Sudden Infant Death Syndrome New recommendations

1 40 TEXAS CHILD CARE / WINTER 2008he American Academy of Pediatrics has pub-lished new SIDS prevention recommendationsthat can affect child care providers who care forinfants. These include new guidelines on side-sleeppositions, pacifiers, soft bedding, and plagiocephaly(misshapen or flattened skull).What is SIDS?SIDS is the leading cause of Death in infants in theUnited States 5,000 to 6,000 deaths a year. Almost 20percent of those deaths occur in child care is defined as the Sudden Death of a previouslyhealthy baby younger than 1 year old. It s identified asthe cause of a Death that is unexplained after a thor-ough case investigation including autopsy, Death sceneinvestigation, and medical history. SIDS is a diagnosisof exclusion. This means that a SIDS diagnosis is madeonly after all factors including injury and illness thatcould contribute to the Death are ruled out. SIDS has been described as a Syndrome in searchof a cause.

2 SIDS rates have dropped dramaticallysince 1992 when parents and other caregivers wereurged to place infants on their backs for sleep. Butunfortunately, the Syndrome is complex and notalways caused by the same factors or conditions. Causes of SIDSIn the medical science world, a theory (an educatedand considered guess) must be researched, studied,and formalized. The theory might be based on theevaluation of medical records, demographics, andanecdotal records. In 2006, researchers determined that abnormalitiesin a part of the brain that controls breathing andarousal likely play a role in SIDS. Other currentresearch points to heart disturbances and geneticdefects and examines environmental factors like theimpact of pacifiers and ceiling fans. At the same time, experts have discounted severalearly causation theories including suffocation, chok-ing, birth injury, and infection. After years of study, researchers have developed atriple-risk model to describe the factors that cancause SIDS.

3 Today, most experts believe that aninfant at a critical developmental stage(the first sixmonths of life) must have a biological vulnerability(an undetectable brain, heart, or genetic defect, forexample) and an environmental stressor(soft bed-ding, for example) for SIDS to factors for SIDSW hile any Infant can die from SIDS, several behav-iors and conditions seem to increase the and physicians have identified risk fac-tors to guide the care of infants. However, these fac-tors do not account for all SIDS deaths and, indeed,some babies seem to be unaffected by that put babies at greater risk for SIDS include the following: Age and sex male babies younger than 6 monthsare most vulnerable; Race Black and American Indian babies are attwice the risk due to genetic and behavioral factors; Premature birth and low birth weight; Sudden Infant Death SyndromeNew recommendations TTEXAS CHILD CARE / WINTER 200841 Sleep position stomach and side sleeping posi-tions put babies at high risk; Sleep environment sharing a bed, soft surfaces,and fluffy bedding increase risk; Cold weather there are more SIDS deaths in thewinter months; Overheating; Second-hand smoke; Unaccustomed tummy sleeping if the infantusually sleeps on the back and then is placed onthe tummy for sleep, there is as much as an 18times greater risk.

4 And Specific maternal characteristics and behaviors amother s young age, smoking, binge drinkingduring pregnancy, and limited or absent prenatalcare are all identified as putting babies at recommendationsThe AAP has issued the following recommendations :Sleep positions: Multiple studies have demon-strated that side position for sleep places infants athigher risk for SIDS than the preferred back (supine)position. Side sleep positions are unstable; the infantis likely to flop to the unaccustomed prone (tummy)position. Babies at highest risk for SIDS (18 percenthigher than consistent back sleepers) are those whousually sleep on the back but are placed on thetummy or roll onto the tummy for typically begin comfortably and consistentlyto roll from back to tummy by 6 months of the risk of SIDS diminishes after this devel-opmental milestone is reached. The AAP says that youdon t have to shift sleeping babies who roll to theirtummies if all other risk factors have been often voice concern about the danger ofchoking or aspiration when babies sleep on theback.

5 Healthy babies who spit up will not shows that there is no increased risk ofaspiration for babies who sleep on their backs. Pacifiers: Studies consistently demonstrate theprotective effect of pacifiers. The specific mecha-nisms involved in this protection are unknown, butit s clear from the research that there is a reductionin the risk of SIDS even when the pacifier falls outof the mouth when the baby falls are downsides, however. These include den-tal malocclusion (for toddlers who don t give up thepacifier by age 3), otitis media(twice the risk of earinfection), gastrointestinal infections, and oralCandida (likely related to lax sanitation practices). If the Infant is being breastfed, it s best to waituntil the baby is at least 1month old before introduc-ing a pacifier to help ensure the firm establishmentof breastfeeding. If the baby refuses the pacifier,don t force it. If the pacifier is useful, use it whenthe baby is falling asleep.

6 Don t reinsert it after thebaby is asleep, don t coat it with sweetener, anddon t put it in your mouth. Clean and replace paci-fiers bedding: Infants who die from SIDS aremore likely to be sleeping in a prone position (facedown) and have soft mattresses and bedding thatcover the nose and baby s crib should be safety-approved with slatsspaced not more than 23/8inches apart. The mattressshould fit snugly in the crib and have a tight-fittingsheet. Chairs, sofas, water beds, cushions, and adultbeds are not safe sleep surfaces for bedding pillows, bumper pads, blankets,quilts, and plush toys can impair the baby s abilityto breathe if they cover the face. Wearable blanketsor sleep sacks are safer than blankets if extrawarmth is needed. If you use a blanket, use the recommended feet-to-foot technique. Place the baby s feet against the footof the crib and tuck the blanket under the baby sarms and along the sides and foot of the crib.

7 Thistechnique keeps the baby from scooting under theblanket and covering the AAP discourages the use of wedges and posi-tioners. Bumper pads are not : Because a newborn s skull issoft and pliable, back sleeping can contribute to aflattening on the back of the head (positional plagio-cephaly). This condition is generally temporary. AsWhen a baby is unresponsive, immediately putinto action your program s medical emergencyplan. Initiate Infant CPR or rescue breathing and call 911. Get help to care for the other children in the group. Contact the child s parents or other emergencycontact. Call the parents of the other children in your care. Do not disturb the scene. Notify child care licensing and your aid for unresponsive infantsTEXAS CHILD CARE / WINTER 200842babies grow and become more active, their skullsround out. Babies spend much of their time in bouncy seats, Infant carriers, strollers, and car safety seats. Each ofthese exerts constant pressure on the back of thehead, especially in the youngest babies who tend tofall asleep in these you place an Infant on the back to sleep,alternate the direction the head faces, causing thebaby to look left or AAP recommends supervised tummy time forawake babies and holding awake babies upright tohelp decrease the constant pressure on the back ofthe head.

8 Tummy time is essential to musclestrength and development. Interact with babies dur-ing tummy time for short periods three to four timesa day, increasing the amount of time gradually asthe baby s strength increases. Safe sleep practicesBecause the safety of children is your highest priori-ty, it s wise to formalize your program s policies forsafe sleeping practices. Share these procedures withfamilies, and ask for a parent s or guardian s signa-ture to reinforce cooperation (and protect you in thecase of SIDS). A formal policy will help maintainquality standards, guide teacher training and expec-tations, and reassure parents that their baby s healthis the following guidelines in establishing safesleep policies for your program. Put babies to sleep on the back. The AAP andlocal health authorities have brochures andposters reinforcing Back is best. Obtain a physician s note for non-back sure the directive describes the prescribedsleep position, the reason for not using the backposition, a time frame for the directive, and thephysician s signature.

9 Keep a copy of the note inthe baby s file and post one on the baby s crib. Maintain a smoke-free environment. Use safety-approved cribs and firm mattresses. Keep the crib free of anything but the baby. If you use blankets, practice the feet-to-foot rule. Sleep only one baby per crib. Maintain room temperature that prevents over-heating (comfortable for a lightly clothed adult). Ifa baby is sweating around the neck or face, itprobably means fever and illness. When this hap-pens, use fewer covers not more. Monitor sleeping babies. Schedule tummy time for babies when they areawake. Avoid apnea monitors and other marketed SIDS-prevention devices. They are costly and unlikelyto prevent a SIDS for Our Children: National Health and SafetyPerformance Standards: Guidelines for Out-of-HomeChild Care Programs, Second Edition. 2002. ElkGrove Village, Ill.: American Academy Academy of Pediatrics. Healthy ChildCare America Back to Sleep Institute of Child Health and HumanDevelopment.

10 Back to Sleep place of Death is considered the Death SIDS is a diagnosis of exclusion, it s nec-essary for officials to conduct a complete investi-gation so they can rule out other causes. Expectthe following procedures: Many people police, child care regulators,medical personnel, and parents will ask for thesame information. Assume everyone is askingfor information so they can help not becausethey think you are to blame. Police investigators will ask for informationabout the baby s health and behavior. They willtake photos and will want to see the environ-ment as it was when the baby died. Don t cleanup or neaten the area. Your licensing agency will ask questions aboutthe event. A SIDS Death is not a reason forlicense revocation. The coroner or medical examiner will compile adetailed medical history and conduct an autopsy. The cause of Death won t be determined untilafter a Death scene investigation and to expect if a baby diesPUT BABIES TO SLEEPON THE BACK.