SIDS and Infant Care Practices

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SIDS and Infant Care Practices

• Lynne Hutchison
• Ed Mitchell
• University of Auckland
• 2008

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NZ SIDS 1987 2004
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SUDI and SIDS

• SUDI sudden unexpected death in infancy
• SIDS Sudden, unexplained death of an infant
  under the age of 1 year that remains unexplained
  after investigation, etc
• Age specific
• Known risk factors

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Triple risk model
SIDS
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SIDS prevention, NZ 2008

• Smokefree from conception
• Sleep baby on back
• Safe sleeping environment
• - Dont sleep with baby if
• baby under 3 months
• mother smokes
• alcohol/drugs
• tired
• Room share with parents first 6 months
• Breastfeed

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Other AAP recommendations 2005

• Offer a pacifier for sleep
• Firm sleep surface
• No soft objects/loose bedding
• Avoid overheating
• Avoid positioning devices
• Avoid home monitors
• Positioning strategies for head shape

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Evidence sleep position

• Prone overwhelming evidence for causal
  association
• Side pooled OR 2.0
• Supine lowest risk for SIDS

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Maternal smoking

• 17 studies since BTS OR 3.9
• Now most important risk factor even after
  controlling for birth weight
• NZCDS PAR 50
• Dose effect
• Infants less likely to wake in response to
  hypoxic challenge

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Co-sleeping / Bed-sharing

• High risk where mother smokes (8 studies)
• Small increased risk in non-smokers in infants
  lt3 months (2 studies)
• Associated with longer duration of
  breastfeeding
• No increased risk in bed-sharing when
  returning infant to own bed (2 studies)
• No evidence yet that co-sleeping is protective
• Dose related
• Couch sharing extremely risky
• Highly variable practice

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Safe sleeping environment

• Most studies show increased risk of SIDS with
  duvets, pillows
• Feet to foot good advice but little evidence
• Keep blankets, duvets away from face

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Room sharing

• Own bed parents room protective
• Decreased risk of SIDS 3-fold

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Breastfeeding

• Most studies show protective effect
• A few show no decreased risk
• NZ argues for a protective effect

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Pacifiers

• Open to debate
• Mitchell 2006 dont discourage pacifiers
• AAP 2005 offer dummy at bedtime until 12
  months of age

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Immunisation

• May halve the risk of SIDS

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Summary

• Major risk factors
• Prone sleep position
• Side sleep position
• Maternal smoking in pregnancy
• Co-sleeping with smoking mother
• (Co-sleeping lt 3 months)
• Major protective factors
• Sleeping in parental bedroom
• Breastfeeding
• Pacifier

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A Survey of Infant Care Practices 2005
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Aims of 2005 SIDS Survey

• To assess mothers knowledge of SIDS risk
  factors
• To assess the prevalence, concerns about, and
  reasons for using various infant care practices

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Methods

• Postal survey in March 2005
• 200 infants aged 6-8 weeks
• 200 infants aged 3-4 months
• One reminder phone call if necessary

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Questionnaire

• Knowledge of SIDS risk factors
• Sleep position
• Room sharing
• Bed-sharing / co-sleeping
• Pacifier use
• Smoking
• Breastfeeding
• Positioning devices
• Head shape concerns

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SIDS risk factors cited by mother
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No factors cited

• Those who cited no factors more likely to
• OR (95CI)
• Not received BIB pamphlet 4.4 (1.8-11.1)
• Be Maori, Pacific, other 14.7 (4.3-50.8)
• Be first-time mothers 3.1 (1.2-8.3)
• Not sleep infant on back 3.3 (1.4-7.7)

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SIDS head shape pamphlets

• Back Is Best pamphlet 71
• More likely to use back (OR 1.97)

• Head shape pamphlet 41
• Head shape concern more likely (OR 1.98)

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Usual sleep position
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Sleep position - NZ studies
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Know versus Do
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Why position chosen ()
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Smoking, Breastfeeding, Pacifiers
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Usual Bed
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Bed-sharing / Co-sleeping
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Reasons for bed-sharing

• Short naps / settling 47
• Baby sleeps better 21
• Prefer closeness 14
• Breastfeeding 13
• Convenience 13
• Only bed available 5

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Room sharing

• Same room as parents 54
• Own/other room 46
• Own bed parents room 39

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Head shape concerns

• 35 concerned

• 81 tried prevention strategies
• 42 varied head position
• 30 changed sleep position
• 11 did tummy time
• 19 did nothing

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Positioning devices

• 32 use a positioning device
• Foam wedge 18
• Safe T Sleep 11
• Rolled towel/blanket 5

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Sleep position concerns

• Choice of sleep position influenced by
• Fear of aspiration
• Poor sleep quality
• Head shape concerns

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Aspiration concerns

• No increased risk of death by aspiration
  (Malloy 2002)
• Choking in supine position may be safer than in
  prone

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Sleep quality concerns

• Kahn (2003) Infants do sleep longer on
  front/side than on back
• BUT more arousals on back probably protective
  for SIDS

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Plagiocephaly concerns

• Plagiocephaly is common
• Most plagiocephaly improves over time
• Neck muscle involvement common
• Craniosynostosis is uncommon

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Prevalence, 2004 study
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Plagio what we have found

• Wide range of severity
• Common features male, firstborn, instrument
  delivered, supine sleep, neck muscle dysfunction,
  right-sided flattening
• Parental concerns not always correlated to
  measurements
• Most plagiocephaly improves over time

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Prevention of plagiocephaly

• Newborn head and neck checks
• Head varying in newborn period
• Positioning strategies
• Tummy time

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So . . . what can YOU do?

• Dispel concerns re aspiration, sleep quality,
  plagiocephaly, immunisation
• Teach plagiocephaly prevention
• Other child care practices to address
• Discourage side sleeping
• Encourage room sharing
• Keep encouraging smoke-free message

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Acknowledgements

• Child Health Research Foundation
• Auckland Medical Research Foundation
• Participating mothers and babies