Safe Sleep at ACH
INFANTS 0- 12 MONTHS OF AGE
Objectives
 Upon completion staff will be able to:
 Define SIDS.
 List the critical SIDS risk reduction messages for parents and
caregivers.
 Describe their key role as educators to parents and caregivers
about SIDS.
 Demonstrate how to document Safe Sleep Environment
assessment and education
SIDS: What is it??
 The leading cause of death in infants from one




month to one year of age.
A sudden and silent disorder that can happen to a
healthy infant.
A death often associated with sleep and little or no
signs of suffering.
Determined only after an autopsy and a thorough
death scene investigation.
A diagnosis of exclusion.
SIDS: What is it???
 Expanding recognition of
complex nature of SIDS risk

The baby’s vulnerability is
undetected;

The infant is in a critical
developmental period that can
temporarily destabilize his or
her systems; and

The infant is exposed to one or
more outside stressors that he
or she cannot overcome
because of the fist two factors.
Infant Mortality by Country
Despite being a
“developed”
nation, the United
States still has a
high infant
mortality rate as
compared with
other countries.
How Does Arkansas Compare???
As you can
see,
Arkansas’
infant
mortality
rate is higher
than the
national
average
Infant Mortality Rate by County
What is being done to prevent SIDS??
 1992

the American Academy of Pediatrics (AAP)
recommends that all healthy infants younger than 1
year age be placed to sleep on their backs or sides to
reduce SIDS.
 1994

“Back to Sleep” campaign launched.
 1996

AAP recommends that infants be placed “wholly”
on their backs, the position associated with the
lowest SIDS risk.
 October 2011

AAP Policy Statement shifts “safe sleep” focus
to include sleep position AND environment
2011 AAP Recommendations
 Supine with Head of Bed flat
 Environment





Firm surface
Fitted sheet
No loose blankets/bedding
No toys/stuffed animals
No positioners
 No Bed Sharing/Co-sleeping
 No tight swaddling

Baby should be able to move legs while swaddled
Supine (on their back)
 ALWAYS place the baby on his/her back to sleep for naps and
at night.
 Supine does not increase risk of choking, even in infants with
Gastroesophageal Reflux (GER) (except in very rare anatomic
abnormalities)
 Elevating head of crib is not recommended (does not help
GER and infant can slide down in crib)
 Side and prone(stomach) sleeping is not safe and is not
advised

Once the infant can roll themselves if they roll onto their side or prone you
DO NOT need to reposition them.
How sleep position effects the airway
Safe Sleep Environment
 Firm sleep surface that is covered by a snug





fitted sheet.
No pillows, soft items (stuffed animals), or loose
bedding/blankets in crib
Do not use bumper pads
If mobiles are used, hang them out of baby’s
reach and remove them once baby can sit up.
Do not use sitting devices (car seat, bouncy
chair, etc.) for sleep.
Sleep positioners are not safe or recommended
Room Share – Don’t Bed Share
 Bed sharing/co-sleeping
 Keep the baby’s sleep area close to but separate from where
parents and others sleep.
 Dangers of bed sharing/co-sleeping include:
 Suffocation
 Falls
 Entrapment/Strangulation
 Refer to the Bed Sharing
Policy in Policy Box!!!
Other Interventions to Reduce the Risk of SIDS
 Breastfeeding

Avoiding smoking, alcohol, illicit drug use during and
after pregnancy

**Smokers should consider changing their clothing before
handling the infant.
 Using a clean dry pacifier when placing the
baby down to sleep.
 Not letting the baby overheat during sleep.
 Do not rely on home monitors and other
products that claim to reduce the risk of SIDS.
Swaddling
 Tight swaddling can put baby at risk for
developmental dysplasia of the hip.

Babies should be able to move legs and hips when swaddled.
 Also consider usage of a wearable
swaddle blanket.

Halo swaddle blankets are utilized
in ITU and NICU. May see usage
hospital-wide in the future.
Tummy Time!!!!
 Provide Tummy Time when the baby is awake and
supervised to reduce the chance of flat spots
developing on the infant’s head.
How do YOU make a difference???
 Hospital Staff can help parents by:
 providing education
 identifying resources
 demonstrating desired behaviors
 Model safe behaviors
 Parents who see their baby supine are nearly twice as likely to
continue the practice at home
 Reinforce safe sleep messages for parents, medical
professionals, and other caregivers
How do YOU make a difference???
 Parent/Caregiver/Family Education
about the SIDS risk reduction
recommendations is vitally important.
 Teach them to teach others.
 About 1 in 5 infant SIDS deaths occur while
an infant is in the care of someone else.
 Parents should teach child care providers,
grandparents, babysitters, and everyone
who cares for the baby!
Changes to Practice @ ACH
 Some patients may not be able to have all
components of Safe Sleep in place secondary to their
medical condition.
 It is important that nursing judgment is utilized and
that patients transition to a complete Safe Sleep
environment before discharge.
 Don’t forget to refer to the Infant Positioning Policy
in Policy Box!!
Changes to Practice @ ACH
 This is a list of conditions that may have portions of
Safe Sleep than cannot be implemented.
Exclusion Criteria
Piece of Safe Sleep Excluded From
When to Transition to Safe
Sleep
Respiratory Distress
HOB flat; positioning supine
Patient no longer experiencing
respiratory distress
Spinal cord Defects
Wt < 1500g or Post Conceptual < 32
Positioning supine
All components
Ready for open crib
Patient being Ventilated (intubated)
HOB flat; positioning aids; blankets for
positioning
Extubated and no longer in
respiratory distress
Head Injury; Increased Intracranial
Pressure; neuro defects
HOB flat; positioning aids; possible need
for blankets
Out of acute phase; may still need
help with positioning
Post-op Cardiac Patients
HOB flat; positioning devices
Extubated and/or move to East (stepdown) if not defect dependent
Trauma, Congenital Abnormalities,
and other
Dependent on diagnosis and patient
condition
Dependent on diagnosis and patient
condition.
Education for Parents/Caregivers, and Families
 Education for Parents and Families

Handout


Located as an addendum to the Infant
Positioning Policy
 Available in English and Spanish
Video
Link on the Team ACH Page
 under “Training and Education Videos”
 Also available on CareHub

Documentation of Safe Sleep
 Safe Sleep Environment Assessment
 Completed every shift

Clocks will populate at the beginning of each shift for
documentation to occur

Will auto populate on all patients 0-12 months of age

Can also be added to the worklist as “Safe Sleep”.
Document “yes” if
all components
listed are in place.
This portion will “grey out”.
No other documentation
needed. Hit “Save” and you
are finished. 
If portions of Safe Sleep are
not in place, document “No”.
If “No” is documented, the
Components not in place/Exclusions
section must be documented on as
well. Check which components are not
in place. A comment can also be
documented.
“N/A” is to only be used
when no components of
Safe Sleep are in place.
This will mainly be seen
in the premature
population.
Exclusion criteria must be documented if
“N/A is chosen. A comment can also be
documented.
Documentation of Education
 Added to General
Teaching and NICU
Teaching
 Select “Safe Sleep
Components”

Document what
teaching was
completed,
response, and
whom was
instructed.
Acknowledgements
 Cribs for Kids
 Hospital Initiative Toolkit

http://cribsforkids.org/hospital-initiative-tools/
 Injury Prevention Center
References
 American Academy of Pediatrics. (2011). Policy
Statement SIDS and Other Sleep-Related Infant
Deaths: Expansion of Recommendations for a Safe
Infant Sleeping Environment.
 Gelfer, P., Cameron, R., Masters, K., & Kennedy, K. A.
(2013). Integrating “Back to Sleep” Recommendations
Into Neonatal ICU Practice. Pediatrics, online March
4, 2013; DOI10.1542/peds.2012-1857
 Price, C. T. & Schwend, R. M. (2011). Improper
swaddling a risk factor for developmental dysplasia
of hip. AAP News, 32 (11).