Presentation objectives: - Identify the issues surrounding infant sleep-related deaths nationally and in West Virginia - Deliver and reinforce infant safe sleep messages - Change practices to prevent infant deaths in West Virginia

1. Say YES to Safe Sleep
Co-sponsored by TEAM for WV Children and
CAMC Health Education and Research Institute
June 2012

2. Panelists
• Joan Phillips, MD, FAAP, Co-Director, Child
Advocacy Center at CAMC, and Clinical Director of
Children‟s Services, Women‟s and Children‟s Hospital
• Diane Hughes, Director, Upper Kanawha Valley
Starting Points Family Resource Center and Certified
Parent Educator
This presentation does not include discussion of any
commercial product(s) or service(s).
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3. Course Objectives
Professionals who are working with families and
caregivers with infants under one year of age will be
able to:
• Identify the issues surrounding infant sleep-related
deaths nationally and in West Virginia
• Deliver and reinforce infant safe sleep messages
• Change practices to prevent infant deaths in West
Virginia
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4. Course Introduction
This training is a tool of Our Babies: Safe
and Sound, an educational campaign that
focuses on preventing infant injuries and
death in West Virginia.
The campaign targets parents and other
caregivers of infants under the age of one,
as well as expectant parents, professionals
and the public.
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5. Pre-Assessment Questions
TRUE or FALSE?
1. Suffocation and strangulation in an
adult bed or other unsafe sleeping
surface is the leading cause of injury-
related death for WV infants under
age 1.
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6. Pre-Assessment Questions
TRUE or FALSE?
2. The latest guidelines on infant safe
sleep from the American Academy of
Pediatrics propose bed sharing as safe
to encourage breastfeeding.
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7. Pre-Assessment Questions
TRUE or FALSE?
3. There is no increase in choking
problems in babies sleeping on their
backs.
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8. Pre-Assessment Questions
TRUE or FALSE?
4. It is safe to have bumper pads in a crib,
but toys, heavy blankets and loose
blankets should be removed.
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9. Pre-Assessment Questions
TRUE or FALSE?
5. Infant safe sleep messages are often
competing with misleading media
messages.
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10. Sudden Infant Death
Syndrome (SIDS)
“… sudden death of an infant under one year
of age which remains unexplained after a
thorough case investigation, including
performance of a complete autopsy,
examination of the death scene, and review
of the clinical history.”
Willinger M., James L.S., Catz C., Pediatr Pathol 1991
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11. Sudden, Unexpected
Infant Death (SUID)
An umbrella term for infant deaths that:
 Occur suddenly and unexpectedly in previously healthy
infants
 Can be explained after a case investigation. Investigations
may reveal head injury, infection or overdose
 Includes SIDS, suffocation, or other unknown causes
 Exclude deaths with an obvious cause such as motor vehicle
accidents
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12. National Overview
 1992: American Academy of Pediatrics (AAP) released its first
recommendations that infants be placed for sleep in non-prone
position
 1994: Back to Sleep Campaign began to educate parents,
caregivers, health providers about SIDS & placement of infants
on their back to sleep; reduced incidence of rate of SIDS by
50%
 State child care regulations also revised, with over 50%
requiring babies to be put to sleep on their backs & soft
bedding not be used in cribs
 While rate of SIDS has decreased, other causes of SUID that
occur during infant sleep (suffocation, asphyxia, entrapment)
have increased in incidence
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13. National Overview
In response to increasing rates of SUIDs:
 2006: Centers for Disease Control began standardized reporting, data
collection, training of professionals for SIDS & SUIDS. Work is underway
on SUID Case Registry to create state-level surveillance systems, use
standard definitions, monitor incidence and describe demographic and
environmental factors to inform prevention activities.
 July 2011: National crib safety regulations were strengthened and a
federal ban on drop-down side cribs was issued.
 Several local jurisdictions have also banned the sale of bumper pads.
 State-led awareness campaigns implemented in 37 states, including Our
Babies: Safe and Sound in West Virginia
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14. National Overview
Revised AAP Guidelines
• Guidelines from the American Academy of
Pediatrics (AAP) have been revised in
October 2011.
• The AAP expanded its recommendations
from focusing only on SIDS to focusing on
safe sleep environments to reduce the risk
of all sleep-related infant deaths.
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15. Clarifying Common Terms
Bed sharing
An infant shares a sleep surface with one or
more adults or other children. In past years,
this was referred to as co-sleeping.
Room sharing
An infant sleeps near the parent or caregivers
in their own crib, bassinet or portable crib.
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16. AAP Expanded
Recommendations
2011 AAP Expanded Policy Statement does not
recommend any specific bed sharing situations as safe
Room sharing without bed sharing is recommended
There is evidence that this arrangement decreases the
risk of SIDS by as much as 50%
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17. National Incidence Data
 According to CDC, approximately 4600 SUID cases
yearly
 383 babies are dying each month across the US
 Rates comparable to birth defects mortality
 About 2500 of these are SIDS, the leading cause of post-
neonatal mortality
 Accidental Suffocation & Strangulation in Bed (ASSB)
rates more than tripled in the last decade
 3.7 to 12.5 deaths per 100,000 live-births from 1995 to 2005
 Potentially preventable infant mortality
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18. Accidental Suffocation &
Strangulation in Bed (ASSB)
 Suffocation by soft bedding, pillow or
waterbed mattress
 Overlaying (rolling on top of or against
infant while sleeping)
 Wedging, or entrapment between, a
mattress, wall, bed frame, etc.
 Strangulation: infants head and neck
caught between bed railings
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19. US SUID-specific infant mortality rates
SUID-
160
1990-2007
1990-
140
hs
0000 birth
120
100
80
Death per 100
60
hs
40
20
0
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
SIDS UNK ASSB Combined SUID
SIDS: sudden infant death syndrome, UNK: Unknown cause, ASSB: accidental suffocation and strangulation in bed,
Combined SUID: SIDS+UNK+ASSB
Source: CDC WONDER, Mortality Files
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20. West Virginia Overview
Data from WV Child Fatality Review Team shows:
• 33 deaths attributed to SUID in WV during 2010
• Of the 33 deaths
• Bed sharing / Co-sleeping was a factor in 16 deaths
• Hazardous bedding was a factor in 21 deaths
• Leading cause of death age 1 - 12 months in
WV
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21. West Virginia Overview
 Suffocation & strangulation in an adult bed or
other unsafe sleeping surface is the leading
cause of injury-related death for WV infants
under age 1
 Risk of sleeping-related infant death is 40
times higher for babies who sleep in adult
beds compared to babies who sleep in their
own cribs
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22. West Virginia Overview
A baby dies in WV every 10 days because of
unsafe sleep conditions
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23. Challenges
• Use of misleading & competing media messages
 Study evaluated pictures in magazines widely read by women
of childbearing age for adherence to AAP guidelines for safe
infant sleep practices. Results showed more than 1/3 of these
pictures demonstrated infants in inappropriate sleep position,
2/3 showed infant sleep environments inconsistent with AAP
recommendations. - Moon, Pediatrics, 2009
 Proponents of “safe” bed sharing perceptions that bed sharing
begets breastfeeding. - Santos J, Peds, 2009
 Myths surrounding choking when infants placed on back
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24. Solutions
o Health care professionals, staff in newborn nurseries
and NICUs, and child care providers endorse and
support the AAP 2011 SIDS risk-reduction
recommendations from birth
o Consistent messaging and tools used through
Our Babies: Safe and Sound campaign
o Expectant and new parents and caregivers, including
grandparents, targeted for education
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25. West Virginia’s Response
Our Babies: Safe and Sound Campaign Goal:
Help prevent injury & death of West Virginia
infants.
The Campaign focuses on 2 issues:
1. Infant Safe Sleep
2. Shaken Baby/Abusive Head Trauma
Prevention
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26. Campaign Overview
Target Audiences:
• expectant parents
• parents of infants under age of one
• other caregivers of infants under age of one
• general public (through the media)
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27. Campaign Supporters
Our Babies: Safe and Sound is a project of TEAM for WV
Children, with support from:
o Funders: WVDHHR / Children’s Trust Fund / Claude
Worthington Benedum Foundation.
o Advisory Panel of Experts
o Parents
o Media consultation
o WV Broadcasters Association
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28. Campaign Overview
Say Yes to Safe Sleep
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29. Say YES to Safe Sleep
Messages
 Put baby’s bed near where you sleep, within arm’s reach, to
make it easier to breastfeed and bond with baby – room
sharing without bed sharing
 „Back to sleep‟ for every sleep
 Babies should sleep alone in a crib (bassinet or portable crib)
at every bedtime & naptime
 Babies should not be placed to sleep on adult beds, chairs,
sofas, waterbeds, or cushions
 Babies should not sleep with anyone
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30. Say YES to Safe Sleep
Messages
 Babies should sleep in a smoke-free area – smoke
exposure during pregnancy and after birth should be
avoided
 There should be no bumper pads, toys, stuffed animals
, or loose blankets in the crib
 Crib should be in good condition and safe (no drop-
down side cribs): www.cpsc.gov
 Breastfeed your baby
 Tell others: “Say Yes to Safe Sleep”
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31. Say YES to Safe Sleep
Messages
 Avoid alcohol and illicit drug use during
pregnancy and after birth*
 Consider offering a pacifier at nap time and bed
time*
 Do not use home monitors as a strategy for
reducing the risk of SIDS*
* New Level A - 2011 AAP Recommendations
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32. Say YES to Safe Sleep Video
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33. Say YES to Safe Sleep Tools
 Materials & tools have been
designed to be
 Attractive & User-friendly with an
emphasis on positive messages
 Based on AAP guidelines
 All materials are FREE and can be ordered
online or downloaded at
www.safesoundbabies.com
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34. Say YES to Safe Sleep Tools
• Brochures
• Posters
• 30 and 60 second Public
Service Announcements
• 5 minute video on Say YES
to Safe Sleep
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35. Say YES to Safe Sleep Tools
• Say YES to Safe Sleep Pledge for parents
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36. Say YES to Safe Sleep Tools
• Say YES to Safe Sleep web-
based Training Module
with key talking points for
providers delivering
materials
• TV and radio spots for
public education
• Website:
www.safesoundbabies.com
for professionals & public
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37. Say YES to Safe Sleep Tools
• Resource Guide for
Community Partners
• Erasable
white
boards
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38. Say YES to Safe Sleep
Implementation Protocol
 Provide consistent, accurate,  Each family receives their own
safe sleep messages to expectant set of materials - Say YES to Safe
parents, parents, and caregivers Sleep Brochure, DVD, Safe Sleep
of infants under one year of age, Pledge - distributed as one
ideally within first few weeks of package
baby’s life
 Person delivering materials
 Trained providers (physicians, reviews content with parents
nurses, in-home family and encourages them to share
educators, child care personnel) information with others
and professionals working with
parents and babies deliver &
reinforce Say YES to Safe Sleep
materials
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39. Say YES to Safe Sleep
Implementation Protocol
Ideal steps in delivering Say YES to Safe Sleep
messages:
 Review materials one-
on-one with parents by
watching DVD &
reviewing brochure
using provided teaching
points
 Answer any questions
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40. Say YES to Safe Sleep
Implementation Protocol
Additional steps in delivering Say YES to Safe
Sleep messages:
 Confirm there is a safe place
for their baby to sleep
 Encourage parents to share
materials with others
 Ask parents to sign sleep
pledge promising safe sleep
practices for their baby
 Reinforce messages at follow-
up visits
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41. Say YES to Safe Sleep
Implementation Protocol
Examples of possible settings for delivering materials:
 Birthing Hospitals by a trained nurse at the bedside,
one-on-one (ideal)
 In-Home settings by a trained in-home family
educator, one-on-one
 Group settings such as prenatal classes, post-natal
classes, community baby showers, child care center
events, etc.
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42. Say YES to Safe Sleep
Implementation Protocol
 Display posters at appropriate locations such as
doctor‟s offices, libraries, child care centers,
hospitals, churches, social service agencies, retail
outlets, etc.
 Show the Say YES to Safe Sleep DVD via closed circuit
TVs in waiting rooms, hospital rooms, community
events, etc.
 Set up a model nursery/safe sleep center with
materials
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43. Say YES to Safe Sleep
Implementation Protocol
• Case Demonstration of teaching points
and script.
• The teaching points and script can be
downloaded at
www.safesoundbabies.com
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44. Summary Review
TRUE or FALSE?
1. Suffocation and strangulation in an adult
bed or other unsafe sleeping surface is the
leading cause of injury-related death for
WV infants under age 1.
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45. Summary Review
TRUE or FALSE?
2. The latest guidelines on infant safe
sleep from the American Academy of
Pediatrics propose bed sharing as safe
to encourage breastfeeding.
6/6/2012 45

46. Summary Review
TRUE or FALSE?
3. There is no increase in choking
problems in babies sleeping on their
backs.
6/6/2012 46

47. Summary Review
TRUE or FALSE?
4. It is safe to have bumper pads in a crib,
but toys, heavy blankets and loose
blankets should be removed.
6/6/2012 47

48. Summary Review
TRUE or FALSE?
5. Infant safe sleep messages are often
competing with misleading media
messages.
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49. Wrap-Up
Complete evaluation
Download teaching
points and script
Order free Say Yes to
Safe Sleep tools
safesoundbabies.com
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50. For More Information
Jim McKay
State Coordinator
Prevent Child Abuse WV
http://www.safesoundbabies.com
Email: jim@teamwv.org
Twitter: @TEAM4WVChildren
Phone: 1-866-4KIDSWV
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