Becky Carver, public health nurse for the health district based in Waycross, works with perinatal partners to educate expectant parents about safe sleeping practices.
“An infant’s death is heartbreaking,’’ Carver says. “I’ve seen losses. In the Deep South, we see things like inadequate bedding, babies and parents sleeping together in recliners, and over-bundling on hot and humid days.”
The number of sleep-related infant deaths that are not caused by Sudden Infant Death Syndrome (SIDS) has risen sharply in the last decade nationally.
Rates of suffocation, strangulation, entrapment and asphyxia have increased, often resulting from where the baby was sleeping at the time. Nationwide, state health departments, including in Georgia, are working to prevent these tragic accidents.
“We lose a healthy baby on the average of every other day based on a sleep-related accident,” says Nancy Nydam, a spokeswoman for the Georgia Department of Public Health.
Georgia had more than 200 sleep-related deaths reported in 2010, including 108 occurring in an adult bed and 32 in a crib.
Although the number of reported cases was a bit lower in 2011, “it’s still far too high” says Arleymah Gray, prevention analyst for Georgia’s Office of the Child Advocate.
In some cases, babies are in adult beds and suffocate when an adult accidentally rolls over on them. Other babies have been found wedged between the back and seat of a couch. Infant sleep positioners with two bolsters can easily trap a baby’s face. In all these cases, autopsy reports list the cause of death as asphyxia.
A crib is the safest place for an infant to sleep. But in some instances the crib space may include pillows, blankets and positioners, and they can create a dangerous environment. Unintentional suffocation is the leading cause of death by injury among U.S. children less than a year old, according to a 2012 CDC report.
The American Academy of Pediatrics’ recommendations for safe infant sleeping environments emphasize that infants should sleep alone in their cribs, on their backs, and with no loose bedding or soft toys.
The AAP advises against a baby sharing a bed with adults, which is known as co-sleeping. This can put an infant at risk of suffocation and strangulation.
Concerns about the dangers of infants sleeping in the same bed as adults go back a long way, long before the term “co-sleeping” was invented. But many people of all educational backgrounds are still unaware that the practice is dangerous.
(Likewise, while it is safest for babies to sleep on their backs, there was a time not so long ago when many parents were told the opposite. So it’s vital that parents get up-to-date advice.)
What’s the best practice?
The AAP recommends that babies sleep in the same bedroom as their parents, but in a separate crib or bassinet, for the first few months of life.
Experts agree that a crib is the safest place for an infant to sleep, but not every family can afford one. In that case, the AAP recommends substituting a dresser drawer that has been removed from the dresser.
Dr. Brenda Fitzgerald, commissioner of the Georgia Department of Public Health, explains that a baby’s death is determined to be SIDS when an infant is considered to be “in the safest possible sleep environment and no other potential risk factors are identified.”
To identify Sudden Unexpected Infant Death, there must be evidence of an unsafe sleep environment or other conditions that could possibly contribute to a death, such as bed-sharing, unsafe sleep positioners, over-bundling, prone positioning, or pre-existing health issues. In Georgia, public health nurses are promoting safe sleep across the state.
“Our Cobb and Douglas public health nurses are making home visits as part of our Children 1st program,” says Kathy Woods, a nurse with the Cobb/Douglas Health District. Home visits are a best practice in nursing and once there the nurse can better visualize the family’s needs. “We talk about safe sleep for their little ones.”
“Babies aren’t dying because the parents are bad people,” says Woods. She suggests that they may not be aware of an infant’s fragility or how dangerous some sleeping arrangements can be.
The Children 1st program is the single point of entry to a statewide collaborative system of public health and other prevention-based programs and services. Nurses who make home visits can rule out problems such as a crib that’s filled with packages or luggage — or even when there’s no available crib for the baby.
Judi Kanne, a registered nurse and freelance writer, combines her nursing and journalism backgrounds to write about public health. She lives in Atlanta.