1. S DS NETWORK OF KANSAS, INC. Safe Slumber: Creating a Safe Sleep Environment Christy Schunn, LSCSW Executive Director SIDS Network of Kansas 8/16/2015

2. S DS NETWORK OF KANSAS, INC. What is SIDS? 8/16/2015 Sudden Infant Death Syndrome (SIDS) is “the sudden death of an infant under one year of age which remains unexplained after a thorough case investigation, including: performance of a complete autopsy, examination of the death scene, and review of the clinical history.” National Institute of Child Health and Human Development, Willinger et al, 1991

3. S DS NETWORK OF KANSAS, INC. Introduction

4. S DS NETWORK OF KANSAS, INC. 2005 March of Dimes Peristats

5. S DS NETWORK OF KANSAS, INC. 8/16/2015SIDS Network of Kansas SIDS Mortality Rate by Race of Mother 1. Native American 145.7 2. African American 113.5 3. White 45.6 4. Hispanic 27.1 5. Asian 18.5 Mathews, Menacker, and MacDorman, 2003 from birth and infant death certificates.

6. S DS NETWORK OF KANSAS, INC. Infants at Highest Risk for SIDS Babies who sleep on their tummies (5x greater risk) Babies put on their tummies to sleep who usually sleep on their backs (as much as 18x) 8/16/2015

7. S DS NETWORK OF KANSAS, INC. Infants at Highest Risk for SIDS Mothers who smoke during pregnancy (3x greater risk) Babies who breathe secondhand smoke (2.5x greater risk) 8/16/2015

8. S DS NETWORK OF KANSAS, INC. SIDS in Child Care Rachel Y. Moon, MD, Children’s National Medical Center, Washington, D.C. Approximately 20% of SIDS deaths occurred while the infant was in the care of a nonparental caregiver. 60% in family child care 20% in child care centers 8/16/2015

9. S DS NETWORK OF KANSAS, INC. SIDS in Child Care Rachel Y. Moon, MD, Children’s National Medical Center, Washington, D.C. Approximately 1 / 3 of SIDS-related deaths in child care occur in the first week, 1 / 2 of these on the first day. Something intrinsic to child care? No Unaccustomed tummy sleeping? Yes 8/16/2015

10. S DS NETWORK OF KANSAS, INC. Facts about SIDS 8/16/2015 When an infant seems to be healthy, but dies usually while sleeping, for no other reason, it is called Sudden Infant Death Syndrome (SIDS). Highest risk is at 2 to 4 months; 91% occur between 1 and 6 months of age. SIDS is sometimes called “crib death.” No one can predict which infants will die from SIDS. There is no known prevention for SIDS.

11. S DS NETWORK OF KANSAS, INC. What we do know… 8/16/2015 Infants who die of SIDS: Do Not cry out Do Not suffocate or choke Do Not suffer

12. S DS NETWORK OF KANSAS, INC. SIDS is not: 8/16/2015 Caused by spitting up, choking or smothering Caused by child abuse/neglect Contagious Caused by immunizations Caused by external suffocation The cause of every unexpected infant death Caused by co-sleeping

13. S DS NETWORK OF KANSAS, INC. 8/16/2015 Triple Risk SIDS Theory Hannah C. Kinney, Harvard Medical School, Boston

14. S DS NETWORK OF KANSAS, INC. Triple Risk SIDS Theory Hannah C. Kinney, Harvard Medical School, Boston Infant Physiologic Responses Arousal response deficit Subtle brainstem dysfunction Slow development External Stress Factors Sleep position Bedding Temperature Season Swaddling Smoking Drug use Minor respiratory symptoms Poverty Limited prenatal care Development (autonomic nervous system) 2-4 months – most unstable 4-6 months – decreasing instability SIDS Infant Physiologic Responses Development External Stress Factors

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16. S DS NETWORK OF KANSAS, INC. Method

17. S DS NETWORK OF KANSAS, INC. 1996 AAP SIDS Statement 8/16/2015 “Healthy term infants should sleep wholly on their back as the safest sleep position.” "Positioning and SIDS: Update,” Pediatrics, Vol. 98, No. 6, December 1996

18. S DS NETWORK OF KANSAS, INC. Anatomy when sleeping on stomach Revised - 0408

19. S DS NETWORK OF KANSAS, INC. Anatomy when supine Revised – 12/08

20. S DS NETWORK OF KANSAS, INC. We don’t recommend this… 8/16/2015

21. S DS NETWORK OF KANSAS, INC. 8/16/2015 How to Create a Safe Sleep Environment Place baby on his/her back to sleep at nighttime and naptime Place baby on a firm tight-fitting mattress in safety approved crib

22. S DS NETWORK OF KANSAS, INC. 8/16/2015 Creating Safe Sleep If using a blanket, put baby with feet at the foot of the crib. Tuck a thin blanket around the crib mattress, reaching only as far as the baby's chest.

23. S DS NETWORK OF KANSAS, INC. Remove all fluffy and loose bedding from the sleep area These include: Pillows Quilts Comforters Sheepskins Stuffed toys Other soft products 8/16/2015 Sleeping Safely

24. S DS NETWORK OF KANSAS, INC. Unsafe Sleeping Environments 8/16/2015

25. S DS NETWORK OF KANSAS, INC. 8/16/2015

26. S DS NETWORK OF KANSAS, INC. 8/16/2015 Placed: Placed down on right side

27. S DS NETWORK OF KANSAS, INC. 8/16/2015 Found: Prone face/nose down

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29. S DS NETWORK OF KANSAS, INC. 8/16/2015 Placed: Placed down on right side, head resting on right arm

30. S DS NETWORK OF KANSAS, INC. 8/16/2015 Found: Prone, head turned slightly to right

31. S DS NETWORK OF KANSAS, INC. 8/16/2015

32. S DS NETWORK OF KANSAS, INC. Placed: down on left side with use of wedge 8/16/2015

33. S DS NETWORK OF KANSAS, INC. Found: rolled forward & face down 8/16/2015

34. S DS NETWORK OF KANSAS, INC. 8/16/2015 Make sure the baby's head remains uncovered during sleep. There should one infant per crib. Safe Sleep

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36. S DS NETWORK OF KANSAS, INC. Safe Sleep 8/16/2015 Consider using a wearable sleeper or other sleep clothing as an alternative to blankets.

37. S DS NETWORK OF KANSAS, INC. Safe Sleep 8/16/2015 Dress the baby in light sleep clothing Keep the room at a temperature that is comfortable for an adult (68º-72º)

38. S DS NETWORK OF KANSAS, INC. Encourage the use of a fan to keep the room well ventilated. 8/16/2015

39. S DS NETWORK OF KANSAS, INC. 8/16/2015 Encourage Breastfeeding

40. S DS NETWORK OF KANSAS, INC. No smoking around infants 8/16/2015 Go outside to smoke Wear an overcoat Removed the overcoat upon return Exposure to smoke in a room where babies sleep, is linked to an increased risk of SIDS.

41. S DS NETWORK OF KANSAS, INC. “Tummy Time” 8/16/2015 Is needed to develop strong muscles Is for babies who are awake and being observed Offered 2 to 3 times a day and increase the amount as the baby becomes stronger.