San Mateo County Safe Sleep Centers
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Transcript of San Mateo County Safe Sleep Centers
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UnderstandingSIDS
& Creating a Safe Sleep Environment in Child Care CentersBy Susana Flores, PHN, SIDS Coordinator April 2012
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Numbers we should remember
2,300 Infants die eachyear of SIDS
5 Babies who are placed to
sleep on their tummies have
a 5times greater risk of
SIDS
20% SIDS deaths occurwhile the infant isunder non-parentalcare.
21 Babies who sleep on theirtummies on top of soft
bedding have a 21timesgreater risk of SIDS
87% A Scottish studyshowed 87%of SIDSoccurred in unsafesleep environments.Only 13%were found oncrib or bassinets
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SIDS in Child Care
Approximately 20% of SIDS deaths occur while the
infant is in the care of a non-parental caregiver. 60% in family child care
20% in child care centers
20% in relative care
Infants tend to be Caucasian, with older, more
educated parents. Moon et al, 2000
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SIDS in Child Care
Approximately 1/3of SIDS-related deaths in
child care occur in the first week, and 1/2ofthese occur on the first day.
Something intrinsic to child care? Not that
weve found yet. Stress, sleep deprivation?
Unaccustomed tummy sleeping? Yes
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Unaccustomed Tummy Sleeping
Increases risk of SIDS (as much as 18 times). Mitchell et al, 1999
Non-parental caregivers may use tummy
sleeping.
Less ability to lift head in tummy position.
Later development of upper body strength. Davis et al, 1998
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What is SIDS?
SIDS is the sudden unexplained death of a
seemingly healthy infant under 12 months of
age that remains unexplained after a
thorough death scene investigation, autopsy
and review of babys medical history. It is adiagnosis of exclusion.
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What is the Challenge in SIDS
Community?
SIDS rates are stagnating and other sleep-
related deaths are increasing. Everybody thinks that his/her baby is the
exception to the rule.
Gastro-esophageal reflux Premature
Bad sleeper
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What is the AAP Doing now?
They released a new set of recommendations to
reduce to risk of SIDS and sleep-related suffocation,asphyxia and entrapment cases, to be used
consistently until the infant is 1 year of age.
These new guidelines are more explicit, concrete
and based on scientific evidence. Theyve released
18 recommendations in total.
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A little History since past 20
years In 1992 the AAP recommended changing infants
sleep position from stomach to back as a result,SIDS rate dropped by 47% in California and 51%
nationally.
In 2006 a new set of recommendations werereleased which are the ones in your handouts.
Since 2006, SIDS rates have remained stable and
others sleep related deaths are increasing.
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SIDS Facts
The exact causes of SIDS are unknown, but
SIDS is NOT caused by
Immunizations
Vomiting or choking
Caused by cribs
Contagious or hereditary
Child abuse or neglect
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Gastro-esophageal reflux and
positioning facts
North American Society of Pediatric
Gastroenterology and nutrition: infants with GEreflux should be placed for sleep in the supine
position except for the rare infant for whom the risk
of death from complication of GE reflux is greater
than the risk of SIDS. (Valdenplas, 2009) Examples: Type 3 or 4 laryngeal cleft (uncorrected) or other
defects where the airways in unprotected
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GE reflux and positioning
Elevating the head of the infants crib while
the infant is supine is no effective in reducing
GE reflux. (Meyers, 1982;Tobin, 1997)
May also result in the infant sliding to the foot of
the crib into a position that may compromiserespirations and therefore is not recommended.
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GE reflux and positioning
Placing infant in sitting devices (car seats,
etc.) makes GE reflux worse. (Orenstein,1983)
May increase risk for upper airway obstruction,
falls and suffocation.
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Triple Risk Model
SIDS
Critical development
period
External stressorsVulnerable
infant
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Modifying SIDS Risks
Risks that can be modified
Risks that cannot be modified
Revised12/08
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SIDS Risk FactorsPregnancy
Low birth weight (less than 5 pounds)
Premature (less than 37 weeks) Mothers who smoke during pregnancy (3x greater risk)
Babies who breathe secondhand smoke
(2.5x greater risk)
Multiple births (e.g. twins, triplets)
Maternal age younger than 20 years
Less than 18 months between births
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Babies at Risk for SIDS
African Americans (2x greater risk)
Partly genetic
Partly behavioral (sleep position, bedsharing)
American Indians (more than 2x greater risk)
Secondhand smoke exposure
Binge alcohol drinking during pregnancy
Overdressing of babies
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Reasons that people place babies
on their tummies They think that babies are more likely to
choke or aspirate if they vomit or spit up
They are worried that babies wont sleep as
well
Parental requests
When babies sleep on the backs, they dont
develop normally.
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Reasons that people place babies
on their tummies Babies sleep better/longer/more deeply when
theyre on their stomachs
The baby will get a flat head if the baby
sleeps on the back.
The baby will get a bald spot from sleeping
on the back.
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Why Child Care Providers
Use Tummy Sleeping Lack of awareness
25% of licensed child care providers say they never heardof the relationship between SIDS and sleep position.
Misconceptions about risk of sleep position Supine and aspiration, choking
Belief that tummy sleeping improves infant comfort Parental preference
Lack of information
Lack of education
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Healthy Child Care America Back to Sleep
Campaign
Launched in 2003
Activities
Increase awareness.
Decrease incidence of SIDS in child care.
Educate policy makers to include back-to-sleep
positioning in child care regulations
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Safe Sleep Practices: Reducing the
Risk of SIDS and other related deaths
Back to sleep for every sleep.
Side sleeping is not safe and is not advised.
Avoid overheating.
Do not overdress baby.
Never cover babys head with a blanket.
Room temperature should be comfortable for a
lightly clothed adult.
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Safe Sleep Practices: Reducing the
Risk of SIDS and other related deaths Breast-feeding is recommended.
Pacifiers may be offered to babies to reduce the risk of SIDS If breastfed, wait until breastfeeding is well established
(approximately 3 - 4 weeks of age), before offering apacifier.
If the baby refuses the pacifier, dont force it. If the pacifier falls out while the baby is asleep, you do not
have to re-insert it.
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Safe Sleep Practices: Reducing the
Risk of SIDS and other related deaths
Safe crib, firm mattress.
Avoid chairs, sofas, air mattresses, water
beds, and adult beds.
Room-sharing without bed-sharing is
recommended.
Do not have more than one baby per crib.
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Safe Sleep Practices: Reducing theRisk of SIDS and other related deaths
Avoid smoke exposure during and after
pregnancy.
Avoid alcohol and illicit drug use during
pregnancy and after birth.
Do no use cardio-respiratory monitors as
strategy for reducing the risk of SIDS.
Spread the word.
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Safe Sleep Practices: Reducing the
Risk of SIDS and other related deaths
Infants should be immunized in accordance with
recommendations of the AAP and CDC. Avoid commercial devices marketed to reduce the
risk of SIDS.
Supervised, awake tummy time is recommended tofacilitate development and to minimize development
of positional plagio-cephaly.
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What does a safe sleepenvironment looks like?
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Benefits of a Safe Sleep Policy
May save lives of babies.
Shows parents babys health and safety is
your #1 priority.
Educates staff.
Consistent care
Educate parents
Professional development
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Elements of a Safe Sleep Policy
Healthy babies always sleep on their backs.
Obtain physicians note for nonback sleepers.
The note should include prescribed sleep position and the medical reason fornot using the back position.
Use safety-approved cribs and firm mattresses.
Crib: free of toys, stuffed animals, and excess bedding.
If blankets are to be used, practice feet-to-foot rule.
Sleep only one baby per crib. Room temperature is comfortable for a lightly clothed adult.
Monitor sleeping babies.
Have supervised tummy time for awake babies.
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Alternate Sleep Position
Require written and signed physicians note.
Identifies medical reason why baby sleeps
in position other than on back
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Handling Parents Concerns
Discuss SIDS and risk reduction strategies
with parents.
Discuss sleep position policies.
Discuss medical waiver and implications.
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What We Need to Do
Implement the Caring for Our Children
standards. Have a safe sleep policy.
Train all caregivers.
Talk with a child care health consultant. Be able to handle an infant medical
emergency.
Be aware of bereavement resources.
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First AidUnresponsive Infant
Teaching resuscitation skills is beyond the scope of this
workshop. You must first practice resuscitation on amannequin.
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 (e.g., dont try to tidy up).
Notify licensing agency and insurance agency.
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Handling a Medical Emergency
Have a plan in place.
Review the plan with all staff perodically.
Be sure you have received training and have
successfully practiced rescue breathing and
skills for handling a blocked airway for infants
in a fist aid course.
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What to Expect if a Baby Dies
Investigation
Several people will ask for the same informationso they can help.
Law enforcement
Note babys health, behavior, etc. Take photos.
Limit disturbance of the area.
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What to Expect if a Baby Dies
Licensing agency
Questions about licensing regulations.
SIDS death not a reason for revoking a license.
Coroner/medical examiner
Conducts autopsy.
Determines cause of death.
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Caring for Our ChildrenNational Standards
Seek support and information from local, state,
or national SIDS organizations. Provide SIDS information to the parents
of the children in the facility.
Provide age-appropriate informationto the other children in the facility.
Make resources for support available
to families and children.
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National Resource Center forHealth and Safety in Child Care
and Early EducationCaring for Our Children: National
Health and Safety Performance
Standards, Third Edition is available
in three formats:
Full PDF - Now available with the
current changes;
grayscaleor color
PDF by Chapter- Now available with
the current changes; smaller file sizes
HTML Version- Now available with the
current changes
These online PDF and HTML formats of
Caring for our Children, Third Edition,
(CFOC3)are updated to reflectchanges/additions since the second
printing of CFOC3in August 2011.
(Each is updated as of April 2012.)
PDFs can be viewed with Adobe
Acrobat Reader
Get Adobe Acrobat Reader
http://nrckids.org/CFOC3/CFOC3-grayscale.pdfhttp://nrckids.org/CFOC3/CFOC3_color.pdfhttp://nrckids.org/CFOC3/PDFVersion/list.htmlhttp://nrckids.org/CFOC3/HTMLVersion/Inside_Cover.htmlhttp://nrckids.org/CFOC3/HTMLVersion/Inside_Cover.htmlhttp://nrckids.org/CFOC3/PDFVersion/list.htmlhttp://nrckids.org/CFOC3/CFOC3_color.pdfhttp://nrckids.org/CFOC3/CFOC3-grayscale.pdf -
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NRCKIDS
Mailing Address:
National Resource Center for Health and
Safety in Child Care and Early Education
13120 E. 19th Ave., Mail Stop F541
PO Box 6511
Aurora, CO 80045
Fax:(303)724-0960
Our offices are open Monday through Friday 7:30am to 4:30pm Mountain
Time
Please send any comments or questions to [email protected] call us at
1-800-598-KIDS (5437)
mailto:[email protected]:[email protected] -
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Partners and Resources
Back to Sleep campaign
www.nichd.nih.gov/sids Phone: 1-800-505-CRIB (2742)
You can receive informational brochures, posters to
provide to families and child care providers
Cause-Coalition against Unsafe Sleep Environments.
http://cribsforkids.org/cause-coalition-against-unsafe-sleep-
environments/
http://www.nichd.nih.gov/sidshttp://www.nichd.nih.gov/sids -
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Partners and Resources
First Candle/SIDS Alliance. 1314 Bedford Avenue,
Suite 210Baltimore, MD [email protected]
Call us toll-free at 1-800-221-7437 Grief Counselors Available 24/7
National SIDS and Infant Death Program Support Center. 2115 Wisconsin Ave, N.W., Suite 601 Washington, DC 20001-2292
Phone; (866)866-7437 E-mail: [email protected]
CJ Foundation for SIDS-888/8CJ-SIDS. (201)996-5301 WWW.CJSIDS.COM
mailto:[email protected]:[email protected] -
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Baby in a Safe Crib