SAFE SLEEP FOR INFANTS The Canadian Foundation for the Study of Infant Deaths National Office: 60 James Street, Suite 403, St. Catharines, Ontario L2R 7E7 Tel: Toll Free: Fax: Website:

Infant Deaths in Canada In Canada, babies continue to die of Sudden Infant Death Syndrome (SIDS) and in unsafe sleep environments Research suggests over half of these deaths could have been prevented Many believe these deaths are the result of lack of education and awareness

Workshop Objectives Hear about SIDS and unsafe sleep practices from mothers that have lost a child Be introduced to behaviors that increase the risk of SIDS and unsafe sleep accidents Be introduced to practices and resources to help you reduce the risk of SIDS and unsafe sleep accidents for infants Discuss your role in reducing infant deaths

The Canadian Foundation for the Study of Infant Deaths The CFSID is dedicated to reducing the rate of sudden and unexpected infant deaths and providing emotional support to those who are affected

CFSID Mandate to deliver infant health and safety education through an extensive network of volunteers in communities across Canada to provide resources and services for all infant deaths including miscarriage and stillbirth with respect to peer support, public education and awareness to support Sudden Infant Death Syndrome (SIDS) related research

The Ontario Safe Sleep Team Who we are? Why we are here? Our mission and message? Some of our successes so far!

autopsy examination of the scene of death review of the case history The sudden death of an infant under one year of age which remains unexplained after the performance of a complete post-mortem investigation including: Sudden Infant Death Syndrome ICD-9 Definition It is a diagnosis of exclusion

SIDS Is Not Caused by external suffocation Caused by vomiting and choking Caused by immunizations Child abuse or neglect Contagious Hereditary Predictable or completely preventable

Increasing the Risk of SIDS Maternal smoking during pregnancy Exposure to second hand smoke Overheating Respiratory illness Sleeping on a soft surface Bed-sharing Soft bedding or stuffed animals in bed

Additional Risks Tummy and side sleeping Substance abuse during pregnancy Teen mothers Mothers with late or no prenatal care Preterm infants Low birth weight infants Multiple births

Triple Risk Model to Explain SIDS Critical period of development Underlying Vulnerability Modifiable Pre- and Post-Natal Environmental Stressors HIGHEST RISK FOR SIDS Possible Brainstem Abnormality (Filiano and Kinney, modified) First 6 months Prone/Side Sleep Position Nicotine Exposure Soft Bedding Overheating Bed sharing

What You Should Know About These Risk Factors Risk factors don’t CAUSE SIDS, but are present in babies that die of SIDS Even babies with no risk factors present can die of SIDS SIDS cannot be completely prevented SIDS is nobody’s fault

Healthy Lifestyle Choices Create a healthy lifestyle for you and your baby Avoid smoking and alcohol during pregnancy and while breast feeding Always provide a smoke free environment for your baby Smoking increases the risk of SIDS

Prenatal Care Mothers with late or no prenatal are at a greater risk of having a child die from SIDS or an unsafe sleep accident Prenatal care is essential to the health of the mother and the infant during pregnancy and after birth

Safe Sleep for Babies What is safe and not safe sleep for babies?

Unsafe Sleep Risk of falling; out of bed or off sofa or chair Risk of becoming trapped in bed or sofa Risk of smothering or suffocation Risk of entanglement Risk of overheating

ONTARIO PAEDIATRIC DEATH REVIEW COMMITTEE ANNUAL REPORT 2009 A total of 96 cases were reviewed this past year 40 of 96 deaths were classified as Undetermined 33 (75%) of the Undetermined cases involved unsafe sleeping environments 19 (58%) of these unsafe sleeping related cases involved bed-sharing

SLEEP SURFACES FOR BEDSHARING DEATHS

Sleep surfaces in 14 unsafe sleeping deaths that did not involve bed-sharing

33 unsafe sleeping related deaths in of the infants were female; 22 were male 31 of the infants were 7 months of age or younger and 2 were 10 months old, stressing the increased risk of sharing a sleep surface with very young babies

Where Should Infants Sleep? Scheers, Rutherford, & Kemp, Pediatrics, October 2003 Based on Risk for SIDS: Greatest if sharing a sleep surface Intermediate if sleeping in another room Least if infant sleeps in same room as parent in own safe crib Safest : Place baby in their own safe crib in the caregiver’s room for the first 6 months

Always on my Back in my own Crib The safest place for a baby to sleep is in their own crib in their caregivers’ room for at least the first six months. Bed Sharing is not recommended anywhere, at anytime!

Back Sleeping April 15, 1992 The American Academy of Pediatrics recommended that healthy infants: “when being put down for sleep, be positioned on their back ….” Since 1992 accredited with 50% reduction in SIDS deaths

Choking Concern Babies have a tonic neck reflex, which causes them to turn their heads to the side when they are placed on their back If the baby does spit up or vomit, the fluid runs out the nose and mouth to the side of the infant, thus avoiding choking

Cribs and Cradles Please see Health Canada’s website at for the current regulations for cribs and cradles Please have a firm fitted mattress A crib purchased prior to September 1986 is not recommended Please NEVER modify a crib or cradle Follow the manufacturer’s instructions Ensure the mattress support is secure

Crib and Cradle Placement Cribs should be away from windows due to falling risks and drafts Be sure to tie up all cords and curtain strings Keep crib away from radiators due to overheating concerns Place mobiles out of baby’s reach and remove when sitting up

Mattress Should be firm and tight fitting If a second hand mattress is all that is available, check it for tears, rips, mould, and do not use it if any of these are present Ensure that it meets current standards and that it fits the crib snugly

Mattress Safety Soft worn or loose fitting mattresses can cause gaps and suffocation hazards Ensure mattress is at lowest setting when baby can sit up Remove mobiles and toy bars when baby starts reaching for them

Always on my Back in my own Crib

Twins Twins if sleeping together should be placed one at each end of the crib, feet to the foot of the crib When they can move freely, separate them into their own cribs

Bassinets Bassinets do not have the same safety standard requirements as a crib If this is your only alternative It should be well ventilated Remove padding Have a firm and fitted mattress Keep it clutter free

Play Pens Playpens are not safe for sleeping. Only use for supervised play Ensure is a newer model with mesh sides for air flow Never place baby in playpen with bassinet or change table insert attached Keep play pen clutter free

NO BEDDING means NO comforters, quilts, sheepskins, pillows, positioners, bumper pads or stuffed animals in the crib Just a light blanket tucked under the arms or the best is a wearable blanket or SleepSack

Overheating Often causes are too much bedding or clothing, or because the room is too hot Ideal room temperature is degrees Dress infant in sleeper and one additional light layer-receiving blanket or wearable blanket

Car Seats Car Seats are not safe for sleeping. 80% of car seats are installed incorrectly! They do not provide a flat firm sleeping surface Avoid covers and blankets If baby does fall a sleep move to a safe sleep surface ASAP Attend a car seat safety and installation clinic

Strollers Strollers are not recommended for sleeping ALWAYS supervise child in stroller ALWAYS use safety belts USE BRAKES when stopped Avoid blankets, pillows and covers Place in horizontal position when child is sleeping

Slings and Carriers Serious injuries and deaths have resulted due to sling and carrier use Slings are not recommended at any time Only a front facing carrier is suggested

Breastfeeding? Research has found that breast feeding your baby can reduce the risk of SIDS When breastfeeding sit up in bed or a chair and be sure to place the baby on their back in their own crib when finished

Pacifiers A pacifier at sleep time has been found to decrease the risk of SIDS If breastfeeding introduce after 1 month If refused-its okay Replace with new one every 2 months Never coat with anything sweet Never add string or ribbon

Flat Head Positional plagiocephaly is an uneven or misshapen head when the infant is born Causes: pressure on the baby’s skull while in the uterus or during birth and is often seen as a flat spot on the back or side of the head may also develop during the first few months of life due to a baby preferring to lie in one position

Remedies If the resting position of the baby’s head is constantly the same, the effects of gravity on a soft, rapidly growing head may cause a flattening on one side Positional plagiocephaly may be prevented or treated by repositioning techniques and by minimizing pressure on the head when the baby is awake. Tummy time! Helmets have been used in some extreme cases

Tummy Time Play Tummy time must be supervised by an adult. This tummy play helps develop good tone in the neck and back muscles and learn to roll over, crawl, sit, and stand Tummy time can begin as soon as the cord falls off All babies should be placed on their tummies to play

Monitors NO evidence that monitor use reduces SIDS CAN NOT prevent SIDS Even if using monitor MUST follow safe sleep practices

When Traveling with a Baby Be aware of what can be done to maintain a safe and healthy environment even when not at home The best alternative is on the floor - no pillows around the infant if a safe crib is not available When visiting family and friends, be aware that not everyone will take the same precautions you do for ensuring an area is free of hazards and safe for children Supervise children closely

Alternate Childcare Children spend time with people other than parents, sometimes for long periods; grandparents, other relatives, nannies, friends, childcare workers, even church “crying rooms” when you are attending a service Children can and do die of SIDS and in unsafe sleep accidents in these settings

Recommendations CFSID recommends a formal written agreement for babysitters and childcare centres that clearly describes your expectations and instructions CFSID recommends that you and all staff associated with infant care sign a back to sleep agreement

Safe Sleep DVD and Guidebook The ABC’s of Safe Sleep DVD and Workshop Guide 18 minute chaptered video with bilingual guide for Educators $10 donation to CFSID Available now!

The ABC’s of Safe Sleep CFSID now offers: The ABCs of Safe Sleep Online Certificate Course

Course Content The ABCs of Safe Sleep course: –explores risk factors of SIDS –provides caregivers with information to improve the health and safety of infants and reduce the risk of SIDS –is designed for anyone providing care to an infant

ABC’s of Safe Sleep Online Certificate Course Course Duration: 2 hours Price: $49.99 Prerequisite(s): None Language(s): English

Online Certification Course for Healthcare Professionals COMING IN 2010! The New Online Certification Course for Healthcare Professionals Launch date and cost to be announced

Additional Resources The Canadian Foundation for the Study of Infant Deaths National Office: 60 James Street, Suite 403, St. Catharines, Ontario L2R 7E7 Tel: Toll Free: Fax: Website: Health Canada Website: Canadian Paediatric Society Website: St. Laurent Blvd., Ottawa, Ont., K1G 4J8 Phone: Fax: Canadian Institute of Child Health Website: Suite 300, 384 Bank Street, Ottawa, ON K2P 1Y4 Tel.: Fax:

Special Thanks to the Ontario Trillium Foundation for funding the Safe Sleep Campaign