'Safe Sleep'

From Medscape Medical News Updated AAP Policy Statement Stresses 'Safe Sleep' Fran Lowry October 21, 2011 (Boston, Massachusetts) — The American Academy of Pediatrics (AAP) has expanded its recommendations to ensure a safe sleeping environment for infants and to further reduce the risk for sudden infant death syndrome (SIDS) in a new policy statement. The recommendations were announced here at the AAP 2011 National Conference and Exhibition by pediatrician and SIDS researcher Rachel Moon, MD, from the Children's National Medical Center, Washington, DC, who led the task force that updated the policy statement. Since 1992, when the AAP recommended that all babies be placed on their backs to sleep, deaths from SIDS have declined dramatically; however, sleep-related deaths from other causes, including suffocation, entrapment, and asphyxia, have increased, Dr. Moon said. She told Medscape Medical News that the new policy statement has 3 important changes. First and foremost is the recognition that breastfeeding protects against SIDS. "In 2005, there was a lot of evidence that breastfeeding was great for preventing infant mortality in general, but not SIDS specifically. But since 2005, there has been a lot of research that has shown that breastfeeding is protective against SIDS, and we wanted to emphasize that and make that change," Dr. Moon said. The second change is an emphasis on immunization. "There's been a lot of press out there about how immunizations may cause SIDS. Again, there's been research to show that this is absolutely not the case. In fact, if you are immunized, your risk of SIDS drops by 50%. We wanted to make that clear; we wanted to put that out there," she said. The third big change, Dr. Moon said, is the recommendation against using bumper pads in cribs to reduce accidental smothering. "We have expanded the recommendations in the policy statement to focus not only on SIDS, but on other deaths that can occur. That is why we are recommending against the cushions that go along the sides of the crib," she said. "Children can be suffocated by them." Other key recommendations are: Always use a firm sleep surface. Car seats and other sitting devices are not recommended for routine sleep. The baby should sleep in the same room as the parents, but not in the same bed (room sharing without bed sharing). Keep soft objects or loose bedding out of the crib. Wedges and positioners should not be used. Offer a pacifier at nap time and bedtime. Avoid covering the infant's head or overheating. Do not use home monitors or commercial devices marketed to reduce the risk for SIDS. Supervised, awake tummy time is recommended daily to facilitate development and minimize the occurrence of positional plagiocephaly (flat heads). Eve R. Colson, MD, from the Yale University School of Medicine, New Haven, Connecticut, told Medscape Medical News that she is very happy to see this focus on preventing accidental deaths. "As a director of our nursery and somebody who is really into medical education of families and of staff, I am glad to see this because we have seen lots of accidental deaths," Dr. Colson, who was not a member of the policy statement task force, said. "We, at Yale, have been so upset by the increased number of deaths in beds happening in New Haven and surrounding areas. In my opinion, the adult bed is not a safe place and I'm glad they've come out with this recommendation." Dr. Colson said she understands "totally" that parents like to be close to their babies, and she encourages this. She said she takes a very sensitive approach when explaining to parents why the adult bed is not safe for babies. "We get SIDS deaths in our emergency room, but we also get babies who have suffocated because somebody rolled on them or they have ended up underneath a pillow or got trapped between the mattress and the wall. This is what we have seen and we want to prevent that." Dr. Moon and Dr. Colson have disclosed no relevant financial relationships. American Academy of Pediatrics (AAP) 2011 National Conference and Exhibition. Presented October 17, 2011.

Infants Should Sleep on Their Backs, in Parents' Room

From Reuters Health Information BOSTON (Reuters) Oct 18 - Putting babies to sleep on their backs on a firm crib mattress in the same room as the parents is among recommendations on a list of safe sleep guidelines for infants released on Tuesday. The American Academy of Pediatrics first said in 1992 that infants should be placed in a non-prone position for sleeping to curb sudden infant deaths. The latest report, published October 17 in Pediatrics, recommends infants sleep wholly on their backs for every sleep, noting that side sleeping is unsafe. Some supervised awake-time spent on the tummy is recommended. A series of 18 recommendations from the academy are intended to help guide parents, health care providers and others who care for infants following an increase in sleep-related deaths over the last few years. The expanded recommendations focus broadly on creating a safe sleep environment that can reduce the risk of sudden infant death syndrome, suffocation, entrapment and asphyxia, the report said. The guidelines also recommend soft objects and loose bedding like quilts, pillows and even bumper pads not be kept in cribs. Infants should not have routine sleep time in sitting devices like car seats and strollers and should not sleep in a bed where they might suffocate, according to the guidelines. The recommendations, geared to infants up to one year old, also emphasize the importance of regular prenatal care for pregnant women and encourage smoke-free environments for pregnant women and children. SOURCE: http://bit.ly/ofygWN Pediatrics 2011.

Keep your baby safe

Injury is the leading cause of death among children in Canada. Some of the biggest dangers to babies are falls, burns or scalds, drowning, choking, suffocation or strangulation, and car crashes. The good news is that these injuries are almost always entirely preventable. Parents can take steps to protect their new baby by: Recognizing everyday risks early, and taking precautions. Anticipating a baby’s new skills, and being prepared. Paying special attention at extra busy times of day. Actively supervising. The best way to prevent injury is to watch, listen and stay nearby. When you have to move away from your baby, put him in a safe place, like his crib. Remember: Your infant can’t lift her head until she is about 4 months old, when her neck muscles are stronger, and then only for a short time. She can’t avoid conditions or objects that make it hard for her to breathe. Your infant can squirm and move along a surface long before she can turn over by herself. Even a newborn can wriggle enough to fall off the change table, bed or sofa. Your infant can grasp and shake things, reach for dangling objects, wave a fist and push down firmly with his legs—and fast enough to knock hot or sharp things from your hand. Before you bring your baby home Make sure your crib has a permanent label with detailed manufacturing information, instructions and a warning statement about mattress size and proper use. Never use a crib that is missing this label, or one made before 1987. Check that all the crib bars are present and secure. The mattress should be firm, flat and fit tight within the crib frame. Sheets are smooth and tight-fitting as well. Corner posts shouldn’t be higher than 3 mm (1/8 inch) above the end panels. The frame must be solid, with no cut-out designs or openings where a baby could catch her head. Crib sides should lock securely in place when raised. Mattress support hangers must be secured by bolts and closed hooks. Don’t use a crib where these hooks are “Z” or “S”-shaped. Be sure to check for loose fittings regularly, especially whenever the crib is moved. Place the crib away from windows, window coverings and blind cords. Do not use bumper pads, pillows, lambskins, quilts, stuffed toys or comforters in the crib. Hang mobiles out of reach of your infant’s hands and fasten them securely to both sides of the crib. Don’t use a bassinet or cradle. Even an infant’s weight and movement can make them tip or collapse. Make sure that shelving or any heavy furniture is anchored securely to the wall. Install a smoke alarm in your baby’s room and check all the household smoke alarms to be sure they are working. Install a carbon monoxide detector in your home. Once baby is home, your precautions and behaviour will help protect her against the most common types of injury. Falls Never leave your infant unattended, or in a carrier on any raised surface, such as a bed, sofa or change table. Make sure your change table has a guard rail and safety strap, and always use them. If the phone rings while you are changing a diaper, take your baby with you to answer it or just let it ring. Store everything you need to change a baby within easy reach, so you don’t have to turn away. Make sure your baby sling or front carrier is appropriate for your baby’s age and size. It should support her head and shoulders and have small leg openings, so she can’t slip out. If you bend over, hold your baby against you with one hand so she won’t fall. Burns or scalds Smoke alarms should be installed on every level of the home and in every sleeping area. Check alarms once monthly to be sure they are working, and change the batteries twice each year, when you change the clocks in the spring and fall. Do not allow smoking in your home. Many house fires are caused by careless smoking or children playing with smoking materials such as lighters and matches. Also, cigarettes and butts are poisonous to young children. Set your hot water heater temperature to 49°C (120°F), or put an anti-scald device on your faucets. A baby’s skin burns very easily. Before bathing, check the water temperature with your elbow or wrist. It should feel warm, not hot. Bathe your baby away from the faucets, and remove him from the tub before running the hot water again. Never carry a baby and a hot drink at the same time. Use plastic mats instead of a table cloth that your baby might pull on and cause a spill of hot liquid. Don’t heat breast milk or formula in a microwave. Dangerous “hot spots” can burn an infant’s mouth. Warm a bottle in a pot of hot water instead, and test the milk on your wrist before feeding. Drowning An infant can drown—very quickly and quietly—in as little as 5 cm (2 inches) of water. Always watch and have at least one hand on your baby when she’s in the bathtub, wading pool or near any standing water. Have everything you need for bathing at hand, so that you never have to turn away. Don’t use a bath seat or ring. They are not safe. Never leave your baby alone in the bath with a brother or sister, even for a few seconds. Do not use a cell phone during bath time. If you must answer the telephone, take baby with you. Choking, suffocation or strangulation Vacuum often, and never leave small objects within a baby’s reach. He will put anything and everything in his mouth. Remove crib mobiles as soon as your baby is 4 months old or pushing up on hand and knees. Use a one-piece soother small enough for infants, with a shield to prevent him from sucking the nipple too far into his mouth. Discard any soother that shows any sign of wear or is more than 2 months old. Get rid of toys with pull strings longer than 20 cm (8 inches) or small, loose or breakable parts that a baby could swallow or inhale. Any object that is small enough to fit inside a toilet paper roll is a choking hazard. Don’t use bibs with ties, or hang pacifiers, a necklace or anything else around an infant’s neck that might catch and strangle her. Keep all plastic bags or wrapping out of reach and out of sight. Car safety All infants need a rear-facing car seat for their first ride home from the hospital. Your baby will use this seat whenever you travel-- even the shortest distance-- for one year or longer. Infants may use a forward-facing car seat once they are at least one year old and at least 10 kg, however it is best to rear-face as long as possible, so look for a car seat with the highest rear-facing weight and length limits once your child has outgrown their first car seat. Install the car seat in the middle of the rear seat—never in the front or near an airbag. Read the manufacturer’s instructions for the car seat and follow all age, height and weight specifications. Secure the car seat using the Universal Anchorage System (UAS or LATCH), which is now mandatory in all car models. Follow both the car seat and car manual instructions. If the UAS system does not secure the seat adequately, then use the seat belt, as indicated in the car seat instructions. Check that the car seat does not move more than 2.5 cm (1 inch) forward or from side to side once it is installed. Harness straps should be threaded just at or below your baby’s shoulders. The chest clip should be at armpit level and the harness should fit snugly. Tuck a blanket around your baby if needed instead of using a bunting bag. Don’t use a car seat that has been in a car crash, even a minor one. It is not safe. Never leave your baby unattended in a car, even to run a quick errand. For more information: Car seat safety Water safety for young children Transportation of infants and children in motor vehicles, a statement of the Canadian Paediatric Society Transport Canada: Safety in the car Reviewed by the CPS Injury Prevention Committee Updated: March 2009 This information should not be used as a substitute for the medical care and advice of your physician. There may be variations in treatment that your physician may recommend based on individual facts and circumstances. Canadian Paediatric Society 2305 St. Laurent Blvd., Ottawa, Ont. K1G 4J8 Phone: 613-526-9397, fax: 613-526-3332