Infant Safe Sleep

Analyses conducted by CPH using the Perinatal Periods of Risk (PPOR) methodology (a new way to analyze fetal and infant deaths that leads to appropriate interventions) have helped the community understand where to focus intervention efforts to reduce infant mortality.  One of the major findings of these analyses was that SIDS deaths occurred at a statistically significantly higher rate for African American babies.  In addition, data obtained from the Franklin County Child Fatality Review process confirms that there is great opportunity to reduce risk factors associated with SIDS occurrence – safe sleep issues including appropriate bedding, position and co-sleeping; environmental tobacco smoke; and smoking during pregnancy.

The Healthy People 2010 goal is to reduce deaths from sudden infant death syndrome (SIDS) to 0.25 deaths per 1,000 live births.  Franklin County falls well short of that goal; in fact, county rates are more than 4 times higher than the HP 2010 goal.  Further, African American infants suffer disproportionately high rates.  In 2004 and 2006, the SIDS death rate for African American infants was nearly twice as high as the rates for Caucasian infants and the overall Franklin County rates; also notably for those years, the rates are more than eight times greater than the HP 2010 goal.

In 2003, a collaborative task force was formed by the COHMAB consisting of maternal and child health organizations to address the risk factors associated with Sudden Infant Death Syndrome (SIDS).  The SIDS task force developed an informational brochure to educate grandparents, specifically African American grandparents, about the risks associated with SIDS and how to reduce such risks.  The SIDS Campaign Task Force was reconvened in 2005 with funding through the CPH Child and Family Health Services grant.  Now known as the Franklin County Infant Safe Sleep and SIDS Risk Reduction Task Force, the group continues to be focused on reducing the incidence of SIDS and infant sleep-related deaths in Franklin County by promoting safe sleep and SIDS risk reduction techniques, and by educating about safe sleep environments to all individuals who are responsible for caring for infants.

The Task Force consists of representatives from Columbus Public Health, COHMAB, Nationwide Children’s Hospital, the OSU Medical Center, Doctors Hospital, Riverside Methodist Hospital, Mount Carmel Health System (including East, West and St. Ann’s), Grant Hospital, Region IV Perinatal Center, March of Dimes, Ohio Department of Job and Family Services, Communities in Schools, and a SIDS parent. 

Since reconvening in November of 2005, monthly meetings have been held.  The Task Force performed literature review and explored other national programs (MI and IN), which justified starting with nurses as educators and models of safe sleep practices. Phase I of the Initiative addressed healthcare professionals in the hospital setting.  Activities included: assessing the current hospital practice and policies regarding infant safe sleep; developing a hospital-based education component addressing infant safe sleep; educating hospital staff regarding infant safe sleep through implementation of the educational component, and evaluating hospital practice and policies post intervention.

In 2007, the Task Force accomplished its goal of developing a hospital model for institutionalizing infant safe sleep.  The model includes an observational audit form, a staff survey, and an educational PowerPoint which includes local Child Fatality Review (CFR) data and American Academy of Pediatrics (AAP) recommendations to reduce the risk of SIDS and infant sleep-related deaths.  The education curriculum aims to educate hospital staff on all recommendations regarding infant safe sleep, safe sleep environments and SIDS risk reduction.

Safe sleep observational audits, assessing the location of the infant (in mom’s room or in nursery), the position of the infant (on back, side, or stomach), the condition of the crib (blankets, stuffed animals, toys, loose items, etc.), and a general comments section, were conducted in the hospital setting in November, 2006.  Analysis results of the observational audits are summarized below:

• At pre-test, 416 audits were conducted and results indicated that: 50% of infants were placed to sleep on their backs and 50% were placed on their sides; 23% of cribs had blankets; and, 13% of cribs had toys
• After the educational intervention occurred, 254 six-week follow-up audits were conducted and indicated that: 80% of infants were placed to sleep on their backs and 20% were placed on their sides; 12% of cribs had blankets; and, 3% of cribs had toys
• After the educational intervention occurred, 253 six-month follow-up audits were conducted and indicated that: 91% of infants were placed to sleep on their backs and 9% were placed on their sides; 4% of cribs had blankets and less than 1% of cribs had toys

Additionally, safe sleep surveys were administered to hospital nursing staff in November, 2006.  These surveys revealed that: the majority (80%) of staff responsible for infant safe sleep education are nurses, specifically R.N.s; the majority of staff (96%) educate face-to-face; 97% of staff recommend back sleeping position; the majority (84%) of education occurs during hospitalization; the most common components of education include: sleep position (96%); infant covering (69%); breastfeeding (69%); what not to put in crib (69%); bedsharing (67%); and crib safety (65%); 65% of staff have not received formal training on infant safe sleep in the past 3 years; 42% of staff do not feel they've received enough training on infant safe sleep; 45% of staff did not know if their hospital has a safe sleep policy; and 96% of staff believe the infant safe sleep message is important.

Phase II of this safe sleep education program is geared towards educating community outreach workers, daycare providers, parents, grandparents and other caregivers of infants. The Task Force, in collaboration with the COHMAB, secured funding from the CJ Foundation for SIDS to host a community symposium, entitled “Safe Sleep for Babies: A Community Awareness Program” which took place in April, 2008.

The Task Force has made great strides in promoting our work at the local, state and national levels.  The CFHS project director (Karen Gray) has conducted local and national presentations highlighting the Franklin County Infant Safe Sleep and SIDS Risk Reduction Initiative at: National Healthy Start grantee meeting in Washington, DC in August, 2007; City MatCH annual conference in Denver, CO in August, 2007; the Ohio LPN conference in Columbus, OH in October, 2007; and the Cribs for Kids conference in Pittsburgh, PA in April, 2008.  The Task Force’s poster session at the City MatCH conference received an honorable mention STAR award for Science Translated to Action and Results.  Additionally, other task force members have highlighted the hospital-based component of the Infant Safe Sleep Initiative at meetings including: Region IV Perinatal Network, Neonatal Network, Trinity Hospital Conference, and Mount Carmel Health System conference.  The Task Force’s work is viewed as a promising practice, and the Ohio Department of Health has expressed interest in trying to replicate the Initiative statewide.

Additional notes/activities for 2007:

• October 2006 - present (and on-going) = participation in various health fairs and information events to promote safe sleep messages;
• November 2007 – Karen Gray, Co-chair of the Task Force, was awarded the March of Dimes Public Health Leadership Award for her work on infant safe sleep;
• February 2008 - A public information on safe sleep subgroup formed.

The two major goals for the upcoming project year include: continuous monitoring of the hospital-based component of the Infant Safe Sleep Initiative; and expanding the infant safe sleep initiative among healthcare providers, home visiting programs, day care and childcare providers, faith-based organizations, parents, grandparents, etc.  The Task Force has secured funding through the March of Dimes to conduct three trainings for day care and childcare providers within Franklin County.

For more information about the Franklin County Infant Safe Sleep and SIDS Risk Reduction Task Force, please contact COHMAB, 614.586.1914 or cohmab03@yahoo.com; or Karen Gray, 614.645.2134 or kareng@columbus.gov.