Sudden Infant Death Syndrome

1. Sudden Infant Death Syndrome SIDS FACTS

2. What Is SIDS? • Sudden Infant Death Syndrome (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 the death scene, and review of the clinical history"

3. What Are the Most Common Characteristics of SIDS? • Most researchers now believe that babies who die of SIDS are born with one or more conditions that make them especially vulnerable to stresses that occur in the normal life of an infant, including both internal and external influences. SIDS occurs in all types of families and is largely indifferent to race or socioeconomic level. SIDS is unexpected, usually occurring in otherwise apparently healthy infants from 1 month to 1 year of age. Most deaths from SIDS occur by the end of the sixth month, with the greatest number taking place between 2 and 4 months of age. A SIDS death occurs quickly and is often associated with sleep, with no signs of suffering, . More deaths are reported in the fall and winter (in both the Northern and Southern Hemispheres) and there is a 60- to 40-percent male-to-female ratio. A death is diagnosed as SIDS only after all other alternatives have been eliminated: SIDS is a diagnosis of exclusion.

4. What Are Risk Factors for SIDS? • The mother's health and behavior during her pregnancy and the baby's health before birth seem to influence the occurrence of SIDS, but these variables are not reliable in predicting how, when, why, or if SIDS will occur. Maternal risk factors include cigarette smoking during pregnancy; maternal age less than 20 years; poor prenatal care; low weight gain; anemia; use of illegal drugs; and history of sexually transmitted disease or urinary tract infection

5. Reducing Risk of SIDS: • 1. Back to sleep: Infants should be placed for sleep in a supine position (wholly on the back) for every sleep. Side sleeping is not as safe as supine sleeping and is not advised.

6. Reducing Risk of SIDS: • 2. Use a firm sleep surface: Soft materials or objects such as pillows, quilts, comforters, or sheepskins should not be placed under a sleeping infant. A firm crib mattress, covered by a sheet, is the recommended sleeping surface.

7. Reducing Risk of SIDS: • 3. Keep soft objects and loose bedding out of the crib: Soft objects such as pillows, quilts, comforters, sheepskins, stuffed toys, and other soft objects should be kept out of an infant’s sleeping environment. If bumper pads are used in cribs, they should be thin, firm, well secured, and not “pillow-like.” In addition, loose bedding such as blankets and sheets may be hazardous.

8. Reducing Risk of SIDS: • 4. Do not smoke during pregnancy: Maternal smoking during pregnancy has emerged as a major risk factor in almost every study of SIDS. Smoke in the infant’s environment after birth has emerged as a separate risk factor in a few studies.

9. Reducing Risk of SIDS: • 5. A separate but proximate sleeping environment is recommended: The risk of SIDS has been shown to be reduced when the infant sleeps in the same room as the mother. A crib, bassinet, or cradle that conforms to the safety standards of the Consumer Product Safety Commission

10. Reducing Risk of SIDS: • 6. Consider offering a pacifier at nap time and bedtime: Although the mechanism is not known, the reduced risk of SIDS associated with pacifier use during sleep is compelling

11. Reducing Risk of SIDS: • 7. Avoid overheating: The infant should be lightly clothed for sleep, and the bedroom temperature should be kept comfortable for a lightly clothed adult.

12. Reducing Risk of SIDS: • 8. Avoid development of positional plagiocephaly: • • Encourage “tummy time” when the infant is awake and observed. This will also enhance motor development.• Avoid having the infant spend excessive time in car-seat carriers and “bouncers,” in which pressure is applied to the occupant. Upright “cuddle time” should be encouraged.• Alter the supine head position during sleep. Techniques for accomplishing this include placing the infant to sleep with the head to one side for a week and then changing to the other and periodically changing the orientation of the infant to outside activity (eg, the door of the room).

13. According to the AAP, other facts about SIDS include that it: • is rare during a baby's first month of life • peaks when an infant is 2 to 4 months old • is associated with the following risk factors: • prone (stomach) sleeping • babies who sleep on a soft surface, including using a pillow, soft mattress, soft bedding, etc. • having a mother who smoked during her pregnancy • having a mother who had late or no prenatal care • getting overheated • young maternal age • preterm birth and/or low birth weight • male gender • is more common in black and American Indian and Alaska Native children • is a little more common during colder months of the year • may be less common in babies who use a pacifier

14. To reduce a baby's risk of SIDS, the AAP also recommends that: • babies be put to sleep on a firm crib mattress that is covered by a sheet, without any soft objects, loose bedding, pillows, stuffed toys, or any other soft objects in the crib • mothers not smoke during pregnancy and not expose infants to second hand smoke • you avoid letting your baby get overheated when he is sleeping • you not use devices that claim to reduce the risk of SIDS or a home monitor • you make sure that all caregivers are aware of these recommendations to reduce the risk of SIDS

15. Children and Sleep • Sleep is very important to a child's well-being. The link between a child's lack of sleep and his or her behavior isn't always obvious. When adults are tired, they can either be grumpy or have low energy, but kids can become hyper, disagreeable, and have extremes in behavior.

16. Children & Sleep • How much sleep do newborns need? • There is no sleep formula for newborns because their internal clocks aren't fully developed yet. They generally sleep or drowse for 16 to 20 hours a day, divided about equally between night and day. • Newborns should be awakened every 3 to 4 hours until their weight gain is established…then, every 5-6 hours

17. Children and Sleep • How much sleep do 1-year-olds need? • 1 to 3 Years • From ages 1 to 3, most toddlers sleep about 10 to 13 hours. Separation anxiety, or just the desire to be up with mom and dad (and not miss anything), can motivate a child to stay awake. So can simple toddler-style contrariness.

18. Children & Sleep • “Back” or “supine” sleeping is the best position (6-Reasons Why) • Safer • SIDS-risk-reduction • Less breathing restrictions • Less Overheating • Easier to check on baby • Easier to hear baby

19. Children & Sleep • Comforters are usually used when children are distressed/need consoling/falling asleep • Whatever the nightly ritual is, your toddler will probably insist that it be the same every night. Just don't allow rituals to become too long or too complicated. Whenever possible, allow your toddler to make bedtime choices within the routine: which pajamas to wear, which stuffed animal to take to bed, what music to play, use of nuks, special “blankies”, etc… This gives your little one a sense of control over the routine. • Common comforters • Problems with comforters

20. Rituals are good for what reasons? Who needs to be told the rituals? Rule for crying at night, “Visit often, pick up rarely” Establishing a bedtime routine helps kids relax and get ready for sleep. For a toddler, the routine may be from 15 to 30 minutes long and include calming activities such as reading a story, bathing, and listening to soft music. Children & Sleep

21. Children & Sleep • Waking—why shouldn’t you punish your child for waking at night? • Common Causes: Even the best sleepers give parents an occasional wake-up call. Teething, hunger, wetness, & bad dream can awaken a toddler. Active dreaming begins at this age, and for very young children, dreams can be pretty alarming. Nightmares are particularly frightening to a toddler, who can't distinguish imagination from reality. (So carefully select what TV programs, if any, your toddler sees before bedtime.)

22. Children & Sleep • Why are some children afraid of the dark? • Children have very vivid imaginations. When the lights go out things look different. As we grow we learn that the things are exactly the same in the dark as they are in the light but for little ones, this is a challenge. They spend a good deal of their day imagining up all sorts of fantastic things and this doesn’t stop simply because it’s bedtime. They also feel less secure because mom or dad is no longer nearby and can feel very alone in their darkened bedroom.

23. Children & Sleep • What can you do if your child is afraid of the dark? • Have a nighttime ritual with your child—security & relaxation • Be wary of the stories you read to your child at bedtime. Make sure they are upbeat and non-threatening. • A warm bath before bedtime is not only soothing but it may help them to drift off to sleep more quickly. • Using a soft nightlight/music may help ease your child • Talk about your child’s nighttime fears during the day. • You can also do a ‘monster check’ before bedtime. Ask your child where they think the monsters may be lurking and inspect each place thoroughly. As you check the closet or under bed state firmly, “Nope, no monsters here”, and then tell your child the room is monster-free. • Monster Spray • TOKENS/TRINKETS/COMFORT ITEMS

24. Children & Sleep • Should you let a child climb into bed with you? How can you limit this? • First, don't move your child out of the crib until he's close to 3 years old. Toddlers have a tough time recognizing that the bed has the same boundaries as the crib • If your child gets up, calmly lead him back to bed and remind him that he must stay there. When he does get back into bed, reward him by telling him how cooperative he is and how pleased you are, and then leave the room. You may have to repeat these last two steps over and over, but if you stay calm, eventually he won't be so excited by the prospect of getting up. • Two of the bigger mistakes you might make when your kids move from the crib to the bed are suddenly changing the routine, such as lying next to your child until he falls asleep, and "rewarding" them by letting them climb into your bed or join the rest of the family in another part of the house.

25. Children & Sleep • What is the warning for sleep walking? • Sleepwalking episodes usually occur one to two hours after going to sleep and last from one to 30 minutes. A sleepwalker has open eyes and a blank expression, and is usually difficult, if not impossible, to awaken. The next morning, he or she won't remember the episode.

26. Children & Sleep • Naps—train them to be REGULAR/EXPECTED • Babies typically have three naps and drop to two at around 6 months old, at which time (or earlier) they are physically capable of sleeping through the night. Establishing regular naps generally happens at the latter part of this time frame, as his biological rhythms mature. The midmorning nap usually starts at 9 a.m. and lasts about an hour. The early afternoon nap starts from 12 - 2 p.m. and lasts an hour or two. And the late afternoon nap may start from 3 - 5 p.m. and is variable in duration.

27. Children & Sleep • Why is 18-mos. awkward for naps? • As your child moves past the first year toward 18-21 months old he will lose his morning nap and nap only once a day for an hour and a half to two hours. • The transition to one nap may be a bumpy one, though, where one nap is not enough and two are too many.

28. Children & Sleep • How should you wake a child from a nap? • Gently, singing, ROUTINE!

29. Children & Sleep • Establishing a Bedtime Routine • Here's a summary of a few ways that may help your child ease into a good night's sleep: • Include a winding-down period in the routine. • Stick to a bedtime, alerting your child both half an hour and 10 minutes beforehand. • Allow your child to choose which pajamas to wear, stuffed animal to take to bed, etc. • Consider playing soft, soothing music. • Don't give your baby or toddler a bottle (of breast milk, formula, or any sugar-containing drink) to aid sleep. This can cause a serious dental problem called "baby bottle tooth decay" because the fluids tend to pool in the child's mouth. • Tuck your child into bed snugly for a feeling of security. • Encourage your older kid or teen to set and maintain a bedtime that allows for the full hours of sleep needed at this age.

30. FAS ARTICLE-HandoutSUMMARIZE THIS READING! -on a separate sheet of paper • Summarizing:1-Change the title of the selection into a question--record somewhere visible • Ex: Postpartum Depression = What is Postpartum Depression? • 2- Look at the first and last sentences of each paragraph/of the selection--isolate these somewhere visible • Again, write on the separate sheet of paper • 3- Find repeated & similar words--record somewhere visible • Again, Again, write on the separate sheet of paper