1. SIDS AND SAFE SLEEP INFORMATION AND PREVENTION April 2009

2. Training Objectives Identify what Sudden Infant Death Syndrome (SIDS) is Recognize the difference between SIDS and Infant Suffocation Recognize ways to prevent SIDS, including the importance of a Safe Sleep Environment

3. What is SIDS? Sudden Infant Death Syndrome (SIDS) is the sudden death of an infant under 1 year of age, which remains unexplained after a thorough case investigation, including the performance of a complete autopsy, examination of the death scene and review of the clinical history. (Willinger et al., 1991) (Willinger et al., 1991)

4. Facts About SIDS SIDS is the leading cause of death in infants between 1 month and 1 year of age. Most SIDS deaths happen when babies are between 2 months and 4 months of age. (National Institute of Child Health and Human Development)

5. Each year in the United States, more than 4,500 infants die suddenly of no obvious cause. Half of these deaths are diagnosed as SIDS. SIDS is more common in male babies. SIDS is most common during winter months.

6. There are no known warning signs or symptoms of SIDS. SIDS is not caused by spitting up, choking or illnesses such as the cold. SIDS is not caused by immunizations. SIDS is not the cause of every sudden or unexpected infant death. SIDS is not child abuse.

7. While there are no known causes of SIDS, there are factors that have been identified as increasing an infants risk for sudden death: Tummy (prone) or side sleeping Tummy (prone) or side sleeping Bed Sharing Bed Sharing Soft Bedding and/or Loose Bedding Soft Bedding and/or Loose Bedding Smoking Smoking Preterm and low birth weight infants Preterm and low birth weight infants

8. Facts About Infant Suffocation Besides SIDS, parents have to also be careful regarding infants sleep environments. Most infant deaths due to suffocation are directly related to an unsafe sleep environment. Infants can suffocate when their faces become positioned against or buried in a mattress, cushion, wedge, pillow, comforter or bumper pad.

9. Infants can also suffocate if their faces, noses or mouths are covered by soft bedding, such as pillows, quilts, comforters and sheepskins. An overlay is a type of unintentional suffocation. This occurs when an infant is sleeping with one or more persons (bed sharing) and someone rolls over on them.

10. Missouri Infant Deaths in 2007 In 2007, there were 127 sudden, unexpected deaths of infants less than one year of age in Missouri, as reported to the Missouri Child Fatality Review Program (CFRP).

11. Of those 127 sudden, unexpected deaths of infants under the age of one year, based on autopsy, investigation and CFRP panel review, 15 were diagnosed as Sudden Infant Death Syndrome (SIDS), 59 Unintentional Suffocation, 25 Illness / Natural Cause, and 23 could not be determined (but had questionable circumstances). Four infants were found to be victims of Homicide and one infants death was determined to be an Accident, resulting from exposure to excessive heat.

12. Sudden Unexpected Infant Deaths in Missouri (2007) The father of an 8-week-old infant put her down to sleep prone on a standard size pillow, in an adult bed. He later found her unresponsive, after she had apparently slid off the pillow with her face down into the bedding. A child care provider placed a 10-week-old infant on his side in a playpen for a nap. A short time later, she found him lifeless on his stomach with his face down.

13. A 6-week-old infant was sleeping in a full- size bed with his mother and two siblings, ages 5 and 3. The mother was awakened by the 5-year-old telling the 3-year-old to get off the baby. The infant was unresponsive. A 3-month-old infant was placed on his stomach in a crib with bumper pads. He scooted to the corner of the crib with his face against the plastic bumper. This created an environment in which he was re-breathing his own exhaled air, causing him to suffocate.

14. Safe Sleep Environments One way parents can help to prevent SIDS is to provide a Safe Sleep Environment. The American Academy of Pediatrics (AAP) does not recommend bed sharing during sleep. The AAP recommends a separate, but approximate, sleeping environment. There is growing evidence that room sharing (infant sleeping in a crib in parents bedroom) is associated with a reduced risk of SIDS.

15. The Center for Disease Control and Prevention recommends the following: Infants should ALWAYS be placed on their backs (face up) when they are resting, sleeping or left alone. Infants should ALWAYS be placed on their backs (face up) when they are resting, sleeping or left alone. Infants should be placed on their tummies ONLY when they are awake and supervised by someone responsible. Supervised tummy time is encouraged to help make an infants neck and back muscles strong. Infants should be placed on their tummies ONLY when they are awake and supervised by someone responsible. Supervised tummy time is encouraged to help make an infants neck and back muscles strong.

16. When infants are sleeping or napping, they should only be placed in cribs approved by the Consumer Product Safety Commission (CPSC). When infants are sleeping or napping, they should only be placed in cribs approved by the Consumer Product Safety Commission (CPSC). If a crib is not available, an infant should be placed on another safe, firm sleep surface such as a bassinet or cradle that does not have fluffy or soft items on its sleep surface. If a crib is not available, an infant should be placed on another safe, firm sleep surface such as a bassinet or cradle that does not have fluffy or soft items on its sleep surface.

17. Infants should always be placed on a firm surface or mattress. Infants should always be placed on a firm surface or mattress. Infants should be dressed in a sleeper or warm pajama instead of covering the infant with a blanket. Infants should be dressed in a sleeper or warm pajama instead of covering the infant with a blanket. If an infant is covered with a blanket, make sure the blanket stays at or lower than the infants waist. If an infant is covered with a blanket, make sure the blanket stays at or lower than the infants waist.

18. Parents or caregivers who want to be close to their infant while they are sleeping, can move the crib or bassinet next to their bed. Parents or caregivers who want to be close to their infant while they are sleeping, can move the crib or bassinet next to their bed. Infants should not be placed to sleep on sofas, couches, pillows or waterbeds. Infants should not be placed to sleep on sofas, couches, pillows or waterbeds. Infants should not be placed to sleep with stuffed toys, pillows, bumper pads, quilts or comforters. Infants should not be placed to sleep with stuffed toys, pillows, bumper pads, quilts or comforters. (Centers for Disease Control and Prevention) (Centers for Disease Control and Prevention)

19. Additional Safe Sleep Environment Tips from AAP: Place the crib in an area that is always smoke free. Place the crib in an area that is always smoke free. Avoid letting the baby get too hot. Dress the baby lightly for sleep and set the room temperature in a range that is comfortable for a lightly-clothed adult. Avoid letting the baby get too hot. Dress the baby lightly for sleep and set the room temperature in a range that is comfortable for a lightly-clothed adult. Breastfeed your baby. Experts recommend that mothers feed their children human milk at least through the first year of life. Breastfeed your baby. Experts recommend that mothers feed their children human milk at least through the first year of life.

20. BABIES SHOULD BE PLACED ON THEIR BACKS TO SLEEP CRIBS SHOULD BE FREE OF STUFFED ANIMALS AND TOYS BLANKETS SHOULD BE AT OR LOWER THAN THE BABYS WAIST CRIBS SHOULD HAVE FIRM MATTRESSES BABYS FACE AND HEAD SHOULD BE UNCOVERED BABIES SHOULD SLEEP IN A SMOKE FREE ENVIRONMENT SAFE SLEEP ENVIRONMENT SAFE SLEEP ENVIRONMENT

21. Using Fans to Prevent SIDS In October 2008, a new study was released from Archives of Pediatrics & Adolescent Medicine. The study included interviews with the mothers of 185 infants who died from SIDS and the mothers of 312 other babies. According to the study, fans in a babys room may help prevent SIDS. Fans offered even more protection to babies sleeping in warm rooms.

22. According to the study, babies who slept with a fan in their room reduced their chances of dying from SIDS by 72 percent. Researchers think fans may help to circulate fresh air and prevent babies from suffocating by re-breathing exhaled carbon dioxide, one of the culprits many doctors feel causes SIDS.

23. Safe Crib Project The Safe Crib Project provides a new, safe crib to families in need, along with parent education about safe sleep arrangements for infants. In communities throughout Missouri, social service agencies, community health agencies, hospitals and other organizations have collaborated to implement the Safe Crib Project, using funding from the Missouri Childrens Trust Fund.

24. The goal of the Safe Crib Project is to save infant lives and support families. For more information about active Safe Crib Projects or funding opportunities, please contact the Childrens Trust Fund at 573-751-5147 or visit www.ctf4kids.org. www.ctf4kids.org

25. For More Information, Visit These Websites: National SIDS/Infant Death Resource Center, www.sidscenter.org www.sidscenter.org National Institute of Child Health and Human Development, www.nichd.nih.gov/sids/sids.cfm www.nichd.nih.gov/sids/sids.cfm SIDS Resources, Inc., www.sidsresources.org www.sidsresources.org St. Louis Safe Sleep Task Force, www.stlsafesleepforbabies.com/

26. Centers for Disease Control and Prevention, www.cdc.gov/SIDS/sleepenvironment.htm www.cdc.gov/SIDS/sleepenvironment.htm First Candle, www.firstcandle.org www.firstcandle.org American Academy of Pediatrics (Healthy Child Care America Back to Sleep Campaign), www.healthychildcare.org www.healthychildcare.org American Academy of Pediatrics, www.aappolicy.org www.aappolicy.org Missouri Department of Health and Senior Services, http://www.dhss.mo.gov/SafeSleep/ http://www.dhss.mo.gov/SafeSleep/

27. Missouri Department of Social Services State Technical Assistance Team Address: PO Box 208 Jefferson City, MO 65102-0208 PO Box 208 Jefferson City, MO 65102-0208 Telephone: (573) 751-5980 (800) 487-1626 (8 a.m. to 5 p.m. CST, Monday – Friday) Email: dls.stat@dss.mo.gov dls.stat@dss.mo.govdls.stat@dss.mo.gov