaddle Sleep Sack Footie pajamas

Please keep these guidelines in mind when evaluating products Not all products marketed for newborns are truly safe or necessary

Baby monitors are not advised- not effective and lots of “false alarms”

Rock and Play Sleeper Made by Fischer Price Soft-sided sling that rocks baby to sleep Recalled on April 11, 2019 by Consumer Products Safely Division 32 deaths have been associated with the product Babies rolled over while unrestrained and were unable to breathe due to their position

Snoo Sleeper- based upon AAP recommendations but check the price!

Following the AAP guidelines is the best way to protect your newborn from both SIDS and accidental sleep- related death.