SIDS? Not SIDS?

A New Look at Sudden Infant

Death Syndrome

Explanation of Concepts and

Definitions • Sleep Position:

There are generally three positions in which babies sleep: 1)

supine, i.e. on the back, 2) prone, i.e. on the stomach, and 3)

on the side. The supine sleep position is promoted by AAP

and the Cribs for Kids Campaign.

• Sleep Surface:

The surface on which a baby is placed for sleep constitutes

a sleep surface. Ideally, infants should sleep in a crib on a

firm mattress that meets current federal safety standards.

• Soft Bedding:

This can include any type of bedding other than a firm, tight-

fitting mattress in a crib that meets current safety standards.

Examples include: pillows, quilts, comforters, sheepskins,

stuffed toys, blankets, waterbeds, soft mattresses,

sofas, and other soft products.

Explanation of Concepts and

Definitions • Bedsharing:

When an infant sleeps with others in an adult bed.

• Co-sleeping:

Involves the infant sleeping in its own space, such as in a

safety-approved crib, but adjacent to the parent or

caregiver.

• Roomsharing:

When the baby sleeps in its own crib in the same room as

the parents.

• Safe Sleep Environment:

This involves a combination of proper sleep position

(supine) on a firm mattress, in a safety-approved crib,

with no soft bedding or blankets in the crib, in a

smoke-free environment.

autopsy

examination of the scene of death

review of the case history

•

•

•

The sudden death of an infant under one

year of age which remains unexplained

after the performance of a complete

post - mortem investigation including:

Sudden Infant Death Syndrome

ICD-9 Definition

The umbrella under which falls:

• Sudden Infant Death Syndrome • Accidental Suffocation

• Entrapment • Asphyxia • Neglect • Homicide

• Hypothermia/hyperthermia • Metabolic disorders

• Unknown

Can be explained or unexplained; natural/undetermined

SUID: Sudden Unexpected

Infant Death

The overwhelming majority of babies who

die from SUID/SIDS are discovered in an

unacceptable sleep position or sleep

location!

FACT!

• FACT: Half of the infants in the U.S.

who die from sudden unexpected death

do so while sleeping with their parents

– Bedsharing and infant death is very different in

the U.S. than it is in other cultures

– If babies routinely sleep with their parents in

other cultures, they:

• Use a firm mat on the floor

• Have a separate mat for the infant

• Do not use soft bedding

Bedsharing and Infant Death

Triple Risk Model

to Explain SIDS

Critical

period of

development

Underlying

Vulnerability

Modifiable

Pre- and

Post-Natal

Environmental

Stressors

HIGHEST

RISK FOR

SIDS

Possible

Brainstem

Abnormality

(Filiano and Kinney, modified)

First 6 months

Prone/Side

Sleep Position

Nicotine

Exposure

Soft

Bedding

Overheating

Bed sharing

Trachea

Trachea

Esophagus

Esophagus

Anatomy and Physiology

In the supine position, the trachea lies on top of the esophagus. Anything regurgitated or refluxed from the esophagus has to go against gravity to be aspirated into the trachea.

Permission to use figure granted by First Candle/SIDS Alliance.

Babies at Risk

• African American babies (2x greater risk)

• Mothers who smoke during pregnancy (3x greater risk)

• Babies who breathe secondhand smoke (2.5x greater risk)

• Babies who sleep on their tummies (5x greater risk)

• Babies put on their tummies to sleep who usually sleep on their backs

(18-20x greater risk)

• Babies who sleep with parent(s) in adult bed (40x greater risk)

Bed Sharing with Siblings, Soft Bedding

Increase SIDS Risk −

Chicago Infant Mortality Study, Pediatrics, May, 2003

• Sleeping on soft bedding:

increased SIDS risk 5 times

• Sleeping on the stomach:

increased SIDS risk 5 times

• SIDS victims were 5.4 times more likely to

have shared a bed with other children.

• Sleeping on the stomach on soft bedding:

increased risk of SIDS 21 times

SIDS is NOT Suffocation

Although SIDS is different from

suffocation, all the measures we use

for SIDS risk reduction also help to

prevent accidental deaths such as

positional asphyxia, overlay, and

entrapment.

These are 100% PREVENTABLE

deaths!

Unsafe Sleep Environment:

Soft Bedding

Unsafe Sleep Environment

What is wrong with this picture?

Jennifer Lopez’s nursery

What is wrong with these pictures?

Unsafe Sleep Environment

April 15, 1992

The American Academy of Pediatrics recommended that healthy infants:

“when being put down for sleep,

be positioned on their back or side.”

December 1996

A revised statement by the AAP stated:

“Back is best.”

November 1998

Cribs for Kids® begins in Pittsburgh, PA.

October 2005

AAP recommends:

“Separate but proximate sleeping environment.”

October 2011

AAP Revised Recommendations Released

Back to Sleep Timeline

SIDS Death Rate and Sleep Position 1988 – 2003

(per 1000 Live Births)

NEW AAP POSITION STATEMENT

OCTOBER 2011

• Always place your baby on his or her back for every sleep time.

• Always use a firm sleep surface. Car seats and other sitting devices are not

recommended for routine sleep.

• The baby should sleep in the same room as the parents, but not in the same

bed (room-sharing without bed-sharing).

• Keep soft objects or loose bedding out of the crib. This includes pillows,

blankets, and bumper pads.

• Wedges and positioners should not be used.

• Pregnant woman should receive regular prenatal care.

• Don’t smoke during pregnancy or after birth.

• Breastfeeding is recommended.

• Offer a pacifier at nap time and bedtime.

• Avoid covering the infant’s head or overheating.

• Do not use home monitors or commercial devices marketed to reduce the risk

of SIDS.

• Infants should receive all recommended vaccinations.

• Supervised, awake tummy time is recommended daily to facilitate

development and minimize the occurrence of positional plagiocephaly

(flat heads).

Additions to AAP Position Statement

OCTOBER 2011

• 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

or entrapment.

Safe-Sleep Survival Kit $74.99

Contact Information

Regina Washington

REMSA/Safe Kids Washoe County

450 Edison Way

Reno, NV 89502

Office - (775) 858-5700, ext. 3139

Fax – (775) 858-5735

Email – rwashington@remsa-cf.com

Website – www.safekidswc.com