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safe sleep

Children's, Health and Safety

Safe Sleep

Statistics reveal 3,500 sleep-related deaths occur each year among infants under 12 months. Alabama has the highest rate of sleep-related deaths across the nation — approximately one hundred or more babies die each year due to unsafe sleep environments.

Dr. Erinn Schmit, a pediatric hospitalist at Children’s of Alabama and assistant professor at the University of Alabama at Birmingham (UAB), says soft bedding and babies co-sleeping with a parent or sibling are two of the most common causes of sleep-related deaths. The highest risk for sleep-related deaths in infants is between 1 and 4 months old, but Dr. Schmit recommends parents keep exercising safe sleep practices up to 12 months.

Dr. Erinn Schmit

ABCs for Safe Sleep Practices

Dr. Schmit suggests using the “ABCs” of safe sleep to remember these practices. This stands for: Alone, Back and Crib.

Alone: Babies should be in their own sleep environment every single time. This means using an approved consumer product safety-rated device, like a crib, Pack ‘n Play or bassinet.

Back: Babies should be on their backs every single time.

Crib: The crib should be empty except for a crib mattress rated for infants (a firm mattress with just a fitted sheet). There should be no loose blankets, stuffed animals, pillows or bumpers –they pose a suffocation risk.

Safe Sleep Environments

“We know that co-sleeping greatly increases their risk for suffocation. We also see some deaths from suffocation due to soft bedding, such as pillows, blankets, sleeping on an adult mattress, or sleeping in a chair or couch. These environments are not meant for babies to sleep in,” Schmit said. “Babies should be sleeping on a firm sleep surface that doesn’t allow for any air pockets where their faces can get stuck.”

For every sleep session, babies should be placed on their back until they can roll over by themselves. Swaddling is helpful for newborns who have a startle reflex that wakes them up; however, parents should swaddle their baby only until they are about 3 to 4 months old, when they begin showing signs of rolling over.

“When they’re showing signs of rolling over, you could either go cold turkey — stop swaddling them altogether—or swaddle just one arm in at a time. But we do know that swaddling while babies are trying to roll can actually increase that risk of suffocation,” adds Dr. Schmit.

Dr. Schmit also cautions against nearby cords from a baby monitor or windows with blinds near the crib. Ensure the crib or Pack n’ Play is away from the window so babies can’t pull on strings connected to the blinds. In addition, make sure baby monitors are mounted on a wall or placed on a bookcase nearby, but not directly by the edge of a crib. “Unfortunately, every year we see strangulation deaths when babies get strings stuck around their necks,” Schmit said.

Sleep sacks are well known among parents with babies and are recommended.  These wearable blankets have a hole for the neck and arms, and either zip or snap in place. Due to the design, sleep sacks don’t have loose material that can get in a baby’s face. 

Sleep sacks for younger babies swaddle with Velcro and sleep sacks for older babies have arm holes and no swaddle. Around three to four months, parents should stop swaddling and switch to a sleep sack without a swaddle.

The American Academy of Pediatrics (AAP) recommends parents share a room, not a bed, with their baby for up to 12 months. Sharing a room can help parents hear noises and be alert to their baby’s needs which can reduce Sudden Infant Death Syndrome (SIDS) and other sleep-related deaths.

Tummy Time and Acid Reflux in Babies

Tummy time is when babies lay on their stomachs for a brief time period while they are awake and supervised. The AAP recommends supervised tummy time for babies each day to help with head and neck strength which further improves motor development. For more information on how long babies of different ages should practice tummy time, refer to this resource from KidsHealth. While babies should practice tummy time, they should not while they are sleeping. Once they can roll themselves onto their tummy, it’s okay to let them roll into that position. Nevertheless, parents should still put them to sleep on their back.

One misconception is that placing babies on their backs may aggravate acid reflux or interfere with proper digestion. This has been scientifically disproven – when babies are laying on their tummies, the food pipe is above the windpipe.

According to the AAP and the North American Society for Pediatric Gastroenterology, Hepatology & Nutrition (NASPGHAN), sleeping on the back is safest for all babies, even those with reflux. The only situations when babies should sleep on their tummy are if they have an unrepaired surgical airway or some other serious issues—in which the doctor may recommend otherwise.

Safe Baby Devices

Parents may try to calm their fussy baby by driving around the neighborhood. Dr. Schmit said this practice is fine, but once the baby is back in the home they should be placed in the crib—not left in the car seat to continue sleeping. Dr. Schmit also urged any parent using a device such as the “Rock ‘n Play” to stop doing so immediately.

“The Rock ‘n Plays—an inclined sleeper that rocks—were recalled a couple of years ago due to being linked to multiple infant deaths around the country. Primarily, this was in situations where babies were strapped in and then rolling over and suffocating. It led to us recommending against all inclined sleepers because of that risk.”

For a list of approved baby devices, Dr. Schmit recommends parents discuss options with their pediatrician or visit websites such as healthykids.org or safetosleep.nichd.nih.gov.

Children's

Nov. 18 is National Injury Prevention Day

Injuries are the leading cause of death and disability to U.S. children. According to the Injury Free Coalition for Kids, 20 children die each day as a result of preventable injuries – resulting in more deaths than all other diseases combined.

Motor vehicle crashes, choking, burns, falls, drowning and poisoning are just some of the health threats that bring nearly 200 children to the Emergency Department at Children’s of Alabama every day.

“Injuries in children are preventable,” said Kathy Monroe, M.D., medical director of the Children’s of Alabama Emergency Department and professor of pediatrics at the University of Alabama at Birmingham. “Children’s is participating in National Injury Prevention Day on Nov. 18 to bring awareness to the alarming statistics related to childhood injuries and to help parents and caregivers learn how to anticipate and prevent childhood injuries.”

The rooftop lights at Children’s of Alabama will be lit green on Nov. 18, joining other pediatric hospitals across the country to “help light the way toward child injury prevention.” Doctors in Children’s Emergency Department and the Adolescent Medicine and Primary Care clinics as well as physicians around the state from the Alabama Chapter of the American Academy of Pediatrics will distribute safety education materials to patient families.

Injuries affect children of all ages. Dr. Monroe and the team of physicians in the Children’s of Alabama Emergency Department offer these age-based tips to protect children from the most common causes of injury.

Infants – Safe Sleep
There are about 3,500 sleep-related deaths among U.S. babies each year, which occur from accidental suffocation, co-sleeping or sudden infant death syndrome (SIDS).

Risk Factors:
• Placing infants to sleep on their stomach
• Sharing a bed with an adult
• Sleeping on a soft surface or with loose bedding
• Exposure to secondhand smoke

What You Can Do:
• Follow the ABCs of safe sleep: Alone, on his or her Back and in a Crib.
• Put your baby to sleep alone. (Never let the baby sleep in bed with you. It is okay to share a bedroom, but not the same sleeping surface until your child is at least one year old.)
• Put your baby to sleep on his or her back. (Babies should always be placed on their backs when going to sleep for both naps and bedtime.)
• Put your baby to sleep in a crib or bassinet. (This should be completely empty except for one fitted sheet. Do not use soft bedding, bumpers, blankets, pillows or soft toys in the crib or bassinet.)

Toddlers – Poisoning
Children of all ages are at risk of poisoning in the home. Young children and toddlers often put what they find in their mouths as a way of exploring their world. Safely storing household medications and products is the best way to prevent your child from accidental poisoning.

Risk Factors:
• Brightly colored or scented cleaning products
• Pills that look like candy
• Toys that have small parts can be a choking hazard

What You Can Do:
• Place cleaning products and chemicals on a high shelf, out of reach of small children.
• Store all medications in a locked place, such as a lockbox or a locked cabinet.
• Do not leave medications out on the counter where children may easily reach them.
• Follow instructions from your doctor or pharmacist to dispose of expired or unused medications.

Preschool Children – Drowning
Drowning is the leading cause of injury-related death in U.S. children ages 1 to 4 years. Drowning can be fast and silent. Children can drown in less than 1 inch of water and can occur in bathtubs and toilets, buckets of water, swimming pools and natural bodies of water.

What You Can Do:
• Use childproof doorknob covers and toilet locks to keep unsupervised young children out of the bathroom.
• Empty buckets, inflatable pools, and bathtubs immediately after using them.
• Ensure that all children wear a Coast Guard approved life jacket while boating or around natural bodies of water.
• Enroll children in swim lessons from an early age to learn water safety skills.
• If you have a pool, install a fence that is at least 4 feet tall and surrounds the pool on all four sides. Use self-closing and self-latching gates to keep young children from entering the pool area unattended.

Older Children – Firearms
Firearm-related deaths are the third leading cause of injury-related death among U.S. children. Young children are curious and cannot truly understand how dangerous guns are (even if you have talked to them about gun safety). If your child comes across a loaded gun, he or she can be accidentally hurt or killed, or may hurt or kill others. Teens can be impulsive and may act without thinking.

What You Can Do:
• Keep all guns locked, either with a gun lock or a gun safe.
• Store guns unloaded and away from ammunition.
• If anyone in the house is undergoing treatment for mental health disorders such as depression or suicidal thoughts, remove all firearms from the house for his/her safety.

Adolescents – Motor Vehicle Safety
Motor vehicle collisions are the number one killer of older children and teens. Learning to drive is an exciting time, but inexperience and distractions can put teens at risk.

What You Can Do:
• Properly restrain children in the correct car seat, booster seat or seat belt, depending on their age.
• Discuss car seat safety with your pediatrician, and make sure you learn how to properly install your car seat in your vehicle.
• Do not allow children under age 12 to sit in the front seat of the vehicle.
• Teach teenagers to obey traffic lights and street signs, drive the speed limit and wear a seat belt.
• Remind teenagers not to talk on the phone or text while driving.
• Model good behavior: always wear your own seatbelt while in a vehicle, and check to be sure that your children are wearing theirs.
• ATVs should only be used while wearing a helmet and following the safety instructions from the manufacturer. Never let a child under 16 ride an adult-sized ATV, and never allow more riders than the ATV was designed to carry.

All Ages – Fire Safety
More than 60 percent of all house fires occur in homes without working smoke detectors. It is important to install smoke detectors on each floor of your home. Test smoke detectors frequently.

What You Can Do:
• Change the batteries of your smoke detectors and check that they work every 6 months.
• Have an escape plan from the home in the event of a fire, and practice with your family.
• Place fire extinguishers in the kitchen, basement and garage.
• Keep matches and lighters out of reach of children.
• Teach children what to do in the event of fire: stop, drop, and roll.
• Make sure space heaters do not come in contact with clothing or other flammable materials. Do not keep space heaters in bedrooms.

All Ages – Motor Vehicle Safety

Motor vehicle crashes are the leading cause of unintentional injury-related death among children ages 19 and under, and more than half of car seats are not used or installed correctly.

What You Can Do:
• Properly restrain children in the correct car seat, booster seat or seat belt, depending on their age.
• Discuss car seat safety with your pediatrician, and make sure you learn how to properly install your car seat in your vehicle.

Visit http://www.childrensal.org/emergency-department for more information.

Children's, Health and Safety

Safe Sleep

SIDS or Sudden Infant Death Syndrome is the number one cause of death in babies under 12 months. SIDS is the sudden and unexplained death of a baby and often occurs during sleep.

SIDS is very frightening for new parents, but there are things you can do to keep your baby safe and help prevent SIDS. Dr. Candice Dye is an Associate Professor of Pediatrics at Children’s of Alabama and UAB. She says parents and caregivers of babies should remember the ABCs of Sleep. “Alone, on their back, in a crib. It’s that simple,” she says.

ABCs of Sleep
•Alone
•On their Back
•In a Crib

Dr. Dye explains each point:

ALONE- “Items in the crib pose a huge suffocation risk,” she says. “No bumper pads, no stuffed animals, no loose blankets. Nothing else in the crib. A boring crib equals a healthy baby.”

On their BACK- “This is different from when our grandparents or parents were doing this, but babies should be laid down on their back,” Dr. Dye says. “This ensures that the baby can breathe and they are not getting trapped face down unable to breathe.”
In their CRIB- “It’s really easy for parents to be tired and want to keep the baby in their bed with them, but an adult mattress is not the same as an infant crib mattress and there is the risk of the adult rolling onto the baby while sleeping,” she says.
Who is at risk?

All babies are at risk for SIDS. There is no single cause. However, SIDS is more common in black and Native American infants than in Caucasian infants. More boys than girls fall victim to SIDS.
Other risk factors include:
•Smoking, drinking or drug use during pregnancy and after birth
•Poor prenatal care
•Prematurity or low birth weight
•Family history of SIDS
•Mothers younger than 20
•Exposure to secondhand smoke
•Overheating

Dr. Dye strongly recommends that parents make grandparents and caregivers aware about the risk of SIDS and that they follow the ABCs of sleep when caring for the baby. She also cautions parents not to rely on store-bought devices or gadgets that may claim to help prevent SIDS.
Once babies consistently roll over from back to front on their own, they are less at risk of developing SIDS and can sleep in the position they choose. Until then, a parent can greatly reduce the risk of their child dying by SIDS by following the ABCs of sleep.