A Guide for Home Visitors: Educating Parents and Caregivers about Safe Sleep

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A Guide for Home VisitorsEducating Parents and
Caregivers about Safe Sleep
Eileen M. Carlins, MSW, LSW Director, Support
Education S.I.D.S. of Pennsylvania Cribs for
Kids Campaign
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S.I.D.S. of Pennsylvania

• Formed in 1981 in Allegheny County, Pittsburgh,
  Pennsylvania
• Provide bereavement support
• Provide education about SIDS
• Support research
• 1992 AAP Recommendation for back sleep
• 1994 Back to Sleep Campaign
• 1998 Creation of Cribs for Kids Campaign

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Perinatal Periods of Risk (PPOR) Model

• Bring community partners together to build
  consensus, support partnerships
• Map fetal infant deaths by birth weight age
• Focus on understanding overall fetal-infant death
  rate
• Look for opportunity gaps between different
  groups
• Target further investigation and actions
• Mobilize for sustainable systems change

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PPOR (Cont.)

• S.I.D.S. of Pennsylvania key partner
• Brought experience about Cribs for Kids to the
  table
• Shared infant death data
• Created logic model
• Targeted infant health cell as key factor
• Targeted SIDS/SUID/safe sleep for further
  investigation action

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Allegheny County (Pittsburgh, PA) Data
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Race and Sleep Location

• 70 of Black Infants (28/40) were placed to sleep
  on a bed/sofa rather than crib
• 52.6 of White Infants (10/19) were placed to
  sleep on a bed/sofa rather than crib

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So Why Call It CRIB DEATH???
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Position of Babies Dying of SIDS/SUID

• 65 of all babies dying of SUID are found in the
  prone or side position
• 63 of Black babies dying of SUID are found in
  the prone/side position
• 61 of White babies dying of SUID are found in
  prone/side position.

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Sudden Unexpected Infant Death Report Allegheny
County 2001-2006

• 68 SIDS/SUID deaths
• Only 2 babies died with no risk factors present!
• 66 babies died while bedsharing, sleeping prone,
  exposed to cigarette smoke, overbundled, with
  soft bedding, etc.

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FACT!!

• The overwhelming majority of babies who die from
  SIDS/SUID are discovered in an unacceptable sleep
  position or sleep location!!

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• A Safe Sleep Space for Baby..
• Baby on the back
• Baby sleeps in crib
• No smoking around
• baby
• Nothing in sleep area
• Do not overheat baby
• Keep babys face
• uncovered
• Firm mattress

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Guidelines for Healthcare Professionals
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Hospital Policy Manual Tool Kit
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A Guide for Home Visitors
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Contents of A Guide for Home Visitors

• Introduction
• Questions to begin conversation about infant safe
  sleep
• Reasons stated for not following infant safe
  sleep practices
• Resources
• Acknowledgements
• Illustrations

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• Questions to begin the conversation..
• What plans have you and your family made to make
  sure your baby is placed to sleep safely?
• What have you heard about safely putting your
  baby to sleep?
• Where and how will your baby sleep when he/she is
  home?
• Where does your baby sleep?
• What do you do to make sure that your baby is in
  a safe sleep area?
• Does your mother, babysitter, aunt, friend know
  about safe sleep?
• The home visitor engages the mother in her home,
  and can assess the environment.

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Reasons Stated for Not Following Infant Safe
Sleep Practices

• Comfort
• Safety (choking)
• Advice from close family members (female)
• Previous experience with other children
• Lack of space for a crib
• Lack of money to secure a crib
• Lack of information or knowledge
• Convenience
• Cosmetic (flat head or bald spot)
• Ability to monitor baby
• Information presented in a culturally
  inappropriate manner
• Distrust of health care provider

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Points for Discussion

• Does mother have crib?
• Discuss how to make crib/bassinet safe
• Review CPSC crib safety guidelines
• Discuss hazards of placing baby on soft surface,
  waterbed, sofa, pillows
• Discuss other sleep surfaces not
• considered safe for infant sleep
• (lambskin, memory foam)

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Six Key Infant Safe Sleep Teaching Points

• Back to sleep
• Separate sleeping area/firm sleep surface/safety
  approved crib
• Nothing but baby in the crib
• No smoking around baby or while pregnant
• Encourage breastfeeding
• Share information with other caregivers

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Recommendations to Reduce SIDS/SUID Risks

• Place healthy infants to sleep on their backs.
• Set up the infants own safe sleeping area in the
  same room with the parents during the early
  months.
• Place healthy infants in cribs that meet the
  minimum federal safety standards. CPSC
  administers mandatory standards for cribs.

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Recommendations to Reduce the SIDS/SUID Risk

• Never place an infant to sleep on a couch, sofa,
  recliner, cushioned chair, waterbed, beanbag
  chair, soft mattress, pillow, synthetic or
  natural animal skins (such as lambskins), or
  other soft surface such as "memory" foam mattress
  toppers and pillows designed for adults.
• Infants should be breastfed for at least the
  first six months.
• Infants should always sleep in a smoke-free home
  or environment.

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Cribs for Kids Risk and Reduction of Sudden
Infant Death Syndrome and Accidental
Suffocation(Journal of Health and Social Work,
August 2007, Volume 32, Number 3)

• Study conducted by Eileen Carlins, MSW and
  Kathryn Collins, PhD, University of Pittsburgh,
  School of Social Work
• Results
• Income less than 20,000 (85)
• Under age 29 (65)
• African American families (51)
• Retrospective study
• Qualitative/quantitative data collected
• 100 of parents used the crib for baby!

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What is wrong with this picture?
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Tummy TimeTummy to play, Back to Sleep!
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Modeling Behavior

• Parents tend to copy practices that they observed
  from people they trust.
• Home visitors, nurses, staff
• We all are
• role models!

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Contact Information

• S.I.D.S. of Pennsylvania/Cribs for Kids
• Suite 250 Riverfront Place, 810 River Ave.
• Pittsburgh, PA 15212
• Phone [phone] Fax (412)
  322-5686
• www.sids-pa.org
• For A Guide for Home Visitors, go to
• http//www.achd.net/hvn/pubs/pdf/HVN_Tool_Kit6.pdf