A decade ago, an anti co-sleeping campaign aimed at reducing Milwaukee’s staggeringly high infant mortality rates, was launched. One of the campaign’s ads pictures an adorable, diapered baby sleeping amidst a cloud of fluffy bedding. The baby snuggles up to a butcher knife strategically tucked under the pillow next to him. The text reads: Your baby sleeping with you can be just as dangerous.
The campaign sought to reduce the city’s infant mortality rate by 2017. Tragically, according to the Fetal Infant Mortality Review (FIMR), those numbers have risen.
In 2017, 120 infants born in the City of Milwaukee died before their first birthday. Over 15 percent of Milwaukee’s infant deaths are attributable to a combination of Sudden Infant Death Syndrome (SIDS) and Sudden Unexpected Death in Infancy (SUDI) and unsafe sleep. Of these deaths, the majority died in an unsafe sleep environment.
Nationally, there are about 3,400 infant sleep-related deaths each year.
This month, we join maternal and child health advocates in recognizing Sudden Infant Death Syndrome (SIDS) Awareness Month– a time to educate parents and caregivers about creating safe sleep environments and reducing the risk of SIDS and other sleep-related illnesses alongside supporting breastfeeding/chestfeeding as the national norm.
Campaigns, like the one released in Milwaukee (no matter how controversial), are a good place to start in promoting healthy public health behavior. However, as noted in the series of learning modules, Building on Campaigns with Conversations: An Individualized Approach to Helping Families Embrace Safe Sleep & Breastfeeding developed by the National Center for Education in Maternal and Child Health (NCEMCH) while it operated the National Action Partnership to Promote Safe Sleep (NAPPSS, 2014-2017), true behavior change is only accomplished by two-way communication.
The modules, designed for a range of health professionals, human service providers, community health workers, home visitors, and peer supporters who interact with families on topics of safe sleep and breastfeeding, urge care providers to “become listeners as much as talkers.”
Telling families what to implement based on expert knowledge is antithetical, the module argues. Instead, care providers must shift their standpoint from expert to resource, supporting families through their own informed decisions. When care providers position themselves as experts as opposed to resources, families often feel as though they cannot be honest about the realities of their experience.
I’ll share a personal example here. At our pediatric office, the computer screens illuminate with an image of an infant sleeping accompanied by text that reads: The ABCs of Sleep; Alone, on Back, in Crib. During the intake questioning at a visit with my first-born, the care provider asked, “Where is your baby sleeping?” I immediately started to sweat, nervous, because our sleeping arrangement looked nothing like what I was seeing on the screen. I timidly reported that my infant slept with me. I watched the care provider input the information, but then we moved onto the next topic. This was a missed opportunity to have a conversation about what safe sleep can look like and a missed opportunity to help create a plan that would support our family decisions.
Time constraints are surely a challenge when supporting families. However, the Building on Campaigns with Conversations learning resource states: “… Research has reported that families are not likely to buy into the recommendations without some understanding of why they are made, [so] not sharing this information is actually wasting valuable time.”
It goes on to suggest, “…The Conversations Approach is a two-way process, [so] you can ask families if they have any questions about why a recommendation is given and deal with that one or more. Also, there are two important themes that you can reference and relate to each recommendation: 1. Making sure the baby gets enough oxygen (keeping the baby’s airways open (nothing covering the face, not cut off by position of the chin on chest) and keeping the baby from rebreathing the carbon dioxide when face down; 2. Making sure the baby does not sleep so deeply that he/she doesn’t wake up if oxygen levels are getting too low. Breastfeeding, of course, has additional benefits.”
It’s essential to recognize that we have strangely unrealistic expectations for infants and infant sleep in our country.
Parents of babies who are only weeks old are often asked if the baby is sleeping through the night.
“Asking this question is like asking if the new baby is reading yet; it is not at all developmentally appropriate,” the module informs.
Helping families reframe what is normal will help elicit healthy behavior and relationships.
Care providers should also be aware that many parents and caregivers have extrapolated through the Back to Sleep campaign that “face up” positioning is as safe as “on back” , Michele Labotz, MD, FAAP explains in Out of the Container, and Onto the Floor. Labotz reports that babies spend almost six hours per day in containers like car seats, strollers, bouncy chairs, and other seating devices.
“Excessive time in these devices inhibits movement and places babies at higher risk for a variety of issues, such as plagiocephaly, decreased strength, and delayed motor milestones,” Labotz writes.
This SIDS Awareness Month, National Institute for Children’s Health Quality (NICHQ) offers many resources related to safe sleep including a short video quiz that can be used by health professionals to engage parents and caregivers in conversations about safe sleep and breastfeeding recommendations.
NICHQ suggests using the quiz as an interactive, visual tool to prompt discussions around best-practices. It can also be shown in pediatric and obstetric waiting rooms, parenting group sessions, birthing classes, and breastfeeding classes.
More Safe Sleep Resources:
Rafael Pérez-Escamilla, PhD Sofia Segura-Pérez, MS, RD and Megan Lott’s, MPH, RDN Feeding Guidelines for Infants and Young Toddlers: A Responsive Parenting Approach, offers sleep and physical activity considerations for infants and toddlers. (p 24-27)