Leveraging AI Avatars for Safe Sleep Education: Combating SIDS Misinformation Through Interactive, Culturally Responsive Tools

Sudden Infant Death Syndrome: An Update

Creating a Safe Sleep Environment for the Infant: What the Pediatric Nurse Needs to Know

A Successful Quality Improvement Project to Improve Infant Safe Sleep Practice

Sudden infant death syndrome and sleep-related sudden unexpected infant death remain leading causes of infant mortality in the United States despite 4 safe sleep guideline restatements over the previous 24 years. Advertising and retail crib displays often promote infant sleep environments that are counter to the most recent American Academy of Pediatrics (AAP) guidelines. Magazine advertisements featuring sleep in parenting magazines from 1992, 2010, and 2015 were reviewed for adherence. Crib displays from nationwide retailers were surveyed for adherence to the latest AAP safe sleep guidelines. The primary outcome was adherence to the guidelines. Of 1758 retail crib displays reviewed, only half adhered to the latest AAP guidelines. The most common reasons for nonadherence were the use of bumper pads and loose bedding. The depiction of infant cribs and sleep products in magazine advertising has become significantly more adherent over time; however, 35% of current advertisements depict nonadherent, unsafe sleep environments. Magazine advertising portraying safe sleep environments revealed racial and ethnic disparities. Although improvements have been made over time with increased adherence to AAP safe sleep guidelines, significant deficiencies remain. Advertising continues to depict unsafe sleep environments. Crib manufacturers and retail establishments continue to market and sell bedding and sleep products considered unsafe by the AAP in approximately half of retail crib displays. Pediatric and public health care providers should continue educational and advocacy efforts aimed at the public, but should also include retailers, manufacturers, and advertising professionals to foster improved sleep environments for all children.

OBJECTIVES/SPECIFIC AIMS: This abstract describes a recently-funded 2 year study that aims to: (1) explore the community advisors’ perspectives of the safe sleep intervention’s acceptability, feasibility, and adaptability using focus groups and key informant interviews. (2) Adapt the selected safe sleep interventions (SSI) and identify promising implementation strategies to support it through an evidence-based quality improvement process with a multistakeholder group. METHODS/STUDY POPULATION: Background sudden unexpected infant death (SUID) is the leading cause of post-neonatal infant death in the United States. Sudden infant death syndrome (SIDS), accidental suffocation and strangulation in bed account for over 50% of SUID, leading to recommendations for supine sleep position and safer sleep environments for infants. However, despite significant reductions in SIDS after “back to sleep” and “safe to sleep” campaigns, significant racial and urban-rural disparities persist. In 2015, the rural-urban crude death rate ratio was 4:1 and Black infants are twice as likely to die from SUID as White infants. Adherence to safe sleep recommendations is highly variable and a number of hospital and community-based interventions have been suggested to improve knowledge and change parent behavior. Hospital programs to promote safe sleep education and policies may serve to educate families about safe sleep, but may not be uniformly available in rural and underserved areas. The AAP evidence-based safe sleep guidelines have demonstrated reductions in SIDS and SUID when child caregivers adhere to them. Community-based SSI, including safety baby showers, promote safe sleep practices, but barriers may exist for participation, especially in rural areas. Partnering with community groups serving a high risk area, we will explore the barriers and facilitators to more widespread safety baby shower (SBS) delivery/adoption in rural underserved communities (RUC). Observation of the evidence-based SBS as it is currently delivered, focus groups and key informant interviews will be conducted with program leaders and participants. Based on this knowledge and using an evidence-based development process, we will adapt the SBS and identify implementation strategies to support its uptake in RUC. RESULTS/ANTICIPATED RESULTS: We expect to develop a modified safe sleep intervention that reaches more expectant and new mothers is more efficient at delivering safe sleep guidelines to rural community members and can be more readily adopted and implemented by RUC. Supporting implementation strategies will be identified during the formative evaluation. DISCUSSION/SIGNIFICANCE OF IMPACT: Developing a safe sleep intervention adapted for the local context through a collective decision-making process between intervention experts and local community advisors will potentially improve safe sleep guideline delivery and adherence in RUC. The next study will pilot test the effectiveness of the adapted safe sleep intervention with identified supporting implementation strategies.

Endorsing Safe Sleep: Helping Nurses Turn Recommendations Into Reality

Sudden infant death syndrome (SIDS) may be the most preventable cause of death for infants 0 to 6 months of age. The American Academy of Pediatrics (AAP) first published safe sleep recommendations for parents and healthcare professionals in 1992. In 1994, new guidelines were published and they became known as the "Back to Sleep" campaign. After this, a noticeable decline occurred in infant deaths from SIDS. However, this number seems to have plateaued with no continuing significant improvements in infant deaths. The objective of this review was to determine whether nurses provide a safe sleep environment for infants in the hospital setting. Research studies that dealt with nursing behaviors and nursing knowledge in the hospital setting were included in the review. A search was conducted of Google Scholar, CINAHL, PubMed, and Cochrane, using the key words "NICU," "newborn," "SIDS," "safe sleep environment," "nurse," "education," "supine sleep," "prone sleep," "safe sleep," "special care nursery," "hospital policy for safe sleep," "research," "premature," "knowledge," "practice," "health care professionals," and "parents." The review included research reports on nursing knowledge and behaviors as well as parental knowledge obtained through education and role modeling of nursing staff. Only research studies were included to ensure that our analysis was based on rigorous research-based findings. Several international studies were included because they mirrored findings noted in the United States. All studies were published between 1999 and 2012. Healthcare professionals and parents were included in the studies. They were primarily self-report surveys, designed to determine what nurses, other healthcare professionals, and parents knew or had been taught about SIDS. Integrative review. Thirteen of the 16 studies included in the review found that some nurses and some mothers continued to use nonsupine positioning. Four of the 16 studies discussed nursing knowledge and noncompliance with AAP safe sleep recommendations. Eleven of the 16 studies found that some nurses were recommending incorrect sleep positions to mothers. Five of the 16 studies noted that some nurses and mothers gave fear of aspiration as the reason they chose to use a nonsupine sleep position. In the majority of the studies, the information was self-reported, which could impact the validity of the findings. Also, the studies used convenience sampling, which makes study findings difficult to generalize. The research indicates that there has been a plateau in safe sleeping practices in the hospital setting. Some infants continue to be placed in positions that increase the risk for SIDS. The research also shows that some nurses are not following the 2011 AAP recommendations for a safe sleep environment. Clearly, nurses need additional education on SIDS prevention and the safe sleep environment, and additional measures need to be adopted to ensure that all nurses and all families understand the research supporting the AAP recommendation that supine sleep is best. Further work is needed to promote evidence-based practice among healthcare professionals and families.

Sleep-related infant deaths are a common and preventable cause of infant mortality in the United States. Moreover, infants of color are at a greater risk of sleep-related deaths than are White infants. The American Academy of Pediatrics (AAP) published safe sleep guidelines to minimize the number of sleep-related infant deaths; however, many families face barriers to following these guidelines. Research on the role of psychosocial risk factors (i.e., depression, stress, domestic violence, substance use) in mothers' engagement in safe sleep practices is limited. The present study examined the role of maternal psychosocial risk factors on maternal safe sleep practices and the moderating effects of maternal race on this relationship. Participants in this study were mothers (N = 274) who were recruited from a Midwestern hospital postpartum. Data on the participants' psychosocial risk factors, and safe sleep practices were collected via telephone interview 2-4months following the birth of their infant. Predictive models indicated that depression and stress impacted mothers' engagement in following the safe sleep guidelines. Specifically, higher levels of maternal depression predicted greater likelihood of co-sleeping, regardless of mothers' race. Higher levels of maternal stress also predicted lower engagement in safe sleep behaviors for White mothers only. Early interventions to address stress and depression may help to increase maternal adherence to the AAP's safe sleep guidelines. Additional research on the underlying mechanisms of depression and stress on maternal safe sleep engagement is needed.

Dear Editor: Dr. Lawrence's editorial, “Solomon's Wisdom,”1 describes her account of a May 19, 2014 meeting at the National Institutes of Health, to which breastfeeding and infant safe sleep experts were invited. She describes the program as being planned by the American Academy of Pediatrics' (AAP's) Task Force on SIDS [Sudden Infant Death Syndrome] and recalls that no breastfeeding advocates were invited to speak. She relates that the Task Force was unaware of the critical congenital heart disease campaign, with the implication that many deaths attributed to SIDS may be undiagnosed heart disease and could be averted with neonatal pulse oximetry screening. She advocates for full neonatal metabolic screening nationally, again implying that many SIDS cases are undiagnosed cases of metabolic disease. Finally, Dr. Lawrence describes an upcoming “final report” of the Task Force, in which there would be “vigorous” support against co-sleeping and no support of breastfeeding. As members of the Task Force on SIDS, we must respectfully point out the inaccuracies in Dr. Lawrence's statements. Several Task Force members attended the meeting, convened by the National Institutes of Health to bring together key stakeholders from the breastfeeding community and Safe to Sleep® campaign to determine best strategies to promote safe infant sleep and breastfeeding within the parameters of the AAP's safe infant sleep recommendations. Invited speakers included a lactation consultant (International Board-Certified Lactation Consultant) and a public health official, who shared their experiences promoting both breastfeeding and safe infant sleep messages, and one Task Force member. Before a diagnosis for SIDS is made, a complete autopsy (including examination of the heart), review of the clinical history, and death scene investigation are required. The autopsy generally includes repeat newborn metabolic screening. If any condition (e.g., metabolic disorder, heart defect) is found during investigation of a sudden, unexpected infant death that is, in the opinion of the coroner or medical examiner, responsible for the infant's demise, the cause of death will be attributed to that condition. Thus, these cases are not considered SIDS and not included in SIDS statistics. An exception is prolonged Q-T syndrome, which is unlikely to be found at autopsy; however, it is also unlikely to be detected through newborn pulse oximetry. Therefore, although these newborn screenings result in early detection and prevention of early death, because the conditions discovered through these tests have been, for the last 20 years, largely already discovered at autopsy, these mandates will unfortunately not eliminate SIDS or other sleep-related infant deaths. Dr. Lawrence alludes to the imminent release of the Task Force's “final report.” There is no such report currently pending. We refer readers to our current (2011) Policy Statement2 and Technical Report,3 which were approved by the AAP Section on Breastfeeding before publication. In these reports, we strongly support breastfeeding: “Breastfeeding is associated with a reduced risk of SIDS. If possible, mothers should exclusively breastfeed or feed with expressed human milk (i.e., not offer any formula or other non–human milk–based supplements) for 6 months, in alignment with recommendations of the AAP.”2 With regard to our “vigorous” campaign against co-sleeping, we strongly support the form of co-sleeping in which the infant sleeps within arm's reach of the parent in a safety-approved, bedside bassinet, portable crib, or crib, such that the infant is within sight, sound, and/or touch. This arrangement, supported by research, reduces the risk of SIDS and can aid in breastfeeding. However, we stand firmly by our recommendation against bedsharing for infants <1 year, which is based on well-designed, peer-reviewed, case-control studies. We agree that there are circumstances (e.g., one/both parents who smoke, parent who has consumed alcohol or sedating substances, on a couch/armchair, with pillows/blankets) that make bedsharing especially hazardous (all described in the 2011 recommendations). However, there is clear and consistent evidence that bedsharing (compared with roomsharing without bedsharing) increases the risk for SIDS and sleep-related deaths, even for infants who are breastfed and whose mothers do not smoke, who are at lower risk for SIDS. A recent meta-analysis of five major case-control studies (1,472 SIDS cases, 4,679 controls) examined the association between bedsharing and SIDS, with particular emphasis on lower-risk babies (i.e., breastfed, nonsmoking mothers). Even among these lowest-risk infants, bedsharing infants were at a fivefold higher risk for SIDS until 3 months.4 We feel an obligation to provide this information to families to enable them to make informed choices; to not do so is, in our opinion, irresponsible. It is our sincere hope that breastfeeding and safe sleep advocates can work together to achieve our common goals of improving infant health and decreasing infant mortality.

Objective: Sleep-related infant deaths are a leading contributor to infant deaths nationally. From 2018 – 2022, sleep-related infant death made up 21 % of infant deaths in Hamilton County and the majority of these sleep-related deaths were suffered by Black infants. The prenatal period is a critical time during which expecting parents are making decisions for their newborn’s sleep environment. Prenatal providers commonly do not discuss the American Academy of Pediatrics (AAP) infant safe sleep guidelines over the course of prenatal care. This lack of safe sleep education may be disproportionately affecting Black parents and infants and leading to lower levels of knowledge of safe sleep guidelines in this population.4 We sought to describe prenatal provider knowledge and practice of AAP safe-sleep guidelines in Cincinnati, Ohio, a region with a marked racial disparity in sleep-related infant death. Study Design: Data were gathered from an anonymous cross-sectional survey of prenatal care providers from the University of Cincinnati, TriHealth, and The Christ hospitals (N=21). Primary outcomes were provider knowledge of AAP safe-sleep guidelines, practice patterns of safe sleep education, and barriers to providing this education. This survey was created in conjunction with Cradle Cincinnati, and descriptive statistics were analyzed using Stata version 15.1. Results: Our sample (N=21) included 11 Attending OB/GYN physicians, 1 Attending Family Medicine physician, 5 Resident OB/GYN physicians, 3 Nurse Practitioners, and 1 Midwife. Surprisingly, not all of our sample correctly identified AAP recommendations when questioned on sleep position (95.2% alone, 95.2% back), sleep environment (100% crib, 85.7% bassinet), and sleep location (90.5% same room as parent). About half of providers reported discussing infant sleep position (52.4%), infant sleep location (47.6%), or infant sleep environment (57.1%), while all providers reported discussing tobacco cessation and breastfeeding. Only 28.6% of providers reported discussing safe sleep with all patients and 19.1% report discussing at multiple visits. Of the sample, 85.7% reported they had received infant safe sleep training before yet only 76.2% of respondents felt their previous safe sleep training was sufficient. The most significant barriers to providing infant safe sleep education to prenatal patients included lack of sufficient time (66.7%) and lack of sufficient materials (23.8%). Conclusions: Providers have knowledge of AAP infant safe sleep guidelines, but a minority of them discuss these guidelines with all prenatal patients or at multiple visits. Increasing the frequency with which Cincinnati prenatal care providers discuss AAP safe sleep guidelines could help combat the difference in parental knowledge that may underlie the regional racial disparity in sleep-related infant death. Providers may feel more able to do so if OB/GYN residency programs and organizations that conduct prenatal care provider training focus on overcoming barriers to discussing safe sleep, such as by provisioning materials and teaching educational techniques conducive to time constraints.

BackgroundSudden unexpected infant death (SUID) remains a leading cause of infant mortality; therefore, understanding parental practices of infant sleep at home is essential. Since social media analyses yield invaluable patient perspectives, understanding sleep practices in the context of safe sleep recommendations via a Facebook mothers’ group is instrumental for policy makers, health care providers, and researchers.ObjectiveThis study aimed to identify photos shared by mothers discussing SUID and safe sleep online and assess their consistency with infant sleep guidelines per the American Academy of Pediatrics (AAP). We hypothesized the photos would not be consistent with guidelines based on prior research and increasing rates of accidental suffocation and strangulation in bed.MethodsData were extracted from a Facebook mothers’ group in May 2019. After trialing various search terms, searching for the term “SIDS” on the selected Facebook group resulted in the most relevant discussions on SUID and safe sleep. The resulting data, including 20 posts and 912 comments among 512 mothers, were extracted and underwent qualitative descriptive content analysis. In completing the extraction and subsequent analysis, 24 shared personal photos were identified among the discussions. Of the photos, 14 pertained to the infant sleep environment. Photos of the infant sleep environment were then assessed for consistency with safe sleep guidelines per the AAP standards by 2 separate reviewers.ResultsOf the shared photos relating to the infant sleep environment, 86% (12/14) were not consistent with AAP safe sleep guidelines. Specific inconsistencies included prone sleeping, foreign objects in the sleeping environment, and use of infant sleeping devices. Use of infant monitoring devices was also identified.ConclusionsThis study is unique because the photos originated from the home setting, were in the context of SUID and safe sleep, and were obtained without researcher interference. Despite study limitations, the commonality of prone sleeping, foreign objects, and the use of both infant sleep and monitoring devices (ie, overall inconsistency regarding AAP safe sleep guidelines) sets the stage for future investigation regarding parental barriers to practicing safe infant sleep and has implications for policy makers, clinicians, and researchers.

Introduction: Sudden Infant Death Syndrome (SIDS) is a term used to describe the sudden and unexpected death of an infant under 1 year of age, where the definitive cause of death cannot really be established, even after thorough investigation. The supine position is recommended by the American Academy of Pediatrics (AAP) as part of a safe sleep routine for babies. However, the prone position is contraindicated, as it is associated with a higher mortality rate. Method: The search for references was carried out on the Virtual Health Library (VHL) and Scielo platforms. The following descriptors were used: “Dorsal Decubitus” AND “Sudden Infant Death”. The following filters were applied: full-text article; main subject “Sudden Infant Death”; language in Portuguese, English and Spanish and publications in the last 5 years (2018-2023). This resulted in a total of 35 results, of which only 11 articles were selected. Results and Discussion: There are several modifiable factors related to sudden infant death, among them: caregivers of children who consume alcohol, tobacco and other drugs in the home during the prenatal and postnatal periods; bed sharing between babies and parents; overheating; presence of soft objects in the crib and loose bedding. Other important guidelines, which have a level A of evidence, for the prevention of SIDS are: exclusive breastfeeding; avoid exposure to cigarettes during and after pregnancy, as well as marijuana, opioids, alcohol and illicit drugs; carry out adequate prenatal care and the correct immunization recommended for the child and do not use home cardiorespiratory monitors. Aside from sleep, it is recommended to disseminate and educate children on safe sleep guidelines from the beginning of pregnancy, given that 40% of mothers say they have not received such guidance and 25% receive information that differs from that advised by the AAP. Conclusion: Sudden Infant Death Syndrome (SIDS) is related to the prone position. In the US, there are racial/ethnic disparities in SIDS mortality rates, associated with socioeconomic factors and lack of resources. It is crucial that public health services promote safe forms of sleep, such as the supine position, adequate feeding before sleep and the use of flat surfaces without objects in the crib.

Objective: Sudden infant death syndrome (SIDS) remains the leading cause of death in the postnatal period. Accidental suffocation and strangulation in bed deaths have quadrupled. The American Academy of Pediatrics (AAP) expanded its back to sleep recommendations to include a safe sleep environment. The AAP makes recommendations to healthcare professionals to model safe sleep practices and educate families on SIDS reduction strategies. The dual aims of this project were to develop a safe sleep educational model for our neonatal intensive care unit (NICU), and to increase the percentage of eligible infants in a safe sleep environment.Method: The NICU Safe Sleep policy was revised to include AAP updated recommendations. Educational updates were provided to staff. A safe sleep packet with a video was created for and shared with families. Wearable blankets were implemented. A safe sleep observation checklist was created. Baseline data and post-education random observations data were collected and shared with staff.Results: At baseline, 21% of eligible infants were in a safe sleep environment. After education and reported observation, safe sleep compliance increased to 88%.Conclusions: With formal staff and family education, optional wearable blanket, and data sharing, safe sleep compliance increased and patient safety improved.

Introduction: Sudden Infant Death Syndrome (SIDS) is a term used to describe the sudden and unexpected death of a baby under 1 year of age, where the definitive cause of death cannot truly be established, even after thorough investigation . Supine is recommended by the American Academy of Pediatrics (AAP) as part of a safe sleep routine for babies. However, the prone position (or prone position) is contraindicated, which is related to a higher mortality rate. Method: The search for references was carried out using the Virtual Health Library (VHL) and Scielo platform. The following descriptors were used: "Supine Decubitus" AND "Sudden Infant Death". The filters were applied: full text article; main subject "Sudden Infant Death"; language in Portuguese, English and Spanish and publications in the last 5 years (2018-2023). In this way, there were a total of 35 results, of which only 11 articles were selected. Results and Discussion: There are several modifiable factors related to sudden infant death, including: caregivers of children who consume alcohol, tobacco and other drugs at home during the prenatal and postnatal periods; bed shared between babies and parents; overheating; presence of soft objects in the crib and loose bedding. Other important guidelines, which have level A evidence, for the prevention of SIDS are: exclusive breastfeeding; avoid exposure to cigarettes during and after pregnancy, as well as marijuana, opioids, alcohol and illicit drugs; carry out adequate prenatal care and correct immunization recommended for the child and do not use home cardiorespiratory monitors. Outside of sleep, dissemination and education regarding safe infant sleep guidelines from the beginning of pregnancy is recommended, given that 40% of mothers say they did not receive such guidelines and 25% receive information that differs from that advised by the AAP. Conclusion: It is concluded that Sudden Infant Death Syndrome (SIDS) is related to the prone position. In the USA, there are ethnic-racial disparities in SIDS mortality rates, associated with socioeconomic factors and lack of resources. It is crucial that public health services promote safe forms of sleep, such as the supine position, adequate feeding before sleep and the use of flat surfaces without objects in the crib.

Infant mortality remains a problem in the United States with sleep-related deaths accounting for a significant portion. Known risk reduction strategies include breastfeeding, avoiding tobacco use and following the American Academy of Pediatrics' safe sleep guidelines. The purpose of this project was to evaluate outcomes of Safe Sleep Instructor-led community baby showers, which included safe sleep promotion, breastfeeding promotion and tobacco cessation education. Certified Safe Sleep Instructors (n = 35) were trained on how to plan and host a Community Baby Shower to provide education to pregnant women of low socioeconomic status or with high risk of infant mortality. Eighteen Community Baby Showers were held across two urban and eight rural counties in Kansas. Surveys were administered pre- and post-event to assess participant knowledge, confidence and intentions to follow through with planned action related to safe sleep, breastfeeding and reducing tobacco risk. Matched data were summarized and evaluated for differences using McNemar's and Wilcoxon Signed Rank tests. Significant increases were observed in Baby Shower participants' (n = 845) reported plans to follow the AAP Safe Sleep guidelines (all p < 0.001), likelihood to breastfeed (p < 0.001), confidence in ability to breastfeed for more than 6 months (p < 0.001), knowledge of local breastfeeding support resources (p < 0.001), knowledge of ways to avoid second-hand smoke exposure (p < 0.001) and knowledge of local tobacco cessation services (p = 0.004). Based on the result of the pre- and post-event surveys, certified Safe Sleep Instructors were able to plan and host successful events to increase knowledge and confidence related to risk reduction strategies to reduce sleep-related infant deaths.