Infant/Toddler Safe Sleep & SIDS Risk Reduction in Child Care

October 9, 2003
Volume 2
Number 4
Stomach To Play...Back To Sleep ~ for baby's health and safety

October is SIDS Awareness Month:
Take Steps Now to Lower SIDS Risks
During the Winter Months


In this issue:

North Carolina's overall infant mortality rate decreased slightly in 2002 compared to 2001. However, the SIDS rate was significantly lower in 2002. Despite this decline, SIDS continues to be the 3rd leading cause of infant deaths statewide. SIDS is the leading cause of deaths in N.C. child care settings.



~ SIDS Stats - SIDS Rate Drops in 2002
Summary: 4 Laws Affecting Child Care
~ How to Manage Positional Skull Deformities
~ Project Update

N.C. SIDS Stats for 2002

North Carolina's SIDS rate dropped to an historic low in 2002! The SIDS rate of .69 per 1,000 live births is significantly lower than the previous year's rate of .86 per 1,000 live births.
~ 81 SIDS deaths were reported representing a 21% decline compared to 2001 in which 102 babies died of SIDS.
~ The SIDS rate for Latinos increased to 9% compared to 7% in 2000.
~ The disparity in SIDS deaths continues among African Americans.
~ Most SIDS deaths (86%) occurred in the first 4 months of life.
~ More males than females died of SIDS.
~ In 48% of the SIDS deaths the mother was a smoker (based on birth certificate matched files in 78 of the SIDS cases; data source: State Center for Health Statistics).

Editor's Note:
Of the 10 deaths reported in child care in 2002, five deaths were attributed to SIDS according to data from the Division of Child Development. SIDS continues to be the leading cause of deaths in child care in N.C. accounting for 2/3 of child care deaths since 1997.

Summary: 4 New Laws Affecting Child Care Effective This Year

Preventing and Managing Positional Skull Deformities (Flat Heads) in Infants

The authors of this clinical report review the occurrence, prevention, diagnosis and management of skull deformities or cranial asymmetry.

An asymmetrical or uneven head shape can result from conditions in utero, from the birthing process or from pressure applied to the back of the skull after birth. A head deformity diagnosis is based on history and confirmed by a physical exam.

The authors note that since 1992 the increase in deformational plageiocephaly (oblique head) is due, in part, to the practice of positioning babies on their back to sleep.* Despite some misshaping of babies' heads the researchers say that the recommended back sleep position shown to lower the occurrence of Sudden Infant Death Syndrome should continue.

Several strategies to prevent or manage skull deformities and flat spots or to keep them from becoming more severe were recommended. Preventive counseling includes teaching parents exercises and ways to alter the position of a baby's head while the baby sleeps. These mechanical adjustments and exercises can also aid in a baby's physical development. These doctors suggest that parents:

Mechanical adjustments and exercises may be warranted for some types of asymmetrical or deformed skulls. Parents can position the baby's head so that the rounded part of the skull comes in contact with the firm mattress. The skull shape should improve after a 2-3 month period as a result of neck exercises, changing head positions when baby is sleeping and giving the awake baby exercise time on his or her tummy. If there is no improvement in the baby's head shape from consistent use of these techniques the pediatrician can make a referral to a specialist such as a physical therapist or pediatric neurosurgeon.

Skull-molding helmets may be beneficial if exercises and changing the baby's head position are not effective. Babies 4-12 months of age may benefit most from using a helmet because their skull bones are malleable and their rapid brain growth may have a normalizing effect. Helmets appear less effective after 12 months of age. Surgery may be warranted for more severe situations if mechanical adjustments such as exercises, head positioning during sleep or helmets did not improve the baby's head shape. Surgery is almost always used for craniosynostosis.

The authors conclude that the pediatrician or other primary health care clinician can oversee the diagnosis and management of deformational plagiocephaly. The mechanical methods of management are more effective when performed early in life but referral to specialized pediatric neurosurgeons should be considered if exercise, positioning or helmets don't yield improvements.

* Editor's Note: In American society today, babies have constant pressure on the back of their skull because of the use of infant carriers, swings, strollers, bouncy seats and car seats and not just because they are positioned on their back to sleep.

Reference: Prevention and Management of Positional Skull Deformities in Infants. Persing, J., J. Hector, J. Swanson, J. Katwinkle, Committee on Practice and Ambulatory Medicine, Section on Plastic Surgery and Section on Neurological Surgery Reference: Pediatrics. 2003;112(1):199-202.

ITS-SIDS Project Update

Phase 2 of the ITS-SIDS Project is in full swing. The ITS-SIDS Curriculum has been updated to include information about the N.C. SIDS Law, Alternative Sleep Position Waivers and the most recent SIDS data. We are currently recruiting Trainers for the ITS-SIDS Project for Train-The-Trainer sessions scheduled in the last two weeks of October. Contact to apply as a trainer.