Infant Safe Sleepand the

Safe to Sleep CampaignGeorgia Hospital Association MeetingOctober 15, 2012Seema Csukas, MD, PHDDirector, Maternal and Child Health SectionGeorgia Department of Public Health

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

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

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.

Safe to Sleep Campaign Materials

https://www.nichd.nih.gov/sids

Safe to Sleep Campaign Materials

https://www.nichd.nih.gov/sids/

AAP Recommendation Overview

• AAP’s new safe sleep recommendations were published on October 20112.

• 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

AAP Recommendation OverviewLEVEL A - Recommendations2

• 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

AAP Recommendation OverviewLEVEL B Recommendations2

• 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”

AAP Recommendation OverviewLEVEL C - Recommendations2

• 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

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

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.

Georgia Data•Georgia Infant Mortality Rate (2002-2006) = 8.243

•Georgia Sudden Infant Death Mortality Rate (2002-2006) = .903

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 SIDS

Total IMR

Clayton, Cobb-Douglas, Fulton

Fulton, Douglas, Cobb, Clayton

42 1.49 11.8

West Central Muscogee, Chattahoochee

15 1.40 15.8

South Lowndes 7 1.71 17.5East Central Richmond 14 2.16 15.1Source: 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

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

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.

DPH SIDS Injury Prevention ProgramUpcoming 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

DPH SIDS Injury Prevention ProgramFuture 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

Resources

• Back to Sleep Campaignwww.nichd.nih.gov/sids/

• American Academy of Pediatrics (AAP)www.aap.org/ www.healthychildren.org

• National SUID / SIDS Resource Centerwww.sidscenter.org/

• Healthy Child Care Americawww.healthychildcare.org/sids.html

• Centers for Disease Control and Preventionwww.cdc.gov/Features/SidsAwarenessMonth/

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 HealthMaternal and Child Health Section (state infant mortality report)http://www.health.state.ga.us/publications/reports.asp

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

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

Questions?