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Tara WestDr. Sonja AndrusIntermediate Composition 208930 October 2016“I did those things with you and you turned out fine, why is it now so different?” We are starting to hear this phrase more often now since SIDS has become more prevalent. Grandparents are questioning the new ways to infant sleep because they raised their children the traditional way and there were little to no problems. Studies have been performed to find out why so many infants have been dying in their sleep. Today, we have yet to determine the true cause of sudden infant death syndrome (SIDS). Researchers have developed new practices that parents can follow to help lower the risk but nothing has been proven to be the ultimate prevention. When presented with this opportunity to develop a research paper, I had to jump on the topic of SIDS. I currently work in a hospital in the postpartum unit with the mothers and their newborns. As you can imagine, this topic is brought up multiple times a day, every day, during my shift. We strive to practice the recommendations of safe sleep in the hospital and strongly encourage mothers to continue on after they are discharged from the hospital to follow these guidelines at home. Are the changes proposed by the supporters of the Safe Sleep Public Education Campaign valid and being accepted by parents and caregivers of newborns? For my research, I am defining Safe Sleep as the current best practices for infant sleeping environments.? The acronym “ABC” is used to define Safe Sleep, A (alone, no blankets, bumper pads, stuffed animals), B (sleeping on their back) and C (safe crib, firm mattress, not sleeping with parents).I look to the American Academy of Pediatrics (AAP) for my first source of information. Ever since 1992, the AAP has released its recommendations for decreasing the rate of SIDS. Some of the causes they mentioned for SIDS and sudden unexplained infant death syndrome (SUIDS) that occur during sleep include: asphyxia, suffocation, entrapment, and unspecified. Despite their efforts to control the rate of SIDS in the early 1990s, incidents have increased since their last statement in 2005. Since then the article written by the AAP has expanded their recommendations to reduce sleep related infant deaths to include: supine positioning, use of a ?rm sleep surface, breastfeeding, room-sharing without bed-sharing, routine immunizations, consideration of using a paci?er, and avoidance of soft bedding, overheating, and exposure to tobacco smoke, alcohol, and illicit drugs. (SIDS, 2011)Molly Shen, from Local 12 News, writes a piece about how SIDS is connected to an inner ear issue earlier this year. She writes about a family where the nurse found their son asleep and not breathing only 8 hours after birth. Doctors were able to start his heart back up again and transferred him to a Children’s hospital. Two days later their son died to what was diagnosed as SIDS. After that unfortunate incident, doctors from that hospital teamed up with researchers from the U.K. to see if an inner ear defect was linked to infant suffocation. She quoted Dr. Daniel Rubens on his thoughts of the connection, "They're not making the arousal movements that the other (healthy) one would do, for example if the airway was obstructed or they simply need to wake up from sleep to move or to breathe," Dr. Rubens said. "The goal would be to have a comprehensive, accurate assessment. This needs to be really accurate so that we will pick up the babies that are at risk." (Shen, 2016)Very recently, the American Academy of Pediatrics held a conference to discuss new safe sleep regulations. This is an update from the policy in 2011. In their website link that gave details following the conference was a video of a family that experienced the loss of their son to SIDS. The mother pointed out that putting your baby alone in the crib does feel “cold” and “harsh” but in reality is very safe and the best thing you can do for your baby. The one time their son wasn’t in the crib was the night they lost him to SIDS. Research says there is a 5 times higher risk of your baby suffocating if put on any soft or squishy surface (pillow, couch). The conference discusses bed-sharing, how it does increase the risk of SIDS if your baby sleeps in the same bed as you. This can be confused with room-sharing. It is actually recommended that infants sleep in the same room as their parents for the first six months of life (optimally for the first year of life) but on a separate sleeping surface such as a crib, bassinet, or playpen with a firm mattress. Room-sharing decreases the risk of SIDS by as much as 50%. Skin to skin immediately following birth and breastfeeding are on the list for safe sleep. "If you are feeding your baby and think that there's even the slightest possibility that you may fall asleep, feed your baby on your bed, rather than a sofa or cushioned chair," said Lori Feldman-Winter, MD, FAAP, member of the Task Force on SIDS and co-author of the report. "If you do fall asleep, as soon as you wake up be sure to move the baby to his or her own bed," she said. The concerns with pillows, sheets, blankets, etc. are the face that they can obstruct the baby’s breathing or can cause overheating. Lastly, they wrap up the article with a few more recommendations. These include: offering a pacifier at naptime and bedtime, do not use home monitors or commercial devices (including wedges or positioners, marketed to reduce the risk of SIDS), receiving all the recommended vaccinations, and supervised awake tummy time. (American Academy of Pediatrics, 2016)In the Safe to Sleep Public Education Campaign’s website, there are educational videos for all family members. Grandparents and other relatives from previous generations can be reluctant to follow these new guidelines because they are so different from the ways they raised their children. One of the grandma’s main concern from the video was that the baby would get cold and they would need the blankets. The daughter then says that her instructor told them about one piece sleepers that would keep babies warm without overheating or suffocating them. The instructor of the new parents’ class states, “The important thing is that your baby is always put down to sleep on his or her back. Around 4 to 6 months, babies start rolling over on their own, and that’s fine; you don’t need to turn the baby back over. Just remember to always put the baby down on his or her back at sleep time—and that goes all the way until the baby is 1-year-old.” Dr. Spong adds in the video, “As a mother of four, I know it can be a challenge to help the grandparents and other caregivers understand the importance of learning today’s safe infant sleep practices, and doing them every time. But taking the time to teach these things can make all the difference.” (“Text Alternative,” n.d.)Next, on the article- Scientific consensus forum to review the evidence underpinning the recommendations of the Australian SIDS and Kids Safe Sleeping Health Promotion Programme. They start off with the statistic that infant deaths attributed to SIDS (among non-Indigenous Australians) has fallen ~83% during the last 20 years, in Australia. Their evidence suggests that this fall can be directly related to Australian public health campaigns. These campaigns are promoting safe sleeping practices. The article says, if these recommendations are followed that SIDS will be estimated to reduce to less than 0.1 per 1,000 live births. Prone sleeping is proven to increase the risk of SIDS by 3-14 times. Head coverings heighten the risk of SIDS by 17 times. The author refers to head coverings as bedding and blankets not as hats. When room-sharing was mentioned, the author pointed out that infants who slept separately from their parents were more likely to be found with their head covered with beddings. Also if placed on their side to sleep and not in the same room as the parents, would be more likely to be found prone (face down) as opposed to rooming in with their caregivers. The preventable risk factors for SIDS can account for over 90% of sudden and unexplained infant deaths. The end goal for this campaign is to implement the knowledge of safe sleep so that babies don’t have to die of SIDS. (Mitchell et al. 2011).This source information points to verified factual data, that concludes Safe Sleep steps are valid, if not the primary way SIDS deaths can be reduced. However this information does not address whether these new methods are being adopted by new parents and caregivers. Are parents aware of this information? Are they putting the steps into practice? If not, what are the reasons? To address these questions, I have requested information from 4 individuals with various backgrounds. As I started this paper, I contacted each individual and found they were very willing to share their thoughts. The interviews were set up with open ended questions, inviting responses and additional feedback comments. My first interviewee is a brand new mother to a 2 week old newborn because she has had the most recent exposure of the new practices given to her by her hospital and other media sources. Next, I spoke to a business professional who has a 1 year old daughter. I selected a nurse that is now a professor teaching nursing students because she has the inside scoop on what new information is being taught to her students. She is also a mother of school age and adolescent children so she might not of have practice safe sleep with her children. Finally, I thought it would be a good idea to have a physician’s perspective on the matter. She focuses on internal medicine as her specialty. The doctor does care for infants in her office so she is teaching these new ways to her patients’ parents. Interview 1 – New mother, Mallory:Mallory is a first time, new mother, age 21. She, her husband, new baby, and dog, all live in the same community where they grew up. Mallory is a college graduation working in the education field, while her husband works for a local construction company. Mallory comes from a very large family; she has 4 other siblings. When I interviewed her about Safe Sleep, she was generally aware of that concept and seemed to be exercising some of the protocols. However, she was confident in the practices that her mother and grandmother had used. Her little one is now 2 months old, and is therefore right at the age most vulnerable for SIDS. Mallory is a young but very smart new mother. In her replies, it was evident that she wants to do the best thing for her child and her family. I believe she has adopted some of the Safe Sleep practices, but still holds back in some areas like bumper pads and small plush animals.Interview 2 – Mother of 1, business professional, Heather:Heather is a business professional, working full time outside of the home (with some work-from-home days each week). She has 1 adorable daughter who is 1.5 years old. Heather and her husband had a hard time getting pregnant, so seemed to have an somewhat heightened need to make sure her only daughter is safe. Heather did receive Safe Sleep information from the hospital after delivery, including no bumper pads, no extra blankets and no co-sleeping. She shared that her mother used bumper pads and blankets for herself and her brother, “there weren’t all of these rules when I was little.” Heather went on to say, “Harper had acid reflux so it was really fun!! NOT! We bought a rock and play since that let her sleep at a slight incline. It worked great. She slept in that right next to our bed the first 6 months of her life. Then Brad works nights and as she got older (older than 6 months) I let her start sleeping with me.” So, based on medical needs, Heather did co-sleep with her daughter. When I asked if would change her sleep arrangements for future children, she said she would probably not co-sleep, but co-sleep if her husband would be working nights at that time.Interview 3 – Mother of 3, practicing and teaching nurse, Holly:Holly is a mother of 3 daughters, age 8, 10 and 16. She is also a practicing nurse and a nursing school professor. Holly brought some unique perspective to my research. While she is 100% on board with the Safe Sleep concepts, she admits not (fully) practicing them with any of her children. While she did not sleep with any of her babies, she did put them to sleep on their bellies and used blankets and bumper pads. The information about Safe Sleep has really been pushed in the last 5 to 7 years, so she was not aware of these concerns until more recently. As a teaching nurse (professor at a local college), Holly is not only aware of the Safe Sleep protocols, she is also teaching them to all her students. Holly shared, “I have personally only been exposed to one case of SIDS during my practice as an NP (nurse practitioner).? We had a patient whose 6 month old baby boy died of SIDS. ? He was in a crib and on his stomach but I am unsure of the other details about the case.? I am aware of a girl that I graduated with whose baby died while she was holding it on her chest.? She fell asleep and again the baby was on its stomach.” She went on to say, “We teach the parents the same things you have noted including never sleeping with the child, no blankets, bumper pads, pillows etc.? I was working in OB once when an 8 or 9 month old was brought in by the squad.? He was sleeping between his parents and the father rolled over on top of him and smothered him to death.” When I asked how the parents she cares for accept and embrace the Safe Sleep information, she said, “Most parents are aware of the importance but I can tell you from experience that they do not listen the majority of the time.? After educating them, I walk into the patient’s room to find the baby lying next to them in the bed.? The only time I tell mothers that this is OK is when they are attempting to lay down to breastfeed.” Holly explained that there is definitely resistance to these practices. Parents feel that if they or their parents slept with new babies and everything was OK, then it should be OK for them. I also asked if Holly’s perspective has changed over time. Her first child is 16 years old, and her youngest is 8, “Yes my views have definitely changed.? With Conner, I would bring her into my bed to breastfeed and allow her to fall asleep between myself and my husband.? She slept with us until she was 4 years old.? With Bentley and Tessa they NEVER slept with me and as I said before I was researching everything to prevent SIDS from happening to my child.? There was so much more information on SIDS after Conner was born.? It is a very scary situation for parents to deal with.”Interview 4 – Mother, Doctor of Internal Medicine (patients of all ages), Dr. Glick:Dr. Glick practices internal medicine, for all ages. She is a mother and a very popular physician. She shared information about how she treats her patients with newborns. Dr. Glick’s office is filled with brochures and other information sources about various conditions and preventive care subjects. She is very enthusiastic when she talks to parents about Safe Sleep and how this helps reduce the risks of SIDS. When parents come in for appointments, she addresses the immediate health needs, and also asks several questions about how the at-home care has been going. Regarding Safe Sleep, she asks about the sleeping environment. If there are any questionable activities, Dr. Glick questions them and provides information and reasons why Safe Sleep steps are important. Dr. Glick also added that she is the mother of an elementary student, and she practices all the Safe Sleep steps. Summary of findingsThis research shows that while the Safe Sleep steps are not generally being embraced. Even though there is clear information as to why Safe Sleep steps should be practiced and that this can be literally a matter of life and death, there is still resistance. There are a few reasons for this:The steps are not easy to follow. Some infants sleep better on their stomach. Sometimes parents feel the need to co-sleep with their babies for various reasons.Since SIDS deaths are somewhat rare, many parents and caregivers have not been exposed to a SIDS death. Therefore, parents feel that if their own parents successfully raised healthy children, then it isn’t really important.While this is discouraging, there were some interview answers showing some parents and caregivers are following the new steps. It is reasonable to conclude that with a continued push if Safe Sleep information, the new steps will eventually be adopted.Works Cited“American Academy of Pediatrics Announces New Safe Sleep Recommendations to Protect against Sids, Sleep-Related Infant Deaths.” States News Service, 24 Oct. 2016.“Infant Bed Shaped To Mimic Womb And Reduce Risk Of Sids Raises $80g.” Fox News, FOX News Network, 15 Aug. 2016.Matthews, Rebecca, and Andrea Moore. “Babies Are Still Dying of SIDS.” AJN, American Journal of Nursing, vol. 113, no. 2, 2013, p. 59.Mitchell, Edwin A et al. “Scientific Consensus Forum to Review the Evidence Underpinning the Recommendations of the Australian SIDS and Kids Safe Sleeping Health Promotion Programme - October 2010.” Journal of Paediatrics and Child Health, vol. 48, no. 8, 3 Nov. 2011, pp. 626–633.Searing, Linda. “Swaddling Babies Is Tied to Heightened Risk of Sudden Infant Death Syndrome.” The Washington Post, 9 May 2016.Shen, Molly. “SIDS study could connect mysterious death to inner ear problem.” Local 12 WKRC Cincinnati, 13 May 2016.Siren, Pontus M. A. “SIDS-CDF Hypothesis Revisited: Explaining Hypoxia in SIDS.” Upsala Journal of Medical Sciences, vol. 121, no. 3, Dec. 2016, pp. 199–201. “SIDS and Other Sleep-Related Infant Deaths: Expansion of Recommendations for a Safe Infant Sleeping Environment.” Pediatrics, vol. 128, no. 5, 17 Oct. 2011, pp. 1030–1039. “Text Alternative: Safe Infant Sleep for Grandparents Video, 7-Minute 26-Second English Version.” U.S National Library of Medicine, U.S. National Library of Medicine, . ................
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