Cribs for Kids: Risk and Reduction of Sudden Infant Death Syndrome and Accidental Suffocation

Abstract

The Cribs for Kids campaign, created in 1998 by a nonprofit voluntary health organization, S. I.D.S. of Pennsylvania, is an innovative program whose aim is to combat infant mortality resulting from sudden infant death syndrome (SIDS) and accidental suffocation in Allegheny County, Pennsylvania. This program was first of its kind in country to include an evaluation component and is germane to social work practice with maternal child health and mental health professionals. This article delineates application of a low-cost but ultimately beneficial intervention to lower risk of SIDS or accidental suffocation by providing education and a safe sleeping environment for infants. SIDS IN THE UNITED STATES SIDS is a frightening phenomenon that has plagued parents for thousands of years. The definition of SIDS is the sudden death of an infant under one year of age, which remains unexplained after a thorough case investigation, including performance of a complete autopsy, examination of death scene, and review of clinical history (Willinger, James, & Catz, 1991, pp. 677-678). SIDS strikes an infant during sleep without warning and remains leading cause of postneonatal infant mortality for infants ages one month to one year in Western countries. Neither parents nor physicians can accurately predict which infants will succumb to SIDS, and in United States nearly 3,000 infants die from SIDS each year (National SIDS/Infant Death Resource Center [NSIDRC], 2004b). Despite widespread risk reduction education from Back to Sleep campaign, initiated in 1994 by a coalition of National Institute of Child Health and Human Development (NICHD), Maternal and Child Health Bureau, American Academy of Pediatrics (AAP), SIDS Alliance, and Association of SIDS and Infant Mortality Programs, it remains an alarming social work and public health dilemma that crosses all ethnic, race, and socioeconomic populations (NSIDRC, 2004a). A SIDS diagnosis is made after death, only after all other possible causes have been eliminated. In fact, researchers and medical practitioners are not certain what causes SIDS, although they believe it to involve a dynamic interaction of several factors (NICHD, 2000b). An infant is at increased risk of SIDS if he or she experiences an unstable period of homeostatic control (that is, an inability of infant's body to maintain equilibrium in physiological systems) during sleep combined with triggering factors such as prone sleep position, bed sharing, soft bedding, maternal smoking, viral infections, and premature birth (Filiano & Kinney, 1994). An infant may be born with an underlying vulnerability that increases risk of SIDS (Panigraphy et al., 2000). After American Academy of Pediatrics changed its recommendation of infant sleep position in 1992 (AAP, 1992) there was a 53 percent decrease in number of SIDS deaths in United States by 2001 (Matthews, Menacker, & MacDorman, 2003) .This suggests that prone sleep position for infants as a risk factor for SIDS can be reduced by using a firm, flat mattress; eliminating fluffy bedding from infant's sleep environment; maintaining a smoke-free environment for infant; and avoiding overheating (NICHD, 2001). The Consumer Product Safety Commission (CPSC), AAP, and NICHD responded to these statistics by recommending that all infants younger than 12 months be put to sleep in a crib with no soft bedding on top of or under baby (CPSC, 1999). On October 10, 2005, AAP Task Force on Sudden Infant Death Syndrome issued a revised policy statement on SIDS and reiterated their policy recommendation of back sleep position on a firm mattress with no soft bedding in crib. The task force further recommended that infant sleep in same room as mother to facilitate breastfeeding, but on a separate sleep surface, such as a crib, bassinet, or cradle that meets CPSC standards for safety. …