by, Sharon C. Hitchcock
Did you know most infant sleep-related deaths are considered preventable? This is good news worth sharing! Because most babies are born in a hospital or birthing center, nurses are uniquely positioned to interact with virtually every new parent. This means nurses play a critical role in helping prevent these deaths. We know that parents trust us (we are the most trusted profession!), watch us, and listen to us. We have a responsibility to make sure we give parents safe sleep recommendations along with the evidence behind them. We have a responsibility to problem-solve with parents about accomplishing safe sleep situations, all while simultaneously respecting their right to decide what is best for their family. The bad news is too many babies are still dying. October is SIDS Awareness month and a perfect time for nurses to spread the good news and advocate for our smallest patients!
Just for clarity, infant sleep-related deaths include Sudden Infant Death Syndrome (SIDS), Accidental Suffocation and Strangulation in Bed (ASSB), and an “Unknown” category where typically risk factors are present or the infant was in an unsafe sleep environment but ASSB is not known with certainty.
These sleep-related deaths, once generally labelled SIDS, are now more commonly referred to as Sudden Unexpected Infant Death, or SUID. In 2013 there were 3,434 SUID deaths, almost 10 per day, in the United States.
The topic of safe sleep can be tricky. There are barriers to some of the recommendations, and discussions have the potential to become controversial. Suffice to say, nurses are aware this is not always an easy topic, and some may prefer to skip it entirely. Hopefully knowing how much influence we can have will motivate us to talk to parents about this important safety issue. It could be a matter of life and death, and the majority of parents are grateful for the information.
The issues surrounding safe sleep are being discussed among healthcare experts and suggestions are emerging about how to better connect with parents. One idea is to acknowledge that parents take risks (we all do!) and adopt a more risk-reduction approach instead of a risk-elimination approach. This change might be simply rephrasing our recommendations from using terms like never and always to something like the safer or safest way for your baby to sleep. As an example, some parents, despite hearing the recommendations against these activities, will choose to continue to sleep with their baby or they might decide to continue to smoke. Our responsibility is to educate and then encourage the safest sleep situation possible, while also respecting the parents’ choices. The best comparison may be with breastfeeding: We all know that exclusive breastfeeding for the first 6 months is best, but we also know that some is better than none, and we readily help parents, if it’s what they choose. Similarly, our job is to advise and help parents do the best they can by providing safe sleep recommendations, being willing and open to discuss their unique situation, and problem-solve with them; all without being dogmatic or rigid. Our job is to educate and encourage, not coerce.
Parents who choose to sleep with their baby might be provided further information on the situations that are especially dangerous (such as with a baby less than 3 months, or with an intoxicated parent), or we can suggest other sleep options such as a co-sleeper that connects to the parent’s bed or setting a timer for moms concerned about falling asleep while breastfeeding. A parent who smokes might be open to smoking outside the home and wearing smoke-free clothes around the baby. Are these the safest ways and environments to promote safe sleep? No, but they are safer and may be what is needed to prevent a death.
ADDITIONAL INFORMATION For nurses
Safe Sleep Strategies (.pdf)
Centers for Disease Control and Prevention . (2015). Sudden unexpected infant death. Retrieved August 20, 2015, from http://www.cdc.gov/sids/aboutsuidandsids.
Hitchcock, S. (2012). Endorsing safe infant sleep: a call to action. Nursing for Women’s Health, 16(5) 386-396.
Horne, R. S., Hauck, F. R., & Moon, R. Y. (2015). Sudden infant death syndrome and advice for safe sleeping. BMJ, 350:h1989. doi.org/10.1136/bmj.h1989
Moon, R. Y., & Fu, L. (2012). Sudden infant death syndrome: An update. Pediatrics in Review, 33, 314-320. doi: 10.1542/pir.33-7-314
Patton, C., Stiltner, D., Wright, K. B., & Kautz, D. D. (2015). Do nurses provide a safe sleep environment for infants in the hospital setting? An integrative review. Advances in Neonatal Care, 15, 8-22.
Shaefer, S. J. (2012). Review finds that bed sharing increases risk of sudden infant death syndrome. Evidence Based Nursing, 15, 115-116. doi.org/10.1136/ebnurs-2012-100750
Volpe, L. E., & Ball, H. L. (2015). Infant sleep-related deaths: Why do parents take risks? Arch Dis Child, 100, 603-604. doi.org/10.1136/archdischild-2014-307745