intro: Welcome to Pediatric Voices, Duke Children's podcast about kids healthcare. Now here's our host, Dr. Richard Chung.

Richard J. Chung, MD: Hello, and welcome to Pediatric Voices, expert insights about timely topics in children's health, brought to you by Duke Children's Hospital and the Department of Pediatrics at the Duke University Medical Center. My name is Dr. Richard Chung, a physician at Duke Children's and a co-host of this show.

Today, we will explore the topic of infant sleep. Sleep is a very common topic of conversation between parents and their pediatricians throughout childhood, but particularly during infancy, or the first year of life. Specifically, we will be discussing something called sudden infant death syndrome or SIDS.

October is SIDS Awareness Month, and there is important information and insights we all need to know to keep infants safe and healthy. To help us understand this topic better, I'll be speaking with Drs. Kristina Nazareth-Pidgeon and Sophie Shaikh, co-chairs of the Duke Safe Sleep Task Force. Dr. Nazareth-Pidgeon is an Assistant Professor of Pediatrics and a Pediatric Hospitalist or a Hospital-based Pediatrician. She has special interest in quality improvement and education, both within healthcare settings and in the community. She also works in a variety of ways to advocate for safe sleep practices both inside and outside of the hospital.

Dr. Shaikh is an Assistant Professor of Pediatrics and Medical Director of the Duke University Hospital Newborn Nursery. She's a Pediatrician with special interest in well-newborn care, breastfeeding, and in quality improvement and patient safety. In her role as Medical Director of Duke's Academic Newborn Nursery, she focuses on educating healthcare providers on providing evidence-based, compassionate newborn care. Welcome to the show, Kristina and Sophie.

Sophie Shaikh, MD: Thanks for having us!

Kristina Nazareth-Pidgeon, MD: Yes, we're very excited to be here.

Richard J. Chung, MD: Awesome. Well, thanks for taking time out of your busy schedules. This is such an important topic and I know that we'll have lot of really important information for our listeners. Let's start though first with you. We'd love to really just kind of get to know our guests as individuals and as professionals.

Maybe let's start with you, Kristina. How did you first get involved in children's health?

Kristina Nazareth-Pidgeon, MD: So that's a great question. I was actually one of those people who was like a camp counselor when I was younger. I always loved kids. I always loved working with kids in all different fashions. And when I got to medical school, I went into medical school thinking I was going to do pediatrics. I tried out everything else and then returned back to pediatrics because I loved the relationships with our patients and our families and that's part of the reason I love the Safe Sleep staff because, you know, this is how we partner with our families to continue to give them kind of both education and help support them at a time which can be kind of challenging within that first year.

Richard J. Chung, MD: Excellent. The camp counselor archetype is actually pretty common among pediatricians. You know, it's a combination of being responsible for kids, making sure they're safe and healthy, teaching them things along the way, including life skills, but then also just having fun, right? And I feel like that's often kind of the way working as a pediatrician feels, right? It's a little combination of all of those things. What about you, Sophie? How did you get interested in pediatrics?

Sophie Shaikh, MD: So I started my own family when I was in medical school and my own pediatrician was such an important part of how I raised my kids and providing information for me and my family, that I really felt that that was going to be a great career for me and I wanted to emulate my pediatrician.

Okay,

Richard J. Chung, MD: Excellent. So that's great. You saw a role model of sorts, an example of what it looks like to support families and children to be healthy and you followed suit. That's really great. And it's a reminder to all of us in this work that people are watching, right? And seeing kind of the work that we do and hopefully being inspired by the things that we're able to do for families and their kids.

 Well, let's launch into this topic of SIDS. Sophie, we'll, we'll start with you. So let's start with some of the basics. What exactly is SIDS and what do we know about what causes it?

Sophie Shaikh, MD: So SIDS, as you mentioned, is short for Sudden Infant Death Syndrome, which is when a baby dies in a sleep environment, and we can't explain why, even after we've done a thorough investigation and medical exam. It's part of a larger group of events called Sudden Unexpected Infant Death, or SUID, which is where a seemingly healthy baby dies unexpectedly.

Sometimes with SUID, we're able to work out why a baby died. Maybe it was something like an infection or a heart defect, or sometimes maybe the baby suffocated in their bed with pillows or blankets. But we call it SIDS when we can't find an explanation for why the baby died in their sleep and we don't really know for sure what causes it.

It seems to happen when there's a problem with a part of the brain that controls breathing and waking up from sleep. When a baby's brain doesn't detect stresses in the environment like low oxygen levels or high levels of carbon dioxide in the blood and doesn't wake a baby up like it's meant to, we think that's what causes a SIDS event.

Richard J. Chung, MD: Got it. Thank you, Sophie. Very helpful background for what this topic is and frankly, very concerning. Right. I think it's one thing in healthcare to have a severe outcome, something that is just frankly scary, but then to not be able to explain it at all and really sort of put a finger on what exactly caused it can be particularly stressful for, for everyone involved.

Kristina, I understand that even if we don't know necessarily what causes SIDS, we do have a sense of risk factors or things that might increase risk for individual infants. Can you share a little bit about what we know about risk factors?

Kristina Nazareth-Pidgeon, MD: Yeah, you're actually totally right on that. And even though we don't necessarily know the underlying cause, we do know that there are things that can help prevent them, but also things that put patients at higher risk for it. So some of the risk factors that will put patients at higher risk are things like exposure to cigarette smoke. Things like being in an overheated environment. The AAP actually removed hats. If you can remember back, all those baby pictures, everyone had kind of their hats in the newborn nursery, but we're taking them away because we know that overheating babies is not helpful. Also if you have a caregiver who's impaired, so this can be alcohol, this can be marijuana, this can be drugs. These are all factors that go, that we know increase the risk of these patients. But on the flip side of that, there's also things that we know that can help prevent it. So there was a big Back To Sleep campaign from the AAP that came out a number of years ago when we decided that babies should sleep on their back.

And so we know that babies sleeping on their back in a flat environment without a lot of stuffed animals and overall empty, with appropriate swaddling. So I talked about kind of overheating and we obviously don't want to overheat these babies. So kind of being appropriate for the weather, but not having big, loose, fleecy blankets that are those really pretty ones that everyone likes to gift.

Those are the ones that we want out. And the other thing that we know is we know that pacifier use and breastfeeding actually are both protective from SIDS events. So those are things that families, we can help support as pediatricians when those questions come up in terms of how to do breastfeeding and pacifier use.

Richard J. Chung, MD: Got it. Super helpful. As mentioned, we don't necessarily know what we don't know what precisely causes SIDS events, but we know about risk factors, and risk factors are important because they give us things that we can do, right? We can address those things and we can take action, even if we can't entirely prevent something.

And so thank you, Kristina, for walking through that. And you mentioned some of the other things that families can proactively do to prevent and decrease the risk of SIDS for infants. One question I had, maybe, and I'll give this to you, Sophie, what about infants who are born early or who have known health problems early in life. Do we know whether there's increased risk of SIDS for infants who have sort of specific health issues?

Sophie Shaikh, MD: Yeah, unfortunately, there is a higher risk of SIDS for babies who are born early. And for those babies, it's really important that once they go home, they follow those safe sleep guidelines. Things that we can do is when they are in the NICU, in the neonatal ICU, as they get closer to going home, once they reach about 32 weeks and are medically stable, the NICU will hopefully be talking to families about how they can prepare for coming home and getting them ready to follow the safe sleep guidelines. There are infants that are born with certain medical conditions and may need slight tweaks to these guidelines to keep them safe at home, but the pediatricians will talk to the families about those exceptions to the rules.

Richard J. Chung, MD: Thank you, Sophie. And just to kind of follow up on what Kristina started in on in terms of tips in terms of these safe sleep guidelines. Kristina mentioned no hats, which is unfortunate, you know, that's kind of a fun part, which I enjoyed when our kids were young, but, you know, certainly first, safety first, of course, and so, Back To Sleep, my understanding is kind of firm sleep surfaces, keeping the crib empty and such. Can you add any more to that? Pacifier use? I think Kristina mentioned as well, but any other particular tips?

Sophie Shaikh, MD: So I will say if you take one thing away from this, you can remember the ABCs of infant safe sleep. So the A is for Alone, which basically means nothing but a baby in their sleep space. So the baby can be wearing tight fitting clothes, a swaddle or a sleep sack, but no loose blankets, pillows, stuffed toys or bumpers in the cribs, just like Kristina said.

The emptier the crib is, the safer the baby is. The B is for Back. So baby should be placed on their back to sleep every single time, not on their side, not on their belly. And the C in the ABC is for crib. Doesn't necessarily mean it needs to be a crib, but this reminds us that the baby should be sleeping in something specifically designed for a baby to sleep in, like a crib, a bassinet, or a pack and play.

These things have firm, flat, non-inclined, sleep surfaces, which are really important for babies and have been safety tested to make sure they're appropriate. A lot of things have been actually removed from the market recently that have had slopes on them, so it's really important that babies sleep in things that are flat, so no sleeping in infant swings and things like that. If you remember those ABCs of infant safe sleep, you really are off to a great start in keeping your baby safe.

Richard J. Chung, MD: That's really helpful. I'm a sucker for a good mnemonic and certainly ABCs is a very pediatric mnemonic and very helpful to remember. Sophie, one other follow up. I know you have particular expertise in breastfeeding and certainly for families, there's a variety of reasons why they might go one route or the other in terms of feeding their infant, but, does breastfeeding have something to do with SIDS risk?

Sophie Shaikh, MD: It does. A baby that is breastfed for two months has a 50 percent decrease in SIDS risk. So that's a really big decrease. Breastfeeding isn't for everybody and there's a lot of factors that go into the parent's decision to breastfeed or not. But if we as pediatricians can help support a family who wants to breastfeed, we really should be, not only for the decrease in SIDS risk, but breastfeeding has so many other health benefits for both the baby and for the mom.

Richard J. Chung, MD: Thanks for pointing that out. I think that's such an important fact. And of course, we support all families to figure out the best path for them in terms of feeding their infant. But certainly, if within reason and possible, supporting breastfeeding, is always part of the conversation. And then just to follow up with you, Sophie, a little bit further, what about co-sleeping or bed sharing?

You know, as, as a parent, of course, being with your infant, snuggling in that particular way that most parents look forward to. What is your guidance with respect to co-sleeping and bed sharing?

Sophie Shaikh, MD: It's such a great question, and one we get from a lot of families. But we know that half of the babies that die of sleep related deaths in the U.S. were bed sharing with a parent when they died. And bed sharing increases a baby's risk of a sleep related death by 10 times. So we recommend that a baby never sleeps in the same bed or on the same sleep surface as a parent, caregiver, sibling, or pet.

Instead, we recommend what we call room sharing without bed sharing; where a caregiver and a baby are in the same room, but separate beds. It's fine to have the bassinet right next to the parent's bed, so long as they're separate.

Richard J. Chung, MD: Got it. Okay. So maybe keeping the infant in the same room, but not on the exact same bedding surface. So kind of adjacent, but separate. Is that what you mentioned?

Sophie Shaikh, MD: Exactly, yes.

Richard J. Chung, MD: Got it. I think my wife might actually like that arrangement as well when I steal the covers in sleep. And so kind of having a separate bed, maybe being in the same room, but having our own territory, I think may be desired, but I digress. Kristina, let's go to you.

So, I understand that there's something called the Federal Safe Sleep for Babies Act. I actually hadn't heard of this before, but in doing research for this particular episode, can you share what that is and what that accomplished?

Kristina Nazareth-Pidgeon, MD: Yeah, it's actually really interesting. Because the safe sleep market for infants actually was not very regulated in the US. Like our first crib laws actually only came out in the 70s. Which, babies had been sleeping in cribs well before that. So there actually was not a lot of regulation.

And in 2019, actually, there was a huge kind of recall. So they started to recall in 2019, multiple of these inclined sleepers. And that was because babies were dying in them. Babies were flipping over in their sleep and were passing away of SIDS like events. And so they actually got pulled off the market.

But what then happened is people were buying them off of social media, they were still using them. And so despite the recall, there continued to be lots of deaths, and so within 2020, we actually had two safe sleep laws, which was actually kind of somewhat unprecedented in the US in terms of safe sleep laws. So the first one actually came out in June of 2020, and it essentially said like, if you are marketing any product which is intended for sleep, it has to meet the safety regulations set out by the government. Because you could essentially put anything on the market and say that it was meant for infant safe sleep, and there was no sort of real rule that said that it had to follow kind of the regulations. That was the first one.

And the big one, which is the one that you had mentioned, which is the Federal Safe Sleep Act, that actually went into effect of November 2022, so just about a year ago, so actually not that long ago. And what that did was it pulled off any inclined sleepers, so all of those like type of swings that were meant for sleep, anything that had more than a 10 degree inclined surface to it, so made it illegal to import, sell on any venue, or manufacture those.

And then the other thing that it really pulled off the market was crib bumpers. So crib bumpers were those really pretty things that we used to, I slept in them when I was a kid because they were on the market, which is, you know, kind of those nice padded, soft things that people put on the edge of the crib.

And really the purpose of that was so that kids' like, legs didn't get stuck in between, they didn't bop themselves while they were sleeping. But what they found, actually, was that babies were getting entangled in them and actually getting trapped in between the crib bumper and the crib itself. And they were actually having strangulation events. So, with this, we actually had a bunch of products pulled recently off the market within the past year. You'll still see a little bit of them floating around because they still exist somewhat on the black market of safe sleep. But for the most part, they are no longer being manufactured or imported.

And so that is why, kind of, you'll see a huge shift in terms of what is actually sold. So now, if it says, meant for sleep, and I encourage all parents to look for this on the boxes, it has to meet the federal regulation, where before it was semi-unmonitored.

Richard J. Chung, MD: Wow. So this is a really changing landscape in terms of the products that are available in different venues. And it's really helpful to just point out that this advance in terms of regulation to keep infants safe is the product of people like you, right, pointing to the safety concerns that are arising in hospitals and communities around the country.

And then really deducing kind of from there, what is going on with these products and then advocating for the policy changes that are needed. And so, it's really helpful to kind of know that this is advancing and it sounds like at the same time that companies are putting out all sorts of products into this very vibrant market, there's also products being taken away.

Now, Kristina, you mentioned though, the sort of quote, black market or, secondary market, I guess, in terms of these products. And so, certainly, there are social media venues and, and other online places where people are swapping things all the time. How would you advise parents navigate that?

Because of course, you know, if it's more affordable, we, we want families to kind of get things that they need for their family in a, in an affordable fashion, but how do they make sure that the things they're getting are safe and up to snuff with the latest standards?

Kristina Nazareth-Pidgeon, MD: Yeah, that's a great question. And you're right. I mean, I myself, right, buy things off social media sites and all those things. And so to me, there's kind of two really good resources. So one is your pediatrician. So if you have any questions about any of the products that are on the market, ask them, get some kind of good guidance from it.

The second is the fact that the consumer product safety report is an online searchable system. And you can actually put direct information into the product that you're trying to get and see kind of if there has been any recalls on it. So that to me was actually very helpful.

I will tell you my oldest infant, well, she's not an infant anymore. My oldest, my eight year old, slept in a product that got pulled off the market and she had reflux. So she was in this incline sleeper, it was one of the first ones that got pulled off the market. And then when I had my twins, a few years later, we bought a bunch of them.

And then I put it into the recall as a kind of over nervous parent and discovered that it got recalled, even though we had just bought two new ones, right? So I think even pediatricians, you know, may not be up to date on the most latest recall. So it's important to enable all parents to make sure that anytime they get any of these things to look into it and know that these are these new regulations. And so there will be more and more products that are actually being pulled off the market.

Richard J. Chung, MD: Got it. So families should not only think about okay, what color do I like or what looks cute in the nursery, but actually do safety research and look things up online. Do your due diligence, right? Because, at the very least we want our infants to be safe. So thank you for those tips, Kristina.

Sophie, I'm curious. With the advancement of infant products and also just the broader advancement of technology, there are these other products I've seen on the market in terms of actual sort of like medical monitoring of your baby at home. And, I imagine that certain parents are really attracted to that idea, right? If they're concerned for their baby's safety for whatever reason. These sort of devices that say that they're going to monitor oxygen or heart rate or breathing, while the infant is sleeping. You know, when I was parent of a young infant,all we had was the monitor, right? And this sort of grainy black and white view of the infant.

And that felt really satisfying to me, right? Because you kind of knew that your baby was there, you know, for whatever that's worth, but now there's all sorts of other layers of technology. And so Sophie, as a pediatrician in the nursery, as families are thinking about how to set up their nursery at home, and monitor their infant while they're sleeping, what do you typically recommend?

Sophie Shaikh, MD: Evidence has shown that some people that use these monitors find them more stressful. Sometimes they alarm falsely and kind of really stress parents out. But if parents want to use them, I think it's really important to know that they still need to follow the infant safe sleep guidance. There have been no commercial monitors that have been shown to prevent sleep related infant deaths. So using a monitor doesn't make it safe for a baby to sleep like on their belly or for bed sharing. You should still follow the AAP safe sleep guidance if you choose to use them.

Richard J. Chung, MD: Okay. So these really haven't been proven to increase safety or prevent negative outcomes. They're out there and, you know, families can maybe consider them, but, certainly talking to your pediatrician, getting more advice from a caring professional who knows your infant and your situation is, is always a good step. Kristina, I wanted to slightly shift gears to maybe an adjacent topic that I know that sometimes comes up, and that is the topic of BRUEs and maybe you'll share with our listeners what exactly that stands for, but what are BRUEs and are they related to this conversation on SIDS?

Kristina Nazareth-Pidgeon, MD: Yeah, that's a great question because, you know, a lot of times parents think that they're very much related. And so, BRUEs are brief, resolved, unexplained events. We actually used to call them ALTEs. Like, when I was a resident, they were the ALTEs, and that was your apparent life threatening event. And really, these are events where your all the infant becomes unresponsive, will have a change in their breathing, a change in their color, a change in their tone, but they're very quick events, and they return back to their normal selves pretty quickly. So, when we look at all the research, though, patients that have BRUEs, or what used to be called ALTEs, are not actually at higher risk of SIDS. So despite the fact that your baby may have an episode where it seems like they're not breathing quite as well, or their color's changing, and it's really scary, right? Like, that's where these names came from. These are scary events. They're not actually related to what we think could potentially be the cause of SIDS. But when you look across the rates, having a BRUE does not increase your risk of having a SIDS event.

Richard J. Chung, MD: Very helpful. So, BRUEs, brief, resolved, unexplained events. You know, I, I like brief and resolved events, but the unexplained piece is the thing that I think bothers us as clinicians and certainly bothers families and, and probably is the connection, right, between the BRUEs and the SIDS is just that, unexplained notion of these concerning events.

And so, uh, but it's helpful to kind of know that, what that nature of connection is or not, so that families are aware. Let's kind of zoom out a little bit actually from SIDS. And Sophie, we'll start with you, but I'd be remiss if I didn't ask two sleep experts today what your favorite tips are, right?

So we started the top saying just like sleep is like this constant conversation, right, between parents and pediatricians and other child health professionals. And for good reason, right? Sleep is such an important part of healthy growth and development. And also sleep is probably the tip of the spear in terms of how infancy and parenting affects parents during that first year of life.

And so, Sophie, what are your favorite tips for families, you know, in the nursery or maybe in clinics, seeing them for these well visits? Do you have some tips that you find to be evidence-based and also effective?

Sophie Shaikh, MD: I'll say two things about infant sleep. The first is that it's really important to talk about safe sleep with anybody who might be taking care of your baby. So that's babysitters, grandparents, other family members, pretty much anyone. We want to make sure that everybody knows what they should be doing to keep the baby safe while they sleep.

It's no good if the parents are diligently doing everything to keep their baby safe, but then, the aunt comes in and does everything completely different and puts the kiddo at risk. And the second thing is sleep is hard. We know that. And safe sleep can be hard. But safe sleep is really important and your baby is worth it.

And hopefully you will get peace of mind by knowing that you're doing everything possible to help your, your baby sleep safely. If it is something that you feel is affecting your quality of life, if it's something that's really preventing you from getting good rest, talk to your pediatrician, and they'll be able to help you out with specific things that might work for your kiddo.

Excellent.

Richard J. Chung, MD: What about you, Kristina? Do you have any tips that you like to share?

Kristina Nazareth-Pidgeon, MD: Yeah, I mean, I think the one thing that I always tell parents is that babies wake up. It is normal. It is part of their development. Every parent goes through it. Because sometimes it can be really isolating when your kid wakes up for the third time in the middle of the night and you will do anything to get them back to sleep.

Like I said, I have have twins, getting your twins in the middle of the night on that third feed to go to bed is pretty heart wrenching. And so, part of the thing I think for parents is to know is that this is normal, right? Your baby's not doing anything wrong, you are not doing anything wrong.

Babies wake up at night. And the thing that is most important is keeping you and your baby safe. Right? We don't want families sleeping on weird things either, right? We want everybody in the house to try to get some sleep, but remember that you are not alone and that parents before you and parents after you are going to be doing the same things, right?

And they're going to be getting up with these babies at night. And so, you are not alone in that there's lots of things. And so what I would say is try to collect your support system, right? So sometimes that means shift work. Sometimes that means, how do you do things with your pediatrician? Sometimes that means taking naps, when potentially your kids are in daycare at 8am, right? So making it work for your lifestyle and making it work for you. There are ways to kind of look into the things. And my other advice is don't keep stuff in your house that you don't want other people to use.

If you have that inclined sleeper next to kind of the crib, the chances of you putting the baby into that inclined sleeper for sleep are not zero. So, if you don't want them used and you feel like it's not going to be safe because we know that they're not, things like that are not safe, don't put them there.

Put them someplace else. Don't put them kind of in that bedroom where everyone can be sleepy in the middle of the night and sometimes you're desperate. I have been in that desperate moment, so I very much understand. But, in those desperate moments, we will do anything to get our kids to sleep. So if you set that environment up for not having all the loose fleecy blankets there, not having your inclined sleepers, not putting your, you know, crib bumpers on, you're going to set you and your infant up for success.

Richard J. Chung, MD: Very helpful. I like the point about remembering that infants waking up is normal, right? It's not convenient. It's not easy, but it is normal. And you're not alone, certainly as parents working and sort of wrangling their infant in the middle of the night. And for both of you pointing out that really just keeping safe products in the space and getting rid of anything that might be unsafe at any level and then also involving the whole team, right?

Sophie, you pointed out that there are a variety of caretakers and it's really important that everybody's on the same page to ensure that we at least are keeping our infants safe, even if, sleep cycles and such might be up and down throughout infancy, but again, that's normal, right? And, and talking to your pediatrician, getting advice, working through things over time.

And like with most things in life, this too will pass, right? This will get better over time. It's just a sometimes challenging period. And so, thank you to both, Kristina and Sophie, for coming on the show today, sharing such great information and expertise about this critical topic of infant sleep, and specifically SIDS during this SIDS Awareness Month.

Infancy is such a delicate time, whether you're a first time parent or a fifth time parent, and, and for this issue of SIDS to be a reality, where there's such a drastic outcome with no warning before, typically, and no explanation after, is just hard for us to wrap our minds around as parents and as clinicians, but as Kristina and Sophie shared, thankfully, we have guidance for parents to decrease risk as much as possible.

So thank you both for sharing this critical information. To kind of wrap our conversation up today, and Sophie, maybe I'll start with you, what inspires you most day to day in your work? You know, we're as a community, as a global community going through such a difficult time right now. And it's always helpful just to really point out, the lights of inspiration day to day that kind of keep us going.

And so for you working in the nursery or otherwise, where do you find your inspiration?

Sophie Shaikh, MD: The thing that gives me most joy in my day working in the nursery is when the oldest siblings come in and meet their new baby for the first time. It's something that was missing during COVID when we had visiting restrictions, and I am so glad that the families are able to come back into the nursery. It is best feeling in the world to just be a fly on the wall during that moment.

Richard J. Chung, MD: That's really beautiful. And I imagine, you know, some of them are wearing their big sibling t-shirt or, or other sort of, uh, props as the big sib, and so that's, that's wonderful. And, such a really poignant memory for everybody involved. What about you, Kristina, working as a hospitalist, where do you find inspiration?

Kristina Nazareth-Pidgeon, MD: To me, the biggest inspiration is when my patients get better, right? Because getting admitted to the hospital is frightening. It's frightening for the patient. It's frightening for the family. Nobody wants their kid admitted to the hospital. And so being able to help them through that acute time, being able to get them in a position where they're ready to transition back to home, back to school, back to their lives, to me, is amazing. Kids get better. So it's really nice, I think, to work in pediatrics and kids are pretty resilient And have a really good attitude about most things. So that, to me is what's inspiring.

Richard J. Chung, MD: And that's rewarding, right? That's the whole point is to get a kid back to who they are, which is this vibrant young person who's on their way to big and wonderful things in their future. So definitely a very rewarding aspect of pediatric practice. Thank you both. And just a reminder to our listeners, to look online for additional resources as was alluded to in the conversation, the American Academy of Pediatrics is always a wonderful resource in terms of evidence-based, high quality information, especially around issues of sleep and SIDS. And then for any products searching online for really the regulations around safety, for those particular products. So thank you to Dr. Shaikh and Dr. Nazareth-Pidgeon for joining us today for this critical conversation.

 Pediatric Voices is produced by the team at Dr. Podcasting. The show has been developed by my co-host, Angelo Milazzo, and me. Thanks to Dr. Ann Reed and the administrative team at Duke Children's, particularly Debbie Taylor and Courtney Sparrow for their support. Find our show and hit the subscribe button wherever you find your favorite podcasts.

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