1. Infant Safe Sleep and the Safe to Sleep Campaign Georgia Hospital Association Meeting October 15, 2012 Seema Csukas, MD, PHD Director, Maternal and Child Health Section Georgia Department of Public Health

2. PURPOSE The purpose of this presentation is to provide: Information on the Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD) Safe to Sleep campaign, An overview of the American Academy of Pediatrics (AAP) safe sleep recommendations and An update on the Georgia Department of Public Health’s (DPH) safe sleep efforts

3. From Back to Sleep…to…Safe to Sleep The Back to Sleep campaign started in 1994. Subsequently, the overall rates of sudden infant death syndrome (SIDS) declined by 50% 1 across all racial/ethnic groups. The Safe to Sleep campaign, launched October 2012,expands the recommendations of the Back to Sleep campaign to address and reduce other causes of infant sleep-related death. Formerly known as Back to Sleep

4. Safe to Sleep Campaign In addition, Safe to Sleep aims to address racial and ethnic disparities in infant sleep-related deaths through tailored outreach and collaborations. The campaign’s main messages are: 1.Babies sleep safest on their backs. 2.Create a separate sleep area for your baby in the same room where the caregiver sleeps. 3.Sleep surface matters. Use a firm surface, covered by a fitted sheet. Remove all bumpers, loose bedding, soft objects and toys.

5. Safe to Sleep Campaign Materials https://www.nichd.nih.gov/sids

6. Safe to Sleep Campaign Materials https:// www.nichd.nih.gov/sids /

7. AAP Recommendation Overview AAP’s new safe sleep recommendations were published on October 2011 2. Recommendations target the creation of a safe sleeping environment for infants to prevent infant sleep death from a variety of causes. The recommendations are divided into 3 levels. – Level A – based on good, consistent scientific evidence – Level B – based on limited, inconsistent scientific evidence – Level C – based on consensus and expert opinion

8. AAP Recommendation Overview LEVEL A - Recommendations 2 Place infants on their back to sleep for every sleep time Use a firm sleep surface Do room-sharing without bed-sharing Keep soft objects, toys and bedding out of the sleep surface Get good and regular prenatal care Keep smoke away from infants during and after pregnancy Avoid alcohol and illicit drugs during and after pregnancy Breastfeed Offer a pacifier during all sleep times Avoid overheating Do not use cardio-respiratory monitors Expand the national campaign to reduce SIDS to focus on safe sleep environment and a reduction in all infant sleep death

9. AAP Recommendation Overview LEVEL B Recommendations 2 Immunize infants according to Centers for Disease Control and Prevention and AAP recommendations Avoid commercial devices marketed as methods to reduce SIDS Provide infant with supervised, regular “tummy time”

10. AAP Recommendation Overview LEVEL C - Recommendations 2 Healthcare professionals, hospital nursery staff, childcare providers should endorse the safe infant sleep recommendations from infant’s birth. Media and manufacturers should follow safe sleep guidelines in advertising and manufacturing. Researchers should continue to work to better understand the risk factors, causes and pathophysiological mechanisms for infant sleep death

11. Role for Hospitals Create Safe Sleep Policies for NICU & Well Baby Nursery Train staff Endorse and model – Supine Sleep Position – Educate families on safe sleep guidelines before discharge

12. An Important Caveat: Infants With Special Medical Needs The DPH SIDS Injury Prevention Program recognizes that caregivers of infants with special medical needs have circumstances that may prevent adherence to many of the safe sleep recommendations. As a result, we recommend: – Caregivers of infants with special medical needs consult their infant’s clinician on the safest sleep techniques for their child. AND – Caregivers talk to their infant’s clinician about safely transporting their infant as babies often fall asleep while riding.

13. Georgia Data Georgia Infant Mortality Rate (2002-2006) = 8.24 3 Georgia Sudden Infant Death Mortality Rate (2002-2006) =.90 3 Public Health Districts with the Highest Infant Mortality Rate including Sleep- Related Deaths (*IMR – Infant Mortality Rate) Public Health District Counties # of SIDS Deaths IMR* for SIDSTotal IMR Clayton, Cobb- Douglas, Fulton Fulton, Douglas, Cobb, Clayton 421.4911.8 West Central Muscogee, Chattahoochee 151.4015.8 SouthLowndes71.7117.5 East CentralRichmond142.1615.1 Source: Chapple – McGruder, T, et.al. From Preconception to Infant Protection. Georgia Department of Public Health, Maternal and Child Health Program, Office of Epidemiology, March 2012, p. 34-35

14. Georgia Data Georgia’s Office of the Child Advocate’s preliminary data from 2010, indicates 100% of the 202 infant-sleep related deaths in Georgia had 1 or more risk factors related to unsafe sleep environment. The highest percentage of risk factors related directly to sleep location, sleep position and bed-sharing: – 84% of infants were not found in a crib – 75% of infants were not found on their back – 58% of infants were sharing a sleep surface

15. DPH SIDS Injury Prevention Program Goal The goal of the program is to build the capacity of district and local health departments to reduce the rate of injury and death among infants from birth to 365 days old.

16. DPH SIDS Injury Prevention Program Upcoming Actions Georgia Crib Match Program (GCMP) Restructure – Ending old GCMP effective October 30, 2012 – Starting new GCMP by November 2012 – Restructured program will target 6 cluster areas of highest infant mortality around the state (See: Data Resources, DPH, MCH, Infant Mortality Report) Infant Safe Sleep Training Update – Available to all counties and community organizations – Mandatory for those that participate in the GCMP – Offered in-person and via video interactive conferencing (VICS) Injury Prevention Toolkit – Information pertains to birth to 365 day old age group – Information focuses on the top 10 causes of injury – Available to all counties and community organizations

17. DPH SIDS Injury Prevention Program Future Directions Offering safe sleep and injury prevention training via the Internet Offering continuing education credits for nurses, certified health educators and social workers Engaging community members via social media Making select information available on DPH website for community members Establishing periodic SIDS and injury prevention bulletins

18. Resources Back to Sleep Campaign www.nichd.nih.gov/sids/ American Academy of Pediatrics (AAP) www.aap.org/ www.healthychildren.org National SUID / SIDS Resource Center www.sidscenter.org/ Healthy Child Care America www.healthychildcare.org/sids.html Centers for Disease Control and Prevention www.cdc.gov/Features/SidsAwarenessMonth/

19. Data Resources State of Georgia, Office of the Child Advocate (state child death data) http://oca.georgia.gov/annual-reports State of Georgia, Georgia Department of Public Health Maternal and Child Health Section (state infant mortality report) http://www.health.state.ga.us/publications/reports.asp

20. Online Training Continuing Education Credit Program on SIDS Risk Reduction Target: Nurses and Pharmacists http://www.nichd.nih.gov/SIDS/sidsnursesce.cfm Reducing the Risk of SIDS in Childcare Target: Childcare Providers and Other Caregivers http://www.healthychildcare.org/sids.html

21. References 1.Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHHD). Safe to Sleep Public Education Campaign. (n.d.). Retrieved from National Institutes of Health website: http://www.nichd.nih.gov/sids/ 2.Task Force on Sudden Infant Death. (2011) SIDS and Other Sleep-Related Infant Deaths: Expansion of Recommendations for a Safe Infant Sleeping Environment. Pediatrics, 128(5), 1030-1039 3.Chapple – McGruder, T, et.al. From Preconception to Infant Protection. Georgia Department of Public Health, Maternal and Child Health Program, Office of Epidemiology, March 2012, p. 34-35

22. Questions?