Hot Topics in Infant Safe Sleep
ASIP-Pregnancy Loss and Infant Death Alliance 2010 International Conference on Perinatal and Infant Death, November 2010
Project IMPACT Webinar Series, 2011
Funding provided by the CJ Foundation for SIDS
Safe sleep messaging, delivered to mothers and fathers by trusted sources from the earliest stages of pregnancy through a child's infancy, can lead to improved sleep practices and greatly reduce the risk of SIDS.
There are many barriers to delivering the safe sleep message, though. Conflicting recommendations from seemingly valid sources can be confusing to even the most knowledgeable caregivers. Parents often don't believe the message, or simply don't listen because it's inconvenient. Family or cultural traditions, reinforced by secondary caregivers including neonatal nurses, daycare providers and even grandparents, can muddy the message even further. And, some emerging issues remain thinly researched, leaving educators with little guidance on how to advise families.
This online project combines two distinct initiatives into one multimedia resource: In November, 2010, Dr. Rachel Moon, MD, an internationally recognized SIDS researcher and educator, led an interactive pre-conference workshop with a room full of neonatal caregivers and other pregnancy and neonatal health educators. Six broad themes were discussed, generating six video segments with vigorous discussions. The following year, Project IMPACT used the video segments as the basis for a series of Webinars in which participants from across the country viewed the videos online, then posed questions for Dr. Moon to answer. The end result is a broad and deep look at infant safe sleep, moderated and supplemented by the country's leading SIDS researcher.
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NEW! Download a Summary of the Interactive Session (PDF).
Scenario 1, in which reflux and car seat sleeping are discussed:
In the opening discussion, one of the first insights is a fun statistic: how many babies experience reflux? Not "most," as some in the audience guessed, but 100%. Reflux is defined and normalized, and positioning is discussed in detail. One of the highlights is the display of a very simple biological diagram of the human infant showing the trachea (breathing) and esophagus (digestion) in relation to each other which dispels any notion that tummy sleeping is safer when reflux is likely. (As an aside, audience members have an interesting discussion about using carseats - AND the clothes dryer! - to lull an infant to sleep.)
Scenario: You're conducting a home visit at the home of a family with a 2 month old infant. The mother reports that the infant has been diagnosed with reflux. She is placing the baby on the stomach because she's worried that he's going to choke. She was also told that she should keep him upright after he eats, so he sometimes sleeps in his car seat.
Scenario 2, in which bed sharing and co-sleeping, and their relationship to breastfeeding, are discussed:
Scenario 2 is meant to be about co-sleeping, and specifically bed sharing, but the conversation ends up covering breastfeeding as well, since many mothers bed-share in order to facilitate breastfeeding.
Scenario: You're seeing the parents of a 2-week old boy who was born at full term with no complications. The mother tells you that the baby sleeps in the bed with her and her husband, because it makes it easier to feed him in the middle of the night. She breastfeeds but supplements with formula. Neither she nor the father is a smoker.
Q&A from Scenarios 1 and 2 among a national online audience
This Q&A session was held as a webinar on 23 August 2011, hosted by Project IMPACT.
Scenario 3, in which twin crib-sharing is discussed:
In this lively discussion, we hear about various solutions for how to put multiples and other close siblings to sleep, some of which are recommended by the group, and others which are most definitely not. The reasons for co-bedding can seem intuitive, but actual research on the subject is thin and results are, as Dr. Moon states, "all over the map."
Scenario: You are talking with a mother who recently had twins. The twins were born at 34 weeks; one weighed 4 pounds and the other 5 pounds at birth. They were in the transitional nursery for 10 days until the smaller one gained enough weight to go home. They are now 1 month old. She tells you that they are sleeping in a single crib in the same room as her and her husband, because it helps them when they are together. They slept in the same bassinet in the nursery.
Scenario 4, in which the preventive effect of breastfeeding is discussed:
In this scenario, the moderator sets up a situation where an expectant mother's life experiences demonstrate why some people are uncertain about safe sleeping practices and other practices that are said to reduce the risk of SIDS. Here, the many known benefits of breastfeeding lead the group to fairly definitive recommendations.
Scenario: You are talking with a woman who is 34 weeks pregnant with her first child. She thinks that she wants to try to breastfeed but isn't sure. Her brother died of SIDS, and she has read conflicting information about whether breastfeeding can prevent SIDS or not. She wants to know what you think.
Q&A from Scenarios 3 and 4 among a national online audience
This Q&A session was held as a webinar on 7 September 2011, hosted by Project IMPACT.
Scenario 5, in which swaddling is discussed:
When the group's "reporter" begins her report by saying she wishes she had not been given the swaddling scenario because she is still very unsure of its risks and benefits, it foretells the entire discussion: not much research has been done, and it is largely inconclusive. The idea of behavior "modeling" in the labor and delivery ward is discussed, and the group generally calls for more research on this emerging safe sleep topic.
Scenario: Several of the nurses at your hospital recently attended a workshop on "The Happiest Baby on the Block," which strongly advocates swaddling. They would like to make swaddling an integral part of nursery protocol. The nursing director is ambivalent about this and is asking for input on this idea.
Scenario 6, in which soft bedding and bumper pads are discussed:
The final scenario generates some of the most lively stories of the day, as almost everyone in the audience has seen or heard of parents (some very famous) who have used completely inappropriate bedding. While for some, matched bedding with stuffed animals and other "comforts" seems to be an aesthetic decision, the conversation covers some genuine misconceptions about what is and is not "comfortable" for the newborn and the infant.
Scenario: You are conducting a home visit with a family with a 2-week old infant. The infant was in the hospital for five days because of maternal fever. The family has both a pack-n-play and a crib in the home. The baby wasn't sleeping well in the pack-n-play, so the grandmother put a pillow between the mattress and the sheet to "soften it up." The sheet is taut over the pillow. The family has also prepared the crib and has put bumper pads for when the baby sleeps there.
Q&A from Scenarios 5 and 6 among a national online audience
This Q&A session was held as a webinar on 16 September 2011, hosted by Project IMPACT.
Rachel Moon, M.D., is an internationally recognized expert in SIDS. She is on the faculty of General and Community Pediatrics at Children's National Medical Center in Washington, serving as the director of Academic Development for the Goldberg Center for Community Pediatric Health, and Principal Investigator for the Center for Clinical and Community Research (CCCR) at Children's Research Center, National Children's Medical Center. She is also Professor of Pediatrics at the George Washington University School of Medicine and Health Sciences.