Safe Sleep

1. Safe Sleep

2. Objectives • Increase understanding of sleep-related deaths • Describe the Triple Risk Model • Identify modifiable/non-modifiable risks • Understand meaning of “Alone, Back, Crib” • Motivate integration of Safe Sleep into nursing • practice

3. SIDS Sudden Infant Death Syndrome SUID Sudden Unexpected Infant Death ASSB Accidental suffocation and strangulation in bed

4. All are terms to describe sleep-related deaths of a baby younger than 1 yr of age

5. Chances of these happening go down with a few simple changes in how babies sleep

6. 1983-1992 5,000-6,000 SIDS deaths/yr 1992 American Academy of Pediatrics recommended infants <1 yr be placed to sleep on back or side 1996 Recommendation changed to sleep only on back

7. Since babies have been put to sleep on their backs SIDS deaths have ’d by 50%

8. However putting babies on their backs has not been enough to prevent sleep-related deaths

9. There are other risks Some are modifiable Some are non-modifiable

10. #1 #2 #3

11. #1 Vulnerable Infant Some babies are more likely to die from SIDS because of abnormal control of: - Blood pressure - Heart rate - Respiration - Chemoreception - Upper airway reflexes - Thermoregulation Non-modifiable Risk Factor

12. #1 Vulnerable Infant Prematurity and Low birth weight SIDS risk:  with  birth wt and  gestational age Non-modifiable Risk Factors

13. #1 Vulnerable Infant Race African American infants >2x more SIDS than Caucasian infants American Indian infants >3x more SIDS than Caucasian infants Non-modifiable Risk Factor

14. #2 Critical Developmental Period Rapid growth and development of brain in 1st year of life Autonomic function reorganization Learned protective behaviors Non-modifiable Risk Factor

15. #3 External Stressor/s We can’t control whether a baby is a “vulnerable infant” or whether a baby is in a “critical developmental period” However We CAN control external stressors ALL are modifiable

16. #3 External Stressor/s Second-hand Smoke

17. #3 External Stressor/s Follow ABC’s of Safe Sleep Alone Back Crib

18. Alone

19. The competition we’re up against

20. This is what we’re asking parents to do

21. NO Pillows Loose blankets Stuffed toys Bumper pads

22. This is no longer acceptable

23. A blanket can become a suffocation hazard If you need to use a blanket use it “Feet to Foot” Like this Not this

24. Yes! to Blanket Sleepers After 37 weeks and prior to discharge swaddling with a blanket during sleep is not recommended

25. Swaddling • 34-37 weeks gestation: • - Swaddle with one blanket below the arms • - If second blanket is needed for thermal support, • place it no higher than baby’s chest and tuck it • around crib mattress

26. What about the baby with poor upper body tone? May need to be swaddled from mid-arms down to help bring arms to midline

27. Good Rules of Thumb Room temperature should be comfortable for a lightly clothed adult ~ 72 degrees Dress baby in no more than one layer than you are dressed

28. A well-fitting hat is OK for thermoregulation for preterms This Not this Remove for sleep at 37 wks or prior to discharge

29. This might look cozy But it is DANGEROUS!

30. Danger of entrapment and suffocation Extremely high risk of death on couches and armchairs Parents should not feed their baby on a couch or armchair if there is a chance of falling asleep

31. Baby should sleep alone Baby may be in parent’s bed for feeding or comforting but should be returned to his/her own bed when parent is ready to return to sleep

32. Billboards in Milwaukee, WI “Your baby sleeping with you can be just as dangerous”

33. Alone but IN room with mother is best

34. Back

35. Every baby should be placed “back to sleep” Every sleep by Every caregiver for the 1st year of life

36. But babies sleep better on their stomachs! Yes, they do But that is why they are more likely to die!

37. Prone position can result in: ’d re-breathing of carbon dioxide • ’d stimulation of laryngeal receptors • causing apnea • ’d efficient loss of heat ’d arousal

38. What about spitting up? In prone position milk may pool in the hypopharynx *Less likely to choke in supine position*

39. Guidelines for premature infants born at < 34 weeks who are medically stable • By 32-34 weeks gestation: • Begin transition to supine sleeping in a flat • bed without nests, pillows or developmental • supports • By 34 weeks gestation or when • successfully weaned to an open crib: • Infant should sleep supine, without nests or • developmental supports and with head of bed flat

40. What about a baby with reflux?  head of bed does NOT  reflux  head of bed may result in baby sliding  and compromising airway However: - Do feed in an  position - Do hold in  position or keep head of bed  for 30 min after feeds

41. Exceptions to this? • Babies with life-threatening airway issues • (e.g. laryngeal cleft…) • Babies with impaired airway protective • mechanisms (e.g. paralyzed vocal cord…) • Babies with aspiration related to reflux • Babies awaiting anti-reflux surgery

42. What about positioning devices? None have been approved

43. But what about positioning devices for our < 32 wk preemies and sick babies? Yes! We can use them! Safe Sleep guidelines are for medically stable babies

44. What about delayed upper body development?

45. Upper body strength will be met with a total Tummy Time of at least 1hr/day Tummy Time when awake and alert

46. What about flat spots on a baby’s head?

47. Tummy Time helps to reduce flat spots • Changing the direction a baby sleeps in reduces flat spots • Flat spots usually resolve in a few • months after a baby learns to sit up

48. What about a bald spot? • Consider a bald spot on the back of a baby’s head • a sign of a healthy baby!

49. Once an infant can roll from • supine to prone and from prone to supine, • infant can be allowed to remain in the • sleep position that he or she assumes

50. Crib