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CHKD

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WHY SIDS?

In the short time I have been immersed in the world of nursing, an issue that has been very important to me is the prevention of Sudden Infant Death Syndrome, also known as SIDS. From working at the Children’s Hospital of the King’s Daughters as an NCP to completing clinical hours there for school, I have observed that this is a frequent topic of conversation and teaching point among nurses and parents. Since I will be working in the Neonatal Intensive Care Unit after graduating and passing the NCLEX, SIDS is an issue that I will be teaching parents about frequently in my role as a nurse.

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WHAT IS SIDS?
Sudden Infant Death Syndrome, also known as SIDS, is defined by Mayo Clinic as “the unexplained death, usually during sleep, of a seemingly healthy baby less than a year old” (2019).

WHO IS AFFECTED?
In 2017, 3,600 cases of sudden unexpected infant death were reported in the United States. SIDS accounted for 38% of these deaths, along with 26% due to accidental suffocation and strangulation in bed and 36% due to unknown causes. SIDS directly affects babies, as well as parents and the healthcare workers caring for them. SIDS affects people of all races, ethnicities and socio-economic status (CDC, 2019).

WHERE, WHEN AND WHY?
SIDS can occur anywhere and anytime that infants sleep, and unfortunately there is no specific scientific answer as to “why” SIDS occurs (CDC,2019).

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There is no specific causation associated with SIDS, but research has shown that newborns sometimes have defects in their brains related to sleep and breathing patterns, which could certainly create conditions for SIDS. According to Mayo Clinic, other factors that could create potential for SIDS include babies born with low birth weights, colds and respiratory infections, co-sleeping with parents, stomach sleeping, soft sleeping surfaces, and being overheated (2019).

According to the Internal Medicine Journal, babies who are 2-4 months of age are at the highest risk of dying from SIDS. The most recent evidence calls for the following major interventions for preventing SIDS:

·Supine sleeping, preferably swaddled with no toys, bottles or blankets in the crib

·Sharing the same room with parents for the first 6-12 months

·Avoiding smoking before and after pregnancy

·No co-sleeping with parents

·Parents placing child in crib before falling asleep in a couch or chair

·Breastfeeding

·Promoting pacifier use while sleeping

·Educating parents about SIDS

(Horne, 2019).

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Women’s health, neonatal and pediatric nurses have crucial roles in educating parents about safe sleeping practices for newborns and infants. I have personally observed Norfolk General and Children’s Hospital of the King’s Daughters implement teaching methods on what is referred to as “Safe Sleep”. According to CHKD’s NICU sleep position policy, neonates over 36 weeks gestation should be placed in completely flat open cribs in a supine position. It is also emphasized that parents of these children be taught these safe sleep techniques prior to discharge from the hospital (Children's Hospital of the King's Daughters, 2017).

WHY IS NURSE INVOLVEMENT IMPORTANT?

In practice, I have seen this policy enforced by both nurses and physicians. Most interactions between nurses and parents I have observed have been positive and constructive in regard to safe sleep. However, I have also observed several nurse-parent interactions in which the mothers are insistent on co-sleeping with their infants, allow loose blankets in the crib with their infants and leave bottles in the crib overnight with their infants. I have also experienced entering a patient room to discover the parents asleep with their baby in the mom’s arms on the couch. Despite policies existing about safe sleep and its benefits, parents still make the ultimate decision on how to position their child while sleeping.

The biggest challenge I have observed in this disconnect between policy and practice is the fact that cultural beliefs and practices often dictate infant sleep routines, and sometimes nurses have trouble in educating these parents with opposing views. For example, the African American population often allow their infants to sleep prone, due to the belief that this position is better for their comfort and digestion. Native American and Latino cultures often heavily encourage co-sleeping, and this belief has been popularized in other cultures as well.

Nurse involvement is important because nurses are constantly at the bedside, observing how parents interact with their children. Nurses have a first-hand look at how their patients are being positioned by their parents, and can often easily cultivate teaching moments into daily care.

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Infant Bedding and Positioning in the NICU 

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Infant Bedding and Positioning in the NICU 

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ANALYSIS: How are our current interventions helping the issue?

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ANALYSIS: How are our current interventions helping the issue?

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According to the CDC, "SIDS rates declined considerably from 130.3 deaths per 100,000 live births in 1990 to 35.4 deaths per 100,000 live births in 2017" (2019). Even though the number of SIDS deaths have dropped drastically, nurses still have lots of work to do in order to keep these numbers dropping.

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Education

Nurses must be educated on the dangers of SIDS, and this includes nurses who are not even in pediatrics or women’s health. All nurses could be exposed to infants in any environment they practice in, whether it be inpatient or outpatient, pediatrics or adult health. Nurses who work with adults may not be aware of the current statistics regarding SIDS. However, adult patients could still present to an emergency room or medical surgical unit with children and infants. Therefore, it is important that nurses of all specialties are educated on the importance of safe sleep for infants. This way, nurses of all specialties can be equipped with the knowledge to intervene if they observe an unsafe situation.

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Promote awareness

Informing parents and the general public of safe sleep practices by raising awareness in the community will ultimately make nurses’s jobs easier in terms of teaching. If parents know coming into the hospital the proper sleep methods and techniques for their infant, this saves the nurse time when formulating their plan of care and discharge. Hospital- sponsored fundraisers and support groups for victims’ families and events promoting the importance of SIDS are great starting points to promoting awareness within communities nation-wide.

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Collaboration is key!

The key to understanding other cultures is to listen to why parents feel the way they feel and collaborate with them to come up with solutions. Nurses often feel intimidated when faced with parents who are set in their traditions that are not always safe, however utilizing resources such as interpreters, social workers, and conducting research on patient cultural practices can help ease some of this anxiety. Listening to the parent’s perspective on why they prefer to let their infant sleep on their belly can not only give insight to the nurse but will also make the family feel valued and respected. A great example of compromise I have witnessed was when a parent believed in the healing power of crystals and insisted on keeping crystals in the baby’s crib at night. The nurse and mom came to a compromise and they allowed the mom to keep the crystals on the windowsill, still in the room but out of the crib.

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Curricular Concepts
·Patient Safety

·Levels of Prevention