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Giving Voice to a Silent Epidemic: SIDS and Other Sleep-Related Infant
Giving Voice to a Silent Epidemic: SIDS and Other Sleep-Related Infant
Giving Voice to a Silent Epidemic: SIDS and Other Sleep-Related Infant
Giving Voice to a Silent Epidemic: SIDS and Other Sleep-Related Infant
CDC
CDC
Giving Voice to a Silent Epidemic: SIDS and Other Sleep-Related Infant
Giving Voice to a Silent Epidemic: SIDS and Other Sleep-Related Infant
Giving Voice to a Silent Epidemic: SIDS and Other Sleep-Related Infant
Giving Voice to a Silent Epidemic: SIDS and Other Sleep-Related Infant
AAP Infant Sleep Recommendations
AAP Infant Sleep Recommendations
Additional Safe Sleep Recommendations
Additional Safe Sleep Recommendations
Alone
Alone
SIDS Risk and Infant Bed Sharing
SIDS Risk and Infant Bed Sharing
Shhh
Shhh
on the Back
on the Back
Prone Sleeping and Aspiration Risk
Prone Sleeping and Aspiration Risk
Prone Sleeping and Aspiration Risk
Prone Sleeping and Aspiration Risk
Prone Sleeping and the NICU
Prone Sleeping and the NICU
in a Crib
in a Crib
Additional Recommendations: Avoid Overheating
Additional Recommendations: Avoid Overheating
Additional Recommendations: Consider Pacifier Use While Sleeping
Additional Recommendations: Consider Pacifier Use While Sleeping
Other Considerations: Tummy Time
Other Considerations: Tummy Time
Other Considerations: Breastfeeding
Other Considerations: Breastfeeding
Other Considerations: Positioners & Monitors
Other Considerations: Positioners & Monitors
Other Considerations: Positioners & Monitors
Other Considerations: Positioners & Monitors
Our Campaign: Beyond Knowledge to Behavior Change
Our Campaign: Beyond Knowledge to Behavior Change
Sleep Safe Campaign: Components
Sleep Safe Campaign: Components
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Giving Voice to a Silent Epidemic: SIDS and Other Sleep-Related Infant Death in Baltimore City

: Francine Mueller. , . , Giving Voice to a Silent Epidemic: SIDS and Other Sleep-Related Infant Death in Baltimore City.ppt zip- 1879 .

Giving Voice to a Silent Epidemic: SIDS and Other Sleep-Related Infant Death in Baltimore City

Giving Voice to a Silent Epidemic: SIDS and Other Sleep-Related Infant Death in Baltimore City.ppt
1Giving Voice to a Silent Epidemic: 31sharing all night long has more than
SIDS and Other Sleep-Related Infant Death doubled in the past 10 years from 6% to
in Baltimore City Stephanie Strauss 13% (Willinger M, 2003, National Infant
Regenold, MD, MPH Senior Advisor Babies Sleep Position Survey). More recent study:
Born Healthy Initiative Bureau of Maternal 1/3 bed share in first 3 months, 27% at 12
& Child Health Baltimore City Health months (Hauck F, 2009, Infant Feeding
Department Practices Study II). Higher numbers in low
stephanie.regenold@baltimorecity.gov. 1. SES, certain ethnic groups (African
2Overview. BCHDs Birth Outcomes Americans, Latinos) - more than 50% may be
Initiative Definitions Epidemiology, bed sharing all night long.
Etiology, and Risk Factors Recommendations 32Shhh...MyShhh...My Child Is Sleeping
Parent Education. (in My Bed, Um, With Me) Child Is Sleeping
3Bmore for Healthy Babies: BCHDs New (in My Bed, Um, With Me). Ask parents if
Initiative. Bold new initiative by the they sleep with their kids, and most will
Baltimore City Health Department & The say no. But there is evidence that the
Family League of Baltimore. Multi-year prevalence of bed sharing is far greater
grant from CareFirst Blue Cross/Blue than reported. Many parents are ''closet
Shield to improve birth outcomes in co-sleepers,'' fearful of disapproval if
Baltimore City. Strategic approach to anyone finds out, notes James J. McKenna,
affect change on all levels- policy, professor of anthropology and director of
service, community and individual levels. the Mother-Baby Behavioral Sleep
4Bmore for Healthy Babies: BCHDs New Laboratory at the University of Notre
Initiative. Our vision: All of Baltimores Dame.. By TARA PARKER-POPE Published:
babies are born healthy weight, full term, October 23, 2007.
and ready to thrive in healthy families. 33Why is Bed Sharing Risky? Soft
Components: Intensive efforts in high-risk bedding, pillows, comforters No safety
neighborhoods to connect people to standards for adult beds Overheating Risk
services. Citywide mass media campaigns. of entrapment.
Policies to improve screening and 34on the Back Not on the stomach or
education. side On the back every time the baby is
5Bmore for Healthy Babies: BCHDs New laid down to sleep.
Initiative. 128 babies under the age of 35Pre-AAP recommendation Post-AAP BTS
one died in Baltimore City in 2009. Campaign (began in 1994). Sleep Position
Baltimore has 4th worst infant mortality Source: NICHD Household Survey SIDS Rate
rate in US: The national rate is 6.9 Source: National Center for Health
deaths per 1000 live births. Baltimores Statistics, CDC.
rate is 12.1 deaths per 1000 live births. 36Prone Prevalence Rates Among Black
African American: 14.3 per 1,000 White: Infants, US. National Center for Health
7.3 per 1,000. Statistics, National Infant Sleep Position
6Bmore for Healthy Babies: BCHDs New data.
Initiative. The leading causes of infant 37Why do parents place their babies
mortality in Baltimore are: #1 Prematurity prone? Comfort Baby sleeps longer, doesnt
and low birth weight complications #2 SIDS awake easily Flattened Skull
and unsafe sleep conditions #3 Birth (plagiocephaly) Safety Concern about
defects Our First Campaign Addresses Safe choking.
Sleep. 38Why is Prone Sleeping Risky? Babies
7Definitions: Sudden Infant Death sleep deeper, experience less movement,
Syndrome (SIDS). The sudden death of an and are less arousable when prone.
infant younger than 1 year of age, that Rebreathing theory: carbon dioxide gets
remains unexplained after a thorough case trapped around the mouth and nose. Risk is
investigation, including: autopsy death higher when infant is used to back
scene investigation clinical history sleeping. Risk of side sleeping similar to
review No cause of death is determined. prone.
Manner of death is Natural.. 39Prone Sleeping and Aspiration Risk.
8Definitions: Sudden Unexplained Infant Being on the back is actually less risky
Death (SUID), or Sudden Unexplained Death for aspiration: secretions pool in the
in Infancy (SUDI). No cause of death able back of the throat, near the esophagus.
to be determined. Infant found in an 40Prone Sleeping and the NICU. Premature
unsafe sleeping environment: on an adult babies are often placed prone to improve
mattress or sofa sleeping with another respiratory mechanics. Parents are likely
adult or child sleeping on the stomach to continue this practice at home.
Inconclusive for asphyxia. Manner of death Teaching and modeling appropriate sleep
is Undetermined. Coded as SIDS for Vital position may not occur in the NICU. 52% of
Statistics. NICU nurses promoted supine sleeping at
9CDC.gov/SIDS/SUID, 2009. discharge (Aris 2006) Recommendation:
10Case #1. A 22-year old single African Place all premature babies supine when
American woman lived in an apartment with respiratory dynamics are stable, well
her three children (ages 3 months, 2 before anticipated discharge. Parents
years, and 4 years). She fell asleep on should be taught and shown to place babies
the couch with her 3-month-old. When she supine during sleep before discharge. Aris
awoke 2 hours later, the baby was C, et.al. Adv Neonatal Care.
unresponsive. The EMS team was unable to 2006;6(5):281-294.
resuscitate the baby. 41in a Crib. A crib, bassinet, or
11SIDS Epidemiology. SIDS is the 3rd portable crib which meets safety standards
leading cause of infant mortality in the No pillows, blankets, stuffed animals,
US, and the 2nd leading cause of death in toys, bumpers.
Baltimore City. It is the leading cause of 42Why a Firm Sleep Surface? Soft or
postneonatal mortality nationally and loose bedding carries 5 times the risk of
locally. Over 2,000 babies die in the US SIDS as firm bedding. Sleeping on the
each year from SIDS. Peak incidence occurs stomach on soft or loose bedding carries
when a baby is between 2 and 4 months. 20 times the risk of SIDS than those
12SIDS Epidemiology: Established Risk infants who slept on their backs on firm
Factors. Prematurity and/or low birth bedding. Infants should not be placed to
weight African American Native American sleep on couches, cushioned chairs,
Male sex Young maternal age Late or no beanbag chairs, sofas, waterbeds, air
prenatal care High parity. mattresses, memory foam mattresses, or
13SIDS Epidemiology: Established Risk lamb skins.
Factors. Maternal drug use during 43Additional Recommendations: Avoid
pregnancy Maternal smoking during Tobacco Smoke. In utero tobacco exposure
pregnancy Environmental tobacco smoke increases the risk of SIDS: Possibly
Overheating Bed sharing Prone/side sleep related to effect on birth weight Prenatal
position Soft bedding. tobacco exposure associated with arousal
14Case #2. A 6-month-old girl was defect Post partum exposure to tobacco
sleeping in an adult bed with her smoke also increases the risk of SIDS.
10-year-old brother. When their mother 44Additional Recommendations: Avoid
checked in on them, the baby was not Overheating. Dress infant according to
breathing and was cold and stiff to the room temperature. Keep temperature
touch. The boys leg was resting on top of comfortable for a lightly clothed adult.
the babys head. EMS was called and Use sleeper or sleep sack. If a thin
resuscitation efforts were started but blanket is usedtuck it in on 3 sides to
were unsuccessful. keep at chest level or below. Dont
15SIDS Epidemiology: Baltimore City. over-bundle.
Deaths per 1,000 live births. Baltimore 45Additional Recommendations: Consider
City - BCHD analysis of data from the Pacifier Use While Sleeping.
Maryland VSA, MD - Maryland Vital Recommendation added in 2005 after
Statistics Reports, U.S. - NCHS Vital multiple studies showed an independent
Statistics Reports. protective effect. Possible mechanisms:
16SIDS. SIDS Etiology: Triple Risk Lower arousal threshold Airway patency
Model. Infant at Critical Development Sleep position Specific Recommendations:
Period. Environmental Factors. Genetic Introduce around 1 month of age or after
Predisposition. Filiano JJ and Kinney HC, breastfeeding is established Use as infant
Biol Neonate, 65:194-197, 1994. is being put down to sleep Do not force
17SIDS Etiology: Critical Development Dont have to reintroduce if it falls out.
Period. Immature respiratory and autonomic 46Other Considerations: Tummy Time.
nervous system Delayed neuronal maturation Persistent flat spots on an infants head,
Poor sleep arousal responsiveness. Moon positional plagiocephaly, can be caused by
RY, et.al. Lancet. 2007;370:1578-1587.; repeated time in one position. Flat spots
Moon RY, Fu LY. Pediatrics in Review. usually disappear in the months after
2007;28(6). learning to sit up. To help reduce flat
18SIDS Etiology: Genetic Factors. spots: Daily Tummy Time while awake and
Serotonin receptor and transporter supervised. Alternate end of crib where
abnormalities that affect arousal response babys head is placed to sleep, or rotate
Polymorphisms in genes that effect ANS position of crib. Limit amount of time
development Abnormalities in the Na+ and baby spends in car seats, carriers, etc.
K+ channels that are associated with 47Other Considerations: Breastfeeding.
prolonged QT syndrome Complement gene May be associated with reduced risk of
deletions and IL-10 gene polymorphisms. SIDS: Breastfed infants are more arousable
Moon RY, et.al. Lancet. at 2-3 months. Some studies show
2007;370:1578-1587.; Moon RY, Fu LY. protective effect, others none. Mothers
Pediatrics in Review. 2007;28(6). can breastfeed successfully without bed
19SIDS Etiology: Environmental Factors. sharing. Moon FY, et.al. Lancet.
Prone and side sleeping positions Smoking 2007;370:1578-1587.
during pregnancy Exposure to smoking after 48Other Considerations: Positioners
birth Bed sharing Use of soft sleep & Monitors. Wedges, blanket rolls can
surfaces (adult bed, sofas) Presence of be a potential suffocation risk. Use of
soft objects and loose bedding (toys, home monitors does not prevent SIDS: In
pillows, blankets and comforters) certain situations a home monitor may be
Overheating. AAP Task Force on SIDS. ordered by the physician for apnea, but
Policy Statement. October 2005. these monitors do not prevent SIDS.
20SIDS Etiology: Rebreathing Theory. 49Safe Sleep Education for Parents and
Infants in certain sleep environments are Caregivers. MUST: Be addressed early and
more likely to trap exhaled CO2 around the often. Help parents prepare to counter
face: Lie prone and contrary advice they receive. Help parents
near-face-down/face-down Soft bedding prepare to insist on consistent provision
Tobacco smoke exposure Infants rebreathe of a safe sleep environment when others
exhaled CO2 : CO2 ? & O2 ?. Infants care for the infant (grandparents,
die if they cannot arouse/respond babysitters, child care providers, family
appropriately. Kinney HC, Thach BT. NEJM members). Be modeled by respected and
2009;361:795-805. credible role models.
21SIDS Etiology: Proposed Causal 50Gallup Poll 2006, Top List of Most
Pathway. SIDS. Pregnancy related risk Honest and Ethical Professionals.
factors (low birth weight, smoking). 51Nurses as Role Models. Nurses can
Genetic risk factors. Vulnerable infant model SIDS risk-reduction techniques to
(impaired autonomic regulation). At risk ensure that families know how to reduce
age group. Environmental risk factors SIDS risk: Nurses who placed infants to
(sleep position, bed sharing, thermal sleep on their backs during the postpartum
stress, head covering, etc.). Mitchell EA, hospital stay changed parents behaviors
Acta Paediatrica, 2009. significantly (Colson, 2002) The most
22 critical period during which nurses can
23SIDS in Baltimore City: Common Risks. influence parents behavior is during the
Stomach sleeping Bed sharing (>75%) 24 to 48 hours following delivery.
Soft bedding Smoke exposure. 52Knowledge vs. Practice. 1999 American
24AAP Infant Sleep Recommendations. Academy of Pediatrics study (Peeke et el)
25 97% of nurses reported awareness of back
26Additional Safe Sleep Recommendations. sleeping recommendation 67% followed the
No smoke exposure No overheating Consider recommendation The majority cited
a pacifier. experience or the potential adverse
27Alone Not with Mom, Dad, or anyone consequences of the back position as
else. Babys sleep area should be close their reason for disregarding the
to, but separate from, where parents recommendation 2004 survey (Bullock et al)
sleep. 96% of nurses reported awareness of back
28SIDS Risk and Infant Bed Sharing. sleeping recommendation 75% reported using
Earlier studies showed increased risk either side position or a mixture of side
associated primarily with bed sharing and back positioning Most nurses thought
among smoking mothers. More recently, two side sleeping was still acceptable Nursery
European studies showed increased risk for staff do not uniformly recommend the back
younger infants even among non-smoking sleeping position.
mothers: European Concerted Action on SIDS 53Our Campaign: Beyond Knowledge to
(Carpenter, 2004) under 8 weeks Scotland Behavior Change. Addresses issues of
(Tappin, 2005) under 11 weeks Germany complacency, convenience Three Baltimore
(Vennemann, 2005) risk was independent mothers tell their own stories about safe
of age, independent of smoking. . England sleep and the choices they would make if
(Blair, 2009) bed sharing on bed or they could go back and make them again.
couch had almost 3 times higher risk of 53.
SIDS; 10 times higher with recent drug or 54Sleep Safe Campaign: Components. Bus,
alcohol use . radio, transit ads Posters, door hangers,
29SIDS Risk and Infant Bed Sharing. rack cards, magnets, onesies, t-shirts
Other factors that increase risk: Multiple News coverage on TV and radio. 54.
bed sharers Bed sharing with other 55Sleep Safe Campaign: Components.
children Parent consumed alcohol or is Powerful video featuring real stories of
overtired Infant between both parents the three Baltimore mothers shown at
Sleeping on sofas or couches Returning the birthing hospitals, the courthouse (jury
infant to his/her own crib is not duty), home visits. Discussion guide to
associated with increased risk. No studies help providers lead a discussion with
have ever shown a protective effect of bed clients before and after the video. 55.
sharing on SIDS. 56Sleep Safe Campaign: Components.
30Why do Parents Bed Share? Safety Can Powerful video featuring real stories of
keep close watch on baby Belief that crib the three Baltimore mothers shown at
death occurs in crib Convenience Feeding birthing hospitals, the courthouse (jury
Checking on baby Comfort Baby sleeps duty), home visits. Discussion guide to
better Mother sleeps better Bonding help providers lead a discussion with
Space/availability of crib. clients before and after the video. 56.
31Bed Sharing Has Become More Popular. 5757.
Renewed popularity of breastfeeding. Bed
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Giving Voice to a Silent Epidemic: SIDS and Other Sleep-Related Infant Death in Baltimore City

Giving Voice to a Silent Epidemic: SIDS and Other Sleep-Related Infant Death in Baltimore City

City London - Here are the historical places as well as the famous parks. Piccadilly. Queen Victoria Memorial. Trafalgar Square. Tower of London. Tower Bridge. Big Ben. Hyde Park with its Speaker's Corner is also here. The famous places in the London. St.James's Park. Statue on border the city of London. Cleopatra's Needle.

London city - Then, the, Country, is, London, of, there. Today London covers a vast area, with millions of inhabitants. The job is done! Right Wrong 3. London began when the Romans came. What is the City of London? Actually there are several Londons. At night it is almost deserted. That was before the Romans came.

City Ukraine - Odessa is situated at the Black Sea coast. The cities of Ukraine. The cities of Ukraine. Dnepropetrovsk Dnepropetrovsk is a dynamic and lively city. It is a very important port and one of the most beautiful cities in Ukraine . From 1918 to 1934 years Kharkov was the official capital of Ukraine.

Sights of London - Marble Arch. Tower of London was 1. a prison 2. a clock 3. a church 4. a park. LONDON EYE. London Telephone Booth. Do you remember any other sights in London? Are you ready to start our journey??? London is situated on the banks of the Thames. London Eye Capsules. Buckingham Palace. James's Park. Choose the correct answer.

Places in London - Globe Theatre. London. The British Museum. The City of London. Drawings. . Historical places. St.James's Park. London is the British capital. Henry Tate. Henry Ford. The Cathedral of Saint Paul. Cleopatra's Needle. Trafalgar Square. The City. The West End. The famous places in the London. River Thames.

Big Ben clock - Nickname. The origin of the nicknameBig Benis the subject of some debate. BIG BEN. At the base of each clock dial in gilt letters is theLatininscription: The surround of the dials isgilded. A modern picture of 'Big Ben'. Significance in popular culture l. The clock and dials were designed by Augustus Pugin.

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