Barb Himes, IBCLC

Since beginning our work in 1994 as part of the coalition that developed the “Back to Sleep” public education campaign, we have conducted outreach and training based on the American Academy of Pediatrics set of recommendations for infant safe sleep, last updated in 2016. (1) The essentials of the guidelines are supine sleep on a firm surface, alone, with no bed-sharing or extraneous bed-sharing, which we term Room Share, Not Bed Share and Keep It Bare.

Unfortunately, after a 50% drop in SIDS rates between 1994 and 1999 (2), the national SIDS rate has not substantially changed. The CDC reports that SUID (which includes SIDS, and accidental suffocation and strangulation in bed (ASSB) is the leading cause of death for infants one month to one year of age, resulting in 3,600 infant deaths nationwide per year.

The good news is that rates of SUID can be decreased without requiring immunization or medical therapy, simply by changing parenting practices. But the challenging news is that changing behavior is often the most difficult thing to do even when the information is effectively shared and next to impossible to do when it is not.

SUID rates have quadrupled since 1984 and are three times greater in Black communities. Studies and direct feedback have identified implicit bias in the health care community as a major stumbling block, along with cultural, societal, and economic factors that foster bed-sharing and other at-risk sleep environments.

Professional Development

First Candle has actively recognized these barriers and made bias training for health care professionals central to our Straight Talk for Infant Safe Sleep program, launched in 2017. We also see the opportunity — and the responsibility — to convey to these professionals the critical role they play in reducing sleep-related infant deaths.

Straight Talk for Infant Sleep is about clearly disseminating the AAP safe sleep guidelines and breastfeeding messages in a way that parents will understand the importance of and accept. And in order to do that, it must first offer effective value for the health care professionals who provide counsel and support for expectant parents and their families.

Straight Talk for Infant Sleep is about clearly disseminating the AAP safe sleep guidelines and breastfeeding messages in a way that parents will understand the importance of and accept. And in order to do that, it must first offer effective value for the health care professionals who provide counsel and support for expectant parents and their families.

• Education assessment of safe sleep guidelines. NICU staff are a trusted resource for parents who may be unaware of what they need to know.
• Thorough review and discussion of the AAP safe sleep guidelines themselves.
• Open discussion to address obstacles to message delivery.
• Communications strategies and coaching techniques to recognize and overcome implicit bias and to develop skills in working with families who have varied environments, beliefs, and customs around infant sleep and breastfeeding practices.

Recognizing and Removing Practitioner and Parent Barriers

We have found that it is critical to acknowledge barriers families have in practicing safe sleep, and then meet those families where they are. Straight Talk for Infant Sleep participants learn how to help parents create a plan for implementing infant safe sleep and breastfeeding that takes into account their beliefs, experiences, values, and living and working conditions.

We also know that it is also critical to acknowledge practitioner barriers that arise from implicit bias; those preconceived and unspoken conclusions reached after “sizing up” patients based on race, age, dress, lifestyle, history, and other factors. All can block the education and willing compliance that needs to happen in order to save infant lives.

Neonatology and NICU Staff as Resource

New parents should also be learning about infant safe sleep practices and concepts such as Room Share, Not Bed Share and Keep It Bare at multiple touchpoints: during prenatal care, in the hospital setting, and at well-child check-ups. Giving parents the opportunity to understand and discuss infant safe sleep and breastfeeding practices increases the likelihood they will become part of their parenting framework.

This framework is especially important for parents with babies in the NICU, where infants may be in medically-indicated sleep positions for days or months that should not be practiced when they come home. Parents may seek to emulate what they see in the hospital setting, and need to be advised and helped to begin new procedures.

NICU nurses play a critical role in helping parents transition to the infant safe sleep practices they should follow at home. In the days immediately before babies are discharged from the NICU, nurses have a critical opportunity to help parents hear and see through demonstration how to help their baby sleep safely at home. The NICU staff are a trusted resource for parents who may be unaware of what they need to know.

And in the COVID-19 times we find ourselves in now, providing infant safe sleep and breastfeeding practices support in a constructive, collaborative and clear manner is more important than ever as families face challenges caused by the pandemic. In a time of uncertainty and additional prophylactic measures, families should be able to find comfort in knowing there are proven steps they can take to safeguard their baby and create a safe sleep environment.

Straight Talk for Infant Safe Sleep workshops can be scheduled by contacting Barb Himes, Director of Education and Bereavement Services, at barb@firstcandle.org. More information on the program and AAP recommendations can be found on the First Candle website.

References:

1. SIDS and Other Sleep-Related Infant Deaths Updated 2016 Recommendations for a Safe Infant Sleeping Environment.
2. https://safetosleep.nichd.nih.gov/activities/SIDS/progress