S AFE B EGINNINGS A PREVENTION PROGRAM FOR S ACRAMENTO C OUNTY TO REDUCE INFANT SLEEP - RELATED DEATHS IN CHILDREN AGES Funded by California Kids Plates

C ALIFORNIA K ID ’ S P LATES F UNDING 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

S AFE B EGINNINGS C OLLABORATIVE 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

S ACRAMENTO C OUNTY S AFE B EGINNINGS C OLLABORATIVE P ARTNERS 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

S ACRAMENTO C OUNTY S AFE B EGINNINGS C OLLABORATIVE P ROCESS 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 above 5

S AFE B EGINNINGS S ACRAMENTO C OUNTY S ERVICE P ROVIDERS Q UESTIONNAIRE R ESPONSES 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

S AFE B EGINNINGS C OLLABORATIVE P ARENT F OCUS G ROUP R ESPONSES 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

S AFE B EGINNINGS C OLLABORATIVE 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

S AFE B EGINNINGS 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 providers Educate parents and caregivers Develop and Implement media campaign (print, TV, radio, video) 9

S ACRAMENTO C OUNTY S AFE B EGINNINGS Infant Safe Sleeping Training for Service Providers 10

L EARNING O BJECTIVES 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

I NFANT S LEEP -R ELATED D EATHS : A Q UICK AND S ILENT K ILLER 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

I NFANT S LEEP -R ELATED D EATHS D EFINITIONS 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

I NFANT S LEEP -R ELATED D EATHS D EFINITIONS 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

I NFANT S LEEP -R ELATED D EATHS D EFINITIONS 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 E STABLISHED R ISK F ACTORS 16 Other Risk Factors Maternal smoking during pregnancy Young maternal age Late or no prenatal care Maternal drinking and /or drug use Male sex African American Native American Sleep Environment Risk Factors: Soft sleep surface (adult bed, couch or pillow) Extra items in the crib: bumpers, quilts, blankets, toys Co-sleeping Sleep position-on stomach or side Overheating Environmental tobacco smoke SIDS and Other Sleep-Related Infant Deaths: Expansion of Recommendations for a Safe Infant Sleeping Environment; Pediatrics Journal, October 2011

B ABIES WHO … …sleep in an adult bed have a 40 times greater risk of SIDS. …sleep on their tummies have a 5 times greater risk of SIDS. ……sleep on soft bedding have a 5 times greater risk o f SIDS. …sleep on their tummies on top of soft bedding have a 21 times greater 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

S ACRAMENTO C OUNTY I NFANT S LEEP -R ELATED D EATHS 2,111 infants died between % (420) of these were infant sleep- related deaths. CDRT 20 Year Report 18 Sacramento County Resident Infant Sleep-Related Deaths (Kernel Density Distribution)

95 Infant Sleep Related Deaths were recorded in Sacramento County from % 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 S ACRAMENTO C OUNTY I NFANT S LEEP -R ELATED D EATHS

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I NFANT S AFE S LEEPING 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

A MERICAN A CADEMY OF P EDIATRICS I NFANT S AFE S LEEPING 2011 R ECOMMENDATIONS 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) A MERICAN A CADEMY OF P EDIATRICS I NFANT S AFE S LEEPING 2011 R ECOMMENDATIONS

24 Room-sharing without bed-sharing is recommended. A MERICAN A CADEMY OF P EDIATRICS I NFANT S AFE S LEEPING 2011 R ECOMMENDATIONS

25 Supervised tummy-time while awake… …beginning at as early of an age as possible, to promote motor development. A MERICAN A CADEMY OF P EDIATRICS I NFANT S AFE S LEEPING 2011 R ECOMMENDATIONS

26 Breastfeeding lowers the risk for SIDS. Put your baby back into his or her own crib to sleep after feeding. A MERICAN A CADEMY OF P EDIATRICS I NFANT S AFE S LEEPING 2011 R ECOMMENDATIONS

Consider offering a clean, dry pacifier at nap and bedtime, but do not force it. 27 A MERICAN A CADEMY OF P EDIATRICS I NFANT S AFE S LEEPING 2011 R ECOMMENDATIONS If breastfeeding, wait 3-4 weeks to introduce the pacifier until the baby has a good latch.

S ACRAMENTO C OUNTY ABC’ S OF I NFANT S AFE S LEEPING 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

S ACRAMENTO C OUNTY – ABC’ S OF I NFANT S AFE S LEEPING 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

S ACRAMENTO C OUNTY – ABC’ S OF I NFANT S AFE S LEEPING 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

A CCESSING R ESOURCES Child Abuse Prevention Center First Candle C onsumer Product Safety Commission American Academy of Pediatrics Juvenile Products Manufacturers Association Halo Sleep Sack 31

32 S ACRAMENTO C OUNTY F AMILY R ESOURCE C ENTERS La Familia Counseling Center th Street Sacramento, CA (916) North Sacramento Family Resource Center 1217 Del Paso Blvd. Sacramento, CA (916) Folsom Cordova Community Partnership Investment Circle Rancho Cordova, CA (916) River Oak Family Resource Center th Avenue Sacramento, CA (916) The Effort Resource Center 6015 Watt Avenue, Suite 2 North Highlands, CA (916) The Firehouse - Mutual Assistance Network 810 Grand Avenue Sacramento, CA (916) Meadowview Family Resource Center 2251 Florin Road, Suite 158 Sacramento, CA (916) Valley Hi Family Resource Center 7000 Franklin Blvd., Suite 820 Sacramento, CA (916)