Personalizing SIDS prevention: Take individual sleeping habits into account

I was staying at a hotel in the mid-2000s when early one morning in an empty lobby a woman burst from the elevator with an infant in her arms screaming, “Help! My baby is not breathing!”

It was one of the few moments I've been called upon to perform cardiopulmonary resuscitation in the community setting since I was first CPR certified, when I was 15 years old and working as a lifeguard.

I knew from the tone and color of this infant that it was too late to save him despite all emergency efforts.  I later learned that this caregiver had placed the infant in bed with her to sleep. 

This was about a decade after the “Back to Sleep” campaign was launched to reduce the risk for Sudden Infant Death Syndrome (SIDS). According to the mother, she had placed the infant on a pillow in the prone position, violating numerous safe-sleeping recommendations, most notably, not placing the infant in the “face up” position.

Since that time, the American Academy of Pediatrics (AAP) has updated its policy statement on reducing the risk for SIDS.  Currently, there are 17 recommendations for safe-sleeping environments, including one aimed specifically at healthcare professionals in newborn nurseries and neonatal intensive care units.

I don't disagree with any of the AAP's recommendations; however, I wish that the recommendations were not so generalized and “one size fits all.”

For example, one recommendation states, “room sharing without bed sharing is recommended,” and includes 12 sub-points outlining specific situations that increase SIDS risk. One such scenario was sharing a bed with a caregiver “who is excessively tired.” Do you know any new mothers who are not excessively tired?

Another provision in the policy statement allows that an infant may be brought into the bed for breastfeeding but should then be returned to his or her crib for a safer sleeping environment after feeding.  Again, I wonder are there any mothers out there who have not fallen asleep in bed with their baby while breastfeeding during the middle of the night?

The most recent AAP policy statement even cites a recent national survey in which 45% of parents admitted to “sharing a bed with their infant at some point during the preceding two weeks.” Because of this, I feel that the AAP recommendations included more encouragement for clinicians to assess and discuss individual sleep environments with parents.

In my opinion, a separate set of recommendations from the Academy of Breastfeeding Medicine provides more family-friendly guidance, including a recommendation that clinicians encourage parents to express their views on bed sharing and sleep practices in order to assess the individual environment and risks, while remaining sensitive to cultural differences. Healthcare providers should then discuss misperceptions with mothers and fathers and make individual recommendations to allow for the safest possible sleep environment for that infant and family.

Read more about ethnic disparities in SIDS risk in Julee's next blog, which will be posted on Wednesday, December 21, 2011.

Julee B. Waldrop, DNP, FNP, PNP, is the Director of the MSN-DNP Program and an associate professor at the University of Central Florida. She provides health care to children at a local community health center.

References

Breastfeeding Medicine. 2008; 3(1):38.

Pediatrics. 2005; 116(5): 1245-1255.

Pediatrics. 2011; 128e: e1341-1367.

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