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

Q: Pacifiers are considered safe to have in cribs with the infants. Why are they not considered to be a risk for SIDS, just like other objects in the crib?

A: There is more and more evidence that pacifiers may reduce the risk of SIDS. Also, unlike most items that are placed in the crib with babies, they are not soft and do not pose an issue with entrapment.

Q: What is the explanation for how pacifiers may be protective against SIDS?

A: Nobody knows the exact mechanisms, but the data that pacifiers are protective are quite striking. There will likely be a fair amount of discussion on this topic in Edmonton,[Canada at the SIDS International Conference July 2-6, 2004 according to Dr. Rachel Y. Moon, Medical Director of the Children's Health Center at the Children's National Medical Center.

Q: Is there a relationship between sleep apnea (a brief pause in breathing) and SIDS?

A: No, this is a common misconception. The 1980's theory that lapses in breathing and heart rate occurred just before an infant died of SIDS started the cardiorespiratory or apnea monitor craze and prompted a home-monitoring industry. There is no scientific evidence that the use of apnea monitors has decreased the rate of SIDS. The current thinking is that monitors should only be used for babies with proven apnea (related to prematurity or other medical conditions) but not as a way to prevent SIDS.

Apnea does not predict SIDS

In 2003, the Committee on Fetus and Newborn reviewed research on the treatment of apnea for premature infants and the use of cardiorespiratory monitors, commonly called apnea monitors, to measure heart rate and breathing. They found that preterm infants may have a higher risk of severe apnea but that the risks of severe apnea drops off by 43 weeks postmenstural age (weeks since a women's last menstural cycle prior to conception) and the monitoring can be discontinued.The Committee concluded that apnea is not associated with nor is it a precursor for SIDS.

Apnea is an unexplained episode of stopping breathing for 20 seconds or longer. It may be associated with a slowed heart rate (bradycardia) and changes in skin color or pallor. One reason why apnea is not believed to predict SIDS includes the fact that many infants experience a pause in breathing and a lapse in heart rate without dying. Also, apnea usually stops at an age before most SIDS deaths occur.

When cardiorespiratory monitors are prescribed for use in the hospital or at home, the Committee recommends that doctors prescribe appropriate monitoring equipment and have a plan for reviewing and ending their use.The monitors should measure both the heart rate and the baby's breathing activity at the same time. The committee concludes, "Prevention of SIDS is not an acceptable indication for home cardiorespiratory monitoring."

The Committee recommends that cardiorespiratory monitors:
1) not be prescribed as a way to prevent SIDS
2) when used for preemies be limited to 43 weeks' postmentrual age or after extreme apnea episodes stop, whichever comes last
3) be used for infants that have unstable airways, rare medical conditions that affect breathing, or lung disease

If an infant is sent home with a monitor, parents should also be able to access medical, technical, psychosocial and respite help. Parents and caregivers should be trained in what to look for if the infant gets distressed. They should also receive training in how to use the monitor properly and in infant CPR.

The Committee also recommended that parents be advised that home cardiorespiratory monitoring does not prevent SIDS. They advocate using the proven SIDS risk reduction strategies such as a back sleep position for infants, a safe sleep environment and no exposure to secondhand tobacco smoke.

Reference: Apnea, Sudden Infant Death Syndrome, and Home Monitoring Committee on Fetus and Newborn - Blackmon, L.R., D.G. Batton, E.F. Bell, W.A. Engle, W.P. Kanto, G.I. Martin, W.N. Rosenfeld, A.R. Stark, J.A. Lemons Reference: Pediatrics. 2003. 111(4):914-917

Editor's Note: If an infant enrolled in childcare requires an apnea monitor, staff should receive training in the proper use of the equipment, know what signs and symptoms to look for if the child is distressed and have access to medical support. Providers can make arrangements with the infant's parents and the equipment company to receive training on the correct use of the monitor.

New and revised SIDS publications are now available from the National SIDS/Infant Death Resource Center. Click on the following resources for more information:

• "What is SIDS?" (revised) http://www.sidscenter.org/SIDSFACT.HTM
• "Responding to a Sudden, Unexpected Infant Death: The Professional's Role" http://www.sidscenter.org/Downloads/S149.htm

Evaluations - Phase 2:

As a result of this training I will ...
...be able to train the childcare providers in my county. This training has well equipped me to convey this vital information. Trainer

Practice placing infants on their backs and have a parents' meeting and a staff meeting on the new law. Now that I understand it better.
Thanks for the good information. Provider

Analysis of 501 providers' evaluations representing 15 counties brings good news and also highlights areas for improving your ITS-SIDS trainings. Overwhelmingly, childcare providers appreciate the ITS-SIDS training you are providing and rate the trainings highly!

80% of providers "Strongly Agree" that learning objectives are clear, the content and objectives are related, information is organized and presented clearly and that they gain new knowledge/skills at the training. Almost all would recommend the training to another childcare provider.

The top five most helpful topics are:

1. information about the N.C. SIDS law
2. educational materials
3. developing a safe sleep policy
4. techniques for reducing SIDS
5. SIDS data/statistics

Providers would like:

• more details about SIDS research, statistics and the causes of SIDS
• more activities and visuals
• practice writing a safe sleep policy

Follow-up with childcare providers

On their evaluations, some childcare providers indicated they would like SIDS information on a regular basis. If providers recorded their email or mailing address as part of their evaluation response, please be sure to help meet their requests. One way to do this is to send them ITS-SIDS updates and the newsletters. Another way is to check in with a phone call or a site visit.

Accomplishments:

The end of June brings to a close the second year and Phase 2 of the ITS-SIDS Project. To-date, the ITS-SIDS Project has accomplished the following:

• Phase 1: 9,226 childcare providers trained; 464 trainings scheduled or completed
• Phase 2: 8,423 childcare providers trained; 443 trainings scheduled or completed
• Phase 3: 2,180 childcare providers trained; 133 trainings scheduled or completed
• TOTALS: 19,829 childcare providers trained; 1,040 trainings scheduled or completed
  

Reminders:

New SIDSEducational Materials Coming Soon - Sample English and Spanish posters will be mailed to you soon. Order materials on-line, by fax (919-828-7470) or by mail. Click here to download an order form.

New Fax Number for Ordering Materials - The N.C. Healthy Start Foundation's new fax number for orders is 919-828-7470.

Non-Exempt Trainers - Please check your training numbers and your training schedule to make sure you are on target.

Date Change - Continue to send all rosters and evaluations to the ITS-SIDS Project through August 2005.