Professional Documents
Culture Documents
September 2007
This Presentation was developed by NWTC in collaboration with The Infant Death Center of Wisconsin, a program of Childrens Hospital of Wisconsin
Parents, guardians, siblings, grandparents, aunts, uncles, teachers, baby-sitters, pastors, church childcare volunteers, case workers, social workers, home visitors, police, emergency service personal, absolutely EVERY child care provider hired for child care services, and anyone else who touches the lives of children.
1.A complete autopsy 2.An investigation of the death scene 3.Review of the medical history and file
Cases failing to meet the standards of this definition, including those without autopsies should not be diagnosed as SIDS.
2.
3.
18.7
18.3
15 10 5 0
14.4
9.2 6.5
5.07 4.52
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
White
Black
Hispanic
American Indian
1.36 1.2
1.35 1.17 1.19 1.03 0.87 0.74 0.69 0.67 0.67 1.25 1.09 0.904 0.8 0.669 0.669 1.04 0.77 0.671 0.529 0.55 0.48 0.486 0.512 0.52
19 91
19 92
19 93
19 94
19 95
19 96
19 97
19 98
19 99
20 00
20 01
20 02
20 03
20 04
WI SIDS Rate
20 05
Approximately 2000 infants die of SIDS every year in the United States. Source: Infant Death Center of Wisconsin In the State of Wisconsin, about 0.52 of 1000 babies die of SIDS each year (WI Deaths 2000). In the United States, approximately 20.4 % of SIDS deaths occurred in regulated child care (1995-1997).
60% in family child care 20% in child care centers 20% in relative care
Non-Parental Childcare
Two-thirds of US infants younger than 1 year are in non-parental childcare.
Approximately 1/3 of SIDS related deaths in childcare occur in the first week. One half of these on the first day. Something intrinsic to child care? NO
A California study found that infants who were usually placed supine but were placed on their sides or prone for the last sleep were at very high risk of SIDS, which emphasizes the importance of every caregiver using the back to sleep position during every sleep period, particularly when the infants accustomed position is supine.
Troubling
In another finding, children placed prone (on their stomachs) by caretakers, more than half were usually put to sleep on their backs by their parents.
This is called unaccustomed tummy sleeping. Why do you think caretakers would do this?
Source: Dr. Rachel Moon Pediatrician at Childrens National Medical Center in Washington, D.C.
Parental preference
Flat Heads-Constant pressure can cause the babys head to be less rounded and
Developmental Lag- Some parents and providers are concerned about the
slight developmental lag in rolling over or sitting up that has been reported in the literature and media among babies who sleep on their backs. This delay is still within the normal range for development. Tummy time helps babies to become more active and strengthen muscles that enable them to roll over or sit up.
on their backs their arms may flail. This startle response may actually be a protective response for the baby, prompting an exchange of fresh air or a slight arousal from deep sleep. their side or stomach more comfortable and this influences how they decide to place baby for sleeping.
Startle Response- Some babies flinch or jerk in their sleep and if they sleep
90 % of SIDS Deaths Occur before the Age of 6 Months. 10% occur between 6 and 12 months of age.
SIDS is a silent death. In those cases which have been observed, the infants do not cry and there is no struggle. SIDS almost always occurs during a sleep period
Source: Infant Death Center of Wisconsin
40% of SIDS Victims Have or Recently Had a Mild Upper Respiratory Infection
The Time of Year can be a Factor SIDS and the Heating Season
Historically, the SIDS statistics always have shown a
distinct seasonality, with higher rates recorded during winter months. A significant decrease has been observed in the seasonal association of SIDS as the stomach sleep position has decreased and SIDS rates have declined.
Source: Infant Death Center of Wisconsin
SIDS Rate and Sleep Position, 1985-99 (Deaths per 1,000 Live Births)
1.5
1.41 1.41 1.37 1.4 1.39
100
1.3 1.3 1.2 1.17 1.03 70 0.87 0.74 0.77 0.72 39 28 0.67 74 78 81 85
Percent Back and Side Sleeping
SIDS Rate
54
50
0.5
0
1985 86 87 88 89 90 91 92 93 94 95 96 97 98 99
Year
RISK FACTORS
The Risk Factors Appear in Higher Numbers for Babies than for the General Population
For instance, if a mom smokes during pregnancy, the baby is three times (3X) more likely to die of SIDS. If there is smoking in the house, the baby is twice (2X) as likely to die of SIDS.
RISK FACTOR
Co-Sleeping or Bed Sharing
While bed sharing between infants and adults is highly controversial, the American Academy of Pediatrics reports that it can be hazardous under certain conditions. Several case studies of accidental suffocation or death from undetermined cause, suggests that bed sharing is hazardous. Adults, children, or siblings should avoid bed sharing with an infant.
Because of these malfunctions, the basic system that maintains that automatic functioning does not work correctly when stressed. The stressor might be sleep position, a cold, or a soft sleep surface.
The predominant hypothesis regarding SIDS is that certain infants for reasons yet to be determined, may have a maldevelopment or delay in maturation of the brainstem neural network that is responsible for arousal and affects the physiologic responses to lifethreatening challenges during sleep. This functional birth defect begins before the baby is born.
Source: The American Academy of Pediatrics
6
Heart
10
11
12
Missed Period
First 6 months of life. Rapid growth and development of brain. 90% of deaths occur in this period.
Critical Development Period
SIDS
Vulnerable Infant Exogenous Stressors
undetectable defect.
Infant with
2. 3.
difference.
Risk factors alone do not cause SIDS. Most babies with one or more of the above risk factors do no succumb to SIDS.
Avoid Overheating
At an early age, babies are unable to regulate their own body temperature. Over time their ability to regulate body temperature and other internal comfort controls increases. Becoming too hot can diminish the babys ability to maintain its core body temperature.
Signs that the baby is too hot include sweating, damp hair, flushed cheeks, heat rash, and breathing rapidly.
Use a temperature that is comfortable for adults in the babys room. Room temperature should be set from 68F to 72F.
Smoking
Do not smoke! Provide a smoke-free environment for babies in your care. Recent research indicates that the risk of SIDS doubles among babies exposed only after birth to cigarette smoke and triples for those exposed both during pregnancy and after birth.
Cribs Not Meeting Safety Standards The crib should be safety approved. The firm mattress should be a snug fit for the crib, portable crib, or playpen. Avoid Chairs, Sofas, And Water Beds In family child care home settings, it is not uncommon to find babies sleeping on a variety of surfaces. Chairs, sofas, waterbeds, cushions and standard or adult beds are NOT safe sleep surfaces because babies can fall or become entrapped in crevices in the furniture or between cushions. Excess Bedding Excess bedding and fluffy blankets, comforters, and pillows can impair the babys ability to breathe if these items cover the face. Toys and stuffed animals as well as bumper pads and wedges should not be placed in the crib. (American Academy of Pediatrics)
research has shown that pacifiers can significantly reduce a babys risk for SIDS.
Experts Recommend
providing your baby with a pacifier EVERY time they are placed down to sleep. While the exact safety mechanism is not yet known, there are many possibilities for this finding. (SIDS Alliance)
It has been suggested that the presence of a pacifier in the mouth may discourage babies from turning over onto their faces during sleep.
Moving or turning may dislodge the pacifier, which may have the effect of encouraging babies to stay on their backs. Another theory suggests that pacifier use might help to keep the tongue positioned forward, keeping the airways open.
It has also been hypothesized that pacifier use may quiet a restless infant, who might otherwise move more aggressively around the crib.
On the other hand, pacifiers may stimulate the upper airway muscles and saliva production, possibly triggering brain activity and ability to arouse from sleep. Increased arousability is seen in infants who usually sleep with a pacifier, even if the pacifier is not being used.
In this photograph, there are three things that promote a safe sleep environment and two things that are risks promoting an unsafe environment. Can you pick them out?
SAFE 1.Sleep Sack rather than blankets.
Risk Factors
There are several things that pose risk factors here.
3.
4.
Bumper pads
Blanket
THIS IS AN UNSAFE SLEEP ENVIRONMENT WITH MANY RISK FACTORS FOR SUDDEN INFANT DEATH SYNDROME.
This is a picture from the Consumer Product Safety Commission that shows how a baby should be placed in a crib when put to sleep at night or for a nap.
Surfaces
Place the Baby on a Firm Mattress and REMOVE: all pillows quilts comforters bumper pads sheepskins stuffed toys and other soft items from the crib Do NOT Place the Baby to Sleep on a: waterbed sofa chair soft mattress Pillow or pillow top mattress sleeping bag or any other soft surface
Forms
Check with your state licensor about an enrollment form that helps to protect you. There is a section for parents to request sleeping positions-Remember, this also protects parents!
Some caregivers and centers will not accept a baby that must be laid in a prone (tummy) position.
Policy
Develop a policy on Back Sleep position for indicating all healthy babies will be placed on their backs to sleep unless a medical condition requires a different sleep position. In the case where a medical condition requires non-supine sleeping, a physician needs to sign off. It should not be a parents choice.
Develop a Plan
Develop a plan if a child stops breathing. What will you do? Who will take care of other children? How will this be handled with parents and the other childrens parents? Have a plan in place. Review the plan with all staff periodically. Practice rescue breathing and choke-saving skills for infants in a first aid course as required by licensing.
Take Classes
Take advantage of classes on emergency procedures, first aid, and risk reduction such as this course. If a child in your care becomes unresponsive do the following:
Call 911. Get help to care for the other children. Call the childs parents or emergency contact. Call the parents of the other children. Do not disturb the scene. Notify your licensor and your insurance agency.
Learn CPR
Learn CPRCardio Pulmonary Resuscitation
Remember, we do not know it is SIDS until after the autopsy.
Play Time
To keep a crib safe, remove all stuffed animals and other soft items from the crib and have toys available for tummy time play. The American Academy of Pediatrics recommends,
Back to Sleep
ALWAYS place a baby on his back to sleep. If he falls asleep while playing on his stomach, turn him over on his back to sleep.
Sudden Infant Death Syndrome Has Been Reduced by Approximately 50% Since the Back To Sleep Campaign Started.
Resources
Following are some links for families and those impacted by infant death: Infant Death Center of Wisconsin A Place to Remember Bereavement Publishing, Inc. Children's Hospital of Wisconsin Bereavement Program C J Foundation for SIDS The Compassionate Friends National SIDS Resource Center SIDS Network, Inc. Crisis, Grief, & Healing March of Dimes American Academy of Pediatrics The National SIDS/Infant Death Center First Candle - Helping Babies Survive and Thrive National Institute of Child Health & Human Development