By Megan M. Krischke, contributor
April 3, 2012 - In 1994, the National Institutes of Health (NIH) launched its "Back to Sleep" public health campaign aimed at reducing the number of deaths resulting from Sudden Infant Death Syndrome (SIDS). The NIH effort has met with great success, reducing the number of infants who die from SIDS by half, according to a new study published March 26, 2012, in Pediatrics.
That same study, however, showed that there is still a lot of work left to be done: SIDS remains the leading cause of death for infants aged 1-12 months. But SIDS and other sleep-related infant deaths can be reduced, the researchers said.
"There are a few things I want nurses to know about the study," began Marianne Willinger, Ph.D., special assistant for SIDS at Eunice Kennedy Shriver National Institute of Child Health and Human Development at the National Institutes of Health. "One is it confirms that as a result of more people placing babies on their backs to sleep, the SIDS rates have come down.”
“Among those babies who do die, however, bed sharing is the more prevalent cause now--a situation responsible for 60 percent of SIDS deaths,” she continued. “It doesn’t mean the absolute number has changed, but rather the proportion, and that is important because it means we need to target and discourage the bed sharing practice."
"There are still babies dying as a result of being placed on their stomachs," she added. "So we must continue to emphasize that babies be placed on their backs for all sleep periods by all caregivers, and we need to start focusing on encouraging parents not to share a bed with their baby and reducing the amount of soft bedding in the crib."
It is important that nurses know, understand and communicate the American Academy of Pediatrics' (AAP) safe sleep guidelines. Studies have shown that nurses’ recommendations influence how a parent places the baby to sleep, and the more sources that communicate or reinforce the guidelines, the higher the likelihood that parents will put their baby on his or her back to sleep.
While most parents will receive a handout about SIDS after delivering their babies, Rose Danaher RN, BSN, BC, neonatal nurse practitioner at Littleton Adventist Hospital, in Littleton, Colo., believes that isn’t enough.
"I think parents should start getting information about SIDS during pregnancy," stated Danaher. "They should get it in their prenatal classes. Nurses should go over the information with parents who should also see nurses model safe practices in the hospital, and after discharge they should continue to get information from their pediatricians. Additionally, the information should be available in multiple languages."
"Nurses can also aid in SIDS reduction by supporting the mother in breastfeeding. The latest findings show that breastfeeding is protective," urges Willinger. "Additionally, while the family is still in the hospital, ask if the baby has a place to sleep at home. Room sharing is protective, bed sharing is a risk. If a family can’t afford a crib, that is important to know before they go home."
Research has found that the babies succumbing to SIDS while bed sharing or sleeping alone in an adult bed are often on their backs.
"As we focus on eliminating bed sharing, it is important that parents learn that yes, you can bring babies into bed to nurse, cuddle and bond, but when the baby is ready to sleep or you are sleepy it needs to be in its own bed to sleep," said Willinger.
"Our current aim is to bring the message of a safe sleep environment. One that addresses not only death due to SIDS but accidental suffocation, strangulation such as becoming trapped between headboard and mattress, being overlain by the parent or having a pillow over a baby’s face," she explained.
Danaher points out that nurses are often guilty of not following the safe sleep guidelines due to long-held practices such as having blankets in cribs and bedding multiples together.
"There is an unsubstantiated fear of babies with reflux choking or aspirating, and thus being placed to sleep on their sides. Additionally, there are no studies supporting the belief that bedding multiples together in the NICU benefits the babies," she mentioned.
Willinger admits that many babies do sleep more soundly on their stomachs and that parents may need help overcoming this and other challenges.
"New parents are very nervous and the thought of SIDS is scary," she reflected. "So what the nurse can do is create a situation where the mother isn’t afraid to admit that she isn’t putting the baby on its back because it cries or it sleeps better in the prone position. Give the mother room to express her concerns about the recommendations and help her find a solution. Encourage persistence. The baby may struggle, but it will learn. If you have a pristine sleep situation by the time they have the motor skills to roll over you don’t have to worry about turning them back."
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