Reducing the Risk of SIDS

Community rallies to prevent leading cause of infant mortality

 

Community members – doctors, hospitals, non-profit organizations and civic groups – are rallying to prevent SIDS (Sudden Infant Death Syndrome), a leading cause of death for infants through their first year of life and particularly between ages 2 to 4 months. SIDS is a sleep related disorder that’s a subcategory of a broader definition taking hold nationally called SUIDS (Sudden Unexplained Infant Death Syndrome).

“SIDS is the most preventable cause of infant mortality, and after the first month of life, is one of the leading causes of infant mortality,” said Carol Brady, executive director for the Northeast Florida Healthy Start Coalition. “We know what to do, and if the families would just do it, we could change that.”

Although the number of infant deaths due to SIDS appears to be declining, the rate of infant deaths in Jacksonville is higher than that for the rest of the state; and, similarly, the state infant mortality rate (IMR) is higher than that for the nation. Perhaps even more disturbing, the infant mortality rate is higher among blacks and other minority populations that it is with whites.

 

Back to Sleep

The rallying cry, “Back to Sleep,” has been in effect since 1992 when the American Academy of Pediatrics implemented a campaign for babies to sleep on their backs. That simple mantra and all those spreading its awareness has led to a decline in the number of SIDS deaths by half of what it was prior to the campaign. But, according to Don Garrison, M.D., NICU medical director at Shands Jacksonville, there are disparities between black and Native American Indian populations.

“I believe that minority populations experience about two and a half times as many incidences of SIDS as white populations,” said Dr. Garrison. “Each year, there are about 55 or 56 out of 100,000 SIDS deaths nationally but minority populations have twice that number. More than half of our birth population at Shands is black.”

Getting the word out and generating awareness is motivating the Northeast Florida Healthy Start Coalition (NEFHSC) and area hospitals to form safe sleep partnerships with other area agencies and even civic groups like Rotary Clubs that spearhead campaigns to educate caregivers, particularly older caregivers who learned the old myth of safe sleep: that babies should be placed on their stomachs to sleep.

Shands Jacksonville teams with NEFHSC, WIC (Women, Infants and Children) and the March of Dimes among others through its internal program, Little Miracles, to educate new parents about well-baby care. Aimed at reducing the high infant mortality rate in Jacksonville and completely underwritten by the hospital, Little Miracles throws three city-wide baby showers a year for new moms that “showers” them much needed information and infant supplies such as bassinets, key to safe sleep practice.

Donna Ghanayem, R.N., heads the Shands new mothers program. “What’s new in the Little Miracles program and in parenting education city-wide is the inclusion of fathers as caregivers. Shands is now teaching dads how to be dads through programs called Daddy Boot Camp and Maternal Gate Keeping. Daddy Boot Camp is a class for dads who bring their babies with them to learn the fundamentals of well-baby care. Maternal Gate Keeping teaches men that when Mom asks for help, it’s not nagging but a sincere request for the father to participate in child care.”

Daddy Boot Camp is taught by six or seven dads. One of the instructors is Jack Johnson with NEFHSC. “It’s really refreshing because he’s a dad who’s also in the military. We’re recruiting more dads to teach Maternal Gate Keeping and Daddy Boot Camp. If they’re interested, they should call Claudette Christopher at 244-4843,” said Ghanayem.”

 

Know the Risks

“We don’t know what causes SIDS,” said Luis Anderson, M.D., Chief of Pediatrics at Flagler Hospital. “A baby can still die of SIDS sleeping face up but comparing cases between babies sleeping face up with those sleeping on their stomachs, there seems to a drastic decline in SIDS cases when babies are on their backs.”

Certain babies do have a higher risk of SIDS: babies who are premature; who have a low birth weight; who are born to mothers who smoke; who are born to mothers who didn’t get prenatal care; and babies born to mothers who gave birth to multiple babies (twins and triplets).

“These babies have a slightly higher risk of SIDS,” said Dr. Anderson, who explains that SIDS is always a diagnosis of exclusion. “When everything else is ruled out, then the death is attributed to SIDS. As a pediatrician, I make it a habit to discuss with all mothers that the babies should be sleeping face up and the nursing staff will also discuss ways to prevent SIDS with new mothers. Before they leave the hospital, moms are instructed to make sure their baby is sleeping on her back. Even if the baby is sleeping on her tummy in front of you, you won’t know because there are no signs of SIDS.”

Dr. Anderson cautions mothers not to smoke at all while they’re pregnant or around the baby when it’s a newborn; to make sure the sleep environment is safe by using a firm mattress with a good-fitting sheet, and that there’s no “stuff” such as toys and thick blankets in the crib.

New findings point to other, simple ways to promote safe sleep. The use of a pacifier will reduce the incidence of SIDS, says Dr. Anderson, “but, we don’t know why.”

Citing a three-year (1997-2000) Los Angeles, Calif. study with 185 mothers whose babies died of SIDS compared with 312 mothers of children who lived, Dr. Anderson says that there’s also a reduction in SIDS when there’s a fan or an open window in the room circulating fresh air. The theory is, he says, that when babies breathe out carbon dioxide, they re-breathe the noxious gas when they’re sleeping on their stomach. Statistics show, he says, that if there’s a fan on in the room there’s a correlating 72 percent reduction in SIDS, and with a window, there’s a 36 percent reduction.

“Safe sleep needs to be practiced until the baby can roll over on its own,” said Brady. “There are lots of reasons why SUIDS happens. The safest place for a baby is in her own bed such as a bassinet right next to mom. And, the bed should be clear of all the stuff like stuffed animals that everybody likes to buy babies. It’s similar to your own bed – you don’t sleep with all the decorative pillows on the bed. Instead, you clear it at night and place them back on the bed in the morning.”

 

 

Spreading the Word

Meg Folds, youth program director for Leadership Jacksonville and San Marco Rotary Club President, helped launch the “This Side Up” SIDS awareness campaign when she first took the mantle of president in April 2008.

“What we did first was to figure out how we can make an impact and then we began fund-raising,” she said. “Since infant mortality is such a big issue here – we’re like a third world country in that respect – we thought we could make the biggest impact through education about safe sleep habits.”

Rotary Club members including area physicians distribute T-shirts with “This Side Up” printed on the front as well as door hangers with safe sleep guidelines so that the safe sleep message is consistent throughout the community.

            “We wanted to distribute the T-shirts and door hangers to Shands because of the great number of babies born there and because the hospital has a tremendous cross section of need. We wanted something that was really cute that wouldn’t be thrown away. The door hanger hanging on a nursery door will get the message to other caregivers. Our ultimate goal is to supply all 12,000 to 16,000 babies that are born each year in Duval and surrounding counties with a packet,” said Folds.

Providing a consistent message for parents and other caregivers is extremely important in preventing SUIDS, says Brady. “Parents of new babies are overwhelmed with information and are often sleep deprived. We want to prevent any confusion about what they can do to prevent SUIDS.”

Getting the message across to parents is just one prism in the spectrum. Other caregivers such as nannies, baby sitters and grandparents also need to know safe sleep practices.

“Unfortunately, surveys have shown that about a fourth of infant day care centers still place infants on their stomachs to sleep. This is something that mothers can check on when they take them to the day care center. It’s something proactive that they can do,” Dr. Garrison said.

NEFHSC also allies with several community service agencies that offer programs for families who may not have the resources to provide babies a safe place to sleep. The AME Church Ministerial Alliance through its program, The Moses Project, distributes bassinets and safe sleep advice.

“This allows them to communicate that they old way is not the right way,” said Brady. “The Moses Project allows education of older caregivers and Cribs for Kids – Healthy Mothers, Healthy Babies of Northeast Florida offers small portable cribs for families who need them. The important point is that there are community programs in place that can help new parents.”

 

Sleep Safe

Although the terminology is confusing – SUIDS or SIDS – the risk factors for SIDS are exactly the same for other sleep related deaths.

“There’s still this concern that the baby will choke if they’re on their back and that’s not so,” said Dr. Garrison. “And, there’s also a fallacy about putting babies on their sides to reduce risk. This actually creates a higher risk of SIDS than if they’re on their abdomen because a baby can roll over to her stomach.”

Preventing the baby from becoming overheated will also reduce the incidence of SIDS, and Dr. Garrison suggests using sleep sets so that loose clothing or blankets won’t accumulate around the baby. He also points out that contrary to popular belief, immunizations are not associated with an increase in SIDS, and that although breast feeding doesn’t affect the incidence of SIDS, breast feeding in general decreases infant mortality.

“All of our pediatric faculty and nurse practitioners, and all the pediatricians and hospitals in the city are very much aware of everything that we know and are aligned with these recommendations,” he said. “I believe that socioeconomic factors seem to play a larger role here than in the rest of Florida (SIDS and other infant problems). We want to continue to dispel the outdated myths surrounding SIDS and let parents know that safe sleep for their babies is very achievable.”