Funded by California Kids Plates

1. Safe Beginnings A prevention program for Sacramento County to reduce infant sleep-related deathsin children ages 0-5 Funded by California Kids Plates

2. California Kid’s Plates Funding • In 1992, the California legislature passed a bill allowing for the sale of Kids' Plates motor vehicle license plates and the creation of the Child Health and Safety Fund. • Revenue from the sale of Kids' Plates goes into the Child Health and Safety Fund and is appropriated to support three child safety issues in California: • unintentional childhood injury prevention, • child abuse prevention, • child care licensing and inspection activities.

3. Safe Beginnings Collaborative • Joint effort between the Child Abuse Prevention Council of Sacramento (CAPC) and Safe Kids Greater Sacramento • Ensures each child has a “safe beginning.” • Partnership brings together the childhood injury and child maltreatment prevention fields, to protect children from injury and death.

4. Sacramento County Safe Beginnings Collaborative Partners • Sacramento County Hospital systems: • Kaiser Permanente, Dignity Health Care Systems (formerly Mercy), Sutter Medical Center Sacramento and UC-Davis Medical Center • Sacramento County Department of Health and Human Services: • Child Protective Services, Public Health, Communication and Media Officer, Women Infants and Children Program (WIC), Child Action, Inc. • Child Abuse Prevention Council of Sacramento • Safe Kids Greater Sacramento • Sacramento Metro Fire, Cosumnes Fire • Child Death Review Team (CDRT) • Sacramento County Building Inspection Division • Sacramento County Coroner

5. Sacramento County Safe Beginnings Collaborative Process How Safe Beginnings was developed: • Reviewed Sacramento, California and nationwide infant sleep-related death data • Surveyed Sacramento County service providers (135 responses) • Conducted parent focus groups (276 Parents) • Researched best/promising practice prevention program models • Developed SBC Infant Safe Sleeping Program utilizing the above

6. Safe BeginningsSacramento County Service ProvidersQuestionnaire Responses • What do you think are the major risk factors for infant sleep-related deaths? • 69% Co-sleeping with adults and/or siblings • 58% Infants sleeping somewhere other than a crib • 44% of parents put infant to sleep on tummy

7. Safe Beginnings CollaborativeParent Focus Group Responses • What do you know about infant sleep-related deaths? • Think of infant sleep-related deaths as a completely natural phenomenon. • Think of SIDS and believe parents have little ability to prevent these deaths • Agreed Infant sleep-related deaths are a major problem • Heard of infant sleep-related deaths on TV, but not within their families/communities

8. Safe Beginnings Collaborative Sacramento County service providers and parent focus group participants overwhelmingly agreed: • An education campaign to raise awareness of the importance of infants (particularly those 6 months of age and younger) sleeping in safe environments was needed for Sacramento County. • Information delivered by: • Birthing Hospitals • Health Care Professionals • Child Care Providers • Family Resource Centers • Community Programs

9. Safe Beginnings SAFE BEGINNINGS GOAL Decrease the number of infant sleep-related injuries and deaths in targeted Sacramento County communities. • Program elements to reduce infant sleep-related deaths include: • Educate service providers • Educate parents and caregivers • Develop and Implement media campaign (print, TV, radio, video)

10. Sacramento County Safe Beginnings Infant Safe Sleeping Training for Service Providers

11. Learning Objectives After training, participants will be able to: • Define infant sleep-related deaths terms • Learn the American Academy of Pediatrics established risk factors for infant sleep-related deaths • Know Sacramento County statistics on infant sleep-related deaths • Become familiar with the AAP 2011 recommendations for Infant Safe-Sleeping • Learn the ABC’s of infant safe sleeping • Identify resources for additional information on infant safe sleeping

12. Infant Sleep-Related Deaths:A Quick and Silent Killer • Infant sleep-related deaths are the leading cause of death for babies one month to one year of age. • Most babies that have an infant sleep-related death appear to be healthy prior to death. • Infant sleep-related deaths occur in all socio-economic, racial and ethnic groups. African American and Native American babies are 2-3 times more likely than Caucasian babies to have an infant sleep-related death. www.firstcandle.org

13. Infant Sleep-Related Deaths Definitions • SIDS – The sudden death of an infant under one year of age, which remains unexplained following an investigation of the case, including the performance of a complete autopsy and review of the clinical history. Critical Development Period (2-4 months) Vulnerable Infant SIDS Outside Stressors

14. Infant Sleep-Related Deaths Definitions • SUIDS – The sudden unexpected/unexplained infant death (SUID) applies to the death of an infant less than one year of age, in which investigation, autopsy, medical history review, and appropriate laboratory testing fails to identify a specific cause of death.  • SUIDS includes cases that meet the definition of Sudden Infant Death Syndrome (SIDS). If there are external or exogenous stressors [risk factors] that a medical examiner would like to incorporate on a death certificate, such as: • co-sleeping or bed sharing, they may be added to the cause of death, such as in the following way: Sudden unexplained (or unexpected) infant death while bed-sharing.

15. Infant Sleep-Related Deaths Definitions • Undetermined Manner – death in which the cause or manner may not be medically identifiable. In this category the manner of death may not be determined due to uncertainty regarding how the fatal condition developed or was inflicted. • Deaths that had insufficient information to assign a manner included in this category are: • infant sleep-related deaths where there is not enough evidence to determine whether the death was caused by parental overlay, SIDS or SUIDS.

16. AAP Established Risk Factors Other Risk Factors • Maternal smoking during pregnancy • Young maternal age • Late or no prenatal care • Maternal drinking and /or drug use • Male sex • African American • Native American Sleep Environment Risk Factors: • Soft sleep surface (adult bed, couch or pillow) • Extra items in the crib: bumpers, quilts, blankets, toys • Co-sleeping • Sleep position-on stomach or side • Overheating • Environmental tobacco smoke SIDS and Other Sleep-Related Infant Deaths: Expansion of Recommendations for a Safe Infant Sleeping Environment; Pediatrics Journal, October 2011

17. Babies who…. have a 40 times greater risk of SIDS. • …sleep in an adult bed • …sleep on their tummies have a 5 times greater risk of SIDS. • ……sleep on soft bedding have a 5 times greater risk of SIDS. • …sleep on their tummies on top of soft bedding have a 21 times greater risk of SIDS. • .... breath secondhand smoke have a 2.5 times greater risk of SIDS Babies of mothers who smoke during pregnancy… have a 3 times greater risk of SIDS. www.cjsids.org

18. Sacramento County Infant Sleep-Related Deaths Sacramento County Resident Infant Sleep-Related Deaths 1990-2009 (Kernel Density Distribution) • 2,111 infants died between 1990-2009. • 20% (420) of these were infant sleep-relateddeaths. 18

19. Sacramento County Infant Sleep-Related Deaths 95 Infant Sleep Related Deaths were recorded in Sacramento County from 2007-2011. 94% had at least one known infant sleep environmental risk factor: • 78% were NOT sleeping in a crib or bassinet (unsafe sleep environment) • 65% were sleeping on an adult bed or couch • 55% were co-sleeping with an adult • 36% were not put on their backs to sleep

20. Sacramento County Infant Sleep-Related Deaths

21. Infant Safe Sleeping • Recent research from the American Academy of Pediatrics indicates that infant sleep-related deaths can be prevented by implementing safe sleeping techniques for every nap and every night. • Recommendations for sleep position and environment should be used consistently for infants up to 1 year of age.

22. American Academy of Pediatrics Infant Safe Sleeping 2011 Recommendations Back to sleep always, for every sleep

23. American Academy of Pediatrics Infant Safe Sleeping 2011 Recommendations • Firm Sleep Surface • Keep soft objects out of cribs • Avoid overheating-no more than one layer more than an adult • Infant clothing that is designed to keep infants warm without possible head covering or entrapment (such as loose blankets)

24. American Academy of Pediatrics Infant Safe Sleeping 2011 Recommendations Room-sharing without bed-sharing is recommended.

25. American Academy of Pediatrics Infant Safe Sleeping 2011 Recommendations Supervised tummy-time while awake… …beginning at as early of an age as possible, to promote motor development.

26. American Academy of Pediatrics Infant Safe Sleeping 2011 Recommendations Breastfeeding lowers the risk for SIDS. Put your baby back into his or her own crib to sleep after feeding.

27. American Academy of Pediatrics Infant Safe Sleeping 2011 Recommendations Consider offering a clean, dry pacifier at nap and bedtime, but do not force it. If breastfeeding, wait 3-4 weeks to introduce the pacifier until the baby has a good latch.

28. Sacramento County ABC’s of Infant Safe Sleeping A for Alone • Babies should always sleep alone in their own crib or bassinette. • Co-sleeping with other children or even parents can be dangerous – others in bed with your baby can accidentally suffocate them by simply lying too close to their mouth or nose, or by rolling onto them while asleep. • Your baby should not sleep with stuffed animals, pillows or blankets — these soft items could accidentally fall over your baby’s face and suffocate them. • A blanket sleeper or sleep sack is enough to keep your baby comfortable.

29. Sacramento County – ABC’s of Infant Safe Sleeping B for Back • Babies who sleep on their backs are much less likely to die of infant sleep-related deaths. • According to doctors, “back sleeping” will not increase a baby’s risk of choking. • Many of our own mothers and grandmothers were taught to put a baby on their tummy to sleep — so you’ll need to gently remind them that to prevent infant sleep-related deaths, it’s “back to sleep.”

30. Sacramento County – ABC’s of Infant Safe Sleeping C for Crib • Cribs and bassinets are the safest places for babies to sleep – as long as you keep them safe! • To make breastfeeding easier keep a crib or bassinet next to your bed and always put your baby back to sleep afterwards. • Cribs should be free of pillows, bumpers, stuffed toys, extra blankets or anything that could accidentally cover your babies face and suffocate them.A blanket sleeper or sleep sack is sufficient. • Make sure that the crib mattress is firm and fits snuggly with no space between the mattress and the side of the crib, where the baby could become trapped. • Unlike firm crib mattresses, today’s adult beds are soft and can cause babies to suffocate.

31. Accessing Resources • Child Abuse Prevention Center www.thecapcenter.org • First Candle www.firstcandle.org • Consumer Product Safety Commission www.cpsc.gov • American Academy of Pediatrics www.aap.org • Juvenile Products Manufacturers Association www.jpma.org • Halo Sleep Sack www.halosleep.com

32. Sacramento County Family Resource Centers La Familia Counseling Center 5523 34th Street Sacramento, CA 95820 (916) 452-3601 North Sacramento Family Resource Center 1217 Del Paso Blvd. Sacramento, CA 95815 (916) 679-3743 Folsom Cordova Community Partnership 10455 Investment Circle Rancho Cordova, CA 95670 (916) 361-8684 River Oak Family Resource Center 4322 4th Avenue Sacramento, CA 95817 (916) 244-5800 The Effort Resource Center 6015 Watt Avenue, Suite 2 North Highlands, CA 95660 (916) 679-3925 The Firehouse - Mutual Assistance Network 810 Grand Avenue Sacramento, CA 95838 (916) 567-9567 Meadowview Family Resource Center 2251 Florin Road, Suite 158 Sacramento, CA 95822 (916) 394-6300 Valley Hi Family Resource Center 7000 Franklin Blvd., Suite 820 Sacramento, CA 95823 (916) 290-8281