Cribs for kids: risk and reduction of sudden infant death syndrome and accidental suffocation.

Cribs for kids: risk and reduction of sudden infant death syndrome and accidental suffocation. The Cribs for Kids campaign, created in 1998 by a nonprofitvoluntary health organization, S. I.D.S. of Pennsylvania, is aninnovative program whose aim is to combat infant mortality (hardware) infant mortality - It is common lore among hackers (and in the electronics industry at large) that the chances of sudden hardware failure drop off exponentially with a machine's time since first use (that is, until the relatively distant time at which enough mechanical resultingfrom sudden infant death syndrome sudden infant death syndrome(SIDS) or crib death,sudden, unexpected, and unexplained death of an apparently healthy infant under one year of age (usually between two weeks and eight months old). (SIDS SIDSsudden infant death syndrome. SIDSabbr.sudden infant death syndromeSIDS,n See syndrome, sudden infant death. ) and accidental suffocation suffocation:see asphyxia. inAllegheny County, Pennsylvania Allegheny County is a county in the southwestern part of the U.S. state of Pennsylvania. As of the 2000 census, the population was 1,281,666. The county seat is Pittsburgh. . This program was the first of its kindin the country to include an evaluation component and is germane tosocial work practice with maternal child health and mental healthprofessionals. This article delineates the application of a low-cost butultimately beneficial intervention to lower the risk of SIDS oraccidental suffocation by providing education and a safe sleepingenvironment for infants. SIDS IN THE UNITED STATES United States,officially United States of America, republic (2005 est. pop. 295,734,000), 3,539,227 sq mi (9,166,598 sq km), North America. The United States is the world's third largest country in population and the fourth largest country in area. SIDS is a frightening phenomenon that has plagued parents forthousands of years. The definition of SIDS is "the sudden death ofan infant under one year of age, which remains unexplained after athorough case investigation, including performance of a completeautopsy, examination of the death scene, and review of the clinicalhistory" (Willinger, James, & Catz, 1991, pp. 677-678). SIDSstrikes an infant during sleep without warning and remains the leadingcause of postneonatal infant mortality for infants ages one month to oneyear in Western countries. Neither parents nor physicians can accuratelypredict which infants will succumb to SIDS, and in the United Statesnearly 3,000 infants die from SIDS each year (National SIDS/Infant DeathResource Center [NSIDRC], 2004b). Despite widespread risk reduction education from the Back to Sleepcampaign, initiated in 1994 by a coalition of the National Institute ofChild Health and Human Development (NICHD NICHDNational Institute of Child Health and Human Development. ), the Maternal and ChildHealth Bureau, the American Academy of Pediatrics (AAP), the SIDSAlliance, and the Association of SIDS and Infant Mortality Programs, itremains an alarming social work and public health dilemma that crossesall ethnic, race, and socioeconomic populations (NSIDRC, 2004a). A SIDSdiagnosis is made after death, only after all other possible causes havebeen eliminated. In fact, researchers and medical practitioners are notcertain what causes SIDS, although they believe it to involve a dynamicinteraction of several factors (NICHD, 2000b). An infant is at increasedrisk of SIDS if he or she experiences an unstable period of homeostatic homeostaticpertaining to homeostasis. control (that is, an inability of the infant's body to maintainequilibrium in physiological systems) during sleep combined withtriggering factors such as prone sleep position, bed sharing, softbedding, maternal smoking, viral infections, and premature birth premature birthBirth less than 37 weeks after conception. Infants born as early as 23–24 weeks may survive but many face lifelong disabilities (e.g., cerebral palsy, blindness, deafness). (Filiano & Kinney, 1994). An infant may be born with an underlyingvulnerability that increases the risk of SIDS (Panigraphy et al., 2000). After the American Academy of Pediatrics changed its recommendationof infant sleep position in 1992 (AAP, 1992) there was a 53 percentdecrease in the number of SIDS deaths in the United States by 2001(Matthews, Menacker, & MacDorman, 2003) .This suggests that theprone sleep position for infants as a risk factor for SIDS can bereduced by using a firm, flat mattress; eliminating fluffy bedding fromthe infant's sleep environment; maintaining a smoke-freeenvironment for the infant; and avoiding overheating OverheatingAn economy that is growing very quickly, with the risk of high inflation. (NICHD, 2001). TheConsumer Product Safety Commission (CPSC), AAP, and NICHD responded tothese statistics by recommending that all infants younger than 12 monthsbe put to sleep in a crib with no soft bedding on top of or under thebaby (CPSC, 1999). On October 10, 2005, the AAP Task Force on SuddenInfant Death Syndrome issued a revised policy statement on SIDS andreiterated their policy recommendation of back sleep position on a firmmattress with no soft bedding in the crib. The task force furtherrecommended that the infant sleep in the same room as the mother tofacilitate breastfeeding, but on a separate sleep surface, such as acrib, bassinet, or cradle that meets CPSC standards for safety. Becauseresearch now indicates a reduced risk of SIDS if an infant uses apacifier during sleep, the task force also recommended that parentsconsider offering a pacifier to the baby when placing the baby down tosleep throughout the first year of life (Task Force on Sudden InfantDeath Syndrome, 2005). RED SHARING AND ACCIDENTAL SUFFOCATION Bed sharing is defined as an infant's sleeping with others inan adult bed or nontraditional surface (cosleeping involves the infantsleeping in his or her own space, but adjacent to the parent orcaregiver). Hazards resulting from bed sharing include overlaying by theparent, sibling, or other adult sharing the bed with the infant andentrapment entrapment,in law, the instigation of a crime in the attempt to obtain cause for a criminal prosecution. Situations in which a government operative merely provides the occasion for the commission of a criminal act (e.g. or wedging of the infant's body and head between themattress and another object, such as bed railings (Nakamura, Wind, &Danello, 1999). A greater proportion of infant deaths occur whilesharing a bed with parents or sleeping on a couch, and this risk isincreased if the parents smoke cigarettes (Blair et al., 1999). Softbedding, such as pillows, blankets, duvets, and comforters, increasesthe risk of accidental suffocation and the risk of SIDS and is typicallyfound in adult beds (Hauck et al, 2003). Furthermore, adult beds do notmeet the same safety standards Safety standards are standards designed to ensure the safety of products, activities or processes, etc. They may be advisory or compulsory and are normally laid down by an advisory or regulatory body that may be either voluntary or statutory. as approved cribs. Research has revealedthat the risk of suffocation increases 20-Fold when infants sleep inadult beds rather than in cribs (Scheers, Rutherford, & Kemp, 2003).Other researchers have called for campaigns to heighten awareness ofbed-sharing dangers when they found that a shared, unsafe sleep surfacewas present in a large majority of deaths (Kemp et al., 2000). In arecent study that examined three risk factors for SIDS--sleep position,sleep surface, and bed sharing--in 109 infants who died suddenly andunexpectedly in North Carolina North Carolina,state in the SE United States. It is bordered by the Atlantic Ocean (E), South Carolina and Georgia (S), Tennessee (W), and Virginia (N).Facts and FiguresArea, 52,586 sq mi (136,198 sq km). Pop. , only eight died while sleeping alone ina crib or bassinette and on their back or side (Alexander & Radisch,2005). Alarmingly, an African American African AmericanMulticulture A person having origins in any of the black racial groups of Africa.See Race. infant in the United States istwo times more likely to succumb to SIDS than a white infant (NICHD,2000a). Research has indicated that prone sleep position was asignificant risk factor in an urban, primarily African American sample,which may partly explain the higher risk for African American infants(Hauck et al., 2002), as well as a greater number of African Americanparents who report placing their infants in an adult bed or on a sofafor sleep (Flick, White, Vemulapalli, Stulac, & Kemp, 2001;Rasinski, Kuby, Bzdusek, Silvestri, & Weese-Mayer, 2003). After implementation of the Back to Sleep campaign, a similardecrease in SIDS deaths was observed in Allegheny County, Pennsylvania,with SIDS deaths declining from 19 deaths in 1992 to 13 deaths in 1998(Wecht, 2002). However, in spring 1998, four other infants died ofaccidental suffocation while bed sharing with adults or others in anadult bed, and a coroner's death scene investigation determinedthat not one of these infants had a crib or safe sleeping environment.Community leaders attempted to address this problem by requesting cribdonations, yet only old, unsafe cribs that could not be used weredonated. THE CREATION OF THE CRIBS FOR KIDS CAMPAIGN Immediately after this bid for cribs failed to produce the desiredresult, the executive director of S.I.D.S. of Pennsylvania contactedcommunity leaders and created a partnership to address this need. InAugust 1998, the Cribs for Kids campaign was launched, and S.I.D.S. ofPennsylvania began distributing new full-size cribs and firm mattresses,along with education about SIDS risk reduction and crib safety, tolow-income families in Allegheny County, Pennsylvania. Furthermore,educational programs were set up at the community level to address theeducational needs of all families in the county. A request and vouchersystem is used whereby the parents request a crib in a letter along withproof of birth, and in turn the organization mails the family a voucherredeemable for a crib and mattress from a local store. Educationalmaterial outlining SIDS risk reduction strategies and crib safety isprovided both with the voucher and with the crib and mattress. In the first full year of the Cribs for Kids campaign, S.I.D.S. ofPennsylvania provided 500 cribs and mattresses and education to familiesin Allegheny County, which exceeded projected expectations and validatedthe committee's presumption of the community's need. The fundsfor the cribs were raised through a variety of means, such as grants,organized community walks and runs, and requests to local Rotary Clubsand from the Allegheny County district attorney's office. EVALUATION OF SERVICES The intent of S.I.D.S. of Pennsylvania and the Cribs for Kidscampaign was primarily to provide a safe sleeping environment forinfants and education about SIDS risk reduction outlined by the NICHD tocontinue to reduce the number of babies dying of SIDS and accidentalsuffocation in Allegheny County. A pilot evaluation study wasimplemented to explore whether the Cribs for Kids campaign waseffective. Three hundred twenty families who requested and received a cribfrom the Cribs for Kids campaign in the first eight months of theprogram were potential participants for this study; however, we targeteda sampling of 150 families to participate in the study. This representedalmost half of the families who received cribs at that time. Aqualitative--quantitative questionnaire containing 18 items wasdeveloped and required approximately 10 to 15 minutes to complete. A research practitioner called potential participants and askedthem to participate in a study about SIDS, safe sleep, and how theprovision of the crib, mattress, and education affected their child carepractices. With verbal consent, the researcher sent a letter reiteratingthe study's purpose, an informed consent form, and aself-addressed, stamped envelope to return to S.I.D.S. of Pennsylvania.The researcher requested participation in numerical order from the listof families served and on the basis of availability through telephonecontact. From the 150 attempts, 105 consent forms were returned,representing a response rate of 70 percent. Attempts were made toincrease the sample population of those who had telephones by makingfollow-up telephone calls; however, we found that many of the familieswho received cribs could not be contacted because their telephones hadbeen disconnected, they had no forwarding address, or they could not befound in the local community by using telephone informational services.We believe that the lack of an incentive, combined with the transientnature of the participants, exacerbated sampling difficulties intracking participants. The questionnaire requested demographic data and included 18questions used to measure the participants' understanding,retention, and adherence to the SIDS risk reduction strategy contentoutlined in the educational pamphlet. Specifically, questions related toeach risk reduction point, such as placing the baby on his or her backto sleep, exposure to cigarette smoke, amount of clothing worn by theinfant, sleep surface for the infant, infant's participation inwell-baby visits, whether the mother breastfed at any time, and thelength of time she breastfed or planned to breastfeed breast��feedor breast-feed ?v. breast-fed , breast-feed��ing, breast-feedsv.tr.To feed (a baby) mother's milk from the breast; suckle.v.intr.To breastfeed a baby. . Other questionsdetermined where the crib was placed and used, whether the participanthad any difficulties in picking up or assembling the crib, suggestionsfor improving the program, and overall satisfaction with the program. WHAT WE LEARNED ABOUT THE CRIBS FOR KIDS CAMPAIGN This study yielded important data. The majority of studyparticipants (65 percent) were younger than 29, were single parents(almost 66 percent), and reported annual incomes of less than $20,001(85 percent). More than half (51 percent) of the participants in thissample identified themselves as African American, and 45 percentidentified as white. The remainder of the respondents (4 percent)identified as being from other racial and ethnic groups. When participants responded to the questions related to the sixrecommendations of the Back to Sleep campaign, 93 respondents (89percent) reported that they read the information; however, 63respondents (60 percent) could not correctly explain the unpreventablenature of SIDS. More than one-third of the participants breastfed forsome time (34 percent), and all of the participants (100 percent)reported that they had taken their infant to well-baby visits and to thepediatrician since the birth. Notably, all participants (100 percent)reported that they used the crib as a safe sleeping environment fortheir infant. This represents complete compliance with therecommendation for an infant to be in a safety-approved crib for sleep.Approximately two-thirds of the participants reported placing theirinfant in the supine supine/su��pine/ (soo��pin) lying with the face upward, or on the dorsal surface. su��pineadj.1. Lying on the back; having the face upward.2. (back) position for sleep, following the Back toSleep guidelines. The survey asked participants where their infant would have sleptif they had not received the crib from the Cribs for Kids campaign, andmore than one-third (38 percent) stated that the infant would have sleptin an adult bed with the parents, one-quarter (25 percent) in abassinet, and the remainder on the floor or in portable cribs orplaypens. A majority of the participants with other children (75percent) reported using old cribs in poor condition for their otherchildren. DISCUSSION The aim of this article is to provide information on a uniquepractice innovation and evaluation study focused on reducing the risk ofSIDS and accidental suffocation. Through the process of implementing theprogram and in the pilot evaluation, we found many benefits of the Cribsfor Kids campaign. Furthermore, the program appears to positivelyinfluence parents' and guardians' child care practices toenhance the safety of their infants. When comparing the names of all 320 families who received cribs andeducation through the Cribs for Kids campaign to the public record ofinfant deaths, no names were found to match. Although families couldhave moved to other areas of the country, it is worth noting that at aminimum the 105 respondents reported no deaths, and it is quite possiblethat the remainder of the population may be safe and alive. In fact,SIDS deaths in Allegheny County, Pennsylvania, dropped by 63 percentfrom 1992 until 2003, from 19 deaths to seven deaths, respectively(personal communication with S. Koehler, forensic epidemiologist, Officeof the Medical Examiner A public official charged with investigating all sudden, suspicious, unexplained, or unnatural deaths within the area of his or her appointed jurisdiction. A medical examiner differs from a Coroner in that a medical examiner is a physician. , Allegheny County, June 29, 2004); nationally,SIDS deaths dropped by 50 percent. Of the infants who died from SIDS in2003 in Allegheny County, only one was sleeping in a crib at the time ofdeath; the others were sleeping in an unsafe environment, such as anadult bed with others or on a sofa, when they died (personalcommunication with S. Koehler). Even though the respondents stated that they read the educationalmaterials and behaviorally indicated that they were in compliance withthe recommendations (safe sleep habits), more than half of therespondents could not explain SIDS. Also troubling was that the familieslisted by the coroner's office whose infants had died may have notreceived educational materials from any service provider, as this is nota requirement for local hospitals. Before leaving the hospital with anewborn, parents are often instructed on proper ways to change diapers,give baths, and clean umbilical umbilical/um��bil��i��cal/ (um-bil��i-k'l) pertaining to the umbilicus. um��bil��i��caladj.1. Of or relating to the navel.2. Relating to the umbilical region of the abdomen. cords; however, there are no standardsin informing new parents on how or why it is important to properly andsafely put their new infant to sleep. Program participants receivededucation and reinforcement at three junctures: when requesting thecrib, on receipt of the crib, and in the interview for the study. Also,after the interview, any questions or concerns were addressed,Dissemination of the sate sleep message could be enhanced by a communityeducation effort in targeted neighborhoods, with bus cards, billboards,and educational seminars. The message may be reinforced by the gift of at-shirt or sheet to participants imprinted with a message to placesleeping babies on their backs in a safe crib. There were several limitations to the evaluation, however. The lackof a control group limited the generalizability of the evaluation to theoverall population and must be interpreted with caution. Furthermore,respondents were self-selected into the Cribs for Kids program and chosewhether to participate in the evaluation study. To mitigate respondentbias, the interviewers strictly adhered to the questions on the scriptedsurvey instrument. POLICY AND PROGRAM DEVELOPMENT The Pennsylvania Child Death Review Team, a program of thePennsylvania AAE recently chose the Cribs for Kids campaign as its focuspreventive program because of the reduction in SIDS and accidentalsuffocation deaths in Allegheny County. S.I.D.S. of Pennsylvania isreplicating the Cribs for Kids campaign with 50 Cribs for Kids partnersin Pennsylvania and 100 partners in 32 other states. We suggest futurestudies of the Cribs for Kids campaign with diverse populations andsettings to further refine the program and evaluate outcomes. Social work practitioners concerned with the infant mortality rate infant mortality raten.The ratio of the number of deaths in the first year of life to the number of live births occurring in the same population during the same period of time. in their communities may partner with local health departments,hospitals, nonprofit agencies, child welfare departments, safe kidscoalitions, or child death review teams to implement the Cribs for Kidscampaign, thereby possibly reducing the number of infant deaths. Socialworkers concerned with maternal child health and infant health are bestsuited to educate and reinforce the concepts of SIDS risk reductionstrategies and safe sleep and can implement a low-cost strategy ($50 to$70 per crib) with the immeasurable benefit of possibly saving aninfant's life. The death of a child inflicts incalculable in��cal��cu��la��ble?adj.1. a. Impossible to calculate: a mass of incalculable figures.b. Too great to be calculated or reckoned: incalculable wealth. suffering, not only on the child's parents, but also on siblings,families, friends, and communities. Disseminating education aboutreducing the risk of SIDS is not sufficient; providing a crib or othersafe sleeping environment can also help reduce infant deaths. Byreducing the number of infant deaths, we reduce the suffering offamilies and society as a whole. The complement to Cribs for Kids is acomprehensive educational drive about SIDS risk reduction strategies.Social workers focus on individuals in their environment, understandsocial interactions and are uniquely qualified to foster collaborationbetween community stakeholders to implement the Cribs for Kids campaignand provide an effective intervention strategy, which ultimatelyempowers families to ensure their infants' health and well-being. 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Pediatric Pathology Pediatric pathology is the subspecialty of surgical pathology which deals with the diagnosis and characterization of neoplastic and non-neoplastic diseases of children. Pediatric pathologists generally work closely with pediatricians. , 11,677--684. Eileen M. Carlins, MSW (MicroSoft Word) See Microsoft Word. , LSW LSW Licensed Social WorkerLSW Lincoln Southwest (Nebraska high school)LSW Light Support WeaponLSW Least Significant WordLSW Last Seen WearingLSW Long Suffering WifeLSW Laboratory Safety Workshop , is director of Support &Education, S.I.D.S. of Pennsylvania, Suite 250, Riverfront riv��er��front?n.The land or property along a river. Place, 810River A venue, Pittsburgh, PA 15212; e-mail: ecarlins@ SIDS-PA.org.Kathryn S. Collins, PhD, MSW, is associate professor, School of SocialWork, University of Maryland University of Maryland can refer to: University of Maryland, College Park, a research-extensive and flagship university; when the term "University of Maryland" is used without any qualification, it generally refers to this school . The authors greatly appreciate all of thefamilies who called the agency for information about keeping theirbabies safe. The authors appreciate their time in participating in theevaluation study of the program. They would also like to thank NicoleMcCormick for her editorial assistance.