as some of you may be aware in the fall
of two thousand eleven the South
Carolina joint citizens and legislative
committee on children recommended action
on safe sleeping for infants as a focus
area for state efforts and resources the
number of infant deaths in South
Carolina due to accidental suffocation
and strangulation in bed had more than
doubled since 2004 Children's Trust was
asked to take the lead on this
initiative and we convened
representatives for more than 20
different areas of expertise medical
non-profit educational and public and
private agencies an important part of
the work was that the Coalition
recommend all safe sleeping curriculum
training and education materials be
based on the American Academy of
pediatric guidelines at the heart of
those guidelines as many of you know
infants should sleep alone on their
backs in a crib without any loose
objects or loose bedding our next
speaker dr. Rachel moon will help us
learn more about the American Academy of
pediatric recommendations look at the
difference between sleep related deaths
and sudden infant death syndrome or SIDS
as some people know it and help us to
understand as some of the important
statistics that go into went into those
recommendations dr. moon's credentials
are very impressive she is an
internationally recognized expert in
sudden infant death syndrome and serves
on the SIDS task force at the American
Academy of Pediatrics she currently is
the director of academic development for
the Goldberg Center for Community
pediatric health and Children's National
Medical Center in Washington DC she
earned her undergraduate and medical
degree from Emory University in Atlanta
and completed her residency at the
Children's Hospital of Philadelphia and
she was also served as a pediatrician in
the air force join me in welcoming dr.
moon
good afternoon everybody I have to say
that it's a little bit daunting to come
up here after the two plenary speakers
that you had this morning and I
apologize in advance there's no dancing
in this session so I really apologize
had I known that that was the
expectation I would have put something
in there but I apologize so what I'm
going to do over the next 45 minutes I'm
going to talk about safe sleep and about
SIDS and and and and how we can keep
keep the baby safe so what so these are
the topics we're going to talk about so
we'll talk about SIDS sleep related
death will talk about why these babies
die we'll talk about statistics and what
then we're going to spend the most of
the time talking about the
recommendations and more importantly the
rationale behind the recommendations
because I think it's really important
for people to understand why before they
understand what so just some definitions
to start with so that we're all on the
same page suid you know it's really
confusing I feel a little schizophrenic
there's a screen there there's a screen
there so I'm just going to try to do
equal billing but if I seem like I'm
spinning then just somebody raise your
hand and tell me to stop okay so suid is
exactly what it sounds like sudden and
unexpected infant deaths so it's when a
baby less than one year of age which is
what we call infants died suddenly and
unexpectedly some people will call it
soo d which is sudden and unexpected
death in infancy so you'll hear both of
those terms bandied about and this is so
you have sewage and then there explain
sewage and there are unexplained
seward's and under explain suid zor
things like trauma drowning car
accidents something that's known
diagnosis like cardiac disease or
something like that and then you have
accidental suffocation which is
important to us because that's one of
the sleep related deaths but that's
something that that ultimately is
explained and then
explained you have the SIDS and then you
have the undetermined an undetermined is
when you have a death and the corner the
medical examiner isn't quite sure what
happened so it looks like a SIDS but the
baby was bed sharing with the parents or
it looks like a SIDS but there have been
two other deaths in that same child care
center in the past couple of years so so
it's when there's a little bit of
uncertainty and the corner of the
medical examiner can't quite pin it down
to one thing so then those are the ones
that become undetermined and the ones
that we are talking about today are the
accidental suffocation the SIDS and the
undetermined and those are what we call
sleep related deaths because most of
them occur when the baby is asleep or
when the baby is in a sleep environment
such as a crib or bassinet or an adult
bed or something like that and the
things that so we have this suffocation
we also have strangulation and
entrapment that goes in with that and
then we had the undetermined some people
call it ill-defined some people call it
unknown and then the SIDS so then what
is SIDS so SIDS is any suid that remains
unexplained even after there's complete
review of the history an autopsy and a
death scene investigation so typically
it's a seemingly healthy baby who's
found dead after a sleep period and they
either died during sleep or during a
transition from sleep to waking now what
is suffocation so here's some more terms
you guys are going to think I'm you're
going to feel like a dictionary by the
end of this so asphyxia you'll hear this
term is anise is any situation where
there's a decrease in oxygen or an
increase in an increase in carbon
dioxide in the body and as you remember
all this breathe in oxygen we breathe
out carbon dioxide so if you have too
much carbon dioxide that's bad if you
have not enough oxygen that's bad so as
fixie is what happens it can happen when
you stop breathing it can happen when
something becomes obstructed your airway
becomes obstructed somebody pressing on
your neck or on your nose or in your
mouth so you can't breathe if Yuri
breathe so imagine a baby face down in
soft bedding they're going to be
reburied
eating that carbon dioxide that they
just breathe out and they're not going
to be getting in any fresh air mne fresh
oxygen so that's what it's fixya is
suffocation is a form of asphyxia and
entrapment is when a baby is trapped
between two hard objects so they can't
get enough so they can't breathe so for
instance the baby's trapped between them
the headboard and the wall the headboard
of an adult been in the wall or the
mattress and the wall or the match it
often happens in scituate in with an
adult bed that's against the wall or
accountants against the wall so it's
when a baby is trapped in that that's
the kind of situation and then
strangulation is when something is
wrapped around the neck causing the baby
causing airway blockage so it doesn't
take a lot of pressure to completely
obstruct a baby's airway you just press
on their airway just a little bit and
that'll do it so asphyxia has always
been a part of SIDS okay and there are a
lot of risk factors that are associated
with environments that are potentially
asphyxiating for children that's why
these are the risk factors so prone
sleeping soft bedding pillows bumper
pads all that kind of stuff bed sharing
all of these things or environments that
could potentially cause asphyxia in a
baby there's some asphyxia situations
that would cause death and any baby so
for instance that baby who was trapped
in between the mattress and the wall
that that kind of a situation any baby
would die in but there are some
situations where not all babies die so
why is that why is it that some babies
die and some babies don't when they're
in that situation so we have this triple
risk model which many of you have heard
about and you have three different
things in this Venn diagram first is you
have a vulnerable baby and this
vulnerable baby is vulnerable because
there's something going on in their body
that makes them vulnerable and we think
that for most of these babies it's that
they don't wake up that they can't
arouse okay so there's a defect in their
brain stem that keeps them from waking
up when they're supposed to wake up and
then you have you put that baby in a
critical period during a critical period
and we know
the highest risk for SIDS and for all of
these does is less than three or four
months of age and the highest Chris is
between two and four months of age and
then if you had that baby in that
critical developmental period and then
you stress that baby by putting the baby
on the stomach or on the side exposing
the baby to smoke bed sharing with that
baby putting the baby in a crib with
bumper pads these are things that can
stress the baby causing a stick seal
situation and you get this whole
conglomeration this perfect storm and
you get a baby's that dies another way
to look at it is you look at a
combination of genetic factors and
behavioral and environmental factors so
this is no different than a lot of
diseases so if we take adult cardiac
disease heart disease for example what
determines whether or not you have a
heart attack well they're going to be
genetic factors okay so do you have a
family history so is there something
going on in your family do you have high
hypercholesterolemia because it's a
familial thing so hyper high cholesterol
and run in your family so there are
genetic factors but then they're all
those behavioral factors as well do you
exercise do you weigh 500 pounds do you
eat fast food three times a day okay
those are the behavioral things so there
are some people that do everything right
okay and you've heard about these people
that the marathon or the drop dead of a
heart attack in every goes oh my god you
did everything right okay but for that
person the genetic factors were so
overwhelming for him that even though he
did everything right it was still too
much for him okay then you have people
that are the total opposite where there
are no genetic factors but they're not
watching their weight they on aren't
exercising their smoking three packs a
day all of this kind of stuff and so
they may not have genetic factors but
they hate but the behaviors overwhelm
their body and they die okay the same is
true with SIDS and all of these deaths
you can have genetic factors that are so
strong you can have such a bad arousal
defect that even though your parents
have done everything right you could
still die it doesn't happen very often
but these are the ones that we always
hear about oh that baby died on his
ACK and so that means the back isn't
good right because you hear about that
exception and so that means that you
don't have to follow the rules ok and
then on the other hand you may have a
baby that has none of these problems but
is in one of these situations where they
can't escape and that anybody would die
so they're getting strangled or they're
suffocating or something like that ok
and and so so these kinds of things so
since is not like unlike a lot of these
other diseases that were used to it's
this this interaction between the
environment and the genetics but
sometimes one of the other can can be
more important and for us we can't
really do anything about the genetics so
we have to we the where we can impact is
on the environment and on the behaviors
and that's what we're trying to do and I
know that I'm a baby boomer because I'm
telling you this and I'm not giving you
an option but that's just too bad so our
current hypothesis is that search
results when a vulnerable baby cannot
adequately defend against an
asphyxiating environment which is a
level of asphyxia where most babies
would not die so the rebreathing theory
tells us that babies and certain sleep
environments are more likely to trap
carbon dioxide around their face so if
you're lying on your stomach in a
facedown or near a facedown position and
there are a lot of babies that like to
do this you can just imagine
particularly if they're soft bedding
there that there can be this pocket of
carbon dioxide around your face ok if
they're soft bedding if there's tobacco
smoke in your environment or you've been
exposed to tobacco in utero we know that
you are more likely to rebreathe it's
jut that this because you because your
brain and your and your lungs don't
develop quite as well and so that's a
defect that's that's there for babies of
smokers and so if you rebreathe the
exhale carbon dioxide if you do not wake
up and if you do not respond
appropriately you will die Hannah Kinney
is a neuropathologist up in Boston and
she and her group at them have found
some neurotransmitter abnormalities in
the brain stem and babies who died
suddenly and unexpectedly and these are
our transmitters a lot of it has to do
with serotonin and it's this whole
network dysfunction and and the
interesting thing is that that some
other scientists have found
polymorphisms or little many changes in
the serotonin transporter protein gene
so that the the babies that are more
likely to die the babies who have died
are more likely to have the genes that
make it so that there's less serotonin
floating around which kind of fits with
the pathology findings as well and up to
seventy percent of the babies who die
have neurotransmitter abnormalities and
these abnormalities are not present and
other babies who die from other causes
so this is just a picture of the
brainstem down here kind of CSIS point
of working no it just doesn't go that
far so over on the right you have all of
these different different components of
the brain stem and all these different
neurotransmitters and you can see that
that it affects upper airway breathing
it affects the lungs it affects the
heart rate affects blood pressure it
affects all of this kind of stuff and it
also affects the brain stem also affects
sleep and arousal and so again if you're
not arousing then that's a problem so
again you have this whole triple risk
model and some things are filled in so
there are things that can make you more
vulnerable so we know that smoking is
going to be a problem we know that
alcohol and illicit drugs I didn't talk
about that much but that can be a
problem if your premature if you have
growth restriction those all make you
more likely to be vulnerable and then
the risk factors and the critical
developmental period as well and then if
we kind of fill this out we know that
there are all these different things on
the left hand side the smoking the race
ethnicity all of those things that are
that our behavior will actually race
ethnicity isn't behavioral but but
prematurity prone sleeping all those
kinds of things and then we know all of
the genetic things over here on the
right and these are just some of the
ones that we know of right now and that
list is just growing and growing and
growing okay so so what we have when you
have a baby that dies from SIDS
you have a baby that's in a sleep
environment and there can be arranged on
the left is not asphyxiating okay and on
the right is very asphyxiating so
there's combinations and there's a
there's a spectrum throughout that so is
the baby on the back is the baby as the
bedding is are there bumper pads is the
head covers their bed sharing all of
those kinds of things determine how is
fixating or potentially asphyxiating
your sleep environment is the other
thing that you have is a baby so how
vulnerable is that baby the ones on the
left are very vulnerable the ones on the
right are not vulnerable so if you have
a baby that's in a severe asphyxiating
environment even though that baby is
totally normal these are the ones that
are the strangulation the overlay the
entrapment the ones that know baby could
escape from okay so then the ones on the
very left those are the ones that have
the brainstem dysfunction and those are
the ones where they did everything right
okay and so those are pretty easy to to
make a diagnosis of okay but there are
interactions that can occur anywhere
along this continuum so we can you can
have a kind of normal baby with a little
bit of a vulnerability who's in an
honest fixating varmint so they're um
their interactions that occur all over
that area so so when you think about the
cause of death and I'm sorry that this
doesn't this doesn't come out so well
over on the very left it's very easy to
say that thats it's because that's
pretty clear-cut and over on the right
is very easy to say that that's
accidental suffocation or strangulation
because that's pretty clear-cut but in
the middle where do you draw the line
when does SIDS become suffocation when a
suffocation sits when is it undetermined
it really it's really hard to know
because the only person that the person
who is making the determination of what
that cause of death is is the medical
examiner of the corner and the only
information he or she has is the
information about the sleep environment
that person doesn't have the information
about the infant and the vulnerability
because there no there's no way for us
to know that at this point in time so
they're making their making this this
cause of death
amination a little bit almost half
blindly and they're doing the best they
can but that's why you have you can have
a baby who dies one personal say it's
suffocation one person will say it SIDS
or and there's a lot of confusion and
and and that's why because people are
trying to do the best they can and make
the best determination they can but
they're working with not all of the
information okay the key to this though
is that even no matter what causes the
death is the same risk factors okay so
if you can get babies to sleep on their
back if you can get the bumper pads out
of the crib if you can get people to put
babies in their crib you're going to
you're going to give you're going to get
rid of all of this stuff okay whether
it's id's whether it's undetermined
whether it's suffocation so that is the
key point to this so a safe sleep
environment can reduce the incidence of
both sits an accidental suffocation and
I think that that you know rather than
get caught up in the terms I think that
you all have to look at the big picture
of that okay so just looking at SIDS
rates and sleep position the the the
rates of sense back to sleep started
which is when the green line started
rates of SIDS have gone down percent
back sleeping have gone up but we've
only gotten two about seventy percent or
75 percent and we can't get up any
further than that and then what's
happening now is that we're getting
these other deaths the ones that are up
on the top of the bars a SSB is
accidental suffocation and strangulation
in bed and the other bar in the middle
is it will define and I apologize that
the colors don't come out so well but
those numbers have gotten bigger and so
the overall post neonatal mortality
hasn't changed in the past 10 or 20
years because because there's a little
bit of a diagnostic shift going on
because people are doing better best
death scene investigations we're
learning more about the environment and
so things that used to be called SIDS
are now being called something else this
is a this is a graph of accidental
suffocation and strangulation deaths and
they've skyrocketed in the last decade
they've gone up four times so what's the
problem
I think that the problem is everybody
thinks that his or her child is the
exception to the rule ok so my baby has
reflux so he doesn't need to sleep he
can't sleep on his back my baby is
premature and the nurses had her on her
stomach my baby is a bad sleeper and
can't sleep on the back how many people
have heard those kinds of things just
about everybody right so everybody
thinks that they're an exception to the
rule so when we created when we wrote
the revised statement we wanted to be
more concrete more explicit explain what
were the true exceptions on what we're
not and make it easier for people like
you who are out there on the front lines
advising parents and providing guidance
the families so in general when you look
at the recommendations we've expanded
them so that they are so there to reduce
the risk of SIDS and sleep related
suffocation asphyxia and entrapment and
you should use the recommendations to
one year until one year of age and why
is that because even though we because
when you do these studies your look it's
case control studies okay so you're
comparing babies who died from SIDS
versus babies who died from everything
or who didn't die and babies who died
from SIDS you can die from SIDS up to
one year of age so that means if you
match each baby who died with a baby who
didn't die they're going to be babies
who are almost one year of age in both
groups and so because it's all the way
up to a year of age we can't look at the
studies and say oh well you can do it up
until here because because the studies
just don't tell us that having said that
I think is most important in the first
six months and and and if you're if in
the in the last six months people are
becoming a little bit more relaxed I
don't worry about it quite as much but
but we but the recommendations are we do
recommend them until a year of age there
are two documents one is a policy
statement which is a summary of the
recommendations in the technical report
which has all of the background
information in the literature review and
has about 300 references to it so if you
need any references that's where to go
so to blitz through the different
recommendations the first one is one
that you
all familiar with back to sleep for
every sleep so that's nap time and not
and and night time and we do not
recommend safe aside sleeping because it
is not safe and I'll tell you why
multiple studies have shown that side
sleep is puts you at higher risk than
the back position and the most recent
studies show that side sleeping is just
as dangerous as stomach sleeping so if
you think you're doing parents a favor
by saying that they can put their babies
on the side you're not okay so it is
unstable and babies if they're on their
side are more likely to end up on their
on their stomach and we know that those
babies the ones that unaccustomed prone
have the high the ones that accidentally
roll into the prone position are the
ones that are the highest risk for SIDS
okay so so you don't want to put them on
their sides but why do people put them
on their sides are on their on their
backs or on their stomachs one is people
are worried about choking an aspiration
right okay everybody words that their
baby is going to choke so a couple of
things that I want to say about this one
is when do you think that a baby's
choking how do you know that a baby's
choking you can hear it right there go
like that right okay that is not choking
that is your gag reflex okay so that is
the baby intentionally trying not to
choke and making themselves not choke so
they're protecting their airway that
noise is the fact that that that that
noise is telling you that that baby's
airway is protected not that anything is
going wrong okay so that's the first
thing and people think that that people
misconstrue that for being actual
choking and they flip out second thing
is people worry about GE reflux okay
what percentage of babies reflux
I hear ninety percent I hear a hundred
percent yeah so what is reflux reflux is
spitting up if it has anybody ever met a
baby who students spit up I would like
to meet that pavey you know I was the
mom who walked around every day with
spit up on her shoulder and nobody told
her and I pretty much only wear dark
colors black and blue and you know so I
never wear peach or things that it might
blend in with so you know that was me
okay so every single baby spits up okay
so that is not an exception so the other
thing is and if you take away nothing
from this talk this is the one you
should take away okay when you are on
your back your trachea which is your
airway is on top of your esophagus which
is your food pipe okay so when that when
you spit up the food goes up comes up
your esophagus and then it has to go up
against gravity to go into your lungs
through your trachea if you on your
stomach the esophagus is on top of the
trachea and there's no resistance going
into your air into your lungs so
anatomically it is more it is easier for
you to aspirate if you are on your
stomach okay so draw a picture for the
parents show them this it's like oh that
makes sense that really makes sense ok
so so and we know also that's just from
study other studies that have been done
not just the anatomical things that if
you put a baby on the back it does not
increase the risk of choking even for
those babies who have reflux so you you
should be placed on your back if you
have reflex the only exception is if you
do not have a gag gag reflex okay or if
you have an airway where your gag reflex
is impaired okay and these are like one
in a million babies these are things
like
I don't even remember Oh type 3 or type
for laryngeal cleft that has been
unrepaired has anybody seen a type 3 or
tie for laryngeal cleft okay I think
that we'd probably you have okay we have
one person okay how many of you seen
okay saw 11 in Korea okay okay so we
probably have a thousand years of
experience here maybe more okay we only
have one case this is this is a truly
rare exception okay so the the net north
american society for gastroenterology
and nutrition these are the reflux
experts okay they say that babies with
reflux should be placed for sleep in the
supine position except again for the
rare baby for whom the risk of death
from complications of GE reflux is
greater than the risk of SIDS okay so
these are again the babies that where
the airway is unprotected okay so what
about elevating the head of the crib
people have people seen that yeah yeah
okay so it doesn't work okay the studies
that were done on this we're done on
babies that were on their stomachs if
you're on your stomach you elevate the
head of the crib that it does help a
little bit if you're on your back and
you elevate the head of the crib it
doesn't do anything okay and we again we
want these babies on their back the
other thing is that when you have a baby
on their back on and you elevate the
head of the crib unless you velcro that
baby to the crib that baby's going to
slide down okay and that when the baby
and babies are not really graceful when
they slide down so when they slide down
to the bottom of the crib they're going
to be all kind of scrunched up okay and
when you grow like that if you're a
little baby that's enough to compromise
your airway remember you just takes a
little bit of pressure to block that
airway and that and that can put a baby
in an associating situation okay car
seats who's seen babies and car seats
because of reflux it makes it worse okay
the studies have shown that it makes it
worse the other thing because you know
what's happening is that you put this
baby in this car seat and there's there
becomes this kink right in
where their stomach is because they're
bent okay and that makes them reflux
more so the other thing is that that we
see babies who fall out of car seats
because people put them on the table and
then attend the toddler sibling goes
rushing by and goes oh and the baby goes
flying so so don't put them in the car
seats because it doesn't really help
okay so who's heard this the baby sleeps
better anybody nobody oh yeah okay so
this is the other reason the babies are
being placed on their stomach and we
know that this is true babies who are on
their stomach they have higher arousal
thresholds so it takes longer to wake
them up so so they sleep longer they
sleep more deeply but then what's the
problem with that they're not arousing
right and that's the whole thing with
SIDS okay so actually having them sleep
better is not a good thing ok so I think
we really do kind of need to change the
definition of what a good sleeper is
okay so good sleeper to me is a baby
that wakes up every through every couple
of hours you know whether it be a
feeding or not and then can put him or
herself back to sleep okay it's not a
baby that sleeps 48 hours without waking
up okay that baby is one that I'm
worried about because I'm worried about
that baby's arousal capability okay but
this is a big thing this was in the New
York Times a few years ago and is still
true that all across the country parents
like mustachio are mounting a minor
mutiny against the medical establishment
since new babies are fine since new
parents are finding out that the
benefits of having babies sleep soundly
more likely when they sleep on their
stomachs outweigh the comparatively tiny
risk of SIDS okay so people are making
this kind of this kind of risk benefit
ratio calculation in their head every
single day okay so what about preterm
babies preterm babies also need to be on
their backs we know that they are more
likely be put on their stomach
particularly initially because on the
respirators and things like that but
they're more likely to sleep prone after
they're discharged as well but we know
that prone sleep position and SIDS that
association for low birth weight and
premature babies is even stronger than
for the term baby so we want them on
their backs but they have to learn how
to be on their backs because you can't
just sleep say have them on their
stomach the whole time of the nursery
and then say okay put them on their back
it's not going to work because it takes
it takes a few weeks for the babies to
learn how to sleep on their backs so you
want to put them on their backs as soon
as they're made the baby's medically
stable and significantly before the
infant's anticipated discharged by 32
weeks gestation okay so that's and then
actually that's a neonatologist that was
their recommendation that they felt that
almost every baby by 32 weeks should be
able to be on their back and certainly
there are going to be exceptions to the
rule but again those are very very rare
exceptions babies on in the newborn
nursery often place on their side again
because there's this there's this
perception that babies are going to spit
up this amniotic fluid and that they're
going to choke on it okay the problem is
the problem in it's probably fine and
it's not a big deal except that if a
parent sees that sees that then they
copy that because if they see you doing
it then what are they going to thank it
doesn't matter if the nurse is doing it
if the doctors doing that the lactation
consultants doing it they know what
they're doing and if they're doing it
either it's not important I'm the
exception right and so I don't have to
do it okay so we want them to be in on
the back as soon as they're ready to be
placed in the bassinet and yeah because
there's no evidence that it actually
helps with putting them on the side
makes any difference with aspiration
okay how about rolling over there there
no data about when it's safe to let them
roll over and stay stay late over say
laid over doesn't right stay rolled over
ok say you know stay in the position
that they work they rolled into you
still want to put them on their backs
until they're one
and then once they can roll comfortably
both ways I'm ok with you know if they
roll that they say the way that they
rolled into as long as you make sure
everything is out of that crib ok
because the worst thing is when a baby
rolls over and rolls into a bumper pad
or rolls into a pillow and gets stuck
and can't get out ok moving away from
sleep position to firm sleep surface you
want them honestly therm sleep surface
firm mattress fitted sheet use a
mattress designed for the product and
you want it to be to maintain its shape
even when you put a fitted sheet on so
if the if the mattress goes like that
when you put the sheet on that's
probably not so good because they're
going to be gaps in there don't put
pillows or blankets in addition to or
instead of the mattress under the baby
this is what a lot of parents will do
they'll put they'll think the mattress
is too hard and then they'll put a
pillow or a blanket on top and then
they'll put the sheet on top of that and
wrap it tightly and because it's tight
they think that's firm okay ask your
parents I bet you some of them are doing
this ok because you tell them firm
mattress and that's what they think they
don't think firm is hard they think firm
is tight ok sitting devices we talked
about this a little bit we really don't
like the sitting devices particularly
for the babies less than four months of
age again because they get into these
positions where where they can become
asphyxiated and airway obstruction
slings you want to make sure the baby's
up their heads are up so that you can
see them because again they can they can
get into problems when they're down in
the sling and then if a baby falls
asleep in one of these devices then you
want to move them into a crib or another
appropriate flat surface as as soon as
possible because this can always happen
ok ok so then soft bedding see I told
you I wouldn't have you dance but I
didn't promise I wouldn't make you laugh
ok so soft bedding why do people use
soft bedding number one it's comfortable
and how does a parent decide that as
comfortable because the parent thinks
that it would be more comfortable and
sometimes because they say that the baby
will sleep better ok but really you know
what I the way that I described
disappearance is that a baby you know if
they're lying on a soft surface they're
kind of struggling to keep their head up
ok and to try to maintain some
equilibrium there so a firm surface is
actually going to be more comfortable
for the baby that people also use soft
bedding because of safety because people
have this idea that if it's soft it's
going to cushion bumps and this is
really true for bumper pads in
particular parents worry the babies are
going to get cold and then the biggest
thing is that it looks nice and it's
cute and you're supposed to buy it and
if it wasn't safe the stores wouldn't
sell it and we know that's not true but
you know soft bedding increases risk of
SIDS fivefold dependent no matter what
position you're sleeping and if you are
sleeping on your stomach and soft
bedding you you're in your risk goes up
21 times the Consumer Product Safety
Commission has reported that the
majority of their sleep related infant
deaths are due to suffocation involving
pillows blanks blankets and extra
bedding in quilts so this is a picture
of a baby and you can just kind of an or
a doll you can just imagine kind of a
pocket of co2 around that baby's face
this is another baby pillows are a huge
issue most of the babies that died with
pillows are prone they're put on top of
a pillow or they roll into a pillow and
and the vast majority of them are less
than four months of age so again keep
the pillows outside of the outside of
the crib when the babies are sleeping
again bumper pads people do use bumper
pads because it's
safety and because they're cute and
because you're supposed to buy them so
they were that the baby's going to hit
the head they were that the baby's arm
or leg is going to get stuck there they
were that the baby's going to scoot into
the corner and they worry about bruises
they worry about social services coming
after them but you know a lot of babies
I against bumper pads and there for
three reasons one is that the soft
pillow like once they suffocate against
or the hard ones they get entrapped in
between the mattress and the bumper pad
and then they can also strangle strangle
off from the bumper pad Thais and the
studies have shown that bumper pads do
not prevent injury serious injury in
these babies because the young davies
the ones that were worried about the
less than four or five month old babies
they can't you can't generate enough
force if you're that little I mean you
only weigh 10 pounds you know you can't
fling yourself across to you know really
do damage okay so if you if you roll
into the crib side you're going to go
bunk and you're going to go on you know
and but it's going to be okay really it
is if your arm a leg is stuck it's
distressing the moms going to probably
cry but you take it out and it's okay
you know as opposed to having a baby die
which you know is just devastating and I
and I don't mean to make fun of parents
you know for wanting the best of their
kids but sometimes and I know this
because I'm a type a parent I'm although
i think i'm getting better but don't ask
my kids because they'll tell you
something different you want the best
for your child you want your child to be
safe you want your child to be happy
those are the two things you want okay
and a lot of the stuff that's out there
is created and is it to try to feed into
those two desires but those two desires
are sometimes not compatible okay and
every once in a while it's okay if your
baby cries it really is because in the
long run it's a safer thing it's a
better thing okay you know if your baby
cries because if your child cries
because she's not going to get hurt
ice cream cone that's okay you know it's
the same kind of thing the other thing
that we found is in our in our focus
groups with parents is that parents will
not put babies and cribs if there's a
bumper pattern there because they can't
see the baby so they'll keep the baby in
the bed with them where they can watch
the baby so if you take the bumper pad
out of the crib then it's magical you
can see the baby ok so again you know
this study showed that the potential
benefits for preventing minor injury
bumper pads was far outweighed by the
risk of severe injury so here's a baby
that got stuck in the corner ok couldn't
get out became entrapped ok so the other
thing there's no evidence that like I
said that these help and so we don't
recommend them so you want to get
everything out of the crib basically the
only thing you want in the crib is the
mattress a firm you know the the sheet
and the baby that's it you can use sleep
clothing wearable blankets as an
alternative the other advantage to these
wearable blankets is that then the
baby's leg doesn't get stuck in between
the slats ok bed sharing my ok with time
five minutes okay choosing a couple of
things about bed shrink bed sharing is
different from co-sleeping co-sleeping
is when a baby and the parent are in the
same environment close enough that they
can see hear or touch each other bed
sharing is a type of yeah co-sleeping
but co-sleeping also involves can be
just room sharing without bed sharing so
when people say that pediatricians don't
want babies to co-sleep that's not true
we want people to be in the same room
with their babies but not on the same
sleep surface because room sharing
without bed sharing is much safer than
having the baby in a separate room and
is definitely much safer than bed
sharing with a baby parents bed share
because it's convenient for feeding
whether you're breastfeeding a bottle
feeding bonding there's this belief that
if you're vigilant that you can keep bad
things from happening to
baby so the best way that so parents
think that they can be most vigilant
when they're sleeping with their baby
because i never really fall asleep when
the babies in the bed with me okay but i
can tell you that's not true and it's
often us and because of that whole idea
it becomes a safety strategy for parents
who know that they're doing things that
they're not supposed to do so if a
parent is putting the baby on the
stomach they're more likely to bed share
with the baby because they want to watch
the baby and we know that that's a
disaster and then there are parents that
worry about environmental dangers they
worry about gunfire they worry about
rats they were about things like that
and they think that having the baby in
the bed with them is going to keep their
baby safe there are a lot of things that
are a problem with bed sharing and I'll
show you a couple of pictures I think
the biggest thing is that the rates of
suffocation and strangulation and
entrapment in bed sharing is just
unbelievable so this is a baby the
momsters baby she's breastfeeding the
baby the dad has older children the
babies for six weeks old the mom goes
out and says please put the baby in the
bassinet the dads worked all day he's
tired he had one glass of wine with
dinner so he falls asleep even though he
doesn't mean to and then the baby rolls
over onto the bed and suffocates and
there's and the bassinet is on the side
of the bed and you can't see it this is
a mom who has six-year-old twins who
spending the night at Grandma's how
she's been on a trip with the baby
returns home very tired there's a crib
in the room but the mom wants to cuddle
and so they fall asleep and in the
middle of the night the mom wakes up and
she can't find the baby and the baby has
been trapped has become entrapped and
has died okay these are normal people
these are well-meaning parents these
aren't bad parents that this happens to
this is a mom who breastfeeds twins in
in a recliner every single night because
she wants to be ready whenever the beo
the babies wake up and so the babies are
two months old and mom has done as every
night since they've come home from the
hospital and so she thinks that this is
safe and then the next morning when she
wakes up when baby has fallen back
behind there and has died there are two
cribs in that home neither them had been
opened yet they're still in the boxes
so we want to babysit bed share not bad
share room share without bed sharing we
know it decreases the risk of SIDS by
fifty percent and is more likely to
prevent suffocation strangulation and
entrapment and it facilitates feeding
comforting and monitoring we do not
recommend the devices that are promoted
to make bed sharing safe because there's
no data on them you can bring the baby
into the bed to comfort and feed but
then when you're ready to go back to
sleep just put the baby back in the crib
there are a lot of people that say that
there are that there that there are safe
ways to bed share there are safe there
may be safe ways to bed share this is a
study that was done was published this
year showing that if you are a smoker
your risk so this is this is no risk
okay and this is lower risk so if you if
you are not a smoker then your and your
bed sharing then your risk your risk
comes down to zero when the baby is 24
weeks of age so about you know six
months of age so right yeah six months
of age okay if you are a smoker your
wrist never comes down to zero okay the
bed sharing increases the risk of almost
any sleep scenario I often get asked a
question what if your bed what if you're
breastfeeding what if you're not a
smoker all that kind of stuff bitch if
you add bed sharing to that know if the
baby is less than three months of age
bed sharing always multiplies your risk
fivefold okay and then you can the and
if you are over three months of age it
doesn't really increase the risk but
definitely under the under the age of
three months 55 times and most of the
families that are bed sharing our
bedroom with younger babies those are
the ones that were most concerned with
I'm not saying that you can bed share
once the babies or three months but the
risk does go down a little bit and so
I'm a little bit less concerned about it
so the things that make I'm bed sharing
especially dangerous again the smoking
excessive soft surfaces sofas armchairs
water beds are horrible pillows blankets
multiple bed shares if the parents had
any alcohol if the baby is less than two
or three months old
the parents smoking or not if the bed
sharing a curse when the baby doesn't
routinely bed share if the veteran was
someone who's not appearance including
siblings and if their bed sharing all
night long I'm not going to talk about
breastfeeding except to say that to do
it and that that that the risk of bed
sharing does and I already talked about
that but even even though you're
breastfeeding that doesn't mean that you
should bed share because the risk of bed
sharing is more than what you gain the
decreased risk that you get from
breastfeeding pacifiers again do it and
that's it I apologize it's uh it was
kind of a rush thing but thank you
For more infomation >> New Volkswagen Polo GTI (2018) Review - Is 'hot' VW a match for the Fiesta ST? | Autocar - Duration: 4:47. 
For more infomation >> 5 Keys for a happy couple - Duration: 1:15. 
For more infomation >> Irritable Bowel Syndrome Treatment | Three Healing Liquefies For The Irritable Bowel - Duration: 5:48. 
For more infomation >> Final donations sought for drive to help homeless in Missoula - Duration: 0:32. 
Không có nhận xét nào:
Đăng nhận xét