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Safe Sleep for Infants

Nurses can help new parents understand how to lay baby safely down to sleep.

Linda Newhouse, MSN, RNC, WHNP, was using a sleep sack with her own babies long before it became chic. She didn't need nursing credentials to know, as a first-time mom, that there is nothing more precious than a soundly - and safely - sleeping baby.

"Babies are always kicking off blankets and I worried," recalled Newhouse, whose oldest child turned 40 in June of this year.

At Riverside Methodist Hospital in Columbus, Ohio, where Newhouse is the advanced practice nurse/educator for Women's Health Services, she couldn't be any more passionate about raising awareness for infant sleep safety - among parents and the nursing staff alike.

The hospital, considered a leader in maternity care, began in 2010 distributing free sleep sacks for every baby born in its well-baby nursery as part of its Safe Sleep initiative to reduce the risk of Sudden Infant Death Syndrome (SIDS) and other infant-related sleep deaths.

"I think the most important thing a parent can do is to feel confident that you are putting your baby to sleep in as safe an environment as possible," Newhouse said.

Expanded Guidelines

While deaths from SIDS have declined dramatically since the American Academy of Pediatrics recommended all babies should be placed on their backs to sleep in 1992, sleep-related deaths from other causes, including suffocation, entrapment and asphyxia have increased.

In an updated policy statement and report, the AAP expanded its guidelines on safe sleep for babies, with additional information regarding what parents need to know before putting their babies to bed. The policy statement, "SIDS and Other Sleep-Related Infant Deaths: Expansion of Recommendations for a Safe Infant Sleeping Environment, and an accompanying technical report, was released in October 2011 at the AAP national conference and Exhibition in Boston, and published the November 2011 issue of Pediatrics.

According to AAP's, the policy statement and technical report provide global recommendations for education and safety. The additions to the recommendations include:

No co-sleeping with infants. 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 and entrapment.

The previous guideline of placing infants on their back to sleep is still the best SIDS prevention, and the new guidelines supplement that recommendation.

According to the Center for Disease Control and Prevention, SIDs is the leading cause of death among infants ages 1-12 months, and is the third leading cause overall of infant mortality in the U.S.

Although the overall rate of SIDS in the U.S. has declined by more than half since 1990, rates for non-Hispanic black and American Indian/Alaska Native infants remain disproportionately higher than the rest of the population. And preventing SIDs remains an important health priority.

Safe Sleep Initiative

With more than 6,500 births a year, the number of babies leaving Riverside with a Halo SleepSack - which the hospital describes as a wearable blanket that replaces dangerous loose bedding in the crib that can cause accidental suffocation - is increasing with each passing day.

Based in Minneapolis, Halo Innovations was founded by William Schmid in 1994, three years after he lost a daughter to SIDS. The company's mission is developing products that set new standards for the safety and improved health of sleeping infants and bringing peace of mind to one's home.

According to Riverside's website, the sleep sack giveaway is part of a broader effort that began in 2007 by the nursing staff to practice and promote safe sleeping positions and environments for newborns. The hospital launched its Safe Sleep initiative after participating on a countywide task force formed in response to 57 infant-related deaths in Franklin County between 2000 and 2003.

As a result, according to the website, Riverside Methodist adopted a "back to sleep" policy - placing babies on their backs instead of their sides. Additionally, nurses began removing blankets and toys from bassinets and educating families about safe sleep practices.

"We know that the safest way for babies to sleep is alone in their cribs, on their backs, without blankets, toys or side bumpers," Newhouse said. "In six months, we changed the entire culture of the hospital to employ these practices, with our nurses serving as powerful role models."

Newhouse conceded it was initially difficult for nurses, who were so used to putting babies down on their side, to put them on their back.

"It was a hard habit to break," she said.

Newhouse is a member of the Franklin County Back to Sleep Task Force. She made a podium presentation on safe sleep at the first annual Cribs for Kids conference.

Heartbreaking loss

As chair of the New Jersey Metro Regional Review Board, which collects data on infant and child deaths in New Jersey for the CDC, Elizabeth Hodgson understands the devastation families experience when a baby dies from an unexpected cause.

In a November 2011 press release updating infant sleep safety and SIDS risk reduction from Children's Hospital of New Jersey (CHoNJ) and the AAP, Essex County, NJ, was found to have the highest number of unexpected infant deaths during sleep, which includes deaths from SIDS, from suffocation due to unsafe bedding and from accidents during co-sleeping with a parent or a sibling.

"It breaks my heart every month to see this report and know that every parent on that list would do anything to get that child back," Hodgson, medical director of the Metropolitan Regional Child Abuse Diagnostic and Treatment Center at CHoNJ, located at Newark Beth Israel Medical Center, Hodgson states in the release. "If we can increase awareness about the hazards, young lives can be saved and tragedy prevented."

To assist families, the CHoNJ introduced the "Rock-a-Bye-Baby" Safe Sleep Campaign. Since its inception in October 2011, at least 200 families have received safe sleep counseling through the Pediatric Health Center, according to Maryellen Wiggins, MSN, RN, ACRN, NE-BC, assistant vice president of patient care at the facility. A nurse since 1979, she's been at Beth Israel, part of the Barnabas Health system, for the last 14 years.

"We are always learning," she said, referring to recommendations, which have changed over the years.

A mother of two, ages 25 and 27, Wiggins noted, "My babies slept on their belly and their side. .. That was the recommendation."

Today, she said the thrust is all about education, and keeping the information uniform is critical. At Beth Israel, she said as many as 100 registered nurses are providing education at any given time.

The Rock-A-Bye-Baby project involves a sleep practices/risks questionnaire given to families within infants under the age of 1 in their care. The questionnaire is followed up by education about safe practices.

In addition, residents and staff at CHoNJ receive annual training by the NJ SIDS Center about safe sleep/sleep risks.

Welcomed Advances

Cindy Scharr of Concord, PA, is a mother of three girls, ages 29, 27, and 23. Inside the "baby box" belonging to her youngest, is the instructions she received from the pediatrician for newborn care.

"Lay your infant on the right side or abdomen after feeding and elevate the head of the crib or bassinet mattress," read the instructions, which Scharr followed to a "t." "Now, it's just the opposite," she recognized . "But things change, and hopefully for the better. There are always new advances."

Looking back, Scharr said she depended on the experts.

"When I had my first child, I had no idea what to do with this 8 pound 9 ounce little person," she said. "The one thing you do know is that everything you do as a parent affects them. It's a daunting thing."

As she looks ahead to one day being a grandmother, Scharr said, "I am going to have to learn all over again."

And that's more than OK with her.

"You want what is best for the baby."

Rose Quinn is a frequent contributor to ADVANCE. 

Articles Archives

My one huge problem with this article: there have been no reliable studies to show that co-sleeping with sober parents is harmful or increases risk of SIDS yet there have been numerous reliable studies showing the many benefits of co-sleeping. Perhaps you should have mentioned the World Health Organization's support of co-sleeping instead of only one agency's opinion which isn't based on facts.

Tana  Goodwin June 12, 2012
Irving , TX


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