The Following is a Timely Tip Provided as a Community Service by the Lourdes Health System

Camden, NJ - Despite a 13-year national campaign emphasizing that babies must be placed on their backs to sleep, some parents are continuing behavior that puts their babies at risk for Sudden Infant Death Syndrome (SIDS), research conducted at Our Lady of Lourdes Medical Center has confirmed.

Among the findings of the "Safe Sleep Initiative to Reduce SIDS Risk" study by the Women's and Children's Division at Lourdes:

• "Back only" was the sleep position for only 38 percent of infants;
• 33 percent of infants did not sleep by themselves in a crib or playpen;
• 20 percent of infants "normally" shared a bed and 13 percent "sometimes" shared a bed.

"These results are alarming and should serve as a wake-up call that more education must be done," said Regina Grazel, MSN, RN, BC, CNS, C, Perinatal Clinical Nurse Specialist and principal investigator. "The back should be the only sleeping position for a baby, who should have his or her own space. Sharing with another child or an adult, the baby could be rolled upon or suffocated."

Grazel and the investigative team from the hospital's pediatrics unit recently presented their findings at nursing conferences in Camden and San Diego.

SIDS Remains a Killer

The American Academy of Pediatrics and the National Institute of Child Health and Human Development launched a campaign against SIDS, also called crib death, in 1994. As a result, SIDS rates have declined by more than 50 percent. However, SIDS remains the leading cause of death for infants 1 month to 1 year of age, claiming 2,100 babies annually.

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Significant health disparities also exist among racial and ethnic groups. African American and Native American infants are more than two times more likely than white infants to die from SIDS, and SIDS mortality rates vary significantly within Hispanic subgroups.

As Our Lady of Lourdes Medical Center serves large, low-income African American and Hispanic populations that may not have received advice on proper baby sleep positioning or had various other household risk factors for SIDS, hospital clinicians sought to determine the scope of the problem and launch their own educational campaign.

"Even though the education has been out there, what parents were supposed to be doing was not being practiced," said Wanda Martorano, BSN, RNC, a co-investigator and Care Manager on the pediatrics unit.

Study Methodology

Grazel, Martorano and pediatric staff nurses Arlene Foley, RNC, and Anne Galdo, BSN, RNC, designed a survey on infant sleep practices. Questions included infant sleeping position, location, clothing, sleep area accessories and environment, as well as queries regarding pacifier use, breastfeeding and smoking. Mothers in the pediatric unit and the Osborn Family Health Center -- Lourdes' medical practice where low-income residents receive OB/GYN, primary and specialty care -- received the survey. One hundred returned surveys, with 99 deemed acceptable.

Grazel said 38 percent of infants were placed only on their backs to sleep, the safest position in preventing SIDS. The remaining 60 percent also slept on their stomachs and sides. Respondents reported infants sleeping in a parent's or sibling's bed and with quilts, pillows or stuffed animals -- all increasing the risk of dying from SIDS, she said.

"The survey also found that infants who wore fewer items of clothing to sleep were more frequently placed on their backs to sleep, demonstrating that some parents are getting the message," Grazel said. "However, there was also a positive correlation between the number of items in the crib and the amount of clothing a baby wore to sleep. To reduce SIDS risk, cribs should be free of stuffed animals and pillows and the baby dressed lightly."

Lourdes Campaign

All mothers of babies ages newborn to 6 months receive culturally appropriate educational materials about SIDS prevention and a Halo® Sleep Sack with the "back to sleep" message printed on the front before being discharged from Our Lady of Lourdes Medical Center. Nurses -- all of whom have received additional training regarding the latest American Academy of Pediatrics' SIDS risk reduction strategies -- demonstrate how to dress the baby in the sack and reinforce safe sleep practices.

Following discharge, nurses make follow-up phone calls to check whether the baby is using the sack and reminder the caregiver of the proper sleep position and location.

"Proper parental education by nurses on infant sleeping practices is essential," Grazel said. "The nurses have to demonstrate it in the hospital for the parents to do it at home."

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Photo of study co-investigator Wanda Martorano with infant in sleep sack available upon request. Please contact Wendy Marano, Director of Public Relations at 856-482-4965.

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Breakout

Key Points for Reducing SIDS from the American Academy of Pediatrics

• Back to sleep: Infants should be placed supine for sleep. Side sleeping is not recommended.
• Encourage "tummy time" during awake periods to prevent positional deformities of the head.
• Baby should be put to sleep on a firm crib mattress.
• Soft objects and loose bedding should not be a part of the infant's sleeping environment. (No stuffed animals in cribs!)
• Do not smoke during pregnancy or expose baby to second-hand smoke.
• Baby and parents should not share the bed for sleep.
• Offer a pacifier at nap and bedtime.
• Avoid overheating.
• Avoid the use of commercial devices marketed to reduce SIDS.
• Do not use home monitors as a strategy to reduce SIDS risk.
• Ensure all child care providers are aware of these recommendations.