SAFE SLEEP FOR INFANTS

1. SAFE SLEEP FOR INFANTS The Canadian Foundation for the Study of Infant Deaths National Office: 60 James Street, Suite 403, St. Catharines, Ontario L2R 7E7 Tel: 905-688-8884 Toll Free: 1-800-363-7437 Fax: 905-688-3300 Website: www.sidscanada.org E-Mail: sidsinfo@sidscanada.org

2. In Canada, babies continue to die of Sudden Infant Death Syndrome (SIDS) and in unsafe sleep environments Research suggests over half of these deaths could have been prevented Many believe these deaths are the result of lack of education and awareness Infant Deaths in Canada

3. Hear about SIDS and unsafe sleep practices from mothers that have lost a child Be introduced to behaviors that increase the risk of SIDS and unsafe sleep accidents Be introduced to practices and resources to help you reduce the risk of SIDS and unsafe sleep accidents for infants Discuss your role in reducing infant deaths Workshop Objectives

4. The CFSID is dedicated to reducing the rate of sudden and unexpected infant deaths and providing emotional support to those who are affected The Canadian Foundation for the Study of Infant Deaths

5. to deliver infant health and safety education through an extensive network of volunteers in communities across Canada to provide resources and services for all infant deaths including miscarriage and stillbirth with respect to peer support, public education and awareness to support Sudden Infant Death Syndrome (SIDS) related research CFSID Mandate

6. Who we are? Why we are here? Our mission and message? Some of our successes so far! The Ontario Safe Sleep Team

7. Sudden Infant Death Syndrome ICD-9 Definition The sudden death of an infant under one year of age which remains unexplained after the performance of a complete post - mortem investigation including: • autopsy • examination of the scene of death • review of the case history It is a diagnosis of exclusion

8. Caused by external suffocation Caused by vomiting and choking Caused by immunizations Child abuse or neglect Contagious Hereditary Predictable or completely preventable SIDS Is Not

9. Maternal smoking during pregnancy Exposure to second hand smoke Overheating Respiratory illness Sleeping on a soft surface Bed-sharing Soft bedding or stuffed animals in bed Increasing the Risk of SIDS

10. Tummy and side sleeping Substance abuse during pregnancy Teen mothers Mothers with late or no prenatal care Preterm infants Low birth weight infants Multiple births Additional Risks

11. Triple Risk Model to Explain SIDS First 6 months Critical period of development Prone/Side Sleep Position HIGHEST RISK FOR SIDS Nicotine Exposure Modifiable Pre- and Post-Natal Environmental Stressors Underlying Vulnerability Soft Bedding Possible Brainstem Abnormality (Filiano and Kinney, modified) Overheating Bed sharing

12. Risk factors don’t CAUSE SIDS, but are present in babies that die of SIDS Even babies with no risk factors present can die of SIDS SIDS cannot be completely prevented SIDS is nobody’s fault What You Should Know About These Risk Factors

13. Create a healthy lifestyle for you and your baby Avoid smoking and alcohol during pregnancy and while breast feeding Always provide a smoke free environment for your baby Smoking increases the risk of SIDS Healthy Lifestyle Choices

14. Mothers with late or no prenatal are at a greater risk of having a child die from SIDS or an unsafe sleep accident Prenatal care is essential to the health of the mother and the infant during pregnancy and after birth Prenatal Care

15. What is safe and not safe sleep for babies? Safe Sleep for Babies

16. Risk of falling; out of bed or off sofa or chair Risk of becoming trapped in bed or sofa Risk of smothering or suffocation Risk of entanglement Risk of overheating Unsafe Sleep

17. A total of 96 cases were reviewed this past year • 40 of 96 deaths were classified as Undetermined • 33 (75%) of the Undetermined cases involved unsafe sleeping environments • 19 (58%) of these unsafe sleeping related cases involved bed-sharing ONTARIO PAEDIATRIC DEATH REVIEW COMMITTEE ANNUAL REPORT 2009

18. SLEEP SURFACES FOR BEDSHARING DEATHS

19. Sleep surfaces in 14 unsafe sleeping deaths that did not involve bed-sharing

20. 11 of the infants were female; 22 were male 31 of the infants were 7 months of age or younger and 2 were 10 months old, stressing the increased risk of sharing a sleep surface with very young babies 33 unsafe sleeping related deaths in 2008

21. Where Should Infants Sleep? Scheers, Rutherford, & Kemp, Pediatrics, October 2003 Based on Risk for SIDS: Greatestif sharing a sleep surface Intermediateif sleeping in another room Leastif infant sleeps in same room as parent in own safe crib Safest : Place baby in their own safe crib in the caregiver’s room for the first 6 months

22. Always on my Back in my own Crib • The safest place for a baby to sleep is in their own crib in their caregivers’ room for at least the first six months. • Bed Sharing is not recommended anywhere, at anytime!

23. April 15, 1992 The American Academy of Pediatrics recommended that healthy infants: “when being put down for sleep, be positioned on their back ….” Since 1992 accredited with 50% reduction in SIDS deaths Back Sleeping

24. Babies have a tonic neck reflex, which causes them to turn their heads to the side when they are placed on their back If the baby does spit up or vomit, the fluid runs out the nose and mouth to the side of the infant, thus avoiding choking Choking Concern

25. Please see Health Canada’s website at www.hc-sc.gc.cafor the current regulations for cribs and cradles Please have a firm fitted mattress A crib purchased prior to September 1986 is not recommended Please NEVER modify a crib or cradle Follow the manufacturer’s instructions Ensure the mattress support is secure Cribs and Cradles

26. Cribs should be away from windows due to falling risks and drafts Be sure to tie up all cords and curtain strings Keep crib away from radiators due to overheating concerns Place mobiles out of baby’s reach and remove when sitting up Crib and Cradle Placement

27. Should be firm and tight fitting If a second hand mattress is all that is available, check it for tears, rips, mould, and do not use it if any of these are present Ensure that it meets current standards and that it fits the crib snugly Mattress

28. Soft worn or loose fitting mattresses can cause gaps and suffocation hazards Ensure mattress is at lowest setting when baby can sit up Remove mobiles and toy bars when baby starts reaching for them Mattress Safety

29. Always on my Back in my own Crib

30. Twins if sleeping together should be placed one at each end of the crib, feet to the foot of the crib When they can move freely, separate them into their own cribs Twins

31. Bassinetsdo not have the same safety standard requirements as a crib If this is your only alternative It should be well ventilated Remove padding Have a firm and fitted mattress Keep it clutter free Bassinets

32. Playpens are not safe for sleeping. Only use for supervised play Ensure is a newer model with mesh sides for air flow Never place baby in playpen with bassinet or change table insert attached Keep play pen clutter free Play Pens

33. NO comforters, quilts, sheepskins, pillows, positioners, bumper pads or stuffed animals in the crib Just a light blanket tucked under the arms or the best is a wearable blanket or SleepSack NO BEDDING means

34. Overheating • Often causes are too much bedding or clothing, or • because the room is too hot • Ideal room temperature is 68-72 degrees • Dress infant in sleeper and one • additional light layer-receiving • blanket or wearable blanket

35. Car Seats Car Seats are not safe for sleeping. 80% of car seats are installed incorrectly! • They do not provide a flat firm sleeping surface • Avoid covers and blankets • If baby does fall a sleep move to a safe sleep surface ASAP • Attend a car seat safety and installation clinic

36. Strollers Strollers are not recommended for sleeping • ALWAYS supervise child in stroller • ALWAYS use safety belts • USE BRAKES when stopped • Avoid blankets, pillows and covers • Place in horizontal position when child is sleeping

37. Slings and Carriers Serious injuries and deaths have resulted due to sling and carrier use • Slings are not recommended at any time • Only a front facing carrier is suggested

38. Research has found that breast feeding your baby can reduce the risk of SIDS When breastfeeding sit up in bed or a chair and be sure to place the baby on their back in their own crib when finished Breastfeeding?

39. Pacifiers A pacifier at sleep time has been found to decrease the risk of SIDS • If breastfeeding introduce after 1 month • If refused-its okay • Replace with new one every 2 months • Never coat with anything sweet • Never add string or ribbon

40. Positional plagiocephaly is an uneven or misshapen head when the infant is born Causes: pressure on the baby’s skull while in the uterus or during birth and is often seen as a flat spot on the back or side of the head may also develop during the first few months of life due to a baby preferring to lie in one position Flat Head

41. If the resting position of the baby’s head is constantly the same, the effects of gravity on a soft, rapidly growing head may cause a flattening on one side Positional plagiocephaly may be prevented or treated by repositioning techniques and by minimizing pressure on the head when the baby is awake. Tummy time! Helmets have been used in some extreme cases Remedies

42. Tummy Time Play • Tummy time must be supervised by an adult. This tummy play helps develop good tone in the neck and back muscles and learn to roll over, crawl, sit, and stand • Tummy time can begin as soon as the cord falls off • All babies should be placed on their tummies to play

43. NO evidence that monitor use reduces SIDS CAN NOT prevent SIDS Even if using monitor MUST follow safe sleep practices Monitors

44. Be aware of what can be done to maintain a safe and healthy environment even when not at home The best alternative is on the floor - no pillows around the infant if a safe crib is not available When visiting family and friends, be aware that not everyone will take the same precautions you do for ensuring an area is free of hazards and safe for children Supervise children closely When Traveling with a Baby

45. Children spend time with people other than parents, sometimes for long periods; grandparents, other relatives, nannies, friends, childcare workers, even church “crying rooms” when you are attending a service Children can and do die of SIDS and in unsafe sleep accidents in these settings Alternate Childcare

46. CFSID recommends a formal written agreement for babysitters and childcare centres that clearly describes your expectations and instructions CFSID recommends that you and all staff associated with infant care sign a back to sleep agreement Recommendations

47. The ABC’s of Safe Sleep DVD and Workshop Guide 18 minute chaptered video with bilingual guide for Educators $10 donation to CFSID Available now! Safe Sleep DVD and Guidebook

48. The ABC’s of Safe Sleep CFSID now offers: The ABCs of Safe Sleep Online Certificate Course

49. The ABCs of Safe Sleep course: explores risk factors of SIDS provides caregivers with information to improve the health and safety of infants and reduce the risk of SIDS is designed for anyone providing care to an infant Course Content

50. Online Certificate Course Course Duration: 2 hours Price: $49.99 Prerequisite(s): None Language(s): English www.sidscanada.org ABC’s of Safe Sleep