Maternal and Child Health Library

MCH Alert: Focus on Infant Mortality is developed by the Maternal and Child Health Library in collaboration with the National Sudden and Unexpected Infant/Child and Pregnancy Loss Resource Center. This and past issues are available online at http://www.mchlibrary.info/alert/archives.html and http://www.sidscenter.org/alert/archives.html.

October 31, 2008

1. SAFE SLEEP PUBLICATIONS MADE AVAILABLE IN SPANISH
 
The National Sudden and Unexpected Infant/Child Death and Pregnancy Loss Resource Center has announced the availability of new Spanish-language resources on safe sleep. The resources, which are translations of documents developed and recently revised by the American Academy of Pediatrics, include the following:

• Guia de Sueno Seguro para el Proveedor de Cuidado Infatil (A Child Care Provider's Guide to Safe Sleep: Helping You to Reduce the Risk of SIDS) offers child care workers information on how to reduce the risk for sudden infant death syndrome (SIDS) among infants in their care. The guide discusses particular SIDS risks for infants in child care, provides basic facts about the incidence and causes of SIDS, offers information about what child care workers can do to reduce the incidence of SIDS, describes safe sleep environments and practices and tummy time, and provides a safe sleep policy. The guide is available at http://www.healthychildcare.org/pdf/SIDSchildcaresafesleep.pdf.
• Guia de Sueno Seguro para Padres (A Parents' Guide to Safe Sleep: Helping You to Reduce the Risk of SIDS) provides parents with information that can reduce their infant's risk for SIDS. The guide discusses working with child care workers and others who care for the infant to help reduce the risk of SIDS, provides basic facts about the incidence and causes of SIDS, offers information for non-parents about how to reduce the incidence of SIDS, and describes safe sleep environments and practices and tummy time. A list of organizational resources is provided. The guide is available at http://www.sidscenter.org/documents/SIDRC/ParentsGuideSleep.pdf.
•  Boca Arriba Para Dormir, Boca Abajo Para Jugar (Back to Sleep, Tummy to Play) provides information for parents and child care workers about placing infants to sleep on their backs and on providing them with tummy time when they are awake. The brochure answers the following questions: (1) How much tummy time should an infant have? (2) What if an infant doesn't like being on her tummy? (3) Doesn't sleeping on her back cause an infant to have a flat head? and (4) How can I exercise the infant while she is on her tummy? A list of steps to follow to create a safe sleep environment is provided, along with a list of national SIDS resources. The brochure is available at http://www.sidscenter.org/documents/SIDRC/SIDSTummyTimeTrifold.pdf.
  

Readers: The publications may also be ordered in hard copy at no charge from the resource center's Web site at http://www.sidscenter.org/order/index.html.
 
Additional Spanish-language publications are available from the resource center's Web site at http://www.sidscenter.org/Espanol/index.html.

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• In the initial observations, 315 infants (51.4%) were placed to sleep supine, 92 (15%) were placed to sleep prone, and 50 (8.2%) were placed to sleep on their sides. An additional 158 (25.4%) were placed sitting or standing in the crib. These were infants who were generally older than age 6 months and resisted being placed down for sleep. 
• In the control group, supine placement increased to 57.1% (not significant), side placement decreased to 3.9% (not significant), and prone placement decreased to 10.6%. 
• In the intervention group, supine placement increased to 62.1%, side placement decreased to 4.4%, and prone placement decreased to 5.9%. 
• Perceived parental objections, child care provider skepticism about the benefits of supine positioning and other safe sleep recommendations, and lack of training opportunities were important barriers to implementation of safe sleep recommendations.

• More than 2,300 participants answered questions concerning infant sleeping arrangements for the 2-week to 3-month time periods; the number decreased to almost 1,800 for the 12-month questionnaire. 
• During the first 3 months, a majority (85%) of the infants slept in the same room as their mother; this percentage declined to 29% by age 12 months.
• Nearly 80% of the mothers of young infants chose the recommended supine position for placing their infant for nighttime sleep, whereas a significant minority (more than 20%) did not follow this recommendation. Noncompliance rates increased with infant age, so that by age 12 months, 36% of mothers were not placing their infant supine.
• Among all women, bed-sharing rates ranged from 42% at age 2 weeks to 27% at age 12 months.
• More than two-thirds of the bed-sharing mother-infant pairs also shared a bed with the mother's partner. Approximately 5% of the mothers and infants slept with other children at age 2 weeks, and this frequency steadily increased to nearly 15% by age 12 months.
• The three most common reasons that mothers cited for bringing the infant into bed were to calm a fussy infant, to help the infant and/or the mother sleep, and to facilitate breastfeeding.
• Mothers' most frequently cited reasons for not lying down or sleeping with their infant were safety concerns, perceived difficulty in later placing the infant in a crib, and that it is "not commonly done in my family."
• Non-Hispanic black mothers were less likely to use the recommended supine infant sleeping position, and nulliparous women were more likely to use the recommended sleeping position.

• After adjusting for matching variables, known risk factors, and other potential confounders, having a fan on in the room during last sleep was associated with a 72% reduction in the rate of SIDS. 
• The effect of fan use on the reduction of SIDS risk seemed to be consistently greater when the infants were in adverse sleep environments (i.e., when the room was warmer, windows were closed, and/or infants were sleeping in the prone or side position). 
• The decrease in SIDS risk associated with fan use was larger in infants who shared a bed with someone other than their parents compared with infants who shared a bed with their parents only. 
• Fan use in infants who did not use a pacifier was associated with an 88% reduction in SIDS risk, whereas fan use was no longer associated with a reduction in SIDS risk in infants who used a pacifier at last sleep.