October is national SIDS (Sudden Infant Death Syndrome) Awareness Month and recognized by the State of New Jersey through a proclamation signed by Governor Chris Christie, calling attention to one of the leading causes of infant mortality. The SIDS Center of New Jersey is leading public health initiatives in the State to reduce the risk and occurrence of the devastating loss with the launch of a new initiative: Nurses LEAD the Way, geared toward nurses who care for infants in nurseries and neonatal intensive care units in hospitals throughout New Jersey.
"Nurses play a critical role in providing safe sleep information to families as they prepare to bring their infants home," Barbara M. Ostfeld, PhD, professor of pediatrics and program director of the SIDS Center of New Jersey at University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School. "Our newest program will reinforce nurses' knowledge and provide them with more tools for Learning about safe sleep, Educating families, Affirming knowledge and Documenting that education has been given."
Nurses LEAD the Way is being implemented in collaboration with the New Jersey Department of Health (NJDOH), and the Maternal and Child Health Consortia. Together, the SIDS Center of New Jersey and the NJDOH have worked to significantly reduce the rate of SIDS in New Jersey during the last two decades.
The SIDS Center of New Jersey also works closely with the New Jersey Department of Children and Families to provide safe sleep education to professionals involved with foster care licensing, as well as case workers in the Division of Child Protection and Permanency, Family Success Centers, and nurse-family partnerships.
"Public health campaigns have altered the way infants are put to sleep, resulting in a significant decline in the rate of SIDS since 1992 both nationally and in New Jersey," said Dr. Ostfeld. "In 1992, more than 70 percent of infants in the United States were put to sleep on their stomachs, a major risk factor for SIDS. Through comprehensive education and guidelines established by the American Academy of Pediatrics, more than 70 percent of infants have been placed to sleep on their back since 2000, leading to the significant decrease in unexplained deaths."
According to Thomas Hegyi, MD, professor of pediatrics and medical director of the SIDS Center of New Jersey at the Robert Wood Johnson Medical School, a diagnosis of SIDS is made when no known cause can be found for the sudden and unexplained death of an infant under one year of age, despite a complete medical examination and police investigation.
Research published by the SIDS Center of New Jersey has contributed to the AAP's safe sleep guidelines, which were expanded in 2011 to address the risks of other sleep-related deaths from such causes as accidental suffocation, strangulation and entrapment. The guidelines offer risk-reduction recommendations targeted toward parents and family caregivers, healthcare and child care providers, social service agencies and health organizations.
"Under the expanded guidelines, the AAP emphasized such long-established recommendations as placing infants on their backs to sleep and the avoidance of bed-sharing in sleep," said Dr. Hegyi. "Some of the new guidelines added, advise caregivers to avoid co-bedding of twins and to eliminate the use of crib bumpers in addition to loose and soft bedding."
Dr. Hegyi noted that there is substantial research to support the recommendation that babies should not sleep in an adult bed, on a sofa or chair alone or with a parent or with someone else. Instead, experts recommend that a safety-approved crib be placed in the adults' room. Other recommendations call for the use of a firm mattress in a safety-approved crib; to avoid using pillows, blankets, quilts, or sheepskins in the baby's sleep area or under the baby; removing soft objects from the crib, such as stuffed animals and loose bedding; and the use of a one-piece sleeper, instead of a blanket. Eliminating a child's exposure to tobacco smoke also is strongly recommended.
Both Dr. Hegyi and Dr. Ostfeld underscore the continuing need for education, despite declines in the rate of SIDS. A study they recently published reported that more than 95 percent of babies who died of SIDS in New Jersey had risk factors present and that one-third had four or more concurrently. They encourage those who educate families to be comprehensive in their message, addressing all risk factors and not just the back to sleep message. "Each risk factor matters," said Dr. Hegyi.
"The safe sleep recommendations are appropriate for the overwhelming majority of infants, including those born prematurely," explains Dr. Hegyi. "As with all aspects of infant care, the baby's doctor and parents should discuss the guidelines to confirm that they are safe and appropriate for their baby." Dr. Hegyi emphasizes the importance of using "tummy time" when an infant is awake and under the watchful eye of their parent or other caregiver. Supervised "tummy time" each day promotes motor development and minimizes the rare occurrence of any flat spots on the infant's head.
Dr. Hegyi and Dr. Ostfeld emphasize that until the causes for SIDS are fully known and can lead to the identification and treatment of living infants who may be vulnerable, the risk-reducing guidelines of the American Academy of Pediatrics are considered by both researchers and healthcare providers to be the most effective methods available to reduce the chance of an unexplained and devastating death.
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