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Deborah Howell (Host): You know, we all want the best for our babies and want to protect them in any way we can. Today, we'll ask the question what is SIDS and how can I reduce the risk for my baby. I'm Deborah Howell and our guests today are Dr. Jenny Camacho, a Neonatologist and Taylor Fauerbach, the Perinatal Center Program Coordinator at Deaconess, The Women's Hospital. And together we'll take on the topic of safe sleep. Welcome, Dr. Camacho.

Jenny Camacho, MD (Guest): Hi, thank you for allowing me to be here.

Host: Absolutely. And welcome to you, Taylor.

Taylor Fauerbach, MSN, RNC-OB (Guest): Hi, Deborah. Thank you for inviting us.

Host: Our pleasure. Dr. Camacho, let's begin with you. What is SIDS and how can I reduce the risk for my baby?

Dr. Camacho: So one thing I want to say that throughout the conversation we're going to have about safe sleep, Taylor and myself will refer a lot to the American Academy of Pediatrics. That's basically the governing organization that gives advice to pediatricians, pediatric subspecialists and anyone providing care to a child.

So we'll call that AAP for short. But to answer your question, SIDS stands for sudden infant death syndrome, and it's basically a cause of death in an infant less than about 12 months old, where the death really can't be explained through any case investigation, like a thorough scene investigation, autopsy, or view of the clinical history.

So, it's a subcategory of a larger group of infant deaths called sudden unexpected infant death or SUIDs. So this is where an infant, less than 12 months suddenly dies unexpectedly, whether or not the case can be explained, but the distinction between SIDS and SUID is really difficult to make, especially when the death occurs during unobserved sleep period.

But there are several things that parents can do to reduce the risk of SIDS for their infant. We'll just go through five of the kinds of things that parents can do. Cause the 2016 AAP guidelines go through several more than that, but I want to just go through the top kind of five.

So the first one is, we need to place your infant on their back to sleep in a safe sleep environment. And we'll, I'll get to what that looks like in just a little bit. Two, breastfeeding your infant, that's been linked to a reduced risk of SIDS. Number three, you want to room share but not bed share. So what that means is that your baby can sleep in your room for the first year if possible, but if not, at least for the first six months, so room sharing is okay, but not bed sharing.

Number four is to remove soft objects and loose bedding from the infant sleep area. This includes pillows, blankets, stuffed animals, anything that's super fluffy. As this puts the infant at increased risk of SIDS, increases their risk of suffocation, those kinds of things, and removing these items reduces the risk of SIDS by 80%.

And finally, this is another one that I get questions about a lot is, don't use the home cardio-respiratory monitors as a strategy to reduce SIDS. These devices haven't really been shown to decrease the incidence of SIDS. Instead, they've actually been shown to increase parent worry, contribute more to parent sleep loss, because they have so many false alarms. So once they found that parents have monitored infants actually felt more depressed compared to infants that weren't monitored. So I think those are some of the five big things that parents can do to reduce the risk of SIDS.

Host: Okay. So I'm sure you probably get this question a lot, does sleeping on their back because flat head syndrome?

Dr. Camacho: I do get this question a lot. So let's talk about what causes positional plagiocephaly or more commonly flathead syndrome. It's due to pressure on the same part of the baby's head for too long or too often. So these flat spots aren't dangerous. They typically will resolve on their own once the infant starts sitting up and they typically aren't related to long-term problems with head shape or things like that. And a lot of parents kind of wonder, well, what can I do to prevent these flat spots? There's a couple of things. Make sure you could have a cuddle time.

So holding your baby up right when he or she isn't sleeping as often as possible, limit the amount of time your baby spends in car seats, bouncers, swings, things like that. Another really good tip is to change the direction your baby lies in the crib from one week to the next. So, for example, have your baby's feet point toward one end of the crib one week and then switch it the next week so that the face toward the other end of the crib, the following week. So, this way they kind of naturally look in different directions each week and it lowers the likelihood of them developing flathead syndrome.

Host: And what does safe sleep look like for a baby?

Dr. Camacho: So I want you, for those that are listening, I want you to close your eyes and I want you to envision the following. So an infant dressed in a sleep sack laying on its back in a crib, on a firm and flat surface, that's covered with a tight fitted sheet and nothing in it, but the baby. It's that simple and straightforward.

Host: Wow. That's just not much. I mean, like you said, it's a very, very, very straightforward. Nothing to get in the way.

Dr. Camacho: Right. And one thing I do want to say about cribs is that parents do need to pay attention to when the crib was manufactured. So, the Consumer Product Safety Commission came out with new guidelines for cribs in June of 2011. So, the parents just need to make sure that the crib was manufactured after that. Or if it was manufactured before that, just to check, to make sure that it's up to date with current safety standards.

Host: Perfect. And let the parents know that eventually your kids can have some stuffed animals in there, but just not right away. Correct

Dr. Camacho: and for how

Host: long?

Dr. Camacho: And for so as far as stuffed animals and pillows and blankets, I had to do some good research on this. And as far as a blanket, they don't recommend any blankets prior to a year. So after about a year and by about 18 months, it's okay for them to sleep with a small light thin blanket.

Pillows the recommendation is for parents to wait until the child's at least two years old. If they're able to safely transition and sleep well in a toddler bed, then that's the time when you can introduce stuffed animals and things like that.

Host: Perfect. One more for you, then we'll go over to Taylor. All right. For those who don't know what is swaddling and is it safe?

Dr. Camacho: Swaddling is basically where you wrap the baby kind of like in a burrito like fashion. And, it's not something that is recommended for safe sleep. But if you do decide to swaddle, you have to make sure that you allow enough room for the infants hips and legs to move around so that you don't cause any sort of hip dysplasia. I think one of the safest ways to keep your baby warm and to keep them comforted is to use a sleep sack. So sleep sacks are basically where it's like a big sleeping bag with holes in the side for the baby's arms. So this is a way to, to keep them kind of covered and nice and warm while they sleep. A lot of times when babies are first born, it's okay to swaddle at that point. But by about four months, when babies start to roll over onto their stomachs, it's not safe to swaddle them after that point.

Host: Okay. And why do people swaddle their babies?

Dr. Camacho: It's something that, especially in the newborn period, newborns, like to still feel like they're in the womb. So, it's a way for them to kind of feel tight and snug and close, like they were in the environment in the womb, but as they slowly start to get older, especially toward late two and four months, they kind of start to wiggle out of the blanket a lot. And so when there's loose blankets or other things around, that kind of increases the risk of suffocation. But that's why people swaddle is, it's a way to comfort the baby.

Host: Got it. Thank you. Taylor, you've been patient. How do I keep my baby warm without a blanket?

Taylor: Well, AAP recommends placing our babies in sleep sacks or some kind of wearable blanket, if they need extra warmth at night. Excess heat is dangerous to babies. So, we don't want to put a lot of layers on that baby. So, the easiest thing you can do is dress your baby in one extra layer that maybe you would normally wear. And if you're worried that your baby's cold, you can use that wearable blanket or a sleep sack, and those are meant to cover the body and not the head.

Host: Got it. Okay. That makes sense. Can I use a bumper pad in the crib?

Taylor: Well, in 2011, it did come out that parents really shouldn't use crib bumpers. Studies have shown that there's really not any evidence that those pads prevent injuries, but rather we're at more risk for suffocation, strangulation, or even trapping a baby when they're used.

Host: Okay. So probably no bumpers. What are DockATots and are they safe?

Taylor: So a DockATot is kind of like a baby nest or pod, and it's this nice, cushy little surface you can put a baby on and they're actually really not safe. The safest environment for a baby sleeping is on something flat and firm. And as Dr. Camacho mentioned, you know, that approved mattress where baby can be sleeping alone and on their back.

Host: Okay. So no DockATots. What if my baby sleeps in a car seat in the car? How do I keep them safe?

Taylor: Well, car seats are for cars. They're just not a substitute though for a firm safe sleep surface, like in a crib or a bassinet. And AAP does advise us to not let baby sleep in an inclined device. And so the safest thing to do for a baby sleeping outside of a car is to put them in a bassinet or crib.

And this isn't really to scare anybody who's traveling with a baby. If your baby falls asleep in a car seat, that is okay while you're traveling. Just be sure to keep your eye on them and make sure they're fully strapped in and really take them out when you get to your destination.

Host: And what is the problem with the incline or incline device?

Taylor: You know, with sleeping on an incline, we worry that that baby's head is going to be dropping forward and it's more safe to keep that baby in that declined position and on their back.

Host: Okay. Is there anything else we should know about safe sleep Taylor?

Taylor: Safe sleep isn't easy. It's definitely a decision that parents have to make, and it is the right one to make. And those early days it's really hard as a new parent to stay awake and to remember, to feed your baby and to remember to put them down in the right space, but coming up with a plan and making sure you talk about it with other people in your life is really helpful.

I know personally I set phone alarms for myself when I was feeding my baby, because that was the time when I was getting the most tired and I felt like that would help keep me awake. And so make a plan to stay awake and know that brighter days are ahead. At some point, your baby will sleep throughout the night. It is going to come. It just might not be right this minute. So come up with a plan and talk about it with other people. So that way anybody who cares for your baby knows about safe sleep.

Host: Knowledge and a plan that is power. Same question to you, Dr. Camacho. Is there anything else we should know about safe sleep?

Dr. Camacho: Yeah, actually there's not currently a federal safety standard for products that are marketed for infant sleep. So, recently the US Consumer Product Safety Commission has approved a new federal rule that will ensure that products that are marketed are intended for infant sleep will provide a safe sleep environment for babies under five months old.

So by the middle of this year, any product that is intended or advertised for infant safe sleep has to follow this new federal safety standards. So I think it's really great news and parents should be on the lookout for any sort of potentially hazardous, safe sleep products that they have gotten like inclined sleepers, travel and compact bassinets or in bed sleepers, items like this have actually been linked to dozens of infant deaths. So, being aware that soon products will have to follow this safety standard. I'm really hoping that this helps reduce deaths due to unsafe sleep. Also the American Academy of Pediatrics revises their safe sleep guidance every five years, the last guidelines came out in 2016.

So we're due for new ones this year. And so while there might not be additional, you know, measures or things that they put in place that we haven't talked about, we're kind of anticipating that the new guidance will really only enhance the information that we've presented today.

Host: Absolutely. And we'll have to have you back when those new guidelines come out so we can get all updated.

Dr. Camacho: Absolutely. Be happy to.

Host: Well, this has been some really good information. Thank you both so much for being with us today, Dr. Camacho and Taylor, to talk about safe sleep. We really appreciate it.

Dr. Camacho: Thank you so much having us and for allowing us to discuss safe sleep with you and how important it is.

Taylor: Yes. Thank you very much.

Host: This is the Women's Hospital, a place for all your life. To schedule an appointment or to learn more, call 812-842-4530. Or visit deaconess.com to get connected to one of our providers. Please remember to subscribe, rate, and review this podcast and all the other Deaconess Women's Hospital podcasts. For more health tips and updates, follow us on your social channels. I'm Deborah Howell. Thanks for listening and have yourself a great day.